Comparison of effectiveness of mifepristone misoprostol combination versus mifepristone Foley EAS (Extra-amniotic instillation of saline) combination in second trimester pregnancy termination

Abstract

Second trimester medical abortion with mifepristone followed by misoprostol is effective and is associated with considerably shorter induction abortion interval. This study is a comparison of the effectiveness, safety profile and side effects of mifepristone- misoprostol and mifepristone-Foley’s EAS combinations in second trimester termination. The patients were grouped into two, first group received oral mifepristone 200 mg followed by vaginal misoprostol 800 mcg after 48 hours and then 400 mcg misoprostol vaginally 3 hourly up to a maximum of 4 further doses. Second group were induced with oral mifepristone 200 mg followed by extra amniotic saline instillation through a Foley’s catheter after 48 hours. The success rates were comparable between the two groups. But the 6 hour expulsion rates (36.4% Vs 0%) as well as 12 hour expulsion rates (56.36% Vs 3.6%)(p value=0.001) were significantly high in mifepristone – misoprostol group compared to mifepristone-Foley EAS group. Mean induction abortion interval was shorter in the first group (14.64hrs vs 18.4hrs)(p=0.026).But the incidence of complaints after administration of misoprostol was significantly high. 7 patients from Group 1 and 5 patients from Group 2 required surgical evacuation for retained placenta. The study revealed that mifepristone-Foley’s EAS induction can be used as an effective alternative to mifepristone-misoprostol combination with similar success rates and significantly reduced side effects but with significantly increased induction abortion interval. The results of this study can be extrapolated to cases where prostaglandins are contraindicated like in previous cesarean section cases. Keywords: Foley EAS, Misoprostol, Abortion, .