Background: Termination of pregnancy during the second trimester (13–24 weeks) carries greater clinical risk compared to earlier gestations and demands methods that are both safe and efficient. Misoprostol is commonly used for medical termination; however, pretreatment with mifepristone may improve its effectiveness by enhancing uterine responsiveness.

Objective: To evaluate and compare the effectiveness and safety of a combined mifepristone–misoprostol regimen versus misoprostol alone for second trimester pregnancy termination.

Methods: This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at a tertiary care institution in Jaipur. Fifty-four women with singleton pregnancies between 13 and 24 weeks were randomly assigned into two equal groups. The study group received oral mifepristone (200 mg) followed by misoprostol, while the control group received only misoprostol. The primary outcomes assessed were induction-to-abortion interval and length of hospital stay. Secondary outcomes included total misoprostol dose and incidence of side effects.

Results: Participants in both groups were comparable at baseline. The combination regimen resulted in a shorter induction-to-abortion interval, reduced drug requirement, and decreased duration of hospitalization. Although adverse effects such as pain, nausea, vomiting, and fever were observed less frequently in the combination group, the differences were not statistically significant.

Conclusion: Pretreatment with mifepristone enhances the efficiency of misoprostol in second trimester termination without increasing adverse effects. The combined regimen is therefore a preferable option where resources permit.

KEYWORDS: Second Trimester Abortion, Mifepristone, Misoprostol, Induction–abortion Interval, Medical Termination of Pregnancy, Maternal Safety.