Methotrexate and misoprostol for early abortion: a multicenter trial. Acceptability

Abstract

A prospective trial was conducted including 300 pregnant women seeking elective abortion to evaluate the efficacy and acceptability of methotrexate and misoprostol for abortion at < or = 56 days gestation. Subjects received methotrexate 50 mg/m2 intramuscularly followed 7 days later by misoprostol 800 micrograms vaginally. The misoprostol dose was repeated the next day if the abortion did not occur. Efficacy is reported elsewhere. Subjects were questioned before the study as to 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. Main outcome measures included reasons for abortion and study participation, attitudes about the nonsurgical abortion experience, and feelings about preference of nonsurgical or surgical abortion. The most common reason cited as to why women chose to have a nonsurgical abortion was to avoid some aspect of the surgery (48.4%). The percent of women who cited that avoiding surgery was an important reason in their choice of nonsurgical abortion varied by study site and according to whether the woman had a prior surgical abortion. Upon completion of the study, 73.4% of women stated it was a good experience, 19.5% a neutral experience, 7.1% a bad experience, and 1.0% gave no response. When asked what method they would choose if they had to have another abortion, 83.5% would choose this method of medical abortion rather than a surgical abortion. Intramuscular methotrexate and vaginal misoprostol are an acceptable and desirable method of abortion.

PIP: Researchers analyzed data on 61 women at San Francisco General Hospital in California, 51 women at Magee-Women's Hospital in Pittsburgh, Pennsylvania, and 47 women at Women's Health Care Services in Wichita, Kansas, to examine their acceptability of the methotrexate and misoprostol regimen for early abortion (56 or fewer days of gestation). The women had participated in a clinical trial of this regimen. They received intramuscular injection of 50 mg/sq. m methotrexate and then vaginal administration of 800 mcg misoprostol seven days later. If the abortion did not occur within 24 hours, they then received the another dose of misoprostol. 55.8% (159) women had had a prior surgical abortion. The leading reason for opting for a nonsurgical abortion was avoidance of some aspect of surgical abortion (59.6%). In Wichita, women who had not had a prior surgical abortion were more likely to want to avoid surgery than those who had had a prior surgical abortion (64.7% vs. 36.2%; p = 0.0011), suggesting that women in Wichita who had had a prior surgical abortion had a more positive experience with surgical abortion than those in other regions. Overall, avoidance of surgery as an important reason in their choice of nonsurgical abortion varied by study site and by the existence of past surgical abortion experience (p = 0.01). Only 7.1% of the women claimed the nonsurgical abortion was a bad experience. 73.4% considered it a good experience, 19.5% a neutral experience. Among the women considering the experience good, the leading reasons for finding it so were avoidance of surgical procedure (29.8%) and the fact that it was more natural than surgical abortion (18.9%). Among the 20 women considering the experience negative, the leading reasons for finding it so were severe pain or cramping (30%), the fact that it was emotionally hard (25%), and the fact that a surgical procedure was required (25%). 83.5% of the women would choose medical abortion again rather than a surgical abortion, if they had to terminate another pregnancy in the future. These findings suggest that this regimen for drug induced abortion is acceptable and desirable.