title: Combined methotrexate and misoprostol for early induced abortion.
abstract: OBJECTIVE
  To determine the effectiveness and side effects of and subject satisfaction with an induced abortion by administration of methotrexate and intravaginal misoprostol.
  
  
  METHODS
  Prospective trial of 100 consecutive pregnant women aged 18 years or older at 8 weeks' gestation or less and wanting an abortion.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Family Medicine, University of Rochester (NY), USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Schaff
authors.forename: S H
authors.initials: SH
authors.lastname: Eisinger
authors.forename: P
authors.initials: P
authors.lastname: Franks
authors.forename: S S
authors.initials: SS
authors.lastname: Kim
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D016595:Misoprostol; D008727:Methotrexate