Second Trimester Abortion With Letrozole and Misoprostol Compared to Misoprostol Alone

An online randomization program will be used to generate a random list and each patients' code will be kept in an opaque sealed envelope. Patients will be randomly allocated with 1:1 allocation ratio into two equal groups in a parallel manner:

• Group I (Letrozole + Misoprostol): Patients will receive letrozole 2.5 mg orally the dose of letrozole is 4 tab once/day for 3 consecutive days, followed by vaginal misoprostol.
• Group II (Misoprostol alone (: Patients will receive vaginal misoprostol alone using the same dosage schedule without letrozole pretreatment.

This study will be open-label due to different drugs and route of administrations used.

Inclusion criteria

• Pregnant women aged 18-45 years.
• Failed pregnancy.
• Gestational age between 14 and 20weeks, confirmed by ultrasonography on the day of admission.
• Hemoglobin concentration >9 g/dL.
• Closed cervix.
• Absence of products of conception in the cervical canal.

• Exclusion Criteria:
• Previous attempt to terminate the current pregnancy.
• Molar pregnancy (hydatidiform mole).
• Pathological uterine lesions including uterine fibroids and congenital uterine malformations.
• Cardiac disease.
• Renal disease.
• Hemorrhagic disorders.
• Body mass index (BMI) >35 kg/m².
• Documented hypersensitivity or allergy to letrozole, misoprostol, or any of the study medications.