Publication:

Prospective comparative study of misoprostol alone versus mifepristone plus misoprostol for second-trimester pregnancy termination

Background Second-trimester medical termination of pregnancy (MTP) is legally permitted in India up to 24 weeks under the MTP Act. Misoprostol is widely used for this purpose, but its efficacy may be enhanced by pre-treatment with mifepristone. This study aimed to compare the efficacy and safety of misoprostol alone versus mifepristone followed by misoprostol for second-trimester pregnancy termination.

Methods A prospective, randomized comparative study was conducted at SKNMC&GH, Pune, involving 61 women between 13-24 weeks gestation. Group I (n=31) received oral mifepristone followed by vaginal misoprostol; Group II (n=30) received misoprostol alone. Primary outcome was induction-to-abortion interval; secondary outcomes included misoprostol dose requirement, need for surgical intervention, and complications.

Results Group I showed a significantly shorter induction-to-abortion interval (7.8±2.3 hrs vs. 11.6±3.1 hrs; p<0.001), required fewer misoprostol doses (3.1±0.9 vs. 4.8±1.2; p<0.001), and had lower curettage rates (6.5% vs. 23.3%; p=0.04). Complete abortion rates were high in both groups (93.5% vs. 86.7%; p=0.37). Stratified analysis confirmed consistent benefits across parity groups and gestational age ranges.

Conclusions Mifepristone pre-treatment significantly improves procedural efficiency and reduces intervention burden in second-trimester medical abortion. The combined regimen is recommended for safer and more predictable outcomes under the MTP framework.