Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient setting

Meena, Neelam; Bindal, Neeta; Meena, Shivraj

doi:10.18203/2320-1770.ijrcog20160586

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…As shown in Table 2, after 24 hours of admission (i.e., 24 hours after the first dose of IMN and placebo), reassessment of Bishop's score was done, in case group it was 5.95 ± 1.59 and in control group it was 3.48 ± 1.35; p value was 0.001 which is statistically significant. This result is in agreement with the study done by Elmahdy et al, 3 Agarwal et al, 4 Rameez et al 5 and Meena et al 6 Similarly, Bishop's score was reassessed after 48 hours of admission (i.e., 24 hours after the 2nd dose of IMN and placebo). In case group it was 7.73 ± 2.26 while in control group it was 4.47 ± 1.73 as shown in Table 2 and Figure 2; p value was 0.001 which is statistically significant as shown in Table 1.…”

Section: Discussionsupporting

confidence: 91%

Effectiveness of Isosorbide Mononitrate in Cervical Ripening before Induction of Labor in Full-term Antenatal Patients

Agrawal¹,

Shrivastava²,

Acharya³

et al. 2019

Journal of South Asian Federation of Obstetrics and Gynaecology

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Aim: The aim of the present study is to prove the efficacy of isosorbide mononitrate (IMN) as a cervical ripening agent before induction of labor in term pregnancies. Materials and methods: The present study was prospective and comparative, experimental randomized placebo-controlled, double-blind study conducted in the Department of Obstetrics and Gynaecology at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, over a period of two years extending from September 2014 to August 2016. Results: There was a marked improvement in Bishop's score in study group as compared to control group. The mean baseline Bishop's score in case group was 2.65 + 1.29 and 2.64 + 1.26 in control group. Bishop's score after the 1st dose (i.e., 24 hours after admission) in study group was 5.95 + 1.56 and 3.43 + 1.35 in control group; p value is 0.001 which was statistically significant while Bishop's score after the 2nd dose (i.e., 24 hours after the second dose and 48 hours after admission) in study group was 7.73 + 2.26 and 4.47 + 1.73 in control group. Conclusion: Isosorbide mononitrate is effective and safe when used for cervical ripening before induction of labor at term without causing any side effect on maternal hemodynamic and hyperstimulation of uterus.

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Section: Discussionsupporting

confidence: 91%

Effectiveness of Isosorbide Mononitrate in Cervical Ripening before Induction of Labor in Full-term Antenatal Patients

Agrawal¹,

Shrivastava²,

Acharya³

et al. 2019

Journal of South Asian Federation of Obstetrics and Gynaecology

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“…Abdellah et al (5) concluded that using a combination of IMN and misoprostol is effective than misoprostol alone in terms of fast cervical ripening and shortening of induction-labor interval. Meena et al (3) evaluated the efficacy and safety of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient setting in India. They concluded that IMN self-administered at home is safe and effective method for cervical ripening prior to induction of labor in women with term pregnancies..…”

Section: Discussionmentioning

confidence: 99%

“…Isosorbide mononitrate (IMN) is a drug used principally in the treatment of angina pectoris and acts by dilating the blood vessels so as to reduce the blood pressure. IMN self-administered at home is safe and effective method for cervical ripening prior to induction of labor in women with term pregnancies as well as in outpatient setup (3) .…”

Section: Introductionmentioning

confidence: 99%

Effect of Isosorbide Mononitrate and Misoprostol for Cervical Ripening in Induction of Labor

Ibrahim

Dayem

Abdelrhman

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Induction of labor has increased dramatically over the past two decades. Indications for induction of labor are either maternal (preeclampsia, pregnancy-induced hypertension) or fetal (post-term dates, growth retardation, ruptured membranes, diabetes). Objective: The purpose of this study was evaluation of the beneficial effect of isosorbide mononitrate and misoprostol for cervical ripening in induction of labor. Patients and Methods: A randomized clinical trial was carried out on 120 full-term pregnant women who were admitted for induction of labor in Zagazig University Hospitals in the period of July 2017 to March 2018. Patients were divided into two groups: Group A included 60 full term pregnant females who received 25 μg misoprostol (Vagiprost tablet) and placebo tablet in the posterior vaginal fornix. Group B included 60 full-term pregnant females who received vaginal 25 μg misoprostol (Vagiprost tablet) plus 40 mg isosorbide mononitrate (Effox tablet) in the posterior vaginal fornix. Results: There was little difference between the effectiveness of vaginal 25 mg misoprostol vaginal inserts and 40 mg isosorbide mononitrate vaginal inserts in induction of labor. The safety profiles of both drugs were similar, but isosorbide mononitrate administration is considered a low-risk method of labour induction for pregnant women at full term. Conclusions: The combination of misoprostol and isosorbide mononitrate may be more safe and effective for induction of cervical ripening in full-term pregnancy in comparison to misoprostol alone.

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“…Vaginal Misoprostol is associated with slower clearance, lower peak plasma levels, and greater effects on cervix and uterus, sublingual route has rapid absorption and higher peak levels than either vaginal or oral administration and higher gastrointestinal side effects, buccal route has similar effects as vaginal routes. Isosorbide nitrate is a Nitric Oxide donor and causes its effect by NO rearrangement of collagen, with effective pre induction cervical ripening without stimulating uterine contractions [13] . Isosorbide mononitrate has been used in earlier studies for cervical ripening in induction of labour at full term pregnancy [11,21] .…”

Section: Current Scenario Of Abortions In Indiamentioning

confidence: 99%

“…Isosorbide mononitrate has been used in earlier studies for cervical ripening in induction of labour at full term pregnancy [11,21] . It has been used earlier for cervical ripening before first trimester surgical evaluation [12][13][14][15][16][17][18][19] Present study is a prospective, randomized, case controlled study between 2017-2019, to compare the efficacy, safety and acceptability of two medical methods in induction of second trimester Abortions at S.C. Government teaching hospital, a tertiary care centre, HIMS, Hassan. This study is conducted to compare efficacy, safety of vaginal isosorbide mononitrate 40ugm followed by vaginal misoprostol 400ugm and repeated 4 th hourly versus oral mifepristone 200ugm followed 24 hrs later by 4 th hourly vaginal misoprostol-400 u gm.…”

Section: Current Scenario Of Abortions In Indiamentioning

confidence: 99%

Efficacy of vaginal isosorbide mononitrate with misoprostol versus oral mifepristone and misoprostol in induction of second trimester abortions: An RCT at a tertiary hospital

Tr¹,

Banapurmath²,

Parvathamma³

2019

Int. J. Clin. Obstet. Gynaecol.

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Objective: To evaluate efficacy of two methods of medical induced abortions in second trimester and to analyse choice of post abortal contraception at a tertiary care centre, in Hassan, karnataka, India. Methods: This is a randomised case controlled study between 2017-2019 among pregnant women attending OPD at S.C government teaching hospital, HIMS, Hassan, Karnataka, India and opting for second trimester abortions as per MTP act, India. In the study, among total 158 clients (n=158), Group A(n=79) received oral misoprostol 4hourly for 5 doses after consent and 24hrs prior vaginal 40ugms of Isosorbide mononitrite, and group B(n=79)received 200 milligrams of Mifepristone orally, 24hrs followed by vaginal 400micrograms of misoprostol, and later 4 hourly 400 micrograms oral/vaginally for a total 5doses . The primary outcome indicators such as blood loss, need for transfusions, side effects, complication, need for surgical evacuation, Induction abortion interval and secondary outcome such as choice of post abortal contraception by clients were analysed. Results: Effectiveness with 5 doses of drugs resulting in Abortion was 78.4% in group T, and 88%in Group C. Side effects were mild, Headache 37%, dizzines and flushing (13%) shivering in group T (23%), were observed in group T, severe patient reported pain was36% in group C and 23% in group T. Median induction abortion interval in test group was 12hrs and 10.5 hrs in control group=0.048 and statistically significant. 14% women in group T, 10%in Group C needed additional dose of misoprostol. 43% in group T and 35% in group C needed\surgical evacuation for removal of placenta and remained products. 2clients had Rupture/dehiscence of scar uterus was seen in group C in previous scarred uterus, who underwent laparotomy and /hysterotomy. 67% of clients for second trimester abortion opted for long Acting reversible contraception (IUCD-41.1%, DMPAinjections-30.4%), surgical sterilization 10%, barrier methods 6% and combined oral pills 9% as post abortal contraception. Conclusion: medical methods are safe, effective in induction of second trimester Abortion including in post caesarian pregnancy, Mifepristone primed medical method of Abortion is more effective and shorter in duration and associated with severe pain. Misoprostol and cervical priming with isosorbide nitrate regime may be used when Mifepristone is not accessible, or in resistant cervix and in scarred uterus as alternate regime.

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Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient setting

Cited by 3 publications

References 18 publications

Effectiveness of Isosorbide Mononitrate in Cervical Ripening before Induction of Labor in Full-term Antenatal Patients

Effectiveness of Isosorbide Mononitrate in Cervical Ripening before Induction of Labor in Full-term Antenatal Patients

Effect of Isosorbide Mononitrate and Misoprostol for Cervical Ripening in Induction of Labor

Efficacy of vaginal isosorbide mononitrate with misoprostol versus oral mifepristone and misoprostol in induction of second trimester abortions: An RCT at a tertiary hospital

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