Medical abortion with oral methotrexate and vaginal misoprostol

Mitchell D Creinin, Eric Vittinghoff, Eric Schaff, Cynthia Klaisle, Philip D. Darney, Catherine Dean

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Objective: To evaluate the safety and efficacy of oral methotrexate and vaginal misoprostol for medical abortion. Methods: A prospective multicenter trial involved 300 women up to 49 days' gestation seeking elective abortion. Subjects received methotrexate 50 mg orally followed 5-6 days biter by misoprostol 800 μg vaginally. The misoprostol dose was repeated if abortion did not occur. Results: Complete abortion occurred in 273 of 299 women (91.3%; 95% confidence interval [CI] 87.5, 94.2%); one woman was lost to follow-up. Abortion occurred within 8 days of the methotrexate in 233 women (77.9%; 95% CI 72.8, 82.5%); the remaining 13.4% of women who aborted did so after a delay of 23.5 ± 9.8 days (median 23 days, range 10-45). Vaginal bleeding lasted an average of 15 and 11 days in immediate and delayed- success abortions, respectively. Complete abortion rates decreased linearly with increasing body surface area. After methotrexate and misoprostol administration, nausea was reported in 37% and 33%, vomiting in 11% and 18%, diarrhea in 12% and 18%, and subjective fever or chills in 15% and 31% of subjects, respectively. Conclusion: Oral methotrexate followed by vaginal misoprostol is effective for abortion and represents an acceptable alternative to intramuscular methotrexate in regimens for medical abortion.

Original languageEnglish (US)
Pages (from-to)611-616
Number of pages6
JournalObstetrics and Gynecology
Issue number4 I
StatePublished - Oct 1997
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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