Please select the eligibility criteria that correspond to the clinical trial below.
Title: Misoprostol Treatment of Incomplete Abortion by Midwives and Physicians. A Randomized Control Trial in Uganda
Brief Summary: Uganda is one of the countries with highest fertility rate in the world, 6.7 children per women. It is estimated that 56 percent of all pregnancies are unintended and the contraceptive prevalence rate in Uganda is 23 percent. Unwanted pregnancy is common and induced abortion is illegal. Unsafe abortion is responsible for significant morbidity and mortality among women in Uganda. Almost 40% of admissions to emergency obstetric care units in Uganda due to unsafe abortion is reported and considered high in international comparison. Studies have revealed that trained midlevel providers can deliver safe post abortion care for incomplete abortion and use manual vacuum aspiration. The prostaglandin E1 analogue misoprostol has been shown to be an effective tool in the treatment of incomplete abortions. This option is so far under-used in developing countries, especially outside the larger hospitals and private clinics. One significant limiting factor in providing safe post abortion care is the lack of providers. So far technical training has been mainly limited to physicians. Training of midlevel providers in misoprostol treatment of incomplete abortion will support task shifting in places where doctors are costly and scarce. By evaluating the effectiveness of mid-level providers (midwives); conducting MVA and administering misoprostol treatment of incomplete abortion the project is attempting to contribute to the reduction of maternal mortality and morbidity and safeguard high quality of post-abortion care.

Women with incomplete abortion will be randomly allocated to undergo a clinical assessment and treatment (MVA or misoprostol) either by physician or midwife with safety and efficacy as main outcomes in a RCT carried out in hospital setting in Uganda. Our hypothesis is that there are no significant differences in effectiveness and safety between manual vacuum aspiration and misoprostol treatment of incomplete abortion provided by physicians and midwife.

The involvement of midlevel providers in treatment of incomplete abortion has previously not been systematically evaluated in African health care setting.


Options:
A: Inclusion Criteria:

* 14 and 24 weeks of gestation
* Both nulliparous and multiparous women
* An unfavorable cervix (Bishop's score less than 8)

Exclusion Criteria:

* Known contraindications to the use of prostaglandins (e.g. asthma)
* Previous uterine scar (previous cesarean or myomectomy where the endometrial cavity was entered)
B: Inclusion Criteria:

* Uterine size no larger than 12 weeks LMP at time of presentation for care.
* Past or present history of vaginal bleeding during pregnancy.
* Open cervical os.
* If ultrasound used evidence of incomplete abortion with substantial debris in the uterus.
* All women would have been advised to have surgical evacuation of the uterus if misoprostol was not available.
* General good health.
* Willing to provide contact information for purposes of follow-up.
* Also in Egypt: 21 years of age or over or parental permission (there is no minimum age requirement in Niger, Mauritania and Senegal).

Exclusion Criteria:

* Contraindications to study drug
* Signs of severe infection, defined as at least one of the following: 1) foul smelling discharge, 2) fever \> 38 degrees C , 3) uterine tenderness
* Hemodynamic disturbances (pulse \>110/min and systolic bp \<100)
* Have an IUD in place; (the IUD may be removed making the woman eligible)
* Suspected ectopic pregnancy
C: Inclusion Criteria:

* midtrimester late abortion
* midtrimester induced abortion

Exclusion Criteria:

* placenta previa
* infected abortion
* rupture of membranes
* s/p cesarean section \*2 or more
D: Inclusion Criteria:

* Bleeding
* Contractions during pregnancy

Exclusion Criteria:

* Known allergy to misoprostol
* Uterine size more than 12 weeks of gestation
* Suspected ectopic pregnancy
* Unstable hemodynamic status and chock
* Signs of pelvic infection and/or sepsis

Answer: D