A randomized trial comparing misoprostol three and seven days after methotrexate for early abortion
| Autor: | Eric Vittinghoff, Mitchell D. Creinin, Stephanie Galbraith, Cynthia Klaisle |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Gestational Age Abortion Injections Intramuscular Drug Administration Schedule Incomplete Abortion Pregnancy medicine Humans Vaginal bleeding Misoprostol Abortifacient Gynecology Abortifacient Agents Nonsteroidal Obstetrics business.industry Age Factors Obstetrics and Gynecology Abortion Induced Vaginal ultrasonography Medical abortion Therapeutic abortion Administration Intravaginal Parity Pregnancy Trimester First Methotrexate Female medicine.symptom business medicine.drug |
| Zdroj: | American Journal of Obstetrics and Gynecology. 173:1578-1584 |
| ISSN: | 0002-9378 |
| DOI: | 10.1016/0002-9378(95)90652-5 |
| Popis: | OBJECTIVE: Our purpose was to determine whether vaginal misoprostol 7 days rather than 3 days after methotrexate injection increases the percent of successful abortions on the day of misoprostol administration. STUDY DESIGN: A randomized controlled trial was performed in women requesting an abortion at ≤56 days' gestation. Eighty-six women were treated with methotrexate 50 mg/m 2 intramuscularly followed 3 days (group 1) or 7 days (group 2) later by misoprostol 800 μg. The misoprostol dose was repeated if the abortion did not occur. RESULTS: Complete abortion occurred in 38 of 46 (83%) patients in group 1 and 39 of 40 (98%) in group 2 ( p = 0.033). Of the women with complete abortions, 30 of 46 (b5%) in group 1 and 27 of 40 (68%) in group 2 aborted the same day as the first or second dose of misoprostol ( p = 0.823). Vaginal bleeding lasted 14 ± 5 (mean ± SD) days in group 1 and 17 ± 9 days in group 2. The remaining women aborted after a delay of 24 ± 6 days in group 1 and 28 ± 13 days in group 2. For these women vaginal bleeding lasted 18 ± 17 and 14 ± 7 days, respectively, and the human chorionic gonadotropin-β level was ≤25 IU/L by 22 ± 7 days after the abortion in group 1 and 19 ± 9 days in group 2. Treatment failures in group 1 were four continuing pregnancies (9%), two incomplete abortions (4%), and two women who requested surgical termination after receiving both medications (4%). The treatment failure in group 2 was an incomplete abortion. Methotrexate and misoprostol side effects were infrequent. CONCLUSIONS: Methotrexate and vaginal misoprostol are more effective abortifacients when the misoprostol is given 7 days rather than 3 days after methotrexate. This treatment regimen may offer an alternative to surgical abortion or the use of antiprogestins and prostaglandin for medical abortion. |
| Databáze: | OpenAIRE |
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