Al-Azhar International Medical Journal | 2021
Misoprostol versus Letrozol with Misoprostol in Management of First Trimesteric Missed Miscarriage
Abstract
Background: A missed miscarriage represents a form of spontaneous abortion, it occurs in about 26% of all pregnancies and the management may be expectantly, surgical, and medical. Misoprostol and letrozole are medications utilized for medical treatment of miscarriages. Aim of the work: to match the security and effectiveness of two treatment modalities (Misoprostol versus Letrozol with Misoprostol) in medical treatment of 1st trimesteric missed miscarriages. Patients and methods: This is an interventional randomized casecontrol investigation that was performed at the outpatient antenatal care clinic of Luxor General Hospital during the period from February to December 2017. The study included a number of 200 cases who have been randomly classified to 2 equal groups: Group-I Misoprostol which included 100 cases received 800-mg of misoprostol vaginally at once of diagnosis and group-II Letrozol + Misoprostol which included 100 cases received 10-mg letrozol 2 times a day for 3-days as pretreatment then 800-mg of vaginal misoprostol. Results: Misoprostol alone group (group-I) has a significantly high duration of vaginal bleeding after the 1st Misoprostol dose and time passed after 1st misoprostol dose till the 1st passage of POC in comparison with group-II, (P-value<0.01 for all). Misoprostol alone group had significantly higher incomplete abortion (P<0.01) and emergency D and C (P=0.03) in comparison with the combined group (group-II). However, induction of abortion interval was significantly high in Letrozol + Misoprostol group in comparison with Misoprostol alone group (99.4 ± 14.3 vs. 61.5 ± 13.2 hrs, P<0.01). Conclusion: The results revealed that a 3-days course of letrozole (10mg per day) trailed by misoprostol vaginally (800-mg) was accompanied with a significantly high full abortions rate in women with first-trimester miscarriage compared to misoprostol alone (81.0% vs. 54.0%) without increasing side effects.