Document Detail


Comparing abortion induced with methotrexate and misoprostol to methotrexate alone.
MedLine Citation:
PMID:  10342080     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This was a dual-cohort study performed to determine if, by using methotrexate alone, abortions could be induced with fewer side effects, without sacrificing effectiveness and patient satisfaction. The subjects were 358 consecutive patients who requested elective medical termination of pregnancy at < 7 weeks gestation. Women were given information and allowed to choose between methotrexate alone (50 mg/m2 intramuscularly) or methotrexate followed 4 days later by 800 micrograms misoprostol vaginally. The two groups were compared with respect to the number of surgical aspirations required, the number of days until the abortion was completed, side effects, and the number of women who would choose the same method again. The surgery rate for methotrexate was 17.2%, whereas for the combination it was 10.9%. The mean numbers of days until the abortion were complete was 23 and 12, respectively. Side effects, mean pain scores, total days of bleeding, and satisfaction rates were not significantly different in the two groups. The high failure rate with methotreaxate alone suggests that it should not be offered despite the high level of satisfaction.
A dual-cohort study was conducted to determine whether abortion induced by methotrexate alone produces fewer side effects than a misoprostol-methotrexate regimen without sacrificing efficacy. 358 consecutive Canadian abortion seekers with pregnancies of 7 weeks' gestation or less were given the choice of a regimen of 50 mg/sq. m of intramuscular methotrexate or methotrexate followed 4 days later by 800 mcg of vaginal misoprostol. 101 women chose the former and 257 opted for the latter regimen. Women tended to choose the methotrexate-only regimen to avoid misoprostol-related side effects; selection of the combination was motivated by a desire for a rapid pregnancy termination. 82 women (82.8%) in the methotrexate-only group and 228 (89.1%) in the combination group aborted successfully. The failure rate in both groups was significantly higher when the procedure was performed at 6 or more weeks of gestation. It took a mean of 23.1 days from injection to complete abortion in the methotrexate-only group compared with 11.7 days in the methotrexate-misoprostol group. More than half the women had medication-related side effects, primarily nausea, vomiting, and diarrhea, with no significant differences between groups. The mean number of days of bleeding was 9.0 in the methotrexate-only group and 10.1 in the combination group. The mean worst pain score (on an 11-point scale) was 6.4 in the former and 6.1 in the latter group. 91.8% of women in the methotrexate-only group and 90.7% of those in the misoprostol-methotrexate group who successfully aborted stated they would chose the same method again. Given the high failure rate, methotrexate alone should not be offered routinely to abortion seekers. Its use should be reserved for women with very early pregnancies who have relative contraindications for misoprostol.
Authors:
E R Wiebe
Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Contraception     Volume:  59     ISSN:  0010-7824     ISO Abbreviation:  Contraception     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-08-10     Completed Date:  1999-08-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0234361     Medline TA:  Contraception     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  7-10     Citation Subset:  IM; J    
Affiliation:
Department of Family Practice, University of British Columbia, Vancouver, Canada.
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MeSH Terms
Descriptor/Qualifier:
Abortifacient Agents, Nonsteroidal / adverse effects,  therapeutic use*
Abortion, Induced / adverse effects,  methods*
Administration, Intravaginal
Adult
Cohort Studies
Drug Therapy, Combination
Female
Gestational Age
Humans
Methotrexate / adverse effects,  therapeutic use*
Misoprostol / adverse effects,  therapeutic use*
Pain Measurement
Patient Satisfaction
Pregnancy
Pregnancy Outcome
Uterus / ultrasonography
Chemical
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 59-05-2/Methotrexate; 59122-46-2/Misoprostol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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