Background: Unsafe abortions are the third leading cause of maternal mortality in India, close to 8 women die from
unsafe abortion each day.(1) MMR in India is 103/100,000 live births (2017-2019),unsafe abortion account for 8% of the
MMR. Both MTP act of 1971 and MTP amendment act 2021,which expanded the scope of the act and provides impetus
for safer abortions, are progressive and encouraging. Each year 4.7-13.2%of maternal death attributed due to unsafe
abortions (2). Unsafe abortion accounts for 13% of maternal deaths worldwide of which 19% occurs in South East Asia (3,
4).Medical methods of abortion has become preferable method with availability of prostaglandin analogue misoprostol
and antiprogesterone mifepristone. There are many studies for both drugs and each study claims its schedule to be
superior and safer than others.(5,6,7)
AIM:This study mainly aims to compare efficacy of Mifepristone and Misoprostol combination versus Misoprostol alone
in procuring complete abortions in first trimester by comparing their Need for Manual /electric vacuum aspiration.
OBJECTIVES:
Ÿ To compare efficacy in relation to gestational period.
Ÿ To compare the Success rate of combination drugs with misoprostol alone.
Ÿ To compare Induction to abortion time intervals.
Ÿ To evaluate the Safety.
This is a prospective observational study conducted at Government Victoria hospital, Department of Obstetrics &
Gynaecology,Andhra Medical College,Visakhapatnam,and Andhra Pradesh
Total no.of patients – 100
No.of women who were given Mifepristone & Misoprostol combination 50
No.of women received Misoprostol alone -50
Observations of this study
1.Maternal age was compared in both the groups.Majority of patients belongs to 21 to 25 years age group.
2.Majority are multigravida in both groups
3.Majority (64%) have opted for termination before 45days in mifepristone +misoprostol group,where as in misoprostol
group 60% between 45-63 days
4.In both major indication for termination is unwanted pregnancy.
5. In mifepristone and misoprostol group 46 cases had complete abortion whereas 4 cases required electric vacuum
aspiration
6.when comparing induction and abortion interval mifepristone and misoprostol group mean interval is 4.31 hours
whereas misoprostol group is 16.18 hours and p value is <0.0001 showing induction abortion interval is less in
mifepristone and misoprostol group
7.Unwanted symptoms were noted in both groups but significantly more with misoprostol only group but the p value was
not significant.
8.There were no statistically significant major complications in both groups,none required blood transfusion
9. Although Mifepristone and Misoprostol combination is costly but more effective with higher rate of complete
expulsion,should be preferred over Misoprostol alone where cost is not a restraining factor.
CONCLUSION
Based on findings from this study it can be concluded that
1. Mifepristone plus vaginal misoprostol combination group is associated with shorter induction abortion interval and
96% success rate when compared to misoprostol group alone.
2. Mifepristone plus vaginal misoprostol combination group is associated with complete abortion rate compared to
misoprostol alone group.Vaginal misoprostol alone group is cost effective.
3. Routine use of Mifepristone-Misoprostol combination is an effective option for early MTP where cost is not a
consideration and is ideal for home management.
4.Complication are less in Mifepristone-Misoprostol combination The only confounding factor is the cost involved which
is about 20 times that of Misoprostol alone
