Methotrexate/misoprostol vs. a more standard approach for termination of pregnancies of undetermined location: a randomized, controlled trial

Abstract

Objective: To conduct a randomized, controlled trial to compare a group of patients receiving methotrexate intramuscularly on day 1 and vaginal misoprostol on day 5 to terminate a pregnancy of undetermined location with a group in which the diagnosis was established prior to treatment.

Study design: We randomized 43 women with a pregnancy of undetermined location to 2 study groups: (1) 1 group received methotrexate/misoprostol, and (2) the other group had a diagnosis established first and then were treated appropriately. The outcomes that were measured for the 2 groups were: (1) hospital admission rate, (2) laparoscopy rate, (3) uterine aspiration rate, (4) patient visits, and (5) interval to end point.

Results: The uterine aspiration rate was lower in the methotrexate/misoprostol group (0.0% vs. 77.3%, p<0.0001). The mean number of patient visits in the methotrexate/misoprostol group was higher (3.8 vs. 2.5 visits, p<0.0001), and the mean interval to the end point in the methotrexate/misoprostol group was higher (26.4 days vs. 4.5 days, p<0.0001).

Conclusion: To terminate pregnancies of undetermined location, empirical methotrexate/misoprostol is associated with a lower uterine aspiration rate but more patient encounters and longer follow-up.