A Comparison of Mifepristone Combined with Misoprostol versus Misoprostol Alone for Second-Trimester Medical Termination of Pregnancy

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 229–240

DOI: 10.46882/2026/IJOG/000496

Original Research Article

Title: A Comparison of Mifepristone Combined with Misoprostol versus Misoprostol Alone for Second-Trimester Medical Termination of Pregnancy

Names of Authors: Mariam T. Bello¹, Grace E. Effiong²

Authors’ Affiliations:
¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
² Department of Public Health, University of Calabar, Calabar, Nigeria

Abstract:
Second-trimester medical termination of pregnancy requires highly efficient drug regimens to reduce the induction-to-abortion interval and limit complications. This randomized, open-label trial evaluated the clinical efficacy and safety of oral mifepristone combined with vaginal misoprostol compared to vaginal misoprostol alone for termination between 14 and 22 weeks of gestation. One hundred and eighty women requiring pregnancy termination for fetal anomalies or medical indications were randomized into two equal groups (n = 90 per group). The combined group received 200 mg oral mifepristone followed 36 hours later by 400 μg vaginal misoprostol every 4 hours (maximum 5 doses). The single-agent group received a matching placebo followed by identical misoprostol protocols. The primary outcome was the mean induction-to-abortion interval. The combined regimen achieved a significantly shorter median induction-to-abortion interval compared to misoprostol alone (10.4 ± 3.1 hours vs. 16.8 ± 4.5 hours, p < 0.001). The successful abortion rate within 24 hours was significantly higher in the mifepristone-misoprostol arm (94.4% vs. 76.7%, p = 0.001). The total dosage of misoprostol required was also lower in the combined cohort (p < 0.001). Incidence of incomplete abortion requiring surgical evacuation was lower in the combined group (5.6% vs. 15.6%, p = 0.028). Maternal adverse effects, including nausea, chills, and diarrhea, did not differ significantly between the groups (p > 0.05). Pre-treatment with oral mifepristone significantly shortens the induction-to-abortion timeline and improves the complete success metrics of misoprostol-induced second-trimester termination.

Keywords: Medical Termination of Pregnancy; Mifepristone; Misoprostol; Second Trimester; Induction-to-Abortion Interval; Complete Abortion.

Manuscript Timeline: Received: May 12, 2026; Revised: July 04, 2026; Accepted: July 24, 2026; Published: August 14, 2026.

Citation: Bello MT, Effiong GE. A Comparison of Mifepristone Combined with Misoprostol versus Misoprostol Alone for Second-Trimester Medical Termination of Pregnancy. International Journal of Obstetrics and Gynecology. 2026; 14(8): 229–240.

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