Evaluation of Clinical Outcomes and Complications Following Second Trimester Medical Termination of Pregnancy: A Prospective Observational Study

Introduction: Second trimester Medical Termination of Pregnancy (MTP) carries higher risks compared to first-trimester procedures. Following the MTP (Amendment) Act, 2021, an increase in mid-trimester terminations has been observed in tertiary care centres in India. Aim: To evaluate the clinical outcomes and safety profile of second trimester MTP in a tertiary care setting. Materials and Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India, from September 2022 to August 2023. A total of 85 mothers between 13 and 26 weeks of gestation undergoing medical termination were included. A regimen of oral mifepristone followed by misoprostol was administered in accordance with standard guidelines. Data on demographic profile, indications, induction-expulsion interval, and complications were analysed. Associations between categorical variables were analysed using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: A total of 85 participants were studied. Age of the study subjects ranged from 16 to 45 years, and the majority, that is, 28 (32.9%) participants, belonged to the 25 to 30 year age group. Foetal anomaly was the most common indication in 61 study subjects (71.7%). Medical methods were sufficient for 61 (71.8%) participants, while 24 (28.2%) required surgical intervention. Retained products were observed in 13 (15.3%) study subjects. There were cases of anaemia observed in 46 (54.1%), but none of them required blood transfusion. Except for febrile morbidity in 6 (7.1%) there were no serious cases of infection, uterine damage or maternal mortality. Maternal age was significantly associated with failure of expulsion (p=0.024) and anaemia (p=0.002). There was a significant association between multiparity and retained product of conception (p=0.005). Conclusion: Second-trimester MTP is effective and safe when performed in a tertiary care setting with appropriate monitoring.