Acceptability of medical abortion with methotrexate and misoprostol

Abstract

A clinical trial of efficacy of methotrexate and misoprostol for abortion was performed involving 86 women requesting an abortion at < 56 days gestation. An acceptability evaluation was included in the design of the trial. Subjects were questioned before the study about their reasons for choosing a medical abortion and past experience with surgical abortion. After the study was completed, the women were questioned about their medical abortion experience. All questions were asked in an open-ended manner. Eighty-five of 86 (99%) patients completed both questionnaires. The most common reason cited as to why women chose to have a medical abortion was to avoid some aspect of the surgery (48%). Forty-one (48%) women had experienced a surgical abortion; 49% of these women chose to have a medical abortion because of a "bad" past experience related to the surgical procedure. Upon completion of this study, 67 (79%) patients stated the medical abortion was a good experience, 12(14%) a bad experience, and 6 (7%) had a neutral response. When asked what method they would choose if they were to have another abortion, 89% would choose this method of medical abortion rather than a surgical abortion. In women who choose to participate in a clinical research trail, methotrexate and vaginal misoprostol are an acceptable and desirable method of abortion.

PIP: A clinical trial involving 86 US abortion patients under 56 days of gestation indicated that the use of methotrexate and misoprostol for induced abortion is a safe, acceptable alternative to surgical abortion. The women--all of whom volunteered for the study--received 50 mg/sq.m of methotrexate intramuscularly followed by vaginal administration of 800 g of misoprostol three or seven days later. The procedure was successful in 77 cases (89.5%). 41 women (48%) had undergone a prior, surgical abortion. These women were more likely to cite avoidance of some aspects of abortion surgery (e.g., the sound and feeling of the suction machine) as the reason they opted for medical abortion, whereas those with no prior abortion history focused on the relative ease of the drug-induced procedure. Overall, 67 (79%) rated the medical abortion as a good experience, 12 (14%) claimed it had been a bad experience, and the rest were neutral. The most frequently cited positive responses to the procedure were avoidance of surgery, ease/lack of side effects, and privacy; negative responses were based on emotional difficulties coping with the bleeding and the anxiety associated with waiting for the drugs to take effect. 89% indicated that, should abortion be necessary again, they would prefer medical over surgical abortion. The positive assessments given by women in this study--the first trial of methotrexate-misoprostol abortion conducted in the US--correspond with those recorded among women in Sweden and France.