Isosorbide Mononitrate a Nitric Oxide Donor: A Study of Its Efficacy and Safety as an Agent for Cervical Ripening

Abstract

Objective To study the efficacy and safety profile of isosorbide mononitrate (IMN) as an agent for cervical ripening. Methodology This study was conducted in the Department of Obstetrics and Gynecology, M Y Hospital & M G M Medical College Indore from September 2011 to February 2013. Pregnant women attending the antenatal clinics were screened for possible participation in the study after explaining the nature of the study. This study was conducted on 150 patients. An initial dose of 40 mg IMN was applied in the posterior vaginal fornix, and the same dose was repeated after 6 h. Cervical ripening was assessed by the change in Bishop Score 12 h after the initial application.Results In a study of 150 cases, mean maternal age was 22.2 ± 2.6 years (range 19-35 years) and mean gestational age was 40.5 ± 1.07 (range 40-42 weeks). 52 women were primigravidas, while 98 were multigravidas. The mean Bishop Score-before drug administration was 1.94 ± 1.3 (range 0-5), and mean fetal heart rate was 137 ± 6.2 bpm. The mean of Bishop scores before IMN administration was 1.94 ± 1.3, while mean of Bishop score after drug administration was 6.7 ± 2.2; mean difference was equal to 4.76. P value was equal to 0.0001. By conventional criteria, this difference is considered to be statistically significant. The mode of delivery 96 (64 %) delivered vaginally, while 54 (36 %) were delivered by Cesarean section. Mean Apgar score at 1 min was 8.2 ± 0.9 SD (range 7-10), while mean Apgar score at 5 min was 9.4 ± 0.6 (range 8-10). The only side effect noted was headache, and 30 cases (20 %) complained of headache. 123Conclusion IMN seems to be effective, safe, inexpensive, and well-tolerated agent for cervical ripening. It is cost effective and safe with minimal side effects.

Effectiveness of Isosorbide Mononitrate vs Prostaglandin E2 Gel for Cervical Ripening: A Study

“…In the present study, the mean gestation age was 40 weeks, which was comparable in both the groups. Our study correlated with Dave et al, 5 Yazdizadeh et al, 6 and Krishnamurthy et al 7 with respect to mean gestational age. In the present study, postdatism (80% in IMN and 77% in PGE2 group) was the most common indication for induction followed by mild preeclampsia (20% in IMN and 23% in PGE2 group).…”

“…In a study conducted by Agarwal et al, 3 the mean age group was 23.4 years in the IMN group and 23.57 years in the PGE2 group, which closely correlates with our study. Also, the findings in Duhan et al, 4 Dave et al, 5 Yazdizadeh et al, 6 and Krishnamurthy et al 7 were comparable with our study.…”

“…In the Agarwal et al 3 study, there was no significant difference paritywise in both the groups. In Dave et al 5 study, in the IMN group, 35.6% were nulliparous and 65.3% were with parity ≥1.…”

“…In the study by Duhan et al, 4 preeclampsia and postdatism were most common indications in both the groups (74% in the isosorbide dinitrate group and 74% in the PGE2 group). In the study by Dave et al, 5 the indications for induction were postterm pregnancies, intrauterine growth restriction (IUGR), intrauterine death (IUD), hypertensive disorders, diabetes mellitus, and oligohydramnios.…”

RETRACTED: Isosorbide mononitrate for cervical ripening in induction of labor for pregnant women with PROM at or post term

“…Thus, in contrast to PGE1 and PGE2, they are not predicted to cause uterine hyperstimulation. 4 The aim of the present study was therefore to evaluate the efficacy of IMN to stimulate cervical ripening before labor induction and decrease the interval time between induction and delivery among pregnant women with PROM at or post term.…”