Isosorbide Mononitrate and Misoprostol for Cervical Ripening in Induction of Labor

Abstract

Background: The most favorable method for cervical ripening is not fully agreed upon by practitioners; however,isosorbide mononitrate administration is considered a low-risk method of labor induction for pregnant women at full term. Objectives: The aim of this study is to evaluate the safety and effectiveness of adding isosorbide mononitrate to misoprostol for cervical ripening in prelabor induction of full term pregnant women in comparison with misoprostol alone. Design: Randomized study. Setting:Ain Shams Maternity teaching hospital. Patients and methods:120 women were divided randomly into two equal arms of 60 women in each one. Intervention:Patients admitted through the reception room or outpatient clinic and they scheduled for induction of labor. Group I were given intravaginal isosorbide mononitrate with misoprostol while group II were given placebo with misoprostol intravaginally. Results:Group I showed better significant improvement than Group II in Bishop Score after 6 hour (7.9 vs 6.6, P=0.001), shorter duration of active phase(8.2 vs 10.9h, P=0.001), as well as the duration of labor(12 vs 17.1h, P=0.001) in group I comparing to group II. The main side effect of IMN was headache. Conclusion: The addition of Isosorbide mononitrate to miso - prostol is safe and increases the effectiveness of pre-induction cervical ripening in comparison to misoprostol alone.