Oral methotrexate and vaginal misoprostol for early abortion

Abstract

Intramuscular methotrexate followed by vaginal misoprostol has been shown to be effective for abortion at < or = 49 days gestation. Oral dosing of the methotrexate may offer advantages over parenteral dosing. This pilot study was performed to evaluate if oral methotrexate would be effective when combined with vaginal misoprostol to effect abortion at < or = 49 days gestation. Twenty pregnant women were randomized to receive methotrexate 25 mg or 50 mg followed 7 days later by misoprostol 800 micrograms vaginally. The misoprostol dose was repeated the next day if the abortion did not occur. Complete abortion occurred in all subjects in both groups within 20 days after the methotrexate. However, women in the 50 mg group passed the pregnancy within 24 hours of the first or second dose of methotrexate more often than women in the 25 mg group (80% vs. 50%, p = 0.35). Vaginal bleeding lasted 12.1 +/- 3.1 days and 9.4 +/- 4.5 days in immediate success and delayed success patients, respectively. Oral methotrexate may be an effective alternative to intramuscular methotrexate in treatment regimens for nonsurgical abortion.

PIP: At the Magee-Women's Hospital in Pittsburgh, Pennsylvania, a clinical investigator compared data on 10 healthy women who received 25 mg oral methotrexate (group 1) with data on 10 other healthy women who received 50 mg oral methotrexate (group 2) to determine whether these two doses followed 7 days later by 800 mcg vaginal misoprostol could safely induce abortion at or less than 49 days gestation. If the women did not experience an abortion, they received a repeat misoprostol dose the next day. All 20 women experienced a complete abortion without a need for surgical procedure within 20 days after oral methotrexate administration. Group 1 had a higher immediate success rate (i.e., abortion within 24 hours of the first dose of misoprostol) than did group 2 (80% vs. 50%), but due to the small sample size the difference was not statistically different (p = 0.35). Vaginal bleeding of women who experienced immediate success lasted longer than those who experienced delayed success (12.1 vs. 9.4 days). Nausea was more common with oral methotrexate than with intramuscular methotrexate reported in another study (45% vs. 19%). On the other hand, vomiting and diarrhea rates were similar. These findings indicate that oral methotrexate may be an effective alternative to intramuscular methotrexate in regimens for nonsurgical abortion.