Effectiveness of mifepristone with foley’s catheter versus foley’s catheter alone for termination of pregnancy with prior cesarean section

Abstract

Background: Termination of pregnancy in the second trimester presents significant challenges in modern obstetric practice, with risks exceeding those of first-trimester termination. It remains a common procedure, primarily due to congenital anomalies and intrauterine fetal death, contributing substantially to the number of abortions or induced deliveries. This study aimed to determine the effectiveness of Mifepristone with intracervical Foley’s catheter for termination of pregnancy at second trimester with history of prior cesarean section in comparison with intracervical Foley’s catheter alone. Methods: This randomized controlled trial was conducted at the Department of Feto-maternal Medicine of Bangabandhu Sheikh Mujib Medical University (BSSMU), Dhaka, Bangladesh from September 2022 to August 2023. Seventy women with singleton pregnancies (14-28 weeks, one/two cesarean sections) were enrolled purposively at BSMMU, randomized into two groups: experimental (Mifepristone and Foley’s catheter) and control (Foley’s catheter only). Data was analyzed via SPSS 26.0. Results: Successful abortion or delivery occurred in 82.9% of cases in the experimental group compared to 60% in the control group, showing a statistically significant difference (P=0.034). The mean induction-to-abortion or delivery interval was significantly shorter in the experimental group (54.12 hours) than in the control group (64.11 hours; P=0.033). Although side effects were less frequent in the experimental group (8.6%) compared to the control group (14.3%), the difference was not statistically significant (P=0.708). Conclusion: The combination of Mifepristone and intracervical Foley’s catheter significantly improved second-trimester abortion or delivery success rates, reduced induction-to-abortion/delivery intervals, and resulted in fewer complications compared to intracervical Foley’s catheter alone.