One-day versus two-day mifepristone-misoprostol interval prior to initiation of misoprostol during late second trimester medication abortion: A cohort study

Sium AF, Teklu H, Reeves M, Belay Tolu L, Prager S

Dec 2023


To compare one-day versus two-day mifepristone–misoprostol interval in late second trimester medication abortion.

Study design

This retrospective cohort study was conducted at St. Paul’s Hospital Millennium Medical College, in Ethiopia. Data were collected retrospectively and analysed with SPSS 23 using simple descriptive analysis, t-test, Chi-squared test, and regression analysis, as appropriate. P-value < 0.05 and adjusted odds ratio (AOR) with 95% CI were used to present results significance.


A total of 282 women who had medication abortion in the late second trimester (167 with one-day and 115 with two-day mifepristone-misoprostol intervals) at 20–28 weeks of gestation were analysed. Both median and mean induction to expulsion interval (I-E) were much higher in the one-day mifepristone-misoprostol (mife-miso) interval than in the two-day mife-miso interval group. The median (and mean) I-E in the one-day interval group was 24 hours (21.9+/−6.6 hours) compared to 12 hours (14.6+/−8.8 hours) in the two-day mife-miso interval group (p-value < 0.001). Expulsion rate within 12 hours of starting misoprostol was significantly higher in the two-day cohort than in the one-day cohort (73% vs 25.6%, p-value < 0.001, aOR = 19.08 95%, CI = 5.1–70.7).


For second trimester medication abortion at later gestation, a two-day mifepristone-to-misoprostol interval significantly reduces induction to expulsion time compared to a one-day interval.


Compared to one-day interval, administration of mifepristone two days prior to misoprostol initiation has a shorter interval of induction to expulsion and a higher rate of abortion completion within 12 hours of initiation of misoprostol during late second trimester medication abortion.


Late second trimester abortion, Later medication abortion, Mifepristone, Mifepristone-misoprostol interval