A prospective observational study of clinical profile, management modalities and outcomes in women undergoing second trimester induced abortions at a tertiary care centre in South Gujarat
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262531Keywords:
Fetal anomalies, Induction-abortion interval, Maternal outcomes, Mifepristone, Misoprostol, Second trimester abortionAbstract
Background: Second trimester abortion is associated with significantly higher maternal morbidity compared to first trimester termination despite accounting for a smaller proportion of induced abortions. Delayed diagnosis of fetal anomalies, limited access to healthcare services, and socioeconomic barriers continue to contribute to second trimester terminations in developing countries. Aim was to evaluate the clinical profile, management modalities, and outcomes of women undergoing second trimester induced abortion at a tertiary care centre.
Methods: This prospective observational study was conducted in the department of obstetrics and gynecology at a tertiary care teaching hospital in South Gujarat over a period of 12 months. Fifty women undergoing second trimester medical termination of pregnancy between 13 and 24 weeks of gestation were enrolled. All participants received mifepristone 200 mg orally followed by vaginal misoprostol 400 µg every 6 hours after 24-48 hours. Clinical profile, indications for termination, induction-abortion interval, success rates, and complications were analysed.
Results: Most participants were multigravida women belonging to rural and lower socioeconomic backgrounds. Fetal anomalies were the most common indication for termination (46%), followed by maternal medical indications (42%). The majority of patients required two to three doses of misoprostol, and 78% achieved abortion within 24 hours of induction. Complete abortion was achieved in 88% of cases. Retained products of conception were observed in 10% of patients, while major complications such as haemorrhage, uterine rupture, or infection were not encountered.
Conclusions: Medical termination using the mifepristone-misoprostol regimen is a safe, effective, and reliable method for second trimester induced abortions when performed under appropriate clinical supervision.
References
Hodgson JE. Second-Trimester abortion: perspectives after a decade of experience. JAMA. 1982;247:693.
Garg A, Goyal N. Medical termination of pregnancy act 1971 and its recent amendments. Indian Internet J Forens Med Toxicol. 2022;20:41-44.
Jones BS, Weitz TA. Legal barriers to second-trimester abortion provision and public health consequences. Am J Public Health. 2009;99:623-30.
Carson SA. Nongenetic Causes of Pregnancy Loss. Springer New York; 1993:112-126.
Apresyan SV, Dimitrova VI, Slyusareva OA. Second trimester medical termination of pregnancy. challenges of implementation. Medicinskij Sovet. 2017;20-25.
Karena ZV, Shah H, Vaghela H, Chauhan K, Desai PK, Chitalwala AR. Clinical utility of mifepristone: apprising the expanding horizons. Cureus. 2022;14(8):e28318
Hofmeyr GJ. Induction of labour with misoprostol. Curr Opin Obstet Gynecol. 2001;13:577-81.
Bej P, Das S. Systematic review on efficacy of mifepristone and misoprostol combination on early trimester medical termination of pregnancy. JCHM. 2019;6:68-71.
Wadhera S, Millar WJ. Second trimester abortions: trends and medical complications. Health Rep. 1994;6:441-54.
Sood SV. Some Operative and postoperative hazards of legal termination of pregnancy. BMJ. 1971;4:270-3.
Abokaf H, Korytnikova E, Yaniv-Salem S, Shoham-Vardi I, Sergienko R, Sheizaf B, et al. Pregnancy outcomes following second-trimester abortions: a comparison between medical and surgical management. A historic cohort study. Int J Gynecol Obstet. 2024;168:1067-72.
Zavier AJF, Jejeebhoy S, Kalyanwala S. Factors associated with second trimester abortion in rural Maharashtra and Rajasthan, India. Global Public Health. 2012;7:897-908.
Thapa M, Parajuly SS, Adhikari R, Shrestha MK. Effectiveness of prenatal ultrasound examination at second trimester in detecting fetal congenital abnormalities-a preliminary study. Med J Pokhara Acad Health Sci. 2019;2:173-7.
Edling A, Lindström L, Bergman E. Second trimester induced abortions due to fetal anomalies-a population-based study of diagnoses, examinations and clinical management. Acta Obstet Gynecol Scand. 2021;100:2202-8.
Rose L, Putnam S, Espey E. First-trimester medication abortion: anemia and blood loss. Curr Opin Obstet Gynecol. 2025;37:387-96.
Shaw KA, Topp NJ, Shaw JG, Blumenthal PD. Mifepristone-misoprostol dosing interval and effect on induction abortion times: a systematic review. Obstet Gynecol. 2013;121:1335-47.
Nissi R, Santala M, Immonen E, Talvensaari-Mattila A. Mifepristone and misoprostol is safe and effective method in the second-trimester pregnancy termination. Arch Gynecol Obstet. 2016;294:1243-7.
Downloads
Published
How to Cite
Issue
Section
