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

Aim: The aim of the study was to investigate the efficacy of methotrexate and misoprostol for the medical termination of early pregnancy with previous cesarean section. Methods: Sixty-six pregnant women of 60 days or less in duration with previous one or two cesarean sections were selected. Each woman received intramuscularly a dose of methotrexate (50 mg). Two to 3 days later, 800 mug of misoprostol was administered intravaginally. Repeat doses were used if there was no significant bleeding. An ultrasonography was done in each case after seven days. Subjects with continuing pregnancies or excessive bleeding had a surgical abortion. A successful medical abortion was defined by vaginal bleeding without surgical intervention and a negative transvaginal ultrasound. Side-effects were noted. Results: Complete abortion occurred in 87.9% cases after first dose of misoprostol, and 6.1% cases had complete abortion after second dose, so out of 66 cases 62 (94%) had a successful medical abortion. Four (6%) subjects required surgical intervention; one for continued pregnancies, one for missed abortion, and two for excessive bleeding. The complete abortion rate was higher for early gestations: 30/30 (100%) at less than or equal to 45 days gestation, 28/30 (93.3%) at 46-50 days gestation, and 2/6 (33.3%) from 50 to 63 days gestation. Vaginal bleeding lasted 15 +/- 7 days. Gastrointestinal side-effects were uncommon, mild, and brief. There was no case of uterine rupture. Conclusion: Medical abortion using methotrexate with misoprostol is safe, cheap, and effective for early pregnancy termination through 8 weeks' gestation even with previous cesarean section.