Objective: To evaluate efficacy of two methods of medical induced abortions in second trimester and to analyse choice of post abortal contraception at a tertiary care centre, in Hassan, karnataka, India.
Methods: This is a randomised case controlled study between 2017-2019 among pregnant women attending OPD at S.C government teaching hospital, HIMS, Hassan, Karnataka, India and opting for second trimester abortions as per MTP act, India. In the study, among total 158 clients (n=158), Group A(n=79) received oral misoprostol 4hourly for 5 doses after consent and 24hrs prior vaginal 40ugms of Isosorbide mononitrite, and group B(n=79)received 200 milligrams of Mifepristone orally, 24hrs followed by vaginal 400micrograms of misoprostol, and later 4 hourly 400 micrograms oral/vaginally for a total 5doses . The primary outcome indicators such as blood loss, need for transfusions, side effects, complication, need for surgical evacuation, Induction abortion interval and secondary outcome such as choice of post abortal contraception by clients were analysed.
Results: Effectiveness with 5 doses of drugs resulting in Abortion was 78.4% in group T, and 88%in Group C. Side effects were mild, Headache 37%, dizzines and flushing (13%) shivering in group T (23%), were observed in group T, severe patient reported pain was36% in group C and 23% in group T. Median induction abortion interval in test group was 12hrs and 10.5 hrs in control group=0.048 and statistically significant. 14% women in group T, 10%in Group C needed additional dose of misoprostol. 43% in group T and 35% in group C neededsurgical evacuation for removal of placenta and remained products. 2clients had Rupture/dehiscence of scar uterus was seen in group C in previous scarred uterus, who underwent laparotomy and /hysterotomy. 67% of clients for second trimester abortion opted for long Acting reversible contraception (IUCD-41.1%, DMPAinjections-30.4%), surgical sterilization 10%, barrier methods 6% and combined oral pills 9% as post abortal contraception.
Conclusion: medical methods are safe, effective in induction of second trimester Abortion including in post caesarian pregnancy, Mifepristone primed medical method of Abortion is more effective and shorter in duration and associated with severe pain. Misoprostol and cervical priming with isosorbide nitrate regime may be used when Mifepristone is not accessible, or in resistant cervix and in scarred uterus as alternate regime.