To evaluate the safety and efficacy of Mifepristone with Misoprostol versus Dinoprostone gel with Misoprostol in second trimester pregnancy termination in tertiary care centre

The study focuses on evaluating second trimester pregnancy termination methods, specifically comparing the efficacy and safety of two medical regimens: Mifepristone followed by Misoprostol and Dinoprostone gel followed by Misoprostol. Abortion, defined as the termination of pregnancy before fetal viability, may be spontaneous or induced. In India, the Medical Termination of Pregnancy Act and its 2021 amendments allow abortion up to 24 weeks for specific categories and beyond that in cases of lethal fetal anomalies with medical board approval. While most abortions occur in the first trimester, 10 to 15 percentage of induced abortions globally and 12.9 percentage in India occur in the second trimester. The increase in second trimester abortions is largely attributed to improved antenatal screening techniques like ultrasound and serum tests that help detect fetal anomalies. Both surgical and medical methods are available for termination, but medical methods are preferred due to a lower risk of complications. Among medical options, prostaglandins like Misoprostol and Dinoprostone are used to induce abortion by ripening the cervix and causing uterine contractions. Misoprostol, a synthetic prostaglandin E1 analogue, is widely used due to its high efficacy, low cost, safety, and ease of storage at room temperature. Dinoprostone  in gel form, is also used for labor induction and abortion. The present study evaluates the 2023 FIGO recommended protocol involving Mifepristone and Misoprostol, comparing it against Dinoprostone gel combined with Misoprostol. The primary objective is to compare the rate of complete abortion and the induction-to-abortion interval between the two drug regimens. The secondary objectives include assessing the need for surgical evacuation, uterine rupture, blood loss, sepsis, pain, and the requirement for analgesia. This randomized controlled trial will be conducted at the Department of Obstetrics and Gynecology, Belagavi Institute of Medical Sciences , Belagavi. The study population will consist of pregnant women between 13 and 24 weeks of gestation who meet the inclusion criteria and seek termination at BIMS. The study will run from March 2024 to September 2025. Participants will be randomly assigned into two groups using sequentially numbered opaque envelopes. Group 1 will receive Mifepristone followed by Misoprostol, while Group 2 will receive Dinoprostone gel followed by Misoprostol. The study aims to determine the most effective and safest combination for second-trimester pregnancy termination by analyzing outcomes across both groups.