A randomized trial of the effect of moistening misoprostol before vaginal administration when used with methotrexate for abortion.

ABSTRACT

PIP: A randomized trial conducted in the US and Cuba assessed whether moistening misoprostol in advance of vaginal insertion enhances the efficacy of medical abortion after methotrexate administration. 240 abortion seekers from Pittsburgh, Pennsylvania (US), and Havana, Cuba, with pregnancies of 49 days' gestation or less were randomized either to dip the four 200-mcg misoprostol tablets in water before administration (group 1) or to insert the tablets dry (group 2). The misoprostol dose was repeated in 1-2 days if abortion did not occur. There were no statistically significant differences between groups 1 and 2 in the cumulative rate of abortion after the first misoprostol dose (73.0% vs. 71.3%), after the second misoprostol dose (84.1% vs. 81.1%), or by 35 days after methotrexate administration (95.2% vs. 91.8%). The proportion of women with a continuing pregnancy, defined as the presence of embryonic cardiac activity 2 weeks after methotrexate injection, was slightly but nonsignificantly higher in group 2 (5.7%) than in group 1 (2.4%). The immediate success rate in Pittsburgh was greater, although not significantly, for women who moistened the misoprostol (87% vs. 76%); in Havana, the opposite trend was observed (82% vs. 86%). Cramping began a mean of 2.8 hours after the first misoprostol administration in group 1 and a mean of 3.5 hours later in group 2. Women in group 1 had significantly more diarrhea (36% vs. 21%) and fever/chills (44% vs. 30%) than those in group 2, but rates of nausea, vomiting, dizziness, and headache did not differ. These findings suggest that moistening misoprostol before vaginal application does not significantly improve the efficacy of methotrexate abortion.