Early medical abortion with methotrexate and misoprostol

Objective: To evaluate the introduction of an early medical abortion progra m with methotrexate and misoprostol, using a standardized protocol. Methods: A total of 1973 women at 34 Planned Parenthood sites participated in a case series of early medical abortion. Ultrasound was used to confirm gestational age of less than 49 days from the first day of the last menstru al period. Women were given intramuscular methotrexate 50 mg/m(2) of body s urface area on day 1, and then they inserted misoprostol 800 mug vaginally at home on day 5, 6, or 7. Women were advised to have a suction curettage i f the pregnancy appeared viable 2 weeks after methotrexate or if any gestat ional sac persisted 4 weeks after methotrexate. Outcomes were complete medi cal abortion and suction curettage. Results: Sixteen hundred fifty-nine women (84.1%) had a complete medical ab ortion, and 257 (13.0%) had suction curettage. The most common reason for c urettage was patient option (8.9%). At 2 weeks after methotrexate use, 1.4% of women had curettage because of a viable pregnancy; at 4 weeks, 1.6% of women had curettage because of a persistent but nonviable pregnancy. One pe rcent of women had curettage because of physician recommendation, most comm only for bleeding. Suction curettage rates decreased with site experience ( P < .006) and were lower at early gestational ages (P < .004) and in nullip arous women (P < .004). Conclusion: Medical abortion with methotrexate and misoprostol is safe and effective and can be offered in a community setting. (C) 2001 by The Americ an College of Obstetricians and Gynecologists.