CONTEXT:Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. OBJECTIVE:To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. METHODS: In this IRB approved prospective study, twenty-two women (mean age 25.4 Â± 3.2 years, range 23-32 years; mean BMI 22.3 Â± 3.4 kg/m(2); mean parity 2.1 Â± 1.4, average gestational age 17.9 Â± 2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. MAIN OUTCOME MEASURES:Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. RESULTS: Mean induction-abortion interval for intravaginal group and combination group was comparable (t = 7.9 Â± 1.8 and 6.5 Â± 3.5 h, respectively). Three patients required surgical evacuation for incomplete abortion (n = 2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6 h was more in the intracervical-intravaginal group (36.3 %). Patients with intracervical misoprostol complained of abdominal pain more often than those in other groups. Excessive bleeding and uterine rupture was not seen in any patient. CONCLUSION:Intracervical misoprostol is an effective method of medical treatment of second trimester pregnancy failure. Its short induction to abortion interval and acceptable safety profile makes induction via the cervical route acceptable for second trimester abortion.