ORAL METHOTREXATE AND VAGINAL MISOPROSTOL FOR EARLY ABORTION

A prospective trial including 300 pregnant women seeking elective abor tion was conducted to evaluate the safety and efficacy of methotrexate and misoprostol for abortion at less than or equal to 63 days' gestat ion. Subjects received methotrexate 50 mg orally and were randomly all ocated to receive 800 mu g of misoprostol vaginally 3, 4, or 5 days af ter administration of the methotrexate. The misoprostol dose was repea ted 48 and 96 h later if abortion did not occur. Outcome measures incl uded successful abortion (complete abortion without requiring a surgic al procedure) and side effects. Complete abortion occurred in 273 of 3 00 patients (91%, 95% CI 87, 94%) patients. No significant statistical differences were found in the success rates when misoprostol was give n days 3, 4, or 5 after the administration of methotrexate IP = 0.69). Vaginal bleeding lasted 7.1 +/- 3.8 days, spotting 4.1 +/- 2.5 days, and total bleeding 11.2 +/- 4.1 days. Side effects for methotrexate we re minimal, whereas, for misoprostol they were mild and transient exce pt for pain. The use of methotrexate and misoprostol together could he an alternative to the intramuscular use of methotrexate or the use of antiprogestins and prostaglandin for medical abortion. (C) 1998 Elsev ier Science Inc. All rights reserved.