Foundation:  Miscarriage occurs when a pregnancy ends before 20 weeks of gestation or when an embryo is conceived that weighs less than 500 grams. Inducing early termination with drugs is a medical treatment mediation option with financial benefits but lower outcomes, and a 60 to 95 percent success rate. The aim of this study was to determine the efficacy and safety of letrozole pretreatment with misoprostol versus misoprostol alone in the treatment of missed first-trimester abortions. The outpatient clinic and emergency division of the obstetrics and gynecology department at Banha university hospitals were the focus of this investigation. For each patient, an itemized history was taken and a careful review was completed. Basic tests such as hemoglobin, blood collection, RH, and trans-vaginal ultrasound were also performed on patients prior to the investigation   First group, the patients were given 600 mcg of misoprostol (three tablets, each 200 mcg) orally as a single dose.  second group, the patients were given letrozole 10 mg (4 tablets, each 2.5 mg) as a single dose for three days, followed by 600 mcg misoprostol orally. Results and end: When letrozole is used before misoprostol for the termination of a missed abortion in the first trimester, the full fetus removal rate is higher than when misoprostol is used alone. Along these lines, in cases of first trimester missed abortion, it is recommended to use letrozole accompanied by misoprostol instead of misoprostol alone for enlistment of early termination.