Comparison of Vaginal Misoprostol, Combined Letrozole and Misoprostol and Combined Laminaria and Misoprostol in the Preparation of Second-Trimester Cervical Abortion

Therapeutic abortion in the second trimester of pregnancy can be done by a number of medical or mechanical methods. The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria in preoperative cervical ripening among women with under second-trimester abortion.
In this interventional study, 120 pregnant women with the gestational age of 20 weeks, who were candidates for therapeutic abortion, were selected and randomly divided into three groups (n=40). Proper counseling was done and a written informed consent was obtained before starting the treatment regimen. The first group received vaginal misoprostol alone and the second group received misoprostol in combination with laminaria and oral placebo. In the third group, in addition to cervical placebo on the first and second days, letrozole was prescribed, and on the third day, the patients were hospitalized and received vaginal misoprostol and third dose of letrozole. The patients were regularly examined every 4 hours, and in the absence of abortion, vaginal misoprostol was repeated after 4 hours.
The results showed that termination of pregnancy was caused by embryo anomaly in 23 cases and fetal death in 97 cases. In this study, response to treatment was 90% in the group receiving laminaria and misoprostol 85% in the group receiving letrozole and misoprostol and 67% in the group receiving misoprostol. Regarding the duration and amount of bleeding, the groups receiving laminaria and misoprostol had the lowest duration and severity of bleeding, but this difference was not statistically significant. Combination of misoprostol and laminaria caused a significantly shorter time interval from the initiation of intervention to abortion, and pain relief was also higher than the other two groups.
Based on the obtained results, a combination of misoprostol and laminaria is recommended for induction of second-trimester therapeutic abortion.