Oral Misoprostol and Vaginal Isosorbide Mononitrate for Labor Induction

Collingham, Justin; Fuh, Katherine C.; Caughey, Aaron B.; Pullen, Kristin; Lyell, Deirdre J.; El‐Sayed, Yasser Y.

doi:10.1097/aog.0b013e3181e408f2

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Nitric oxide donors like isosorbide mononitrate have been used as cervical ripening agents in first trimester and for induction of labour at term in the past. [4][5][6] Nitric oxide donors induce production of matrix metalloproteinases namely MMP-1 and MMP-9, which are essential for collagen degradation. 7 It also increases proinflammatory cytokines and prostaglandins.…”

Section: Introductionmentioning

confidence: 99%

Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Saxena¹,

Jaiswal²,

Kabra³

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Background: Aim of the study was to compare the efficacy of misoprostol alone and misoprostol with isosorbide mononitrate in reducing the induction abortion time interval in second trimester termination of pregnancy.Methods: A randomized control prospective study was conducted. Patients seeking second trimester abortions were randomized in to two groups. Group A received 400 ugm of misoprostol per vaginum every 4 hours up to maximum of 5 doses. Group B patients received 400 ugm of misoprostol and 40mg of isosorbide nitrate intravaginally. Repeat dose of 400 ugm misoprostol and 20 mg of isosorbide mononitrate was given every 4 hours up to a maximum of 5 doses. The induction to abortion interval and side effects of the drugs used were noted.Results: A total 71 women seeking second trimester termination between 12 to 20 weeks gestation were recruited for the study. In group A, there were 36 patients and in group B there were 35 patients. In group A the mean induction abortion interval was 14.8±4.16 hours while in group B the mean induction-abortion interval was 12.45±3.9 hours. Patients treated with isosorbide mononitrate and misoprostol combination had statistically significantly lower induction abortion time interval when compared with misoprostol alone (p value 0.018).Conclusions: The study demonstrates that the combination of isosorbide mononitrate and misoprostol is more effective for termination of second trimester pregnancy than misoprostol alone.

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Section: Introductionmentioning

confidence: 99%

Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Saxena¹,

Jaiswal²,

Kabra³

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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show abstract

“…As mentioned earlier, several studies have tried to show the effect of NO on cervical pre-induction ripening. [ 15 16 17 18 19 20 21 22 ] Many of these studies have used isosorbide mononitrate and no study has been conducted with ISDN so far. Findings of previous studies indicated that delivery length from the onset of intervention in the misoprostol group was shorter and the need for induction in this group was lower.…”

Section: Discussionmentioning

confidence: 99%

“…Findings of previous studies indicated that delivery length from the onset of intervention in the misoprostol group was shorter and the need for induction in this group was lower. [ 16 ] Due to difficult access to misoprostol and its high cost in Iran, and dangers of using misoprostol including systolic tachycardia, uterine hyperstimulation, and other risks to the fetus, this medication should always be prescribed in certain circumstances only.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the slow systemic absorption through vagina, this interval seemed sufficient. [ 16 ] Wolfer and Facchinetti used 60 mg of isosorbide mononitrate at a 24-h interval for two preadmission dosages. After 24 h, the cervix began to soften and reached its peak within 48 h.[ 15 ] In all these studies, isosorbide mononitrate was administered orally, and it seems that improper absorption of the sufficient amount by vagina and cervix might address the effectiveness of this combination.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the effect of oral and vaginal isosorbide dinitrate in pre-induction cervical ripening in term pregnancy: A controlled clinical trial

2015

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Background:Cervical ripening for labor induction is one of the most important issues in midwifery. Isosorbide dinitrate (ISDN) is one of the most important choices that have been proposed for cervical ripening, but still there are controversies regarding its prescription. The present study aimed to evaluate the effects of vaginal and oral ISDN compared to the control group for pre-induction cervical ripening.Materials and Methods:In this non-blinded clinical trial, 149 nulliparous women with term or prolonged pregnancy were randomly selected and divided into three groups by block randomization. The intervention group included vaginal (50 subjects, 40 mg) and oral (49 subjects, 20 mg) ISDN groups. The third group was the control group (50 subjects) which did not receive any medication. The amount of ripening was given by Bishop score evaluated before taking medication and 24 h after taking it.Results:After 24 h, Bishop score in vaginal ISDN group significantly increased compared to the oral ISDN and control groups (P < 0.001 for both). Although the increase in Bishop score was lower in the oral ISDN group than in the vaginal group, it had a statistically significant increase in comparison to the control group (P = 0.001). All the three groups were matched regarding pregnancy termination and cesarean causes, and there was no statistically significant difference among the three groups (P > 0.05).Conclusion:Prescribing vaginal ISDN for cervical ripening was effective, and it can be used with confidence.

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“…There is now data about the use of ΝΟ donors in induction of labor [8,9] and also first trimester terminations of pregnancy [2,10]. The published results are contradictory and inconclusive.…”

Section: Introductionmentioning

confidence: 97%

Can isosorbide mononitrate be useful in second trimester termination of pregnancies?

et al. 2013

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Oral Misoprostol and Vaginal Isosorbide Mononitrate for Labor Induction

Abstract: I.

Cited by 14 publications

References 25 publications

Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Comparing the effect of oral and vaginal isosorbide dinitrate in pre-induction cervical ripening in term pregnancy: A controlled clinical trial

Can isosorbide mononitrate be useful in second trimester termination of pregnancies?

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