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Abstract
Objective: to review medical abortion with emphasis on studies using methotrexate and misoprostol.
Data Sources: a MEDLINE search and bibliographies from relevant articles were used. Only studies in English and French with medical abortion using mifepristone, methotrexate and misoprostol were reviewed.
Data selection: only studies using mifepristone with 100 or more women were included. All studies using methotrexate and misoprostol alone or in combination were reviewed.
Results: in early pregnancy, combinations of mifepristone with prostaglandin or methotrexate with misoprostol are effective for pregnancy termination. When misoprostol is used to augment mifepristone or methotrexate, its vaginal application appears to be superior to the oral route. Vaginal misoprostol (800 μg) is more effective applied five to seven days after the methotrexate than three days after. For inevitable or incomplete abortions, misoprostol alone may be used effectively to avoid surgery. When surgical abortion fails, medical abortion is an excellent back-up treatment.
Conclusion: medical abortion with mifepristone or methotrexate plus misoprostol is a safe and effective method of pregnancy termination. Because the complete abortion rate with medical abortion is less than with vacuum aspiration, surgery cannot be completely avoided. Commitment on behalf of both physician and patient is necessary to ensure safety. If mifepristone becomes available in Canada, studies comparing its use to methotrexate will be of paramount importance to help to determine the best method. Further research into medical abortion is important to women’s health as this method is highly acceptable and has the potential to increase access to safe abortion.
Résumé
Objectif : Examiner l’avortement thérapeutique en insistant sur les études portant sur le méthotrexate et le misoprostol.
Sources des données : Une recherche dans MEDLINE et les bibliographies d’articles pertinents. On n’a examiné que les études en anglais et en français portant sur les avortements thérapeutiques réalisés au moyen de la mifépristone, du méthotrexate et du misoprostol.
Sélection des données : On n’a examiné que les études portant sur 100 femmes ou plus ayant utilisé la mifépristone. On a examiné toutes les études portant sur le méthotrexate et le misoprostol, utilisés seuls ou en association.
Résultats : Au début de la grossesse, les associations de miféprostone et de prostaglandine ou de méthotrexate et de misoprostol sont efficaces pout provoquer un avortement. Quand le misoprostol sert à accroître l’effet de la mifépristone ou du méthotrexate, l’application vaginale semble donner de meilleurs résultats que la voie orale. Le misoprostol par voie vaginale (800μg) est plus efficace si on l’applique cinq à sept jours après le méthotrexate, plutôt que trois jours après le méthotrexate. En cas d’avortements inévitables ou incomplets, le misoprostol seul peut être utilisé efficacement pour éviter la chirurgie. En cas d’échec de l’avortement chirurgical, l’avortement thérapeutique constitue un excellent traitement de rechange.
Conclusion : L’avortement thérapeutique au moyen de la mifépristone ou du méthotrexate et du misoprostol est une méthode sûre et efficace pour mettre fin à la grossesse. Puisque le taux d’avortements complets obtenu au moyen de l’avortement thérapeutique est inférieur à celui obtenu au moyen de l’avortement par aspiration, on ne peut pas éviter complètement la chirurgie. L’engagement à la fois du médecin et de la patiente est nécessaire pour garantir l’innocuité. Si la mifépristone est commercialisée au Canada, des études sur son utilisation par comparaison avec celle du méthotrexate auront une importance capitale pour déterminer la meilleure méthode. D’autres recherches sur l’avortement thérapeutique sont importantes pour la santé des femmes puisque cette méthode est très acceptable et parce qu’elle pourrait accroître l’accès à un avartement sûr.
Key Words
References
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Article info
Publication history
Accepted:
December 15,
1997
Received in revised form:
December 15,
1997
Received:
October 1,
1997
Identification
Copyright
© 1998 Published by Elsevier Inc.
