Misoprostol plus Isosorbide Mononitrate versus Misoprostol for Termination of Anembryonic Pregnancy

Abstract

Objective: Is to to assess the efficacy and safety of vaginal misoprostol plus isosorbide mononitrate versus misoprostol in termination of anembryonic pregnancy. Setting: Department of Obstetrics and Gynecology, Woman’s Health Hospital, Assiut University. Methods: 108 women scheduled for termination of anembryonic pregnancy were recruited were assigned randomly to vaginal misoprostol 800 g plus isosorbide mononitrate 40 mg or vaginal misoprostol 800 g plus placebo .The efficacy of the medication was evaluated by predetermined outcome variables for Successful expulsion of gestational sac in both groups and need for surgical interference.

Efficacy and safety of isosorbide mononitrate plus misoprostol compared to misoprostol alone in the management of the first and second trimester abortion: a systematic review and meta-analysis

“…All seven included studies were randomized controlled trials. The studies were conducted in various countries, including India [ 16 , 17 ], Egypt [ 13 , 14 , 25 ], the UK [ 18 ], and Greece [ 15 ]. The studies were published from 2001 [ 18 ] to 2023 [ 13 ].…”

“…The operative duration was statistically significantly shorter in the combination group than in the Misoprostol group. Abdominal pain was statistically significant and more prominent in group Misoprostol group while headache was more significant in the combination therapy group Khalifa (2021) [ 25 ] Egypt Women scheduled for termination of anembryonic, maternal age ≥ 20 years, no vaginal bleeding, no dilation of the internal os, mean gestational sac diameter greater than 25 mm, and no yolk sac First trimester N = 54 800 mcg Misoprostol plus 40 mg ISMN tablets in the posterior vaginal fornix (single dose) N = 54 800 mcg Misoprostol plus placebo were applied in the posterior vaginal fornix A combination of Misoprostol and ISMN is more effective than misoprostol alone in the termination of anembryonic pregnancy and with less frequency of side effects. Ledingham (2001) [ 18 ] United Kingdom Primigravid women undergoing surgical termination by vacuum aspiration First trimester N = 22 400 mg Misoprostol plus 40 mg ISMN intravaginally (single dose) N = 21 400 mcg Misoprostol intravaginally No discernible benefits were observed in combining misoprostol with ISMN as opposed to using misoprostol alone for pre-operative cervical ripening in the first trimester.…”

“…In three studies [ 13 , 18 , 25 ], women who were going to have an abortion in the first trimester of pregnancy were included in the study. Two studies were conducted on pregnant women at 12–20 weeks of gestation [ 16 , 17 ], and in the remaining two studies [ 14 , 15 ], women were included in the study from the 13th to the 24th week of pregnancy.…”

“…Table 2 shows the risk of biased judgment for included RCTs. Regarding the overall risk of bias, there were three low-risk studies [ 16 , 18 , 25 ], one some-concern study [ 17 ], and three high-risk studies [ 13 – 15 ].…”

“…Three studies [ 13 , 18 , 25 ] evaluated the effect of combination intervention compared to vaginal misoprostol alone for the first-trimester abortion. The referenced studies administered vaginal misoprostol at dosages ranging from 200 to 800 mcg and utilized ISMN in quantities ranging from 20 to 40 mg. Khalifa et al [ 25 ], specifically applied a combination therapy consisting of 800 mcg of misoprostol and 40 mg of ISMN as a single dose to the posterior vaginal fornix. We evaluated this regimen against the administration of 800 mcg of misoprostol alone.…”