A Retrospective Analysis Comparing Protocols in Medical Abortion with MTX/MSP and MSP Alone in a Women's Health Center in Latin America

Agustín González R. MD. Fundación ESAR, Colombia, South America

Three medicines are being used worldwide for early medical abortions: mifepristone, methotrexate and misoprostol. In the majority of countries in Latin America the access to legal and/or safe abortions is restricted and, in addition, mifepristone is not registered and unavailable. Thus, women commonly request an effective medicine (instead of a surgical method) to help them solve an unplanned early pregnancy; one of these medicines is misoprostol which they can obtain over-the-counter in pharmacies.  A network of providers who offer comprehensive services in sexual and reproductive health apply regimens for early medical abortion such as misoprostol alone or methotrexate + misoprostol with a variety of ways of administration.

Thus, women commonly request an effective medicine (instead of a surgical method) to help them solve an unplanned early pregnancy; one of these medicines is misoprostol which they can obtain over-the-counter in pharmacies. A network of providers who offer comprehensive services in sexual and reproductive health apply regimens for early medical abortion such as misoprostol alone or methotrexate + misoprostol with a variety of ways of administration.

A retrospective analysis, in collaboration with Gynuity Health Projects, of 8,768 cases of women with gestations < 56 days who sought a medical abortion, will be presented comparing efficacy for the four regimens used: 1) misoprostol alone, 2) oral methotrexate + buccal misoprostol, 3) oral methotrexate + vaginal misoprostol and 4) IM methotrexate + vaginal misoprostol. The data were collected from a women's health center in Latin America.

In this real-use setting, methotrexate appears to confer a significant advantage over misoprostol alone for early medical abortion. Younger gestational age, being nulliparous, and lack of previous abortions are also determinants of success. These findings are important particularly for settings where mifepristone remains unavailable.