ALTERNATIVE APPROACHES TO MEDICAL ABORTION
DOI:
https://doi.org/10.15547/tjs.2024.01.011Keywords:
letrozole, mifepristone, methotrexate, misoprostol, non-invasive, abortionAbstract
Medical abortion involving various pharmacological agents has demonstrated high levels of complete uterine evacuation. Alternative approaches involving letrozole, mifepristone, methotrexate used synergically with misoprostol are non-invasive elective methods of achieving complete abortion. Abortion induced by mifepristone, letrozole and misoprostol results in complete evacuation in 98% of the cases.The synergic effect of mifepristone and misoprostol achieves 98.2% effectiveness. Medical management of abortion with letrozole and misoprostol has 97.8% complete expulsion. Current reports of surgical termination of pregnancy reveal 97% effectiveness.
Letrozole destabilizes the dominant position of mifepristone but the reports of its non-significant prevalence regarding complete abortion should be verified by a larger number of studies. Medical abortion is non-inferior in its effectiveness to surgical abortion and is unambiguously likely to become in the future the principal recommendation for termination of early pregnancy.
References
Sedgh, G.Bearak, J. et al., Abortion incidence between 1990 and 2014: Global, regional, and subregional levels and trends,
Lancet, 2016 Jul 16; 388(10041): 258–267.
doi: 10.1016/S0140-6736(16)30380-4; www.pubmed.ncbi.nlm.nih.gov
Bankole, A., Remez, L. et al., From unsafe to safe abortion in Sub-Saharan Africa: Slow but steadprogress, 2020; p.17; www.guttmacher.org
Medication Abortion Now Accounts for More Than Half of All US Abortions, February 2022, Policy Analysis; www.guttmacher.org
Telbiyska, K., Place occupied by elective abortion in the regulation of birth rate in Bulgarian women nowadays, Thesis; 136-138, 2023.
Bousiéguez, M. et al., Safety, efficacy and acceptability of outpatient mifepristone/misoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City.; Reprod Health Matters, 2015 Feb; 22(44 Suppl 1):75-82.; doi: 10.1016/S0968-8080(15)43825-X, www.pubmed.ncbi.nlm.nih.gov
Shochet, A., Turok, D. et al., Single dose letrozole and misoprostol for termination of pregnancy through 63 days’ gestation: A pilot study; Contraception, Volume 120, April 2023, 109924; www.sciencedirect.com
Hamel, Ch., Wessel, S. et al., Diagnostic criteria for retained products of conception—A scoping review, Acta Obstet Gynecol Scand., 2021 ; 100(12): 2135–2143, doi: 10.1111/aogs.14229
Afifi, A., Hassan, F. et al., Misoprostol versus Letrozol with Misoprostol in Management of First Trimesteric Missed Miscarriage, Al-Azhar International Medical Journal, 2021; Article 10, Volume 2, Issue 10, p. 59-65 XMLPDF, DOI:10.21608/aimj.2021.89692.1545, 2021; aimj.journals.ekb.eg
Jain, K., Dutton, C. et al., A prospective randomized, doubleblinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy, Hum Reprod, 2002; 17(6):1477-82; doi:10.1093/humrep/17.6.1477. www.pubmed.ncbi.nlm.nih.gov
Torky, H., Marie, H. et al., Letrozole vs. Placebo Pretreatment in the Medical Management of First Trimester Missed Miscarriage: a Randomized Controlled Trial, Geburtshilfe Frauenheilkd, 2018 Jan;78(1):6369.doi:10.1055/s0043122499. www.ncbi.nlm.nih.gov
Abbasalizadeh, F., et al., Comparison Between Effect of Letrozole Plus Misoprostol and Misoprostol Alone in Terminating Non-Viable First Trimester Pregnancies: A Single Blind Randomized Trial, 2018 Mar; 12(1): 27–332018; www.pubmed.ncbi.nlm.nih.gov.
Lee, V., Ng, E., et al., Misoprostol with or without letrozole pretreatment for termination of pregnancy, Randomized Controlled Trial, Obstet Gynecol, 2011 Feb; 117(2Pt1):317323. doi10.1097/AOG.0b013e3182073fbf 2011; www.pubmed.ncbi.nlm.nih.gov
Malloch, L., Rhoton-Vlasak, A., An assessment of current clinical attitudes toward letrozole use in reproductive endocrinology practices, Fertility and Sterility, 2013, Volume 100, Issue 6, p.1740-1744; www.sciencedirect.com
Albrecht, E., Aberdeen, G., Pepe, G., The role of estrogen in the maintenance of primate pregnancy. Am J Obstet Gynecol, Am J Obstet Gynecol, 2000;182(2):432-8. doi: 10.1016/s0002-9378(00)70235-3; www.pubmed.ncbi.nlm.nih.gov
Bisagni, G., Cocconi, G. et al., Letrozole, a new oral non-steroidal aromastase inhibitor in treating postmenopausal patients with advanced breast cancer. A pilot study, Annals of Oncology, 1996;7(1):99102, DOI: 10.1093/oxfordjournals.annonc.a010490, www.researchgate.net
Du, L., Wun, H. et al., Comparing letrozole and mifepristone pre-treatment in medical management of first trimester missed miscarriage: a prospective open-label non-inferiority randomised controlled trial, 2023; https://doi.org/10.1111/1471-0528.17646, www.obgynonlinelibrary.wiley.com
Lee, V., Gao, J., et al., The effect of letrozole with misoprostol for medical termination of pregnancy on the expression of steroid receptors in the placenta. Hum Reprod, Hum Reprod, 2013; 28(11):2912-9, doi: 10.1093/humrep/det345;
www.pubmed.ncbi.nlm.nih.gov
Yung, S., Lee, V. et al. The effect of 7 days of letrozole pre-treatment combined with misoprostol on the expression of progester-one receptor and apoptotic factors of placental and decidual tissuesfrom first-trimester abortion: a randomized controlled trial, Contraception, 2016 Apr; 93(4):323-330. doi: 10.1016/j.contraception.2015.12.005. Epub 2015 Dec 19, www.pubmed.ncbi.nlm.nih.gov
Bahaa, H., Ahmed, A. et al., A Comparative Study between Methotrexate versus Letrozole Prior to Misoprostol in Induction of First Trimester Missed Miscarriage, MJMR, 2022; Vol.33,No.4,p.(177-184); www.mjmr.journals.ekb.eg.
Lee, V., Yeung, T., et al., Effect of letrozole on uterine artery Doppler flow indices prior to first-trimester termination of pregnancy: a randomized controlled trial; Ultrasound Obstet Gynecol, 2012 Oct;40(4): 383.doi: 10.1002/uog.12301. www.pubmed.ncbi.nlm.nih.gov
Schiessl, B., Innes, B., et al., Localization of angiogenic growth factors and their receptors in the human placental bed throughout normal human pregnancy. Placenta, 2009; Volume 30, Issue 1, January 2009, p.79-8; www.sciencedirect.com
Kallner, H., et al., Effect of letrozole on uterine tonus and contractility: a randomized controlled trial, Contraception, 2012 Oct; 86(4):41924.doi:10.1016/j.contraception.2012.02.008. Epub 2012 Apr 20; www.pubmed.ncbi.nlm.nih.gov
Autry, B., Wadhwa, R., Mifepristone-StatPearls Treasure Island (FL): StatPearls Publishing, 2022; Bookshelf ID: NBK557612 www.ncbi.nlm.nih.gov
Du, L., Wun, R. et al., Prospective open-label non-inferiority randomised controlled trial comparing letrozole and mifepristone pretreatment in medical management of first trimester missed miscarriage: study protocol, BMJ Open, 2022 Jan 31;12(1):e052192.doi:10.1136/bmjopen-2021-0521922022; www.pubmed.ncbi.nlm.nih.gov
Konopka, C., Azzolin, V. et al., Misoprostol modulatesvthe gene expression prostaglandin E2 and oxidative stress marker in myometrial cells, Prostaglandins Other Lipid Mediat, 2016 Nov:126:38-45. doi: 10.1016/j.prostaglandins.2016.09.003. Epub 2016 Sep 16.2016; www.pubmed.ncbi.nlm.nih.gov
Weeks, A., Alia, G., Blum, J. et al., A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion, Obstet Gynecol, 2005 Sep;106(3):540-7. doi:10.1097/01.AOG.0000173799.82687.dc2005; www.pubmed.ncbi.nlm.nih.gov
Behnamfar, F., Mahdian, M., Rahimi, F.et al., Misoprostol abortion: ultraso-nography versus Beta-hCG testing for verification of effectiveness. PakJ Med Sci, Pak J Med Sci, 2013 Nov; 29(6):1367-70. doi:10.12669/pjms.296.3361 2013; 29: www.ncbi.nlm.nih.gov
Dickinson, J., Misoprostol for second-trimester pregnancy termination in women with a prior cesarean delivery, Obstet Gynecol, 2005 Feb;105(2):352-6.
doi:10.1097/01.AOG. 0000151996.16422.88 2005; www.pubmed.ncbi.nlm.nih.gov
Abortion care guidline, 2022; p.82 who.int
nhsl.guiflines.scot.nhs.uk, 2021
Parker, B. M., Gupta, A. et al., Methotrexate for cornual ectopic pregnancy. Cureus, 2020; DOI:10.7759/cureus.9642; www.cureus.com
Taher, E., Swelam, M., Mansy, A., & Elgammal, M., Methotrexate and Misoprostol against Misoprostol Alone for Early Medical Abortion: Compa-rative Study. Journal of High Institute of Public Health, 2014; doi 10.21608/jhiph.2014.20338
Naghshinesh, E., et al., The effectiveness of using misoprostol with and without letrozole for successful medical abortion: a randomized placebocontrolled clinical trial, J Res Med Sci., 2015 Jun; 20(6): 585–589. doi: 10.4103/1735-1995.165964; www. ncbi.nlm.nih.gov
Behroozi-Lak, T. et al., Evaluation of effect of letrozole prior to misoprostol in comparison with misoprostol alone in success rate of induced abortion. ,Journal of Gynecology Obstetrics and Human Reproduction,Volume 47, Issue 3, March 2018, p. 113-117, www.sciencedirect.com
Javanmanesh, F., et al.i. Comparison of Using Misoprostol with or without Letrozole in Abortion Induction: A Placebo-Controlled Clinical Trial. Journal of Obstetrics, Gynecology and Cancer Research, 3(2):49 52, DOI:10.30699/jogcr.3.2.49, 2018; www.researchegate.net
Mohammed AL-taie, M. et al., Medical Induction of First Trimester abortion by Misoprostol or Misoprostol with Letrozole, 2021; Indian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1. www.medicopublication.com
Yeung, T., Lee, V. C, et al., A pilot study on the use of a 7-day course of letrozole followed by misoprostol for the termination of early pregnancy up to 63 days.
Contraception, 2012 Dec; 86(6):763-9.
doi:10.1016/j.contraception.2012.05.009. Epub 2012 Jun 18; www.pubmed.ncbi.nlm.nih.gov
Chai J, Ho P C., A pilot study on the combined use of letrozole, mifepristone and misoprostol in termination of first trimester pregnancy up to 9 weeksʼ gestation. www.pubmed.ncbi.nlm.nih.govEur J Obstet Gynecol Reprod Biol, 2013 Dec;171(2):291-4. doi: 10.1016/j.ejogrb.2013.09.017. Epub 2013
Fiala, C. et al., Verifying the effectiveness of medical abortion; ultrasound versus hCG testing. Eur J Obstet Gynecol Reprod Biol, 2003 Aug 15;109(2):190-5. doi: 10.1016/s0301-2115(03)00012-5.
Lui, M., Ho, P., First trimester termination of pregnancy. Best Pract Res Clin Obstet Gynaecol, 2020; Feb:63:13-23; doi:10.1016/j.bpobgyn.2019.06.004. Epub 2019 Jul 12;
www pubmed.ncbi.nlm.nih.gov
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Trakia University
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
