A prospective randomized comparison of mifepristone with misoprostol and prostaglandin E2 gel with misoprostol for medical termination of pregnancy between 13-20 week of gestation

Background: Worldwide mid-trimester abortion constitutes 10-15% of all induced abortions. Similar trend is seen in India where mid-trimester abortion accounts for 12.9% of all abortions. Prostaglandins have been used for therapeutic termination of pregnancy from 9-22 weeks of gestation since 1970s. The ideal method for mid-trimester abortion with best efficacy and acceptability and least side effects are still to be found. Objective of this study was to compare two drug regimens for mid trimester abortion using mifepristone with intra-vaginal misoprostol and prostaglandin E2 (PGE2) gel with intra-vaginal misoprostol for efficacy and side effects.Methods: This prospective randomized comparative clinical study was conducted on 50 women seeking mid trimester abortion, in two groups. One group received PGE2 gel and misoprostol, second group received mifepristone and misoprostol. Induction abortion interval, side effects were compared between two groups.Results: The mean induction-abortion interval in Group 1 was 6.50±3.54 hours and in Group 2 was 7.33±2.5 hours. In Group 1, success rate at 15 hours was 88%. In Group 2, success rate was 92% both at 15 and 24 hours. Surgical evacuation was required in 8% women in both groups.Conclusions: Both regimens are safe and has a few minor side effects. There was no major side effect and blood loss was within acceptable limits in both groups. The cost of abortifacients and hospital stay was lessor in group1 (prostaglandin gel and misoprostol) making it more economical