Outcome of Combined Mifepristone and Misoprostol Versus Misoprostol Alone in the Management of First Trimester Abortion

Background: Early abortion is a frequent pregnancy complication, occurring in 10- 20% of clinically diagnosed pregnancies. Abortion can cause heavy bleeding, infection, anxiety, sadness, and post traumatic stress disorder (PTSD).

Aim: This study compares mifepristone and misoprostol for first-trimester abortion against misoprostol alone.

Methods: Approval of the protocol was taken by the Institutional Ethical Committee of ICMH, Matuail, Dhaka before the commencement of the study. This Randomised Controlled Trial was conducted Department of Obstetrics & Gynaecology, Institute of Child and Mother Health, Matuail, Dhaka on 70 women with first trimester abortion with prefixed specific inclusion and exclusion criteria. Participants were divided into Group A and Group B based on offered intervention. Group A received 200mg mifepristone and misoprostol 800μg orally and group B received only misoprostol 800μg orally. The expected primary outcome was successful expulsion of conception. The secondary outcome included number of doses for successful expulsion, time interval between first dose and spontaneous expulsion and side effects. Data were processed manually and analyzed with the help of SPSS Version 26.0. Quantitative data were expressed in mean and standard deviation; and comparison was done between the groups by independent sample “t” test. Qualitative data were expressed in frequency and percentage; and comparison was done between groups by Chi-square / Fisher’s Exact test. A probability value of <0.05 is considered statistically significant.

Result: In regard to the observed results, it was shown that Group A exhibited a higher rate of successful expulsion of conceptions (77.8%) compared to Group B (50%). The average number of doses required for effective expulsion in Group A was found to be lower (2.19±0.69) compared to Group B (3.41±2.53%). The duration of successful expulsion was found to be shorter in group A (14.28±3.84) compared to group B (20.93±5.67). Combination group exhibited a low incidence of maternal problems (33.3%). The duration of hospitalization was notably shorter in group A. All relationships exhibited statistical significance at a significance level of p<0.05.

Conclusion: Combined regimen of mifepristone and misoprostol appears to be a more effective, safer, and efficient approach for first-trimester pregnancy terminations compared to using misoprostol alone.