Comparative Study of Mifepristone and Misoprostol Vs Misoprostol Alone in Second Trimester Medical Termination of Pregnancy

INTRODUCTION Abortion is the termination of pregnancy by the removal or expulsion of products of conception. Medical abortions are those induced by abortifacient drugs. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the early 1970s and the antiprogestogen Mifepristone in the 1980s. Although many different drugs have been used, alone and in combination, to induce abortion, a regimen composed of Mifepristone plus Misoprostol has been the one most widely used since Mifepristone was first approved as an abortifacient. . The World Health Organization (WHO) recommends this drug combination, with an initial dose of Mifepristone followed by Misoprostol 24 to 36 hours later, for early medical abortion. The World Health Organization approved both Mifepristone and Misoprostol for termination of early pregnancy by including them in the list of Essential Medicines in 2005. AIM To compare the efficacy of Mifepristone and Misoprostol vs Misoprostol in second trimester medical termination of pregnancy Methodology- Data of women attending GYNAEC OPD MMCH& R I, Kaanchipuram seeking MTP for various reasons will be collected. Sample Size 50 patients in each group. {Randomly selected} GROUP A Combination regimen -- 200 mg oral Mifepristone, followed 48 hours later by 400micrograms of vaginal Misoprostol every 4th hourly upto 4 doses. GROUP B Misoprostol alone - 400micrograms of Misoprostol vaginally inserted 4th hourly upto 4 doses RESULTS Majority of the patients had termination of pregnancy in 13 to 15 weeks of gestation in Mifepristone plus Misoprostol group and 19 to 21 weeks in Misoprostol group. The most common indication for termination of pregnancy in both the group is unintended pregnancy. Among both the groups mean abortion interval in Mifepristone plus Misoprostol group was 9.08hrs whereas in Mifepristone group 17, 86hrs. The difference between them was found to be statistically significant with p value less than 0.001. When compared to induction abortion interval and parity in both the groups multigravidas is comparatively shortened than primigravida with p value no significant Repeat dosage of Misoprostol in Mifepristone plus Misoprostol is comparatively less when compared to Misoprostol group alone. There was no failure in Mifepristone + Misoprostol group compared to 4 % failure rate in Misoprostol group with p value of 0.046 The percentage of complete abortion in Mifepristone plus Misoprostol group was 88 % whereas in Misoprostol group was 72 %. Successful abortions who expelled completely or incompletely within 48hrs in Mifepristone plus Misoprostol group is 100 % and 96 % in Misoprostol group. Average cost of Misoprostol group is Rs.56.10 and Mifepristone plus Misoprostol group is Rs.329.60. CONCLUSION Mifepristone plus vaginal Misoprostol combination group is associated with shorter induction abortion interval and 100 % success rate and complete abortion when compared to Misoprostol group alone. Misoprostol group alone is cost effective