Misoprostol alone highly effective for pregnancy termination

Key takeaways:

• Nearly all women taking misoprostol alone had a complete abortion without procedural intervention.
• Most women expelled the pregnancy a median of 12 hours after starting misoprostol.

Use of misoprostol alone, without a procedural intervention, was an effective method for terminating pregnancy, which offers more options for women seeking medical abortion, researchers reported in JAMA Network Open.

“The aim of much of the clinical literature on misoprostol alone was to establish recommended dosing and administration routes; as a result, clinical data on the effectiveness of currently endorsed misoprostol-alone protocols are sparse,” Ruvani Jayaweera, PhD, MPH, research scientist at Ibis Reproductive Health, and colleagues wrote. “Additional research is needed on the currently endorsed misoprostol-alone regimen, particularly given the lack of detailed information about the physical experience of using misoprostol alone.”

Jayaweera and colleagues conducted Studying Accompaniment Feasibility and Effectiveness (SAFE), a prospective observational cohort study with 637 women who called safe abortion hotlines and accompaniment groups that provided counseling on abortion options in Argentina, Nigeria and Southeast Asia. All participants completed surveys at baseline and during two follow-up periods.

The primary outcome was effectiveness of misoprostol alone, defined as self-reported complete abortion without procedural intervention at 1 and 3 weeks after taking misoprostol. Secondary outcomes included the safety of misoprostol alone assessed by self-reported heavy bleeding, pain, fever or discharge indicative of potential complications and by medical treatment indicative of potential adverse events.

Overall, 92.8% of women were from Nigeria, 7.1% were from Southeast Asia and 0.2% were from Argentina. During last follow-up at a median of 22 days after taking misoprostol, 98.1% of women had complete abortion without procedural intervention.

Six participants reported potential adverse events. Most women experienced bleeding for a median of 4 days, and most women expelled the pregnancy a median of 12 hours after starting misoprostol.

The most commonly reported adverse events of the misoprostol regimen were nausea (52.6%), fever (36.4%) and diarrhea (28.4%).

“The findings of this study indicate that misoprostol-alone regimens may open opportunities for innovative access through nontraditional practitioners, pharmacists and other contexts,” the researchers wrote. “As abortion access, and specifically medication abortion, comes under increasing legal attack around the world, expanding the availability of existing, evidence-based methods for medication abortion can help to ensure that all people can access abortion when and where they need it.”