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

Rubab Sarmin; Maliha Tasnim; Sharif Mohammad Towhid Tarif; Mahzabin Husain; Jannatul Ferdous Chowdhury; Effat Aziz; Tasnia Sultana; Salma Akter

doi:10.18203/2320-1770.ijrcog20253890

Authors

Rubab Sarmin Department of Obstetrics and Gynecology, Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh
Maliha Tasnim Department of Obstetrics and Gynecology, Chittagong Medical College and Hospital, Chittagong, Bangladesh
Sharif Mohammad Towhid Tarif Department of Otolaryngology and Head Neck Surgery, Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh
Mahzabin Husain National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
Jannatul Ferdous Chowdhury Department of Obstetrics and Gynecology, Sarkari Karmachari Hospital, Dhaka, Bangladesh
Effat Aziz Department of Obstetrics and Gynecology, East West Medical College, Dhaka, Bangladesh
Tasnia Sultana Department of Obstetrics and Gynecology, Ad-Din Akij Medical College, Khulna, Bangladesh
Salma Akter Department of Obstetrics and Gynecology, 250 Bedded General Hospital, Sirajganj, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253890

Keywords:

Foley’s catheter, Mifepristone, Misoprostol, Scarred uterus, Second-trimester abortion

Abstract

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.

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