Comparison of letrozole vs mifepristone pretreatment with misoprostol in second trimester abortion induction : A RCT

In second trimester, women seek termination of pregnancy due to various social and medical factors including delayed decisions, lack of awareness, poverty, limited education and availability of abortion services. Common reasons for mid-trimester abortions include fetal anomalies, uterine defects, placental causes and medical disorders.

Abortions account for 8 percent of maternal mortality ratio in India and nearly 10 women reportedly die due to unsafe abortions everyday in India. Several methods are used for mid-trimester abortions, with medical methods being the most popular due to their effectiveness and fewer complications. Letrozole, mifepristone and misoprostol are commonly used drugs for this purpose. Mechanical methods using hygroscopic dilators and foleys catheter are also employed. Surgical methods like dilatation and evacuation are also used but have higher risks associated.

In many countries, mifepristone is not available and is expensive compared to letrozole. There is a need to find a cheaper and easily available alternative. Letrozole is easily available as it is registered for treatment of estrogen dependent advanced breast cancers and infertility.

Further studies are needed to refine abortion techniques, aiming to decrease procedure duration and potential complications while ensuring higher efficacy and patient tolerance.