Misoprostol alone vs. methotrexate followed by misoprostol for early abortion
Bibliographic record
Abstract
Misoprostol is an inexpensive, easily available drug that has been increasingly used to induce medical abortion. Effectiveness rates of misoprostol taken alone, at different doses and according to various protocols, have been reported to range from 64% to 94% in terminating pregnancies of a duration less than 8 weeks [1], and misoprostol has a higher peak serum concentration when taken sublingually than orally or vaginally [2]. The purpose of this study was to determine whether 400 μg of sublingual misoprostol plus 400 μg vaginal misoprostol taken as a one-step procedure was as effective as 50 mg/m2 of intramuscular methotrexate followed by 800 μg of vaginal misoprostol, the standard protocol recommended by the National Abortion Federation [3], [4]. This was a randomized, controlled, open-label trial of abortions induced in women with a pregnancy duration of 7 weeks or less, documented by an endovaginal ultrasonographic evaluation. In the methotrexate/misoprostol group, the participants were given 50 mg/m2 of methotrexate (Novopharm) on day 1, and at least 72 h later they were asked to moisten four 200 μg tablets of misoprostol (Apotex) with a few drops of water each and insert them into the vagina. In the misoprostol-only group, the participants received 400 μg misoprostol sublingually, and using a speculum and warm water to cleanse the vagina, the physician moistened 400 μg of misoprostol with warm water and placed it in the vaginal fornices. The first follow-up visit, which included an ultrasonographic assessment, was within 7 days. If the abortion was not completed, the women were offered more misoprostol or surgical removal of the conception products, along with further follow-up. The main outcome measure was a complete abortion after the first dose of misoprostol. Of 765 women assessed for eligibility, 300 were randomized, of which 2 dropped out, leaving 298 participants for analysis. The two groups were similar with respect to age, gestational age, ethnicity, obstetrical history, preprocedure depression, present anxiety and dysmenorrhea pain scores. There were no significant differences in effectiveness, pain scores, acceptability or adverse effects between the two regimens (Table 1). In each group, one participant was treated for bleeding complications but no participant required a transfusion or hospitalization. The one-step, misoprostol-only regimen was found to be similar to the usual methotrexate/misoprostol regimen in both efficacy and acceptability. The protocol involving a vaginal wash and placement of the misoprostol tablet by the physician is more costly in staff time and therefore not likely to be adopted by clinics. In the previously reported studies with acceptable rates of complete abortion, repeated doses were used [1]. Therefore, it is likely that the best regimen for misoprostol alone is 800 μg taken several times vaginally. A great concern in this study was that seven women required surgical completion for on-going pregnancies. In any planning of abortion services using methotrexate and/or misoprostol, it is crucial to provide careful follow-up, with surgical completion if needed, because of possible methotrexate- and misoprostol-related anomalies. Ibis Reproductive Health and the Department of Family Practice of the University of British Columbia provided financial support for this study.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".