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                           MEDICAL REFERENCES
               to the use of Methotrexate as an abortifacient
                              (July, 1994)
-------------------------------------------------------------------------------

Note: Entries 1 and 3 refer to the same article.

1. Creinin, M. D. and P. D. Darney. 1993. Methotrexate and misoprostol for
early abortion. Contraception 48:339-348.

KEYWORDS : medical abortion; methotrexate; misoprostol; --hCG; vaginal
ultrasound; Abortion; Pregnancy; gestation; Prostaglandin;

NOTES    : Methotrexate is cytotoxic to trophoblast and, in low doses, has
minimal side effects. It is used to treat both gestational trophoblastic
neoplasia and ectopic pregnancy. The cytotoxic effects of methotrexate on
intrauterine trophoblast should be equivalent. To test this hypothesis, ten
pregnant women, < 8 weeks' gestation were treated with methotrexate 50 mg/m2
intramuscularly followed 3 days later by misoprostol, a prostaglandin E1
analogue. The first 4 patients received misoprostol 600 ug orally; none
aborted soon after the misoprostol. Two patients aborted 25 and 26 days after
the methotrexate injection and two elected a suction abortion after 14 days
(one by choice and one because the pregnancy was still viable). The last 6
patients received misoprostol 800 ug vaginally and aborted within 3- 8 hours.
One patient had an incomplete abortion requiring a suction curettage 34 days
after the misoprostol. Vaginal bleeding for these 6 patients lasted an average
of 29 +/- 11 days (range, 12-42 days). No methotrexate side effects were
observed. Vaginal misoprostol (800 ug) was significantly more effective (p =
0.005) than oral misoprostol (600 ug) in effecting abortion after
intramuscular methotrexate. AUTHOR
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2. Buckshee, K. and A. J. Dhond. 1992. A new nonsurgical technique for
termination of intrauterine pregnancy associated with large multiple uterine
leiomyomas. Int. J. Gynecol. Obstet. 37:297-299.

Keywords : abortion; Methotrexate; Intrauterine pregnancy; Leiomyoma;
pregnancy; Techniques; termination;
-------------------------------------------------------------------------------
3. Creinin, M. D. and P. D. Darney. 1993. Methotrexate and misoprostol for
early abortion. Contraception 48:339-348.

Keywords : Methotrexate; misoprostol; Early abortion; abortion; Medical
abortion; _-hCG; vaginal ultrasound; pregnancy; gestation; prostaglandin;
trophoblast; low dose; side effects; ectopic; ectopic pregnancy; women; first;
injection; curettage; oral;

Notes : Methotrexate is cytotoxic to trophoblast and, in low doses, has
minimal side effects. It is used to treat both gestational trophoblastic
neoplasia and ectopic pregnancy. The cytotoxic effects of methotrexate on
intrauterine trophoblast should be equivalent. To test this hypothesis, ten
pregnant women, < 8 weeks' gestation were treated with methotrexate 50 mg/m2
intramuscularly followed 3 days later by misoprostol, a prostaglandin E1
analogue. The first 4 patients received misoprostol 600 ug orally; none
aborted soon after the misoprostol. Two patients aborted 25 and 26 days after
the methotrexate injection and two elected a suction abortion after 14 days
(one by choice and one because the pregnancy was still viable). The last 6
patients received misoprostol 800 ug vaginally and aborted within 3- 8 hours.
One patient had an incomplete abortion requiring a suction curettage 34 days
after the misoprostol. Vaginal bleeding for these 6 patients lasted an average
of 29 +/- 11 days (range, 12-42 days). No methotrexate side effects were
observed. Vaginal misoprostol (800 ug) was significantly more effective (p =
0.005) than oral misoprostol (600 ug) in effecting abortion after
intramuscular methotrexate. AUTHOR
-------------------------------------------------------------------------------
4. Creinin, M. D. 1993. Methotrexate for abortion at 42 days gestation.
Contraception 48:519-525.

KEYWORDS : Methotrexate; abortion; gestation; Medical abortion; _-hCG;
vaginal ultrasound; pregnancy; trophoblast; low dose; side effects; ectopic;
ectopic pregnancy; early pregnancy; prostaglandin; women; injection; first;
Intrauterine pregnancy;

NOTES : Methotrexate is cytotoxic to trophoblast and, in low doses, has
minimal side effects. It is used to treat gestational trophoblastic neoplasia
and ectopic pregnancy and has recently been shown to have similar effects on
intrauterine trophoblast. A prior study suggested that methotrexate may
successfully cause abortion of an early pregnancy without prostaglandin. To
test this hypothesis, ten pregnant women at </= 42 days gestation were treated
with methotrexate 50 mg/m(2) intramuscularly. Vaginal bleeding started 24 +/-
10 (mean +/- standard deviation) days after the injection and lasted 10 +/- 3
days. Methotrexate side effects occurred in 4 patients and were limited to the
first 4 days after the injection. Methotrexate alone appears sufficient to
abort a very early intrauterine pregnancy. AUTHOR
-------------------------------------------------------------------------------
5. Wiebe, E. R. 1994. Methotrexate and misoprostol used in abortions. Can.
Med. Assoc. J. 150:1381-1382.

Keywords  : Methotrexate; misoprostol; abortions; abortion;

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-------------------------------------------------------------------------------
Life Communications -               Volume 3, No. 23             November, 1993
-------------------------------------------------------------------------------
3)                      No Need To Wait for RU-486

Recent research at the University of California, San Francisco has shown that
a combination of two drugs already legal in the US induces "safe" at-home
abortions.  Dr. Mitchell Creinin and Dr. Philip Darney administered the
anti-cancer drug methotrexate (destabilizing the uterine lining) followed by
the ulcer medicine misoprostol (causing uterine contractions) to ten pregnant
women, and succeeded in killing eight of the unborn children.  Excited about
these results (soon to appear in the journal _Contraception_), the University
has started testing the procedure on more pregnant women (and unborn children).
+-----------------------------------------------------------------------------+
| Credits:                                                                    |
| 3 - From an AP article in the [Pittsburgh] North Hills News Record, October |
|     23, 1993, p. A3.                                                        |
+-----------------------------------------------------------------------------+


-------------------------------------------------------------------------------
Life Communications -             Volume 4, No. 10                   July, 1994
-------------------------------------------------------------------------------
2)      California Experiment Successful with Another Chemical Savior

In November and December in Tustin, California, nine women volunteered to
participate in an experiment by Dr. William Moss: Each woman was less than
eight-weeks pregnant, and  was injected in the buttock with a drug called
methotrexate, a cancer-fighting drug common in chemotherapy because it kills
fast-growing cells.  Several days later, an artificial hormone called
misoprostol was placed in the vagina.  It makes the uterus contract and expel
what remains of the pregnancy. Moss reported that several women complained of
bad cramps, and that all the pregnancies were terminated, with no serious
apparent side effects.

A feminist group raised objections to doctors (like Moss) using women as
guinea pigs for their experiments.  A spokesman for the U.S. Food and Drug
Administration commented that what Moss is doing is permissible, yet the
California Medical Board has refrained from judgment. Evidently, some
doctors have been using methotrexate for several years to end particularly
dangerous early pregnancies - such as ectopic pregnancies, backed up by a
1991 study published in _Obstetrics & Gynecology_ which concluded that
methotrexate is "safe and effective and preserves reproductive potential,"
and claimed a success rate of 96.7%.  For comparison, surgical abortions are
successful in killing the developing child about 99% of the time.

A 21-year-old woman, who asked her name be withheld to protect her privacy,
had her abortion this way.  "It's more natural," she said.  "You (get) your
pills, and it's done with.  It's a good plan for people who are afraid to go
through surgery and general anesthesia."

Thus pregnancy is again reduced to the level of yet another disease: the
obviously `natural' thing to do is to go to the doctor, `take your pills' and
be `done with' it. Somehow this view seems to forget a certain small someone.
+-----------------------------------------------------------------------------+
| Credits:                                                                    |
| 2 - From a May 94 article by Teri Sforza from the _Orange County Register_, |
|     Santa Ana, California. Many thanks to Reader Dr. Fred Worth             |
+-----------------------------------------------------------------------------+

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