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Methotrexate and misoprostol when surgical abortion fails
E A Schaff1, M Wortman, S H Eisinger
1Department of Family Medicine, University of Rochester, NY, USA.
Obstetrics and Gynecology
|March 1, 1996
Summary
Methotrexate and misoprostol effectively induce abortion in early pregnancies (up to 8 weeks) when anatomical issues prevent surgical procedures. This medical abortion method offers a viable alternative for women with uterine or cervical anomalies.
Area of Science:
- Reproductive Medicine
- Pharmacology
- Gynecology
Background:
- Suction curettage for early pregnancy termination can be challenging or impossible in cases of uterine or cervical anomalies.
- Alternative medical abortion methods are needed for patients with complex gynecological anatomy.
Purpose of the Study:
- To evaluate the efficacy and safety of methotrexate and misoprostol for inducing abortion in pregnancies up to 8 weeks.
- To describe the use of this medical regimen in patients with uterine or cervical anomalies contraindicating suction curettage.
Main Methods:
- A series of four women with pregnancies ≤8 weeks and failed suction curettage received intramuscular methotrexate (50 mg/m²) followed by vaginal misoprostol (800 µg).
- Repeat misoprostol doses were administered based on bleeding response and hCG levels.
- Follow-up included hCG assays, symptom logs, and satisfaction questionnaires.
Main Results:
- All four women with conditions including uterus bicornis bicollis, bicornuate uterus, leiomyomas, and cervical stenosis achieved complete abortion.
- Mild gastrointestinal side effects (nausea, vomiting, diarrhea) were reported by all subjects.
- All participants expressed satisfaction and would recommend the procedure over surgical abortion.
Conclusions:
- Methotrexate and misoprostol provide a successful medical abortion option for early pregnancies complicated by uterine or cervical anomalies.
- This regimen is a safe and effective alternative when suction curettage is contraindicated or has failed.