Combined methotrexate and misoprostol for early induced abortion
E. A. Schaff, S. H. Eisinger, P. Franks and S. S. Kim
Department of Family Medicine, University of Rochester (NY), USA.
OBJECTIVE: To determine the effectiveness and side effects of and subject
satisfaction with an induced abortion by administration of methotrexate and
intravaginal misoprostol. SUBJECTS AND DESIGN: Prospective trial of 100
consecutive pregnant women aged 18 years or older at 8 weeks' gestation or
less and wanting an abortion. INTERVENTIONS: Intramuscular administration
of 50 mg of methotrexate per square meter of body surface area on day 1 and
a misoprostol 800-micrograms vaginal suppository on day 3. Administration
of misoprostol was repeated the following day if no bleeding occurred after
the first dose. PROTOCOL: After pregnancy dating by clinical criteria,
subjects were followed up with serum beta-human chorionic gonadotropin
(beta-hCG) determinations on days 1, 7, and 14 and a high-sensitivity urine
hCG test every 2 weeks until the value was less than 10 IU/L. Subjects
completed a daily symptom log and satisfaction questionnaire on day 14.
MAIN OUTCOME MEASURES: Complete abortion as defined by vaginal bleeding and
a beta-hCG value of less than 10 IU/L without surgical intervention,
complications and side effects, and patient satisfaction. RESULTS:
Ninety-seven subjects had a complete abortion and one subject had vaginal
bleeding and a 94% decrease of her beta-hCG value on day 7 but was
subsequently unavailable for follow-up. Two subjects required surgical
procedures: one with a continued pregnancy and one for excessive bleeding.
No failures or complications occurred in early gestations prior to 45 days
from the last menstrual period. Seventy-three percent responded to
misoprostol treatment with bleeding within 12 hours and had a mean decrease
of 90% in their beta-hCG value on day 7. Twenty-seven percent had no
immediate bleeding response to misoprostol administration, began bleeding
on day 10 (SD, 8 days), and had a mean decrease of 10% in their beta-hCG
value on day 7. Seventy percent reported nausea; 46%, diarrhea; and 23%,
vomiting. Ninety-three percent agreed that the procedure was acceptable and
95% would recommend the procedure. CONCLUSIONS: Methotrexate and
misoprostol were effective in inducing an abortion up to 8 weeks. Home
administration of a compounded misoprostol vaginal suppository was
successful. Although gastrointestinal tract side effects were common, women
found the procedure and its side effects acceptable.
