Mifepristone-misoprostol versus misoprostol alone for second trimester termination of pregnancy in a tertiary hospital in Hong Kong Abstract

Wai-Yan YEUNG, Tsz-Ching LEE
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong

Objectives: To compare the mifepristone-misoprostol regimen with the misoprostol-alone regimen in terms of safety and effectiveness in women who underwent second trimester medical termination of pregnancy (MTOP).
Methods: Medical records of all women with singleton pregnancy who underwent MTOP during the second trimester at Queen Elizabeth Hospital between 1 January 2018 and 31 December 2019 were reviewed. Patients were prescribed with misoprostol 400 μg every 3 hours up to a maximum of five doses per day orally or vaginally, or with mifepristone 200 mg followed by misoprostol after 36 to 48 hours. The primary outcome was the time from first misoprostol dose to fetal expulsion.
Results: Of 94 patients (mean age, 33.5 years) included, 48 received the mifepristone-misoprostol regimen and 46 received the misoprostol-alone regimen. The mean gestational age was 16 weeks 4 days. Compared with the misoprostol-alone group, the mifepristone-misoprostol group had shorter time to fetal expulsion (7.3 hours vs 11.3 hours, p=0.017), shorter time to placental expulsion (7.9 hours vs 12.2 hours, p=0.026), higher proportion of successful abortion within 10 hours (71.7% vs 43.8%, p=0.005) and 24 hours (95.7% vs 79.2%, p=0.016), and lower number (3 vs 5, p<0.001) and dosage (1200 μg vs 1600 μg, p<0.001) of misoprostol administered. Complication rate was similar between the two groups.
Conclusion: The mifepristone-misoprostol regimen is effective and safe for second trimester MTOP, with a shorter time to fetal expulsion.
Hong Kong J Gynaecol Obstet Midwifery 2022; 22(2):101-6
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