FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 333:537-540 August 31, 1995 Number 9 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Although medical termination of pregnancy is available in Europe and China as an alternative to surgical termination, political and social factors have blocked medical approaches to pregnancy termination in the United States. Methotrexate, which is toxic to trophoblastic tissue, has been used safely to treat unruptured ectopic pregnancies. This report describes the use of a single low dose of methotrexate followed by intravaginal misoprostol for the medical termination of early pregnancy.

Methods Women seeking termination of pregnancy were selected for this study on the basis of their good general health, emotional stability, and a pregnancy of 63 days or less in duration. Each woman received an intramuscular dose of methotrexate (50 mg per square meter of body-surface area). Five to seven days later, 800 µg of misoprostol was administered intravaginally. If abortion did not occur after seven days, the woman was offered a second dose of misoprostol or vacuum aspiration. Successful abortion was defined as a complete termination of pregnancy within seven days after the first or second administration of misoprostol.

Results A total of 171 of the 178 women enrolled in the study (96 percent) had successful medical abortions. Twenty-five women (14 percent) did not have an abortion after the first dose of misoprostol and received a second dose. Eighteen subsequently had complete abortions, but seven required suction curettage. In all seven women who required suction curettage, there was histologic evidence of disruption in the conceptus. No important side effects or complications were noted.

Conclusions The combination of methotrexate and misoprostol represents a safe and effective alternative to invasive methods for the termination of early pregnancy.

Source Information

From the Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York.

Address reprint requests to Dr. Hausknecht at 1075 Park Ave., New York, NY 10128.

Full Text of this Article

Related Letters:

Methotrexate and Misoprostol to Terminate Early Pregnancy
Perrone J., Hoffman R. S., Yankowitz J., Niebyl J. R., Grunberg S. M., Swanson K. T., Levitt N., Hausknecht R.
Extract | Full Text  
N Engl J Med 1996; 334:399-400, Feb 8, 1996. Correspondence

This article has been cited by other articles:

• Shannon, C., Brothers, L P., Philip, N. M., Winikoff, B. (2004). Ectopic Pregnancy and Medical Abortion. Obstet Gynecol 104: 161-167 [Abstract] [Full Text]  
• Jain, J. K., Dutton, C., Harwood, B., Meckstroth, K. R., Mishell, D. R. Jr (2002). A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Hum Reprod 17: 1477-1482 [Abstract] [Full Text]  
• BULLETTI, C., DE ZIEGLER, D., DE MOUSTIER, B., POLLI, V., BOLELLI, G., FRANCESCHETTI, F., FLAMIGNI, C. (2001). Uterine Contractility: Vaginal Administration of the {beta}-Adrenergic Agonist, Terbutaline: Evidence of Direct Vagina-to-Uterus Transport. Ann. N. Y. Acad. Sci. 943: 163-171 [Abstract] [Full Text]  
• Simonds, W., Ellertson, C., Winikoff, B., Springer, K. (2001). Providers, Pills and Power: The US Mifepristone Abortion Trials and Caregivers' Interpretations of Clinical Power Dynamics. Health (London) 5: 207-231 [Abstract]  
• Goldberg, A. B., Greenberg, M. B., Darney, P. D. (2001). Misoprostol and Pregnancy. NEJM 344: 38-47 [Full Text]  
• BORGATTA, L., BURNHILL, M. S., TYSON, J., LEONHARDT, K. K., HAUSKNECHT, R. U., HASKELL, S. (2001). Early Medical Abortion With Methotrexate and Misoprostol. Obstet Gynecol 97: 11-16 [Abstract] [Full Text]  
• Ngai, S.W., Tang, O.S., Chan, Y.M., Ho, P.C. (2000). Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability. Hum Reprod 15: 1159-1162 [Abstract] [Full Text]  
• Christin-Maitre, S., Bouchard, P., Spitz, I. M. (2000). Medical Termination of Pregnancy. NEJM 342: 946-956 [Full Text]  
• Janssen, N. M., Genta, M. S. (2000). The Effects of Immunosuppressive and Anti-inflammatory Medications on Fertility, Pregnancy, and Lactation. Arch Intern Med 160: 610-619 [Abstract] [Full Text]  
• Lloyd, M.E., Carr, M., Mcelhatton, P., Hall, G.M., Hughes, R.A. (1999). The effects of methotrexate on pregnancy, fertility and lactation. QJM 92: 551-563 [Full Text]  
• Grimes, D. A. (1999). A 26-Year-Old Woman Seeking an Abortion. JAMA 282: 1169-1175 [Full Text]  
• DAVIS, A. R., MILLER, L., TAMIMI, H., GOWN, A. (1999). Methotrexate Compared With Mercaptopurine for Early Induced Abortion. Obstet Gynecol 93: 904-909 [Abstract] [Full Text]  
• JAIN, J. K., KUO, J., MISHELL, D. R. Jr (1999). A Comparison of Two Dosing Regimens of Intravaginal Misoprostol for Second-Trimester Pregnancy Termination. Obstet Gynecol 93: 571-575 [Abstract] [Full Text]  
• Westfall, J. M., Sophocles, A., Burggraf, H., Ellis, S. (1998). Manual Vacuum Aspiration for First-Trimester Abortion. Arch Fam Med 7: 559-562 [Abstract] [Full Text]  
• Pastuszak, A. L., Schuler, L., Speck-Martins, C. E., Coelho, K.-E. F.A., Cordello, S. M., Vargas, F., Brunoni, D., Schwarz, I. V.D., Larrandaburu, M., Safattle, H., Meloni, V. F.A., Koren, G., Neto, J. C. (1998). Use of Misoprostol during Pregnancy and Mobius' Syndrome in Infants. NEJM 338: 1881-1885 [Abstract] [Full Text]  
• Miller, N. H., Miller, D. J., Pinkston Koenigs, L. M. (1998). Attitudes of the Physician Membership of the Society for Adolescent Medicine Toward Medical Abortions for Adolescents. Pediatrics 101 : e4-e4 [Abstract] [Full Text]  
• Spitz, I. M., Bardin, C. W., Benton, L., Robbins, A. (1998). Early Pregnancy Termination with Mifepristone and Misoprostol in the United States. NEJM 338: 1241-1247 [Abstract] [Full Text]  
• Doss, B. J., Ramirez, N. C., Lawrence, W. D. (1997). Failed Methotrexate-Treated Ectopic Pregnancies: Clinicopathologic Correlations. INT J SURG PATHOL 5: 83-93 [Abstract]  
• Gorlick, R., Goker, E., Trippett, T., Waltham, M., Banerjee, D., Bertino, J. R. (1996). Intrinsic and Acquired Resistance to Methotrexate in Acute Leukemia. NEJM 335: 1041-1048 [Full Text]  
• Perrone, J., Hoffman, R. S., Yankowitz, J., Niebyl, J. R., Grunberg, S. M., Swanson, K. T., Levitt, N., Hausknecht, R. (1996). Methotrexate and Misoprostol to Terminate Early Pregnancy. NEJM 334: 399-400 [Full Text]  
• (1995). MEDICAL TERMINATION OF PREGNANCY. JWatch General 1995: 1-1 [Full Text]