Short-Interval Mifepristone-Misoprostol Versus Misoprostol Alone for Second-Trimester Abortion: A Retrospective Observational Study

Introduction The aim of this study was to evaluate the efficacy and safety of a short-interval (12-24 hours) mifepristone-misoprostol regimen compared with a misoprostol-only protocol for medical management of second-trimester fetal demise. Material and methods A retrospective observational study was conducted on women diagnosed with second-trimester fetal demise (13-23.6 weeks of gestation) who underwent medical uterine evacuation at a tertiary medical center. Patients were managed according to departmental protocols in effect during specific time periods and received either a mifepristone (600 mg) and misoprostol combination regimen (study group) or misoprostol alone (control group). The primary outcome was successful abortion, defined as fetal expulsion following the completion of the predefined misoprostol course without the need for additional misoprostol cycles or alternative interventions. Secondary outcomes included the induction-to-expulsion interval, predefined complications, and analgesic requirements. Multivariable logistic regression analysis was performed to identify factors associated with successful abortion, including age, gravidity, gestational age, and treatment protocol. Results A total of 178 women were included, of whom 118 received the mifepristone-misoprostol regimen and 60 received misoprostol alone. The success rate was significantly higher in the combination group compared with the misoprostol-only group (80.5% vs. 48.3%, p < 0.001). The overall complication rate, including profuse bleeding, infection, and need for additional intervention, was significantly lower in the combination group (1.7% vs. 10.0%, p = 0.031). No statistically significant difference was observed in the induction-to-expulsion interval between groups. Analgesic requirements were significantly lower in the combination group. Multivariable analysis demonstrated that use of mifepristone and increasing parity were independently associated with higher odds of successful abortion. Conclusion In women with second-trimester fetal demise, a short-interval mifepristone-misoprostol regimen is associated with significantly higher success rates and fewer complications compared to misoprostol alone. These findings support the effectiveness and safety of short-interval combination therapy in this clinical setting.