COMPARISON WITH EFFICACY WITH LETRAZOLE PLUS MISOPROSTOL VERSUS MISOPROSTOL ALONE IN MEDICAL MANAGEMENT WITH MISSED ABORTION IN 1ST TRIMESTER WITH PREGNANCY

Abstract

Objectives: To compare  efficacy with letrozole plus misoprostol versus misoprostol alone in  medical management with first-trimester missed abortion.

Methods: This randomized controlled trial was conducted in  Department with Obstetrics and Gynecology, MNCH Hospital, Faisalabad, Dec 2024 to May 2025. A total with 120 women aged 18–35 years with ultrasound-confirmed first-trimester missed abortion were randomized into two equal groups ( n = 60  each). Group A received a single dose with vaginal misoprostol. Group B received oral letrozole  twice daily for 3 days followed by  800 g  vaginal misoprostol on Day 4.   primary outcome was efficacy (complete abortion confirmed by ultrasound on Day 15 without surgical intervention).   secondary outcome was induction-to-expulsion time. Data were analyzed using SPSS v25; Chi-square and Student’s  t -tests were applied with  p < 0.05  considered statistically significant.

Results: Baseline characteristics, including maternal age ( 27.77  SD 4.33  vs.  27.83  SD 4.39  years), gestational age ( 8.82  SD 1.55  vs.  8.64  SD 1.48  weeks), and BMI ( 26.00  SD 2.44  vs.  25.83  SD 2.45 kg/m 2), were comparable ( p > 0.05 ).   complete abortion rate was significantly higher in Group B than in Group A ( 73.3%  [44/60] vs.  46.7%  [28/60];  chi 2 = 13.084, p < 0.001;  . Group B demonstrated a significantly shorter mean induction-to-expulsion time compared to Group A ( 8.58  SD 1.66  vs.  14.81  SD 2.61  hours;  p < 0.0001 ).

Conclusion: Pre-treatment with letrozole significantly improves  complete abortion rate and substantially shortens  induction-to-expulsion interval compared to misoprostol alone in first-trimester missed abortion.