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Abstract Objective: To systematically review the clinical efficacy and safety of application of mifepristone combined with misoprostol vaginal medication for termination of second trimestic. Methods：The database of PubMed, the Cochrane library, CBMdisc, FMJS, VIP, Wanfang and CNKI were searched from inception to Sep. 2017. Randomized controlled trials（RCTs）of termination of second trimestic by mifepristone combined with misoprostol vaginal medication( group B) or by rivanol amniotic cavity injection( group A) were reviewed and evaluated. Rev Man5.3 software was used for Meta analysis. Results：Eighteen RCT with 3,216 patients were eligible and included in the systematic review. Meta analysis showed that the group B was significantly superior to the group A in the time of launching uterine contraction，fetal delivery and total duration of labor (P＜0.00001，WMD =0.65，95%CI 0.76,0.54;P＜0.00001，WMD =0.77，95%CI 0.86,0.68; P＜0.00001，WMD =0.63，95%CI 0.48,0.73）, improved success rate of termination of second trimestic（P=0.000 5，WMD=10.50，95%CI16.46，4.55）, and decreased the incomplete abortion rate(Z=4.21,P<000001,95%CI0.42,0.73).There was no significant differences in the amount of vaginal bleeding within 24 hours after delivery between two groups（P=0.09, WMD =0.66, 95%CI 1.42,0.11）. The incidence of nausea, vomiting and gastrointestinal symptoms of women in group B were significant higher than those of women in group A (Z =1187, P < 0.00001,95%CI 11.62,30.65). Conclusions: Mifepristone combined with vaginal misoprostol for termination of second trimestic is more efficacy than the intraamniotic injection of rivanol, which has lower rate of tissue residues, dilation and curettage of uterus, less blood loss, lower rate of cervicovaginal injury. It is a safe and effective method for termination of midterm pregnancy. However, due to the limitations of the number and quality of the literature included in the system evaluation, more rigorous evidence is needed.
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