Publication:

Comparative study of mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second-trimester medical abortion

Background Misoprostol is widely used for cervical ripening and uterine contractions, while mifepristone priming improves uterine sensitivity to prostaglandins and may enhance treatment efficiency. The present study compared the efficacy and safety of mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second-trimester termination of pregnancy (14-20 weeks).

Methods This prospective comparative study included 150 women with singleton pregnancies between 14 and 20 weeks, allocated into two equal groups (n=75 each). Group 1 (Mife+Miso) received mifepristone 200 mg orally, followed after 36 hours by vaginal misoprostol 800 µg, then 400 µg vaginally every 3 hours up to four doses or until expulsion. Group 2 (Miso alone) received vaginal misoprostol 800 µg, followed by 400 µg every 3 hours up to four doses or until abortion occurred. Participants were monitored for expulsion, adverse effects, and complications; incomplete/failed abortions were managed with appropriate additional interventions.

Results Baseline characteristics were comparable (mean age 24.43±5.13 vs 24.12±5.00 years; p=0.711). Complete abortion occurred in 90.7% of group 1 versus 65.3% of group 2 (p=0.0005), and overall success (complete abortion) remained significantly higher in group 1 (p=0.0004). The mean induction–abortion interval was significantly shorter with the combination regimen (7.38±2.60 vs 9.97±3.67 hours; p<0.001), with more women aborting within ≤8 hours (66.7% vs. 41.3%; p=0.003). The mean total misoprostol dose was lower in Group 1 (1413.33±368.10 vs. 1850.67±370.67 µg; p<0.001), and dose-category distribution differed significantly (p<0.001).

Conclusions Mifepristone priming followed by vaginal misoprostol was more effective and faster than vaginal misoprostol alone for second-trimester medical abortion.