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Int J Gynaecol Obstet. 2002 Aug;78(2):139-45.

Randomized trial of isosorbide mononitrate versus misoprostol for cervical ripening at term.

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1
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. mgxbc@nottingham.ac.uk

Abstract

OBJECTIVES:

To assess the adverse effects of isosorbide mononitrate (IMN) compared with misoprostol for cervical ripening at term.

METHODS:

One hundred and seven women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly allocated to receive either a 40-mg IMN tablet vaginally (n = 55) or 50 microg misoprostol vaginally (n = 52) every 6 h for a maximum of three doses. They were sent to the labor ward for amniotomy or oxytocin if either their Bishop scores were more than 6 or their cervices were not ripe 24 h after the treatment. Adverse effects, progress, and outcomes of labor were assessed.

RESULTS:

Isosorbide mononitrate was associated with fewer adverse effects especially uterine tachysystole (0 vs. 19.2%, P < 0.01) and hyperstimulation (0 vs. 15.4%, P < 0.01). The time from start of medication to vaginal delivery in IMN group was significantly longer (25.6 +/- 6.1 vs. 14 +/- 6.9 h, P < 0.01). Oxytocin was needed in 51 women (92%) of the isosorbide mononitrate group and six women (11%) of the misoprostol group (P < 0.001). The cesarean rate was not significantly different between the groups, but the major indications were different: dystocia (45%) in the IMN group vs. persistent non-reassuring fetal heart rate pattern (56%) in the misoprostol group.

CONCLUSIONS:

Cervical ripening with IMN resulted in fewer adverse effects, but was less effective than misoprostol.

PMID:
12175715
[Indexed for MEDLINE]
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