Clinical efficacy of mifepristone followed by vaginal misoprostol in medical termination of second trimester pregnancy

Abstract

Background: Second trimester abortions constitute a notable proportion of pregnancy terminations worldwide and are associated with increased morbidity compared to first trimester procedures (1, 2). This study aimed to evaluate the clinical efficacy and safety of vaginal misoprostol administered after oral mifepristone for second trimester medical termination of pregnancy. Methodology: This prospective observational study was conducted at a tertiary care hospital over one year. Seventy-five women eligible for termination under the MTP Act 1971 were enrolled. Each received 200 mg oral mifepristone followed, after 36 hours, by 800 µg vaginal misoprostol, repeated every three hours up to four doses. Data were analyzed for induction-abortion interval, completeness of abortion, adverse effects, and hemoglobin change. Results: The mean age of participants was 29.5±4.6 years, and 61.3% were multigravidae. The mean induction-to-abortion interval was 6.9±3.9 hours (range 1-20 hours). Complete evacuation occurred in 66 women (88%), while 9 required surgical evacuation for retained products. The mean hemoglobin drop was 0.74 g/dL. Minor side effects included abdominal pain (36%), vomiting (8%), and fever (5.3%). No major complications such as uterine rupture or excessive bleeding were observed. Conclusion: The combination of oral mifepristone followed by vaginal misoprostol is a safe, efficient, and well-tolerated regimen for second trimester abortion. It offers a high success rate, minimal side effects, and reduced hospital stay, making it a reliable alternative to surgical termination.