Mifepristone plus misoprostol versus misoprostol for second trimester termination of pregnancy

Objective: The present study was conducted with the aim to assess and comparatively evaluate the safety and efficacy of mifepristone plus misoprostol versus only misoprostol in second trimester termination of pregnancy
Materials and Methods: The present study was conducted in Rajindra Hospital, Government medical college, Patiala. Group A received Tab Mifepristone 200mg orally. After 48 hours 400 µg of Tab Misoprostol was placed vaginally. Then every 4th hourly 400 µg of misoprostol tab was placed vaginally upto maximum of five doses including the first dose or till expulsion of foetus. Group B received tablet misoprostol as mentioned in group A without prior mifepristone .After 24 weeks of gestation 200 µg of misoprostol was used. The subjects were closely monitored for any side effects. Induction abortion interval is the time period between insertion of first intravaginal misoprostol tablet to expulsion of products of expulsion. The process was considered failure if abortion failed to occur even after 12 hours of last dose of misoprostol.
Results : Mean time for onset of contractions was 4.53 hours in group A and 7.43 hours in group B. Mean time of onset of bleeding was 4.54 hours in group A and 7.39 hours in group B(P value <0.001). Induction abortion interval when calculated in both groups came out to be 8.12 hours in group A and 13.41 hours in group B which was statistically significant. Mean dose of misoprostol was 769.89 µg in group A and 1043.2 µg in group B Side effect profile was similar in both groups. Shivering was the most common side effect in both groups followed by diarrhoea followed by nausea and vomiting. Side effects were not related to number of doses of misoprostol given and occurred in most of the subjects quite early after 2nd or 3rd dose. The number of subjects who needed check curettage were almost similar in both groups. Success rate was 97% in group A and 87% in group B. The subjects who were unsuccessful either had drug failure or had to discontinue misoprostol due to severity of side effects.
Conclusion: Mifepristone and misoprostol combination is better than misoprostol alone for second trimester termination of pregnancy. The time of onset of contractions, the time of onset of bleeding, Induction abortion interval, mean doses of misoprostol are reduced with the combination regimen. Success rate of combination regimen is more as compared to misoprostol only regimen.