الفهرس 
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Abstract
Summary
Early pregnancy loss is defined as a nonviable, in-trauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gesta-tion. In the first trimester, the terms miscarriage, sponta-neous abortion, and early pregnancy loss are used inter-changeably, and there is no consensus on terminology in the literature (ACOG, 2018). Early pregnancy loss is common, occurring in 10% of all clinically recognized pregnancies. Approximately 80% of all cases of pregnan-cy loss occur within the first trimester (ACOG, 2018).
Letrozole is a non-steroidal aromatase inhibitor used for the treatment of estrogen-dependent breast can-cer. Estrogen is produced by aromatase enzyme activity from androgens. Estrogens are essential for continuation of the pregnancy. Letrozole reversibly and competitively bonds with the iron in cytochrome P450 and prevents the production of estrogen by the enzyme aromatase (Javadi et al, 2015).
This study aimed to assess the effect of letrozole as a new synergistic agent in combination with sublingual misoprostol compared with misoprostol alone for medical termination of pregnancy.
This study was conducted at Ain Shams University, Maternity hospital during the period between March 2022 to September 2022.
Patients fulfilling the inclusion criteria were recruit-ed, then informed consent was taken from each patient be-fore participating in the clinical trial. This was followed by detailed history, thorough examination and investiga-tions which included haemoglobin level, blood group and Rh type.
Patients were divided into 2 groups:
group I, (Misoprostol group) received 600 mi-crograms of misoprostol (Misotac®, Tab. 200 mcg, Sigma company, Egypt) administered sublingual on the 1st day of enrolment (3 tablets twice, 4 hours apart).
group II, (letrozole + Misoprostol group) received letrozole 2.5mg (Femara®, Tab. 2.5-mg, Novartis company, Egypt) , one dose 10 mg (4 tablets) on the 1st day of enrolment followed by 600 micrograms of misoprostol (Misotac®, Tab. 200 mcg, Sigma com-pany, Egypt) administered sublingual on the 2nd day of enrolment (3 tablets twice, 4 hours apart).
Our study demonstrated that 10 mg of letrozole for one day followed by 600mcg of sublingual misoprostol was more effective than misoprostol alone for induction of abortion in first trimesteric missed abortion.
One hundred forty two women were assessed for eligi-blility and randomly assigned into two intervention groups. During following period, Not meeting inclusion criteria (n=14), Declined to participate (n=33), Other reasons (n=5) were excluded. Finally, 90 women were enrolled, divided in-to 45 women in letrozole + Misoprostol and 45 women in Misoprostol group. Four women from Misoprostol group and 2 women from Letrozole + Misoprostol group were lost to follow-up. Baseline characteristics regarding age, parity, gestational age and BMI revealing non significant difference between studied groups. The mean interval for time of start of bleeding, induction to expulsion interval and abortion time were significantly lower in Letrozole + Miso-prostol women compared to Misoprostol group (P 0.001). The most common side-effects in both groups were ab-dominal pain and headache. The incidence of side-effects was comparable for the two groups (P > 0.05), also the se-verity of side-effects was not significantly different between groups (P > 0.05). Complete abortion was observed in 36 subjects in Letrozole +Misoprostol group which was signifi-cantly more frequent than 26 subjects in Misoprostol sub-jects (83.7% and 63.4%, respectively, P < 0.05). No statisti-cal significance was seen regarding Hb levels before and af-ter treatment, while Hct levels showed significant difference before and after treatment concerning women underwent complete abortion only in the 2 studied groups