Letrozole Versus Mifepristone and Misoprostol in Silent Miscarriage

This is a randomized double blinded trial comparing the use of mifepristone versus letrozole as pre-treatment in the medical management of first trimester silent miscarriage using misoprostol.

Both groups will receive misoprostol (which is the standard management for medical management of silent miscarriage locally), but they will be randomized to either adding mifepristone or letrozole as pre-treatment. Mifepristone is usually taken once 2 days before misoprostol, whereas letrozole is taken 10mg daily for 3 days before misoprostol. Placebo of letrozole and mifepristone will be given to maintain double blindness of the groups.

Inclusion criteria

• Diagnosed with silent miscarriage <= 12 weeks of gestation by ultrasonography
• Single intrauterine gestational sac
• No heavy per-vaginal bleeding
• No severe abdominal pain
• No features of intrauterine infection
• Able to understand the proposed research and able to comply with instructions
• Having given voluntary written informed consent

Exclusion criteria

• Known allergy to mifepristone, misoprostol or letrozole
• On drugs with potential drug interactions with mifepristone e.g. aspirin, clopidogrel, anti-coagulants etc.
• Suspected ectopic or molar pregnancy or multiple pregnancy
• Distorted uterine cavity by uterine septum or submucosal fibroids
• Presence of intrauterine contraceptive device
• History of bleeding tendencies e.g. haemorrhagic diseases, current anti-coagulant treatment
• Previous history of retained products of gestation/ failed medical management of miscarriage
• Opt for expectant or surgical management of miscarriage