A comparison of isosorbide mononitrate and misoprostol cervical ripening before suction evacuation

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 102; no. 3; pp. 583 - 588
• Main Authors: Ivy Li, C.F, Carina Chan, C.W, Ho, P.C
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2003; Elsevier Science
• Subjects: Abortion, Induced - methods; Adolescent; Adult; Analysis of Variance; Biological and medical sciences; Cervical Ripening - drug effects; Double-Blind Method; Female; Genital system. Reproduction; Humans; Isosorbide Dinitrate - analogs & derivatives; Isosorbide Dinitrate - therapeutic use; Medical sciences; Middle Aged; Misoprostol - therapeutic use; Pharmacology. Drug treatments; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Probability; Sensitivity and Specificity; Statistics, Nonparametric; Vacuum Curettage - methods; Antianginal agent; Suction; Coronary vasodilator agent; Prostaglandin E1; Antiulcer agent; Uterine cervix; Misoprostol; Randomization; Antisecretory agent; Organic nitrate; Female; Human; Aspiration; Induced abortion; Isosorbide mononitrate; Controlled therapeutic trial; Oxytocic; Antiarrhythmic agent; Ripening; Donor; Analog; Nitric oxide; Evacuation; Double blind study; Preoperative; Comparative study; Prostaglandin derivatives
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(03)00514-3

To compare the efficacy of a nitric oxide donor (isosorbide mononitrate) and a prostaglandin E1 analogue (misoprostol) for cervical priming before suction termination of pregnancy. This was a randomized, double blind, placebo-controlled trial. One hundred twenty-six healthy women requesting termination of pregnancy between 9 and 12 weeks’ gestation were recruited. Women were randomized into three groups: control, isosorbide mononitrate, and misoprostol. All women were given moistened intravaginal study drugs (placebo, 40 mg of isosorbide mononitrate, or 400 μg of misoprostol) 4–6 hours before suction evacuation. Side effects were assessed 3 hours after drug administration. The cervical dilatation and the cumulative force required to dilate the cervix to 8 mm were measured by a cervical tonometer before suction evacuation. Operative blood loss was measured after sieving off the products of gestation. There were no differences in the baseline cervical dilatation, cumulative force, and operative blood loss between the isosorbide mononitrate and placebo groups. However, women in the misoprostol group had a significantly greater cervical dilatation, required less cumulative force, and had less blood loss than women in the isosorbide mononitrate or control group. The majority (more than 80%) of women in all three groups found their cervical priming agents acceptable. Intravaginal isosorbide mononitrate was less effective than misoprostol in cervical ripening before suction termination of pregnancy.