A novel approach - letrozole in the management of retained products of conception: a case report

Abstract

Miscarriage affects 15-20% of pregnancies, often in the first trimester, with 1-5% involving retained products of conception (RPOC). Traditional management includes misoprostol or surgical evacuation. WHO guidelines suggest oral letrozole, an aromatase inhibitor, as an alternative for first-trimester medical termination of pregnancy (MTP). This case reports on the effectiveness of letrozole in treating RPOC.A 20-year-old primigravida with persistent vaginal bleeding post-MTP presented with RPOC. Despite prior misoprostol treatment, bleeding continued. Ultrasound revealed RPOC (3.20×2.57 cm) with vascularity. Letrozole 5 mg daily for 5 days was administered after informed consent. Follow-up ultrasound showed complete resolution of RPOC, with no significant side effects. Letrozole, a third-generation aromatase inhibitor, has shown potential in managing RPOC by inhibiting estrogen production, thus facilitating expulsion. This case supports its efficacy and tolerability as an alternative to surgical intervention or traditional medical treatments. Letrozole effectively resolved RPOC in this case, highlighting its potential as a non-invasive treatment option. Further research is needed to validate its standard use for RPOC.