Clinical Status of Midtrimester Termination in Severe Preeclampsia

Background: Severe preeclampsia is a life-threatening hypertensive disorder of pregnancy that may necessitate midtrimester termination to prevent maternal and fetal complications. Pharmacological induction using misoprostol, with or without prior mifepristone, is commonly employed, but evidence on comparative efficacy in this high-risk population remains limited. Objective: To assess the assess the clinical Status of midtrimester termination in severe preeclampsia. Methods: This hospital-based comparative prospective study was conducted at the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, from July to December 2021. A total of 84 women between 20 and 28 weeks of gestation with severe preeclampsia requiring termination were enrolled and randomly assigned to Group A (combined mifepristone and misoprostol, n = 42) or Group B (misoprostol alone, n = 42). Group A received 200 mg oral mifepristone followed 24 hours later by 100–400 mcg vaginal misoprostol every three hours until complete expulsion. Group B received the same misoprostol regimen without mifepristone pre-treatment. Primary outcome was induction-to-abortion interval; secondary outcomes included induction failure, total drug dose, and maternal complications. Data were analyzed using SPSS v23.0, with p < 0.05 considered statistically significant. Results: Baseline characteristics, including age, occupation, parity, and gestational age, were comparable between groups. Successful abortion was achieved in 97.6% of Group A and 92.9% of Group B, with induction failure rates of 2.4% and 7.1%, respectively (p = 0.305). No statistically significant differences were observed in demographic variables or induction outcomes between the groups. Conclusion: Both combined mifepristone and misoprostol and misoprostol alone are effective for midtrimester termination in women with severe preeclampsia, with high success rates and low failure. Pre-treatment with mifepristone shows a modest advantage in success and may be considered a safe and effective option in this high-risk population.