Vaginal administration of the nitric oxide donor isosorbide mononitrate for cervical ripening at term: a randomized controlled study

Ekerhovd, Erling; Bullarbo, Maria; Andersch, Björn; Norström, Anders

doi:10.1016/s0002-9378(03)00865-2

Cited by 45 publications

(45 citation statements)

References 16 publications

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“…As seen in the Norwegian study in the current study too there was no evidence of any adverse effects on the fetus detected by CTG and umbilical artery Doppler RI and PI [19].…”

Section: Discussionsupporting

confidence: 75%

“…PR and a mild but significant decrease of both SBP (p< 0.001) and DBP (p< 0.0001), 180 minutes after vaginal ISMN 40 mg. However, none of the women in that study required medical treatment [19]. In the current study, although a mild increase of maternal PR (p< 0.001) was noted in both ISMN 40 mg and ISMN -SR 60 mg groups, there was no significant reporting of palpitations by these women.…”

Section: Discussioncontrasting

confidence: 61%

“…The maternal and fetal haemodynamic changes occurring after vaginal administration of ISMN for pre-induction cervical ripening at term, have not been found to be clinically significant [4,17,19].…”

Section: Introductionmentioning

confidence: 93%

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The efficacy of two different doses of vaginal isosorbide mononitrate in pre induction cervical ripening: a double blind randomised controlled trial

Vidanagamage

Goonewardene

2011

Ceylon Med. J.

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Objective Nitric oxide donors have been shown to cause cervical ripening. The aim of this study was to evaluate the effects on the mother and the fetus when isosorbide mononitrate (ISMN) 40 mg or the sustained release ISMN (ISMN -SR) 60 mg was administered vaginally for preinduction cervical ripening.Methods A double blind randomised controlled trial. Consecutive women (n=156) with uncomplicated singleton pregnancies between 40 weeks +5 days and 41 weeks' gestation with modified Bishop Scores (MBS) <5 were allocated by stratified (primp / multip) block randomisation to receive ISMN 40 mg, ISMN -SR 60 mg or the placebo vitamin C 100 mg vaginally.Results At the commencement of the study the parity and mean age, MBS, pulse rate (PR), systolic and diastolic blood pressure (SBP and DBP), umbilical artery resistance index (RI) and pulsatility index (PI) were similar among the three treatment groups. There was significant increase (p<0.001) of mean MBS by 1.3 (95% CI 0.8, 1.7) in primips and by 1.7 (95% CI 1.3, 2.0) in multips at 6 hours and by 2.4 (95% CI 1.9, 2.7 ) in primips and by 2.3 (95% CI 2.0, 2.6) in multips at 48 hours. Greater proportions of primips (42% with ISMN -SR 60 mg and 31% with ISMN 40 mg, p<0.05) were favourable for induction of labour (IOL) after 48 hours in comparison with the controls (7.6%). Greater proportions of multips (46% with ISMN -SR 60 mg and 40% with ISMN 40 mg, p<0.05) were favourable for IOL after 48 hours in comparison with the controls (16%). A mean increase of PR by 6.7-10.2 bpm (95% CI 5.0 -12.5, p<0.001) in both ISMN groups at 180 minutes persisted up to 360 minutes. A mean reduction of SBP by 7.3 -10 mmHg (95% CI = 8.0-11.5, p<0.001) in both ISMN groups at 180 minutes persisted up to 360 mins. No significant change was seen in DBP, RI or PI. Frequency of maternal side effects (mainly headache) were higher in ISMN groups. Conclusions

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“…As seen in the Norwegian study in the current study too there was no evidence of any adverse effects on the fetus detected by CTG and umbilical artery Doppler RI and PI [19].…”

Section: Discussionsupporting

confidence: 75%

Section: Discussioncontrasting

confidence: 61%

See 1 more Smart Citation

The efficacy of two different doses of vaginal isosorbide mononitrate in pre induction cervical ripening: a double blind randomised controlled trial

Vidanagamage

Goonewardene

2011

Ceylon Med. J.

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“…Thus nitric oxide donors such as IMN appear to be the ideal cervical ripening agent prior to labour induction. 11 Isosorbide mono nitrate (IMN) is a nitric oxide (NO) donor that can be used for cervical ripening without causing uterine contractions and the need for fetal monitoring and therefore be safely administered at home. 8,12 Studies have also shown that vaginal IMN has no clinically significant adverse effects on either maternal or fetal haemodynamics.…”

Section: Introductionmentioning

confidence: 99%

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

Meena¹,

Bindal²,

Meena

2016

Int J Reprod Contracept Obstet Gynecol

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“…The standardized cervical priming and induction of labor are predominantly achieved by means of PG administration. However, in the recent years, there has been a considerable interest in the use of misoprostol [3][4][5] and NO donors [6,7] for cervical ripening and labor induction.…”

Section: Introductionmentioning

confidence: 99%

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

Dave

Nigam

Maru

2014

J Obstet Gynecol India

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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.

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Vaginal administration of the nitric oxide donor isosorbide mononitrate for cervical ripening at term: a randomized controlled study

Cited by 45 publications

References 16 publications

The efficacy of two different doses of vaginal isosorbide mononitrate in pre induction cervical ripening: a double blind randomised controlled trial

The efficacy of two different doses of vaginal isosorbide mononitrate in pre induction cervical ripening: a double blind randomised controlled trial

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

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

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