Comparing the effects of vaginal misoprostol and isosorbide mononitrate on cervical ripening in abortions under 20 weeks: a randomized controlled trial
DOI:
https://doi.org/10.18203/2349-3259.ijct20221104Keywords:
Misoprostol, Isosorbide mononitrate, Abortion, Cervical ripeningAbstract
Background: In the first trimester of pregnancy, 15 to 20 percent of pregnancies result in miscarriage. Misoprostol is a widely medication that used for induction of labor in the second trimester; therapies, early termination of pregnancy and also used in duration of term delivery. The objective of this study was to comparing the effects of vaginal misoprostol and isosorbide menonitrate on cervical ripening in abortion under 20 weeks.
Methods: In this prospective randomized clinical trial, 120 pregnant women with miscarriage were enrolled in the study and randomly divided into 3 groups: vaginal misoprostol, isosorbide mononitrate and control group. The effect of all drugs on cervical dilatation and ripening, time needed for abortion, and also their side effects were evaluated.
Results: The mean of VAS in misoprostol group with 6.2±2.3 was significantly more than isosorbide mononitrate group with 3.4±1.5 and control group with 3.2±2.4. The rate of abortion in misoprostol group was significantly lower than other two groups. The change in dilation rate more than 3 cm in misoprostol group with 50% was significantly more than other two groups with 35% and 20%. Nausea, diarrhea, fever and bleeding rate were higher in the misoprostol group than other two groups. Headache in the isosorbide mononitrate group was significantly higher than the other groups.
Conclusions: The results showed that we can use isosorbide mononitrate as a suitable alternative with better safety to vaginal misoprostol in cervical repining in abortions under 20 week.
References
Cunningham FG, Hauth JC, Leveno KJ, Gilstrap L, Bloom SL, Wenstrom KD. Williams obstetrics. 24th ed. New York, NY: McGraw Hill; 2015: 41-42.
Gynuity Health Project. Map of Misoprostol Approval page, 2008. Available at: https://gynuity. org/downloads. Accessed on 21 January 2022.
Bollagragada S, Mackenzie F. A randomized placebo controlled trial of outpatient cervical ripening with isosorbidemononitrate prior to induction of labour. BMC Pregnancy Childbirth. 2006;6:25.
Ekerhovd E, Bullarbo M, Andersch B, Norström A. Vaginal administration of the nitric oxide donor isosorbide mononitrate for cervical ripening at term: a randomized controlled study. Am J Obstet Gynecol. 2003;189(6):1692-7.
Buhimschi I, Ali M, Jain V, Chwalisz K, Garfield RE. Differential regulation of nitric oxide in the rat uterus and cervix during pregnancy and labour. Hum Reprod. 1996;11(8):1755-66.
Tommiska MR. Nitric oxide in the human uterine cervix: endogenous ripening factor. Ann Med. 2008;40(1):45-5.
Wing DA. Labor induction with misoprostol. Am J Obstet Gynecol. 1999;181(2):339-45.
Herabutya Y, Prasertsawat P, Pokpirom J. A comparison of intravaginal misoprostol and intracervical prostaglandin E2 gel for ripening of unfavorable cervix and labor induction. J Obstet Gynaecol Res. 1997;23(4):369-74.
Nicoll AE, Mackenzie F, Greer IA, Norman JE. Vaginal application of the nitric oxide donor isosorbide mononitrate for preinduction cervical ripening: a randomized controlled trial to determine effects on maternal and fetal hemodynamics. Am J Obstet Gynecol. 2001;184(5):958-64.
Chwalisz K, Shao-Qing S, Garfield RE, Beier HM. Cervical ripening in guinea-pigs after a local application of nitric oxide. Hum Reprod. 1997;12(10):2093-101.
Buhimschi I, Ali M, Jain V, Chwalisz K, Garfield RE. Differential regulation of nitric oxide in the rat uterus and cervix during pregnancy and labour. Hum Reprod. 1996;11(8):1755-66.
Facchinetti F, Piccinini F, Volpe A. Chemical ripening of the cervix with intracervical application of sodium nitroprusside: a randomized controlled trial. Hum Reprod. 2000;15(10):2224-7.
Wölfler MM, Facchinetti F, Venturini P, Huber A, Helmer H, Husslein P, et al. Induction of labor at term using isosorbide mononitrate simultaneously with dinoprostone compared to dinoprostone treatment alone: a randomized, controlled trial. Am J Obstet Gynecol. 2006;195(6):1617-22.
Gelber S, Sciscione A. Mechanical methods of cervical ripening and labor induction. Clin Obstet Gynecol. 2006;49(3):642-57.
Zargar M, Nazari MA, Hormozy L, Mohammadi MH. Efficacy of transcervical foley catheter and laminaria on induction of labor in post-term pregnancy: a clinical study. Tehran Univ Med J (TUMJ) 2014;72(3):161-6.
Lee VC, Tang OS, Ng EH, Yeung WS, Ho PC. A pilot study on the use of letrozole with either misoprostol or mifepristone for termination of pregnancy up to 63 days. Contraception. 2011;83(1):62-7.
Chanrachakul B, Herabutya Y, Punyavachira P. Randomized trial of isosorbide mononitrate versus misoprostol for cervical ripening at term. Int J Gynaecol Obstet. 2002;78(2):139-45.
Moukhah S, Ahmadi F. Preinduction cervical ripening using oral and vaginal isosorbide dinitrate in patients with term pregnancy : A randomized clinical trial. Koomesh. 2016;17(4):863-70.
Dehghani FR, Sekhavat L, Ghafoorzadah M, Tabatabaii R, Farajkhoda T. A comparison between Efficacy of Vaginal Isosorbide Mononitrate and Low Dose Syntocinon on Cervical Ripening at Labor. Iranian J Obstetr Gynecol Infert. 2011;14(3):29-39.
Yazdizadeh H, Abedi P, Najar SH, Ahmadi AK. The Effect of Vaginal Administration Isosorbide Mononitrate on Cervical Ripening and Iduction of Labor In Postterm Pregnancy. Jundishapur Scientif Med J. 2012.
Habib SM, Emam SS, Saber AS. Outpatient cervical ripening with nitric oxide donor isosorbide mononitrate prior to induction of labor. Int J Gynaecol Obstet. 2008;101(1):57-61.
