Treatment of Incomplete Abortion with Misoprostol (Cytotec)
Misoprostol (Cytotec) is highly effective for treating incomplete abortion, with success rates of approximately 94% when administered as a single 600 mcg oral dose. 1
Recommended Dosing and Administration
- A single dose of 600 mcg oral misoprostol is the recommended regimen for treatment of incomplete abortion in women with uterine size equivalent to ≤12 weeks gestation 1
- Alternative administration route: 400 mcg sublingual misoprostol has shown similar efficacy (94.5%) compared to 600 mcg oral misoprostol (94.6%) 2
- Most women (>80%) will complete the abortion within one week of misoprostol administration 2
- If abortion remains incomplete at one-week follow-up, patients may be offered an additional week of observation or immediate surgical evacuation 3
Efficacy and Safety
- Misoprostol is slightly less effective than surgical evacuation for incomplete abortion (94.4% vs 100% success rate) 3
- Common side effects include abdominal pain, vaginal bleeding, headaches, and dizziness/weakness 2
- Most patients (>90%) report that side effects are tolerable 4
- Patient satisfaction rates are high (approximately 95%) and comparable to surgical management 5
- Approximately 90% of women who receive misoprostol for incomplete abortion would recommend this treatment to others 4
Important Contraindications and Precautions
- Misoprostol should NOT be used for cervical preparation or induction of labor in women with previous cesarean delivery 6
- Patients with end-stage renal disease should be considered high-risk and managed in an experienced center with appropriate emergency support services 7
- Baseline assessment of renal function, electrolytes, and bleeding risk should be performed in high-risk patients 7
Clinical Monitoring
- Patients should be monitored for:
Follow-up Care
- Follow-up visit should be scheduled one week after misoprostol administration to confirm complete abortion 3
- If abortion remains incomplete at one week, options include:
- Additional follow-up visit one week later
- Immediate surgical evacuation 3
- Consejería anticonceptiva should be provided after treatment to prevent unwanted pregnancies 8
Advantages Over Surgical Management
- Easier to provide in low-resource settings 3
- Avoids risks associated with surgical intervention (perforation, anesthesia complications) 8
- May be preferred by patients who wish to avoid surgical procedures 2
- More cost-effective, especially in resource-limited environments 3
Pitfalls and Caveats
- Surgical evacuation has lower risk of prolonged bleeding (9.1% vs 28.3% with medical method) 8
- Surgical evacuation has lower risk of infection (1.3% vs 23.9% with medical method) 8
- Surgical evacuation has lower rate of retained tissue requiring additional procedures (1.3% vs 17.4% with medical method) 8
- Patient preference should be considered when choosing between medical and surgical management 8