Early medical termination pregnancy with methotrexate and misoprostol in lower segment cesarean section cases

Gautam, Roli; Agrawal, Vishal

doi:10.1046/j.1341-8076.2003.00108.x

Cited by 14 publications

(6 citation statements)

References 23 publications

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“…All of these women aborted completely. This conclusion is consistent with the findings of Gautam et al [ 17 ] who reported successful abortion without complications in 66 women with ≤ 60 days pregnancy and with history of previous one or two cesarean sections.…”

Section: Discussionsupporting

confidence: 93%

Low Dose Mifepristone And Vaginal Misoprostol: A Safe Option For Termination Of Pregnancy Up To 63 Days

2007

IJGO

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Aim: To evaluate the efficacy and safety of low dose mifepristone (200mg) followed 48 hours later by 400µg of vaginal misoprostol to terminate pregnancy up to 63 days Methods: This was a prospective study enrolling 72 healthy women, 37 with less than 49 days gestation (group A) and 35 with 50 to 63 days gestation (group B). They were given 200 mg of mifepristone orally followed by 400µg of misoprostol vaginally after 48 hours. Failure was defined as need for surgical intervention for any reason. Secondary outcome measures were side effects, complications and acceptability. Results were compared between the two groups. Results: Both the groups were comparable with respect to age, parity and hemoglobin. Complete abortion occurred in 97.3% in <49days pregnancy group and 97.1% in 50 -63 days group. In 19.4% subjects, bleeding started following mifepristone alone and in rest it started within 4 hrs of receiving misoprostol and lasted for 11.5 days. Mean duration of bleeding was longer in group B (13.15 vs. 9.97 days). Mean fall in hemoglobin was minimal (0.42 gm%) though it was more in group B (0.49gm%) than in group A (0.37gm%). Moderate amount of pain was reported by 71.4% and 37.8% subjects in group B and A respectively. Analgesics were required by 13.9% of subjects. Incidence of nausea, vomiting and diarrhea was 26.4%, 9.7% and 15.3% respectively and it was similar in either groups. Conclusion: Medical abortion using low dose mifepristone and vaginal misoprostol is a safe and effective option for terminating pregnancy up to 9 weeks.

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Section: Discussionsupporting

confidence: 93%

Low Dose Mifepristone And Vaginal Misoprostol: A Safe Option For Termination Of Pregnancy Up To 63 Days

2007

IJGO

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“…Four case series of women with prior uterine surgery (primarily cesarean sections) have been reported. These series include women who received mifepristone and oral misoprostol [135,136] and methotrexate and vaginal misoprostol [137] for medical abortion, and women who received vaginal misoprostol alone for treatment of early pregnancy failure [138]. They include a total of 392 women with no reported uterine rupture, giving a 95% confidence interval of 0 to 0.8%.…”

Section: Uterine Rupturementioning

confidence: 99%

Medical Abortion in Early Pregnancy

Creinin

Danielsson

2009

Management of Unintended and Abnormal Pregnancy

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The standard or classic regimen of mifepristone 600 mg followed 36 to 48 hours later by a prostaglandin analog, typically misoprostol 400 µg orally, is highly effective for abortion up to 49 days' gestation.r Mifepristone can be used at a dose of 200 mg, instead of 600 mg, with equal efficacy and lower cost. r When the misoprostol is used vaginally, the gestational age limit can be extended to 63 days and the medications can be administered as little as 6 to 8 hours apart or even simultaneously.r Buccal and sublingual misoprostol also are effective when used at 24-to 48-hour intervals after mifepristone. These alternative routes appear to have more side effects than vaginal administration.r Ultrasound examination 1 week after administering the medications is highly predictive of long-term success of the medical abortion procedure.r Methotrexate and misoprostol can be used as an alternative regimen in women up to 49 days' gestation. The methotrexate does not appear to have immediate effect in the abortion process; rather, by rendering the pregnancy nonviable, methotrexate may serve as a backup for women who do not abort shortly after misoprostol administration.r Misoprostol alone, in repeated doses, can be used for abortion where mifepristone is too expensive or unavailable. The recommended regimen for pregnancies up to 63 days' gestation is 800 µg administered vaginally every 3 to 24 hours for a maximum of three doses.

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“…Mifepristone in combination with misoprostol is an efficacious and safe alternative for women preferring non‐surgical treatment for early termination of pregnancy (TOP). Previous studies have addressed concern regarding use of misoprostol in women with previous uterine surgery. However, no uterine ruptures occurred in a case series of 392 women with previous Cesarean section undergoing TOP with mifepristone and oral misoprostol, methotrexate and vaginal misoprostol or vaginal misoprostol alone.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have addressed concern regarding use of misoprostol in women with previous uterine surgery. However, no uterine ruptures occurred in a case series of 392 women with previous Cesarean section undergoing TOP with mifepristone and oral misoprostol, methotrexate and vaginal misoprostol or vaginal misoprostol alone. In contrast, several studies have demonstrated that previous Cesarean delivery might increase the risk of retained products of conception after early TOP.…”

Section: Introductionmentioning

confidence: 99%

Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy

Liu

Tzeng

et al. 2016

Ultrasound in Obstet & Gyne

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Early medical termination pregnancy with methotrexate and misoprostol in lower segment cesarean section cases

Abstract: Medical abortion using methotrexate with misoprostol is safe, cheap, and effective for early pregnancy termination through 8 weeks' gestation even with previous cesarean section.

Cited by 14 publications

References 23 publications

Low Dose Mifepristone And Vaginal Misoprostol: A Safe Option For Termination Of Pregnancy Up To 63 Days

Low Dose Mifepristone And Vaginal Misoprostol: A Safe Option For Termination Of Pregnancy Up To 63 Days

Medical Abortion in Early Pregnancy

Association between ultrasonographic parameters of Cesarean scar defect and outcome of early termination of pregnancy

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