Use of Letrozole pretreatment with Misoprostol for Induction of Abortion in First Trimester: A Randomised Controlled Trial

Abstract

Missed miscarriage is the death and retention of the products of conception in utero and by ultrasound CRL >7mm with no fetal life or MSD>25 mm with no yolk sac or fetal pole (RCOG, 2011). Medical abortion become an alternative to the surgical methods of abortion with the availability of prostaglandin analogues in the early 1970s and the anti-progestin mifepristone in the 1980s (Chai and Ho, 2013). Misoprostol is synthetic prostaglandin E1 analogue which can cause uterine contractions and ripening of cervix. However, mifepristone is expensive and only available in 44 countries. Letrozole (a third –generation selective aromatase inhibitor), its action is suppressing estrogen production by the corpus lutem which may assist in the induction of abortion. Letrozole in a dose of seven and half milligram given daily for two days and then followed by 800 microgram of vaginal misoprostol induced complete abortion in 80% of patients with gestation less than 63 days (Lee et al., 2011). The aim of the work: This trial was performed to compare the efficacy of using letrozole pretreatment before