Effect of misoprostol with and without letrozole on inductio
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Abortion is one of the most common complications of pregnancy. One type of abortion, missed abortion, occurs in 15%–20% of clinically diagnosed pregnancies and is the retention of pregnancy products in the uterus for several days or weeks after death of the fetus. Various medical and surgical methods have been used to manage missed abortions.
Surgical methods include dilatation and curettage, and vacuum aspiration. Because these methods are expensive and involve anesthesia, however, medical methods are generally
preferred over surgical methods for abortion. Medical approaches include prostaglandins, both alone and in combination with other drugs.

Among various prostaglandins, prostaglandin E1 (misoprostol) has received marked attention because of its high safety and the possibility of outpatient use. Misoprostol is widely used for induction of delivery in the second trimester, as well as curettage, therapeutic abortion, and hemorrhagic treatment after term delivery. A study was conducted to determine whether addition of letrozole to a misoprostol?based abortion regimen can increase the rate of complete abortion.

In total, 120 women completed the study: 60 in the misoprostol plus letrozole group, and 60 in the misoprostol only group. Complete abortion was documented for 93 women: 48 in the misoprostol plus letrozole group and 45 in the misoprostol only group. The mean duration of induction in the misoprostol plus letrozole and misoprostol only groups was 7.35 and 8.2 hours, respectively. In summary, the present study found that, as compared with misoprostol alone, a
combination of misoprostol with letrozole did not lead to a higher frequency of complete abortion or shorter duration of induction among women with first-trimester missed abortion.

Source: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.13326
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