METHOTREXATE AND MISOPROSTOL FOR EARLY ABORTION

Methotrexate is cytotoxic to trophoblast and, in low doses, has minima l side effects. It is used to treat both gestational trophoblastic neo plasia and ectopic pregnancy. The cytotoxic effects of methotrexate on intrauterine trophoblast should be equivalent. To test this hypothesi s, ten pregnant women, <8 weeks' gestation were reated with methotrexa te 50 mg/m(2) intramuscularly followed 3 days later by misoprostol, a prostaglandin E(1) analogue. The first 4 patients received misoprostol 600 mu g orally; none aborted soon after the misoprostol. Two patient s aborted 25 and 26 days after the methotrexate injection and two elec ted a suction abortion after 14 days (one by choice and one because th e pregnancy was still viable). The last 6 patients received misoprosto l 800 mu g vaginally and aborted within 3-8 hours. One patient had an incomplete abortion requiring a suction curettage 34 days after the mi soprostol. Vaginal bleeding for these 6 patients lasted an average of 29 +/- 11 days (range, 12-42 days). No methotrexate side effects were observed. Vaginal misoprostol (800 mu g was significantly more effecti ve (p=0.005) than oral misoprostol (600 mu g) in effecting abortion af ter intramuscular methotrexate.