DOI: https://doi.org/10.36347/sjams.2026.v14i03.002

Pages: 327-332

Background: Termination of pregnancy in the midtrimester (20–28 weeks) is a high-risk procedure, particularly in women with severe preeclampsia, due to increased maternal morbidity and mortality. Pharmacological induction using misoprostol is common, but pre-treatment with mifepristone may enhance efficacy and reduce induction-to-abortion intervals. Evidence on optimal regimens in preeclamptic women is limited. Objective: To compare the effectiveness, safety, and induction-to-abortion interval of combined mifepristone and misoprostol versus misoprostol alone in midtrimester termination of pregnancy among women with severe preeclampsia. Methods: A hospital-based comparative prospective study was conducted at Dhaka Medical College Hospital from July to December 2021. Eighty-four women at 20–28 weeks of gestation with severe preeclampsia requiring termination were enrolled and randomly assigned to Group A (n=42, mifepristone 200 mg orally followed by 100–400 mcg vaginal misoprostol every 3 hours) or Group B (n=42, misoprostol alone). Primary outcome was induction-to-abortion interval; secondary outcomes included number of misoprostol doses, method of termination, blood loss, adverse effects, and need for surgical intervention. Data were analyzed using SPSS v23.0; p<0.05 was considered significant. Results: The mean induction-to-abortion interval was significantly shorter in Group A (12.72 ± 5.33 hours) compared to Group B (15.67 ± 4.74 hours; p=0.010). Group A required fewer misoprostol doses (mean 2.7 ± 1.0) than Group B (3.4 ± 1.3; p=0.007). Spontaneous expulsion rates were high in both groups (Group A: 97.6%, Group B: 92.9%), with minimal need for MVA/D&C. Adverse effects, including fever and diarrhea, were mild and comparable between groups (p>0.05). Conclusion: Pre-treatment with mifepristone significantly improves the efficiency of midtrimester medical termination in women with severe preeclampsia by shortening the induction-to-abortion interval and reducing the