Abstract

Backgrounds & Objectives: Miscarriage is the most common complication of pregnancy. Misoprostol (Miso), a synthetic analogue of prostaglandin E1, has an uterotonic effect and it can stimulate myometrial contraction and cause cervical ripening and dilatation. Letrozole (LTZ), non-steroidal reversible aromatase inhibitor acting by suppressing the peripheral conversion of androgen to estrogen which is important in the maintenance of pregnancy. Our aim was to compare the success rate & safety of LTZ combined with Miso to Miso alone in the management of first trimester delayed miscarriages (FTDM) up to 12 weeks gestation. Patients & Methods: 126 patients of 20-83 years old were enrolled in a hospital based clinical trial and allocated into 2 groups. LTZ/Miso group (n=64) given LE, 2.5 mg every 8 hrs./ 3 days followed by per-vaginal (PV) Miso 800 μg on 4th day and Miso group (n=62) received only PV Miso 800 mcg and repeated if necessary. All patients were with Hb > 10g/dL. Exclusion criteria: medical conditions contradicted with induction of abortion. Vital signs, any side effects including PV bleeding were recorded. US done 7 days post misoprostol to monitor outcomes. Evacuation carried out if medical management failed. Data analysis by using SPSS version for windows, P-value significant if < 0.05. Results: 4 patients from LTZ/Miso group & 6 from Miso group lost in follow-up and were excluded. The remaining in both groups completed the study and analyzed. Complete miscarriage rate in LTZ/Miso group (48/60, 80%) was significantly higher than that of Miso group (29/56, 51.8%) (P