Figures & Tables
Tables
Strength of Evidence Description I Strong evidence from at least one systematic review of multiple well-designed, randomized controlled trials. II Strong evidence from at least one properly designed, randomized controlled trial of appropriate size. IIIa Evidence from well-designed trials/studies without randomization that include a control group (e.g., quasi-experimental, matched case-control studies, pre-post with control group). IIIb Evidence from well-designed trials/studies without randomization that do not include a control group (e.g., single group pre-post, cohort, time series/interrupted time series). IV Evidence from well-designed, nonexperimental studies from more than one center or research group. V Opinions of respected authorities, based on clinical evidence, descriptive studies, or reports of expert committees. Note: Gray includes 5 levels of evidence. For the “What Works” compendiums, level III was subdivided to differentiate between studies and evaluations whose design included control groups (IIIa) and those that did not (IIIb).101 Qualitative studies can be classified as either level IV or V, depending on number of study participants and other factors. For more detail about these types of studies and their strengths and weaknesses, see Gray (2009).7
- TABLE 2 Effectiveness and Satisfaction With Treatment for Incomplete Abortion, Misoprostol Compared With Surgical Evacuation, 10 Countries, 2005–2012
Article Country (Sample Size) Study Design: Misoprostol/ Surgical Comparison Group Effectiveness: % With Complete Evacuation % Client Satisfaction With Procedure Comments Blandine 201217 Burkina Faso (N = 99) 400 mcg misoprostol sublingually/ referral for surgical M: 98% M: 99% PAC with misoprostol introduced to 2 district hospitals with no previous PAC service. All eligible women chose misoprostol over optional referral for MVA. Dao 200718 Burkina Faso (N = 447) 600 mcg misoprostol orally/MVA M: 94%
S: 99%M: 97%
S: 98%2 teaching hospitals. Weeks 200514 Uganda (N = 317) 600 mcg misoprostol orally/MVA M: 96%
S: 92%M: 94%
S: 95%Misoprostol was associated with less pain and fewer complications but increased bleeding. All received antibiotics after treatment. Taylor 201119 Ghana (N = 230) 600 mcg misoprostol orally/MVA M: 98%
S: 99%M: 94%
S: 89%44% were very satisfied with misoprostol vs. 8% with MVA; 95% of those treated with misoprostol would choose it again vs. 36% treated with MVA. Shwekerela 200720 Tanzania (N = 150) 600 mcg misoprostol orally/MVA M: 99%
S: 100%M: 99%
S: 100%75% were very satisfied with misoprostol vs.55% with MVA; more side effects were associated with misoprostol; greater pain with MVA. Bique 200721 Mozambique (N = 270) 600 mcg misoprostol orally/MVA M: 91%
S: 100%M: 96%
S: 100%87% were very satisfied with misoprostol vs. 37% with MVA; trained midwife provided MVA with only verbal anesthesia; tertiary hospital site. Montesinos 201122 Ecuador (N = 242) 600 mcg misoprostol orally/MVA M: 94%
S: 100%M: 96%
S: 97%47% were very satisfied with misoprostol vs. 40% with MVA; ultrasound use decreased threefold for misoprostol and MVA in 1 year. Shochet 201223 Senegal (N = 199)
Niger (N = 152)
Mauritania (N = 119)
Nigeria (N = 51)
Burkina Faso (N = 318)400 mcg misoprostol sublingually/ standard surgical care (MVA or D&C) Senegal
M: 93%
S: 100%
Niger
M: 89%
S: 100%
Mauritania
M: 91%
S: 100%
Nigeria
M: 96%
S: 100%
Burkina Faso
M: 98%
S: 100%Overall in the 5 countries M: 99%
S:98%Antibiotics given with the surgical option; success rates much higher with misoprostol after first month from introduction. Ultrasound not needed on site. Nurses and midwives had prominent roles in care in Burkina Faso, Niger, and Senegal. Abbreviations: D&C, dilation and curettage; M, misoprostol; MVA, manual vacuum aspiration; PAC, postabortion care; S, surgical.
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