Publication:

Comparative effectiveness of mifepristone with misoprostol versus intracervical Foley’s catheter in mid-trimester missed abortion with scarred uterus

Background Second-trimester pregnancy termination carries higher risks than first-trimester procedures, making pharmacologic methods preferable. Misoprostol is widely used, while intracervical Foley’s catheter aids cervical ripening and stimulates prostaglandin/oxytocin release. Combined mifepristone and misoprostol have been shown to shorten induction-to-abortion time compared to Foley’s catheter alone. This study aimed to evaluate the effectiveness of combined mifepristone and misoprostol versus intracervical Foley’s catheter for mid-trimester missed abortion in women with a scarred uterus.

Methods This quasi-experimental study was conducted at the department of gynecology and obstetrics, Dhaka Medical College Hospital, including 72 women aged 18-35 years with missed abortion and prior cesarean section. Participants were divided into two groups: group I (n=36) received combined mifepristone and misoprostol, and group II (n=36) received Foley’s catheter alone.

Results Group I had a lower mean gestational age (16.2±2.6 versus 23.1±2.0 weeks), higher abortion success rate (97.2% versus 94.4%), shorter induction-expulsion time (7-12 hours in 86.1% versus >18 hours in 58.3%), and fewer surgical interventions (2.8% versus 5.6%) compared to group II. Side effects were more frequent in group I (55.6% versus 27.8%). All differences were statistically significant (p<0.05).

Conclusions Combined mifepristone and misoprostol is more effective than Foley’s catheter alone for mid-trimester missed abortion in scarred uterus, yielding higher success rates and shorter induction-expulsion times.