Digital Uterine Evacuation - Revisited' - for Religious Reasons as first Line Therapy for Incomplete Abortion

Objective: Digital uterine evacuation is very old and obsolete method for incomplete abortion. It still has a role especially in areas where women do not consent for surgical evacuation due to religious belief and at lower level settings with minimal skilled staff. This study was planned to see the efficacy of digital uterine evacuation combined with oral misoprostol for incomplete abortion.

Material and Methods: It is a prospective study at an emerging new hospital, with minimal skilled staff and the area catering mainly the rural women with high parity, who did not consent for surgical evacuation due to religious beliefs. It included 50 women presenting with incomplete abortion in the outpatient department and emergency with gestational age less than 12 weeks. The patients underwent digital uterine evacuation followed by five sequential doses of 400 mcg misoprostol orally four hourly. Ultrasound was done after 48 hours of last dose to confirm complete uterine evacuation.

Results were compiled and analysed at end of the study. Results: Fifty women with incomplete abortion were enrolled. All were uneducated, from rural background and did not consent for surgical evacuation. Mean age was 29.65 ± 3.74 years; parity was 4.28 ± 2.57 and gestation age was 8.92 ± 3.02 weeks. Most of the women were grand multipara and 96% were uneducated. Ninety eight percent women achieved a complete non-surgical uterine evacuation with digital evacuation and oral misoprostol and only in one woman (2%), surgical evacuation was needed.

Conclusion: The regimen of digital uterine evacuation and oral misoprostol is very effective in terms of a high rate of complete uterine evacuation and provides an alternative to surgical intervention thereby reducing the burden of skilled surgical providers in low resource settings and increased access to abortion care where the women do not give consent for surgical abortion due to religious belief.