Methotrexate and misoprostol for early abortion in adolescent women

Study Objective: Investigate the potential effectiveness, side effects, and acceptability of medical abortion in female adolescents. Design: Multicenter cohort study. Setting: Magee-Womens Hospital (Pittsburgh, PA) and University of British Columbia (Vancouver, BC, Canada). Participants: Twenty-five pregnant adolescents less than 18 years old up to 49 daysʹ gestation. Interventions: Methotrexate, 50 mg/m2 intramuscularly, followed 5 to 6 days later by misoprostol, 800 μg vaginally, self-administered at home. Misoprostol administration was repeated by a doctor if abortion did not occur within 1 or 2 days. Acceptability was assessed before methotrexate injection and at follow-up 5 weeks later. Main Outcome Measures: Successful abortion (complete abortion without requiring a surgical procedure), immediate success (abortion within 24 hours of initial or repeat misoprostol administration), and acceptability. Results: Complete abortion occurred in 24 of 25 (96%; 95% confidence interval [CI], 88%–100%) subjects. Immediate success abortion occurred in 23 (92%; 95% CI, 81%–100%) of these young women; the remaining subject who aborted did so on study day 10. The single failure was an incomplete abortion. Of the 23 participants who completed the follow-up acceptability evaluation, 4 (17%) believed that the process was a negative experience; 83% of participants would choose this same method again for a future abortion if needed and would recommend this method to a friend. Those who would not try this method again were without support of another individual at the time of the abortion. Conclusions: This medical abortion regimen is effective in adolescents. The overall acceptability in adolescents is similar to that reported for women 18 years of age or older. To minimize the likelihood of a negative experience with this abortion method in adolescents, home support for these patients should be evaluated during pretreatment counseling.