Foundation: Miscarriage is the end of pregnancy before 20 weeks of development or an embryo conceived weighting under 500 grams. Inciting early termination by drugs is an option for medical procedure mediation, which has financial advantages with lower results and its pace of achievement is 60 to 95 percent. The point of this investigation was to analyze the adequacy and security of letrozole pretreatment with misoprostol and misoprostol alone in the management of first trimester missed Abortion. Strategies: This investigation was directed at outpatient clinic and emergency division of obstetrics and gynecology department at Banha univeristy hospitals. Itemized history was taken and cautious assessment was accomplished for all patients. Likewise fundamental examinations as hemoglobin, blood gathering, RH and trans-vaginal ultrasound were done for patients before the investigation. First gathering: The patients got 600 mcg of misoprostol (three tablets, every tablet 200 mcg) orally as a solitary portion. Second gathering: The patients got letrozole 10 mg (4 tablets, every one 2.5 mg) as a solitary portion for 3 days followed by 600 mcg misoprostol orally. Results and end: The utilization of letrozole pretreatment followed by misoprostol for termination of missed abortion in the first trimester is related with higher complete fetus removal rate than misoprostol alone. Along these lines, it is prescribed to utilize letrozole followed by misoprostol routine for enlistment of early termination in cases with first trimesteric missed abortion rather than misoprostol alone.