Oral methotrexate compared with injected methotrexate when used with misoprostol for abortion,

Objective: This study was undertaken to compare oral to injected methotrexate with respect to effectiveness, side effects, and acceptability. Study Design: One hundred women in an urban primary care practice were randomly assigned in phase 1 to receive 50 mg/m2 methotrexate by either the oral or the injected route. In phase 2 another 87 women were allowed to choose between the oral and injected routes. In both phases and in all groups the methotrexate was followed 5 to 7 days later by misoprostol administered vaginally by the patient. The main outcome was the success rate (the number whose pregnancies aborted without surgery); other outcomes included side effects and acceptability. Results: There were no differences in rates of success, side effects, or acceptability between groups receiving oral and injected methotrexate. Among the women in phase 2 the oral form was chosen by 57.5%. Conclusion: This study indicates that for medical abortions induced with methotrexate and misoprostol it is possible to offer both the oral and injected routes of methotrexate without sacrificing efficacy and that about half of the women offered a choice will choose the oral route. (Am J Obstet Gynecol 1999;181:149-52.)