Misoprostol versus combined regimen of mifepristone and misoprostol in termination of second trimester pregnancy

The present prospective study was conducted over 12 months at Dr. Mansukh Bhai K. Shah medical college and Sushilaben M. Shah multi-specialty hospital, Ahmedabad, serving predominantly lower socioeconomic groups. The objective was to assess the safety and efficacy of misoprostol alone versus a combined regimen of mifepristone and misoprostol in second-trimester pregnancy termination. A total of 18 patients were enrolled and divided into two groups. Group A received 200 mg oral mifepristone, followed 24 hours later by 200 mcg misoprostol administered vaginally every 4 hours up to a maximum of 4 doses or until expulsion occurred. Group B received only 200 mcg vaginal misoprostol every 4 hours, up to 4 doses. Success was defined as complete expulsion of the fetus and placenta without the need for surgical intervention. In group A, the success rate was 100%, and none of the patient’s required dilatation and evacuation (D and E). In contrast, group B had a success rate of 80%, with 2 patients (20%) requiring D and E. There were no failures in either group, defined as failure to abort within 72 hours of the last dose. The induction-abortion interval was shorter in the mifepristone-primed group. The study concludes that pre-treatment with mifepristone significantly improves the efficacy of second-trimester pregnancy termination with misoprostol, reduces the need for Surgical intervention, and shortens the induction-to-abortion interval. The combined regimen of mifepristone and misoprostol is thus more effective and safer than misoprostol alone.