The results of using the combination of letrozole and misoprostol in comparison with laminaria and misoprostol in preparing the cervix for miscarriages under the second trimester of pregnancy


  • Soureh Sheikham Department of Gynecology and Obstetrics Specialist, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
  • Firouz Amani Department of Biostatistcis, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran



Laminaria, Misoprostol, Letrozole, Second trimester


Background: Therapeutic abortion in the second trimester pregnancy is the choice treatment in cases with severe anomalies or intrauterine fetal death. It can be done by a number of medical (e.g. misoprostol and letrozole) or mechanical methods (e.g. laminaria). The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria for preoperative cervical ripening among women with under second trimester abortion.

Methods: In this interventional study, 80 pregnant women in the second trimester pregnancy (Gestational age under 20 weeks) were randomly divided in two groups (n=40). One group received vaginal misoprostol in combination with laminaria and oral placebo and other group received vaginal misoprostol in combination with letrozole. Patients regularly examined every 4 hours and in the absence of abortion, vaginal misoprostol repeated after 4 hours. No report of products of conception abortion considered as complete abortion and the patient discharged. Data collected in a cheklist and then analyzed by statistical methods in SPSS version 21.

Results: Complete abortion was reported in 70 (87.5%) of all patients which in group letrozole+misoprostol in 34 (85%) and in laminaria+misoprostol was reported in 36 (90%). 6 (15%) Curettage was reported in group letrozole+misoprostl and 4 (10%) in laminaria+misoprostol and the difference were not statistically significant.

Conclusions: Results showed that both of combination are effective in the abortion but misoprostol in combination with laminaria is recommended for the induction of second trimester therapeutic abortion.


Cunningham FG, Hauth JC, Leveno KJ, Gilstrap L, Bloom SL, Wenstrom KD. Williams obstetrics. 24th ed. USA, New York: McGraw-Hill; 2015:241-2.

Jahanshahi M, Montazeri M, Mohammadreza KN, Kargar S. The effect of misoprostol with and without letrozole in inducing successful medical abortion. Iran J Obstet Gynecol Infertil. 2023;25(11):8-15.

Javanmanesh F, Kashanian M, Mirpang S. Comparison of Using Misoprostol with or without Letrozole in Abortion Induction: A Placebo-Controlled Clinical Trial. J Obstet Gynecol Cancer Res. 2018;3(2):49-52. Shah I, Åhman E. Unsafe abortion: global and regional incidence, trends, consequences, and challenges. J Obstet Gynecol Canada. 2009;31(12):1149-58.

Map of Misoprostol Approval page. Available at: Accessed on 20 November 2023.

Begum MR, Ferdous J, Begum A, Quadir E. Comparison of efficacy of aromatase inhibitor and clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Fertil Steril. 2009;92(3):853-7.

Beucher G, Baume S, Bekkari Y, Legrand HM, Herlicoviez M, Dreyfus M. Medical treatment of early spontaneous miscarriages: a prospective study of outpatient management using misoprostol. J Gynecol Obstetric Biol Reprod. 2004;33(5):401-6.

Lee VC, Ng EH, Yeung WS, Ho PC. Misoprostol with or without letrozole pretreatment for termination of pregnancy: a randomized controlled trial. Obstet Gynecol. 2011;117(2):317-23.

Hofmeyr GJ, Gülmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2003;1:CD000941.

Elhassan EM, Nasr AM, Adam I. Sublingual compared with oral and vaginal misoprostol for labor induction. Int J Gynaecol Obstet. 2007;97(2):153-4.

Sanchez-Ramos L, Kaunitz AM. Oral administration of misoprostol for labor induction: a randomized controlled trial. Obstet Gynecol. 1997;90(1):153-4.

Almog B, Levin I, Winkler N, Fainaru O, Pauzner D, Lessing JB, et al. The contribution of laminaria placement for cervical ripening in second trimester termination of pregnancy induced by intra-amniotic injection of prostaglandin F(2)alpha followed by concentrated oxytocin infusion. Eur J Obstet Gynecol Boil. 2005;118(1):32-5.

Thornburg LL, Grace D, Gray AL, Glantz JC, Pressman EK. Placement of laminaria tents does not improve time to delivery in patients undergoing second trimester labor induction with misoprostol. J Matern Fetal Neonatal Med. 2010;23(8):928-31.

Mazouni C, Vejux N, Menard JP, Bruno A, Boubli L, d'Ercole C, et al. Cervical preparaiom with lamiaria. Contraception. 2009;80(1):101-4.

Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Engl J Med. 2001;344(1):38-47.

Chung YP, Hwa HL, Ko TM. Laminaria and sulprostone in second trimester pregnancy termination for fetal abnormalities. Int J Gynaecol Obstet. 1999;65(1):47-52.

Berek JS, Novak E. Berek and Novak's gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007:299-300.

Salari Z, Sarifi L, Aali SH. Comparison of vaginal misoprostol with and without laminaria in second trimester induction abortion. Kerman Univ Med Sci. 2011;19(2):160-7.

Jain JK, Mishell DR. A comparison of misoprostol with and without laminaria tents for induction of second-trimester abortion. Am J Obstet Gynecol. 1996; 175(1):173-7.

Rezaei Z, Heydari S, Ghaseminejad A, Sadegi A, Gorbani yekta B. Letrozole and misoprostol versus misoprostol alone for termination ofpregnancy: a randomized clinical trial. Tehran Univ Med J. 2014;71(11):700-6.

Behrashi M, Nezam-Zavareh J, Mesdaghinia E, Hashemi T, Mousavi GA, Mahdian M. Comparing the effects of vaginal misoprostol and laminaria on cervical ripening in labor induction among the term parturients. Feyz. 2014;18(1):46-51.

Prasad S, Kumar A, Divya A. Early termination of pregnancy by single- dose 800 mug misoprostol compared with surgical evacuation. Fertil Steril. 2009;91:28-31.

Borgatta L, Chen AY, Vragovic O, Stubblefield PG, Magloire CA. Arandomized clinical trial of the addition of laminaria to misoprostol and hypertonicsaline for second-trimester induction abortion. Contraception. 2005;72(5):358-61.

Gagné A, Guilbert E, Ouellet J, Roy V, Tremblay JG. Assessment of pain after elective abortion relating to the use of misoprostol for dilatation of the cervix. J Obstet Gynecol Canada. 2010;32(3):244-53.

Khooshideh M, Yarmohammadi N, Shahriari A, Sheikh M. Sublingual misoprostol plus laminaria for cervical preparation before surgical management of late first trimester missed abortions, a randomized controlled trial. J Mater Fetal Neonat Med. 2017;30(3):317-22.




How to Cite

Sheikham, S., & Amani, F. (2024). The results of using the combination of letrozole and misoprostol in comparison with laminaria and misoprostol in preparing the cervix for miscarriages under the second trimester of pregnancy. International Journal of Basic & Clinical Pharmacology, 13(2), 208–212.



Original Research Articles