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.
Conclusion
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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References
Kelly A J, Kavanagh J, Thomas J: Vaginal prostaglandin (PGE2 and PG F2a) for induction of labour at term, Cochrane Database Sys Rev 2003 CD003101, update in Cochrane Database Syst Rev.2009;(4):CD003101.
Kelly A J, Tan B: Intravenous oxytocin alone for cervical ripening and induction of labour, Cochrane Database Syst. Rev.2001 CD003246 update in Cochrane Database Syst Rev. 2009;(4):CD003246
Wing DA , Paul RH: A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction, Am J Obstet Gynecol.1996 Jul 175(1), 158-164.
Sanchez-Ramos L, Peterson DE, Delke I, et al. : Labour induction with prostaglandin E1 misoprostol compared with dino- prostone vaginal insert: A randomized trial, Obstet Gynecol.1998, 91(3), 401-405
Nunes F., Rodrigues R. and Meirinho M.: Randomized comparison between intravaginal misoprostol and dinoprostone for induction of labor, Am. J. Obstet. Gynecol.1999 Sep; 181(3) 626-629.
Chanrachakul B., Herabutya Y., Punyavachira P.: Randomized trial of isosorbide mononitrate versus misoprostol for cervical ripening at term, Int J Gynaecol Obstet.2002 Aug, 78(2)139-145,
Ekerhovd E,Bullarbo M,Andersch B, et al. : Vaginal administration of the NO donor IMN for cervical ripening at term: A randomized controlled study. Am J Obstet Gynecol 2003 Dec;189(6);1692-7 .
Rameez MF, Goonewardene IM : Nitric Oxide donor isosorbide mononitrate for pre- induction cervical ripening at 41 weeks gestation: a randomized controlled trial. J Obstet Gynaecol Res 2007Aug; 33 (4): 452-6.
Gabriel R, Darnaud T, Chalot F, et al. Transvaginal sonography of the uterine cervix prior to labor induction. Ultrasound Obstet Gynecol 2002 Mar; 19(3); 254-7.
Bullarbo M, Norstrom A, Andersch B, et al. : Isosorbide Mononitrate induces increase cervical expression of cyclooxygenase-2, but not of cyclooxygenase – 1, at term. Eur J Obstet Gynecol Reprod Bio 2007 Feb;130(2):160-164.
Thaler I, Kahana H: The effect of a nitric oxide donor on fetal heart rate patterns in patient with hypertention. Obstet Gynecol 2002 Nov; 100(5 Pt 1): 987-991.
Osman I, MacKenzie F, Norrie J, et al. The “PRIM” study: a randomized comparison of prostaglandin E2 gel with the nitric oxide donor isosorbide mononitrate for cervical ripening before the induction of labor at term. American Journal of Obstetrics and Gynecology 2006 Apr ,194(4) 1012-1021.
Compliance with ethical requirements and Conflicts of interests
The research is in compliance with ethical standards. Permissions have been taken and is approved by the intitutional ethical committee. The authors have no conflicts of interest.
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Dave, A., Nigam, P. & Maru, L. Isosorbide Mononitrate a Nitric Oxide Donor: A Study of Its Efficacy and Safety as an Agent for Cervical Ripening. J Obstet Gynecol India 65, 162–166 (2015). https://doi.org/10.1007/s13224-014-0577-5
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DOI: https://doi.org/10.1007/s13224-014-0577-5