Combined methotrexate and misoprostol for early induced abortion.

E. A. Schaff, S. H. Eisinger, Peter Franks, S. S. Kim

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)774-779
Number of pages6
JournalArchives of Family Medicine
Volume4
Issue number9
StatePublished - Sep 1995
Externally publishedYes

Fingerprint

Misoprostol
Induced Abortion
Methotrexate
Chorionic Gonadotropin
Hemorrhage
Pregnancy
Suppositories
Uterine Hemorrhage
Intravaginal Administration
Body Surface Area
Patient Satisfaction
Nausea
Vomiting
Gastrointestinal Tract
Pregnant Women
Diarrhea
Urine
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Schaff, E. A., Eisinger, S. H., Franks, P., & Kim, S. S. (1995). Combined methotrexate and misoprostol for early induced abortion. Archives of Family Medicine, 4(9), 774-779.

Combined methotrexate and misoprostol for early induced abortion. / Schaff, E. A.; Eisinger, S. H.; Franks, Peter; Kim, S. S.

In: Archives of Family Medicine, Vol. 4, No. 9, 09.1995, p. 774-779.

Research output: Contribution to journalArticle

Schaff, EA, Eisinger, SH, Franks, P & Kim, SS 1995, 'Combined methotrexate and misoprostol for early induced abortion.', Archives of Family Medicine, vol. 4, no. 9, pp. 774-779.
Schaff, E. A. ; Eisinger, S. H. ; Franks, Peter ; Kim, S. S. / Combined methotrexate and misoprostol for early induced abortion. In: Archives of Family Medicine. 1995 ; Vol. 4, No. 9. pp. 774-779.
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abstract = "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.",
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AB - 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.

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