Second-Trimester Induction Abortion Using Two Pretreatment Mifepristone Regimens: A Randomized Controlled Trial

Background Second-trimester abortion is a critical aspect of reproductive healthcare, and reducing the induction-to-expulsion interval (IEI) improves patient outcomes. Mifepristone followed by misoprostol is the standard regimen. This study evaluates whether sequential dosing of mifepristone shortens the IEI compared to a single dose. Methods A randomized controlled trial was conducted at Amrita Institute of Medical Sciences with 54 women between 13 and 20 weeks of gestation. Participants were randomized into two groups: the Mife-1 group received a single 200 mg dose of mifepristone on Day 1, while the Mife-2 group received 200 mg on Days 1 and 2. Misoprostol (600 mcg vaginally, followed by 400 mcg orally every four hours) was administered after 36-48 hours. The primary outcome was IEI; secondary outcomes included prostaglandin requirement and the need for surgical evacuation. Results The Mife-2 group had a significantly shorter IEI (7.93 ± 3.679 hours) compared with the Mife-1 group (10.41 ± 4.263 hours, p = 0.026). Prostaglandin requirement was lower in the Mife-2 group, though not statistically significant (p = 0.087). Fewer participants in the Mife-2 group required surgical evacuation. Conclusions Sequential mifepristone dosing significantly reduces IEI, suggesting improved efficiency in second-trimester abortion. Larger studies are recommended to confirm safety and effectiveness.