A comparison between Efficacy of Vaginal Isosorbide Mononitrate and Low Dose Syntocinon on Cervical Ripening at Labor

Document Type : Original Article

Authors

1 Associate Professor and Infertility Fellowship, Department of Obstetrics & Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2 Assistant Professor, Department of Obstetrics & Gynecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

3 Resident, Department of Obstetrics & Gynecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

4 Assistant Professor, Department of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Abstract

Introduction: Cervical ripening for labor induction is one of the obstetrical problems. The aim of this study was to compare the efficacy profile of isosorbide mononitrate with low dose syntocinon for cervical ripening at labor.
 
Methods: The study population was nulliparous women referred to Shahid Sadoughi Hospital of Yazd in 2008-2009. 100 primigravid women were randomly assigned to two groups that received either vaginal isosorbide mononitrate tablets 40 mg (n= 50) or low-dose syntocinon (n= 50) with simplification method. Effectiveness of each agent was the cervical ripening effect and the time from initiation of the treatment to delivery that were compared between two groups. Efficacy and safety outcomes were compared in two groups. Data were analyzed by t-test and Fisher’s exact test with SPSS software version 15.
 
Results: The results showed that there were no significant differences between the two groups regarding mean of age and gestational age (with sonography and Last Menstrual Period). Mean of cervical ripening time was 36.13±4.057 hours in isosorbide mononitrate group and 36.28±3.886 hours in low–dose syntocinon group (P=0.876). There was no significant difference in mode of delivery (cesarean or vaginal) between two groups. The most common side effect in isosorbide mononitrate group was light headache (70%) and in low-dose syntosinon group it was tachysystole/hypertone (4%). One and five minute’s neonatal apgar were similar in two groups.
 
Conclusion: Use of vaginal isosorbide mononitrate was as effective as low dose syntocinon in cervical ripening can be used as an effective, simple, low cost and safety method in cervical ripening.

Keywords


1. Tenore. JL. Methods for cervical ripening and induction of labor. Am Fam physician 2003; 67: 2123-8.
2. Bollapragada S, Mackenzie F, Norrie J, Petrou S, Reid M, Greer I, et al. IMOP: randomised placebo
controlled trial of outpatient cervical ripening with isosorbide mononitrate (IMN) prior to induction of labor–
clinical trial with analyses of efficacy, cost effectiveness and acceptability. BMC Pregnancy Childbirth
2006;6:25.
3. Osman I, Mockenzie F, Norrie J, Murray HM, Greer IA, Norman JE. A randomized comparison of PGE2 gel
with the nitric oxide donor ISOSORBIDE MONONITRATE for cervical ripening before the induction of
labor at term. Am J Obstet Gynecol 2006;194(4):1012-21.
4. Cunningham F, Kenneth L, Bloom S, Hauth J, Gilstrap L, wenstrom K. Williams Obstetrics. 22nd ed. New
York: McGraw Hill; 2005. p. 22- 25.
5. American College of Obstetrics and Gynecologists (ACOG): Assessment of Fetal Lung Maturity (ACOG
educational bulletin No. 230). Washington, DC, ACOG, 1996.
6. ACOG committee on obstetric practice. ACOG committee opinion No. 342 induction of labor for vaginal
birth after cesarean delivery. Obstet Gynecol 2006;108(2):465-8.
7. Mullin PM, House M, Paul RH, Wing DA. A comparison of vaginally administered misoprostol with extra –
amniotic saline solution infusion for cervical ripening and labor induction. Am J Obstet Gynecol
2002;187(4): 847-52.
8. Harman JH Jr, Kim A. Current trends in cervical ripening and labor induction. Am Fam Physician.
1999;60(2):477-84.
9. Nicoll AE, Mackenzie F, Greer IA, Norman JE. Vaginal application of the nitric oxide donor isosorbide
mononitrate for preinduction cervical ripening: a randomized controlled trial to determine effects on maternal
and fetal hemodynamics.Am J obstet Gynecol 2001;184(4):958-64.
10. Nunes P F, Campos PR, Manvel M. Intravaginal glyceryl trinitrate and dinoprostone for cervical ripening and
induction of labor. Am J Obstet Gynecol 2006 Apr;194(4):1022-6.
11. Habib SM, Emam SS, Saber AS. Outpatient cervical ripening with nitric oxide donor ISOSORBIDE
MONONITRATE prior to induction of labor. Int J Gynaecol Obstet 2008;101(1):57-61.
12. Rameez MF, Goonewardene IM. Nitric oxide donor isosorbide mononitrate for pre-induction cervical
ripening at 41 weeks' gestation: A randomized controlled trial. J Obstet Gynecol Res 2007; 33: 452-6.
13. Bullarbo M, Orrskog ME, Andersch B, Granström L, Norström A, Ekerhovd E. Outpatient vaginal
administration of the nitric oxide donor isosorbide mononitrate for cervical ripening and labor induction
postterm: a randomized controlled study. Am J Obstet Gynecol 2007; 196(1):50.e1-5.
14. Ekerhovd E, Bullarbo M, Andersch B, Norström A. Vaginal administration of the nitric oxide donor
isosorbide mononitrate for cervical ripening at term. Am J obstet gynecol 2003; 189: 1692-7.
15. Sanchez-Ramos L, Kaunitz AM, Del Valle GO, Delke I, Schroeder PA, Briones DK. Labor induction with
the prostaglandin E1 methyl analogue misoprostol versus oxytocin: a randomized trial. Obstet Gynecol
1993;81(3):332-6.
16. Ferguson JE 2nd, Head BH, Frank FH, Frank ML, Singer JS, Stefos T, et al. Misoprostol versus low dose
oxytocin for cervical ripening: a prospective, randomized double-masked trial. Am J obstet Gynecol
2002;187(2):273-9.
17. Radulovic N, Norstrom A, Ekerhovd E. Outpatient cervical ripening before first–trimester surgical abortion:
a comparison between misoprostol and ISOSORBIDE MONONITRATE. Acta Obstet Gynecol Scand
2007;86(3):344-8.
18. Arteaga-Troncoso G, Villegas-Alvarado A, Belmont-Gomez A, Martinez-Herrera FJ, Villagrana-Zesati R,
Guerra-Infante F. Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of
cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester
surgical evacuation of retained products of conception. BJOG 2005;112(12):1615-9.
19. Haghighi L, Hemmat M. Comparison of the Effect of Prostaglandin Suppository & Intravaginal Isosorbide
Dinitrate on Cervical Dilatation in the First Trimester of Pregnancy. J Iran Univ Med Sci 2004;11(43):731–6.
20. Thomson AJ, Lunan CB, Ledingham M, Howat RC, Cameron IT, Greer IA, et al. Randomised trial of nitric
oxide donor versus prostaglandin for cervical ripening before first-trimester termination of pregnancy. Lancet
1998;3;352(9134):1093-6.