EFFECT OF LETROZOLE PRETREATMENT WITH MISOPROSTOL FOR INDUCTION OF MEDICAL ABORTION (Comparative study)

Abstract

Early pregnancy failure is a common complication affecting 10-20% of pregnant women. Surgical evacuation is a standard management for termination of pregnancies of less than 12 weeks of gestation in many countries. Although it is an effective method with a success rate of 97%, it is associated with anesthetic and surgical risks such as uterine perforation, Asherman’s syndrome, cervical trauma, infection that leading to infertility, pelvic pain, and increases chance of ectopic pregnancy. The alternatives to surgical treatment are either expectant management or medical treatment .Expectant management’s success rate is too low to be used in routine clinical practice..

The most widely used regimen for induction of medical abortion involves the use of oral mifepristone 200 mg followed by vaginal misoprostol 800 mcg 24–48 h later.

However, mifepristone is expensive and is only available in 44 countries.. Misoprostol, a synthetic PGE1 analog, is principally used to prevent peptic ulcer induced by ingestion of non-steroidal anti-inflammatory drugs. It is approved by ACOG and used in developing countries for induction of medical abortion because it is inexpensive, stable at room temperature and available.

The abortion rate at 24 h with misoprostol alone was only 72–85.9% depending on the different regimens and dosages used. It is well known that estrogen and progesterone are important hormones in maintaining early pregnancy. Indeed, the use of anti-progestogenic agents like mifepristone combined with prostaglandins has resulted in improved success in termination of early pregnancy. The next logical step would be to explore the use of anti-estrogenic agents. In this study, we used letrozole (a third-generation selective aromatase inhibitor) as an effective adjunct to misoprostol for termination of first trimester missed abortion; its action is suppressing estrogen production by the corpus luteum which may assist in induction of abortion.