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

Vanishree Mangalsing Chavhan; Kishorkumar Hol; Aparna Sasane; Vaibhavi Dhenge

doi:10.18203/2320-1770.ijrcog20260545

Authors

Vanishree Mangalsing Chavhan Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
Kishorkumar Hol Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
Aparna Sasane Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
Vaibhavi Dhenge Department of Obstetrics and Gynecology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260545

Keywords:

Mifepristone, Misoprostol, MTP Act, Second-trimester abortion

Abstract

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.

References

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Arora C, Yadav K, Samaria M, Benwal DK. Comparative study of mifepristone plus vaginal misoprostol versus vaginal misoprostol for second trimester (13-20 weeks) abortion at a tertiary care centre in Western India. Int J Clin Obstet Gynaecol. 2022;6(3):41-4. DOI: https://doi.org/10.33545/gynae.2022.v6.i3a.1181

Mukhopadhyay P, Bag TS, Kyal A, Bhuniya A, Saha TK. Second trimester abortion with vaginal misoprostol: is there any advantage with prior mifepristone priming? J South Asian Feder Obst Gynae. 2022;14(2):78-83.

Tang OS, Ho PC. Medical abortion in second trimester. Best Pract Res Clin Obstet Gynaecol. 2002;16(2):229-37. DOI: https://doi.org/10.1053/beog.2001.0273

Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Mid-trimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004;69(1):51-8. DOI: https://doi.org/10.1016/j.contraception.2003.09.006

World Health Organization. Safe Abortion: Technical and Policy Guidance for Health Systems. 2nd ed. Geneva: WHO; 2012.