الفهرس 
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Abstract
Miscarriage represents a very common event, occurring in approximately one-third of all pregnancies and affecting approximately 25% of all women during their reproductive lives (Black et al., 2017).
Estrogen is important in the maintenance of pregnancy. The anti-estrogen action of Letrozole has been shown to be useful in pretreatment for termination of pregnancy, in combination with misoprostol (Lee et al., 2013).
The regimen of 2 days of Letrozole 7.5 mg daily combined with vaginal misoprostol 800 mg is associated with a complete abortion rate of 80% in subjects with gestation less than 63 days. In subjects with gestation less than 49 days, the complete abortion rate was higher (87.5%), (Lee et al., 2011b).
This clinical trial conducted at Zagazig General Hospital during the period between January 2019 and March 2020.
Patients seem to be fulfilling the inclusion criteria recruited; then, an informed written consent taken from every patient before starting the examination to confirm fulfilling all inclusion and exclusion criteria.
Followed by Careful and detailed history and examination of all the patients.
Hemoglobin, hematocrit, Blood group, Rh, and Transvaginal ultrasound were done for all patients before the study.
Patients fulfilling inclusion and exclusion criteria divided into two groups.
First group (160 patients) received misoprostol with Letrozole, and the second one (other 160 patients) received misoprostol with placebo.
group (A):
Women received three tablets of Letrozole daily as a single dose, each tablet 2.5 milligram for three consecutive days. In the third day, after Letrozole dose, four tablets of vaginal misoprostol (total 800 micrograms) given every three hours for a maximum two doses.
group (B):
Women received three tablets of placebo as a single dose, each tablet 2.5 milligram for three consecutive days. In the third day, after placebo dose, four tablets of vaginal misoprostol (total 800 micrograms) given every three hours for a maximum two doses.
Temperature, blood pressure and pulse recorded hourly. Side effects, presence of vaginal bleeding and the time of expulsion of tissue mass recorded too.
If the vaginal bleeding affects patient general condition, surgical evacuation was done immediately.
The follow- up visit on day seven during which a transvaginal ultrasound scan was performed and blood sample was taken for hemoglobin level.
In participants with incomplete or missed miscarriage on day seven, surgical evacuation was performed under general anesthesia.
Surgical evacuation was also done at any time over the seven days follow up period if there was heavy bleeding or on patient’s request.
If no emergency or elective curettage was necessary over the seven days, the outcome of treatment was classified as ”complete miscarriage”.
This study demonstrated that 7.5 mg Letrozole for three days followed by 800 micrograms of vaginal misoprostol is more effective than misoprostol alone for first trimester abortion.
In the 320 women that were recruited, the complete miscarriage rate of the Letrozole group was significantly higher than that of placebo group (82.6% compared with 68.2%).