Randomized trial of isosorbide mononitrate versus misoprostol for cervical ripening at term
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...
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Published in | International journal of gynecology and obstetrics Vol. 78; no. 2; pp. 139 - 145 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Shannon
Elsevier Ireland Ltd
01.08.2002
Elsevier Science |
Subjects | |
Online Access | Get full text |
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Summary: | 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 μg 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. |
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ISSN: | 0020-7292 1879-3479 |
DOI: | 10.1016/S0020-7292(02)00128-5 |