Second Trimester Medical Abortion with Two Sequential Doses of Mifepristone Followed by Catheter Plus Misoprostol Versus Single Dose of Mifepristone Followed by Catheter with Misoprostol

Introduction- Although the majority of abortions occur in the first trimester, 13% are conducted during the second trimester worldwide due to delayed diagnosis of foetal defects and failure to identify an unwanted pregnancy in the first trimester. The present study was conducted to compare the effect of two sequential doses of mifepristone followed by catheter plus Misoprostol versus single dose of mifepristone followed by catheter with misoprostol in second trimester abortion. Material and methods- The present comparative study was conducted at Dept of Obst & Gynae SMGS hospital for a study period of one year among 100 pregnant women who wants to get abortion in second trimester. Patients were divided into two groups GROUP A (50 patients) in which women were given two sequential doses of mifepristone followed by catheter plus Misoprostol and GROUP B (50 patients) in which women were given single dose of mifepristone followed by catheter with misoprostol. The Statistical Package for Social Sciences (SPSS for Windows version 25) was used to do the statistical analysis. Every statistical test was conducted at a significance threshold of p> 0.05 and was two-sided. Results- In both groups, the predominant indication was foetal congenital abnormalities (88% in Group A compared to 86% in Group B). No statistically significant variation in indication distribution was seen (p = 0.747). The majority of patients in both groups exhibited a closed, uneffaced cervix, signifying an unfavourable cervical condition prior to therapy. In Group A (2-dose), 88% had a closed cervix, compared to 92% in Group B (1-dose). A minor percentage in both groups exhibited marginally more favourable results (cervix accommodating one finger with early effacement). Although not statistically significant (p = 0.067). Group A (2-dose mifepristone) had a significantly reduced Induction-to-Abortion Interval (IAI) (mean 3.54 ± 1.89 hours compared to 5.39 ± 2.09 in Group B; p = 0.012), and required fewer misoprostol doses on average (1.98 vs 2.37; p = 0.02). Both regimens were predominantly safe; however, Group B (1-dose) exhibited marginally elevated rates of mild problems such as fever, diarrhoea, and haemorrhage. Conclusion – This comparative study concludes that administering two consecutive doses of mifepristone, followed by catheter induction and misoprostol, is a more efficacious. The two-dose regimen markedly decreases the induction-to-abortion duration and the necessary misoprostol dosage while preserving a favourable complication profile.