Misoprostol and illegal abortion in Rio de Janeiro, Brazil

We report on the determinants and consequences of induced abortion among 803 women admitted to hospital with abortion complications in Rio de Janeiro, Brazil, in 1991. 458 (57%) women reported using misoprostol to induce abortion, 74% in the first 4 months of pregnancy. Doses of 200-16,800 micrograms were reported, with a median of 800 micrograms. 65% of the women took the drug orally, 29% used a combination of oral and vaginal routes, and 6% administered it intravaginally. Vaginal bleeding and uterine cramps were the commonest reasons for seeking hospital care. Only 8% of women reported gastrointestinal side-effects. Misoprostol induced vaginal bleeding within 12 h of administration in 52% of the women, but 16% waited 10 days or more for onset of bleeding. 4% were admitted to hospital with complete abortion. The likelihood of bleeding starting within 12 h increased with duration of gestation and it was greater when the drug was used both orally and intravaginally. A significantly smaller proportion of women taking misoprostol than of those who induced abortion by catheter insertion presented signs of infection or physical injuries or required blood transfusion (< 0.0005). Among 803 women interviewed at delivery as controls, 6% had taken misoprostol but abortion had not ensued. Misoprostol has an important role as an abortifacient among the women studied.