الفهرس 
First Trimesteric Miscarriage (Missed Abortion)Only 14 pages are availabe for public view
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Abstract
Missed miscarriage is the death and retention of the products of conception in utero and by ultrasound CRL >7mm with no fetal life or MSD>25 mm with no yolk sac or fetal pole (RCOG, 2011).
Medical abortion become an alternative to the surgical methods of abortion with the availability of prostaglandin analogues in the early 1970s and the anti-progestin mifepristone in the 1980s (Chai and Ho, 2013).
Misoprostol is synthetic prostaglandin E1 analogue which can cause uterine contractions and ripening of cervix.
However, mifepristone is expensive and only available in 44 countries.
Letrozole (a third –generation selective aromatase inhibitor), its action is suppressing estrogen production by the corpus lutem which may assist in the induction of abortion.
Letrozole in a dose of seven and half milligram given daily for two days and then followed by 800 microgram of vaginal misoprostol induced complete abortion in 80% of patients with gestation less than 63 days (Lee et al., 2011).
The aim of the work: This trial was performed to compare the efficacy of using letrozole pretreatment before misoprostol versus using misoprostol alone for the medical termination of first trimester missed abortion.
This clinical trial was conducted at Ain Shams University Maternity Hospital in the period between January 2020 and August 2020, and was registered at clinical trials.gov Identifier.NCT04590482.
Patients that seem to be fulfilling the inclusion criteria were recruited, then, an informed written consent was taken from every patient before starting the examination.
Followed by detailed history and clinical examination of all the patients.
Hemoglobin, hematocrit, blood group, PT, RH, and trans- vaginal ultrasound were done for all patients before the study.
Patients fulfilling inclusion criteria were divided into two groups.
group (A)
55 women received one tablet of letrozole (2.5 milligram) each 12 hours for 2 days followed by 4 tablets of vaginal misoprostol (200 microgram) and another dose per vagina after 4 hours if needed.
group (B)
55 women received one tablet of folic acid as a placebo each 12 hours for 2 days followed by 4 tablets of vaginal misoprostol (200 microgram) and another dose per vagina after 4 hours if needed.
Temperature, blood pressure and pulse were recorded hourly.
Side effect as fever, nausea, vomiting and presence of vaginal bleeding were recorded too.
If excessive vaginal bleeding occurred jeopardizing maternal life surgical evacuation was done immediately.
Trans –vaginal ultrasound was performed for each patient if remnants >3 cm redosing of misoprostol would be occurred,followed by surgical evacuation if failed.
Hemoglobin (Hb) and hematocrit (HCT) levels are recorded after 24 hours from abortion to estimate the decrease in Hb level.
In participants with incomplete or missed abortion on day seven surgical evacuation was performed under general anesthesia.
The result of the study demonstrated an increase in complete abortion rate (primary outcome) at day 3 in group A (56.6%) more than group B (35.2%) which was statistically significant.
Also there was an increase in the incidence of complete abortion at day 7 in group A (77.4%) more than group B (68.5%) but with no statistically significant difference between the two groups.