A comparison of isosorbide mononitrate, misoprostol and combination therapy for first trimester pre-operative cervical ripening: a randomised controlled trial

M A Ledingham, A J Thomson, C B Lunan, I A Greer, J E Norman

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To determine whether a combined therapy with isosorbide mononitrate (40mg) and misoprostol (400 microg) for pre-operative cervical ripening in the first trimester would result in improved clinical effectiveness, and fewer side effects compared with each agent used alone.

DESIGN: Randomised controlled trial.

SETTING: Glasgow Royal Infirmary.

POPULATION: Sixty-six primigravid women scheduled for suction termination of pregnancy.

METHODS: Women were randomly assigned to receive before surgery, per vaginam, isosorbide mononitrate 40 mg (n = 22), misoprostol 400 microg (n = 22) or both agents together [isosorbide mononitrate 40 mg and misoprostol 400 microg] (n = 22).

MAIN OUTCOME MEASURES: 1. To assess the cumulative force required to dilate the cervix to 8 mm; 2. the onset of new symptoms before termination of pregnancy.

RESULTS: The cervical resistance following combination therapy with isosorbide mononitrate and misoprostol was not significantly different than following misoprostol alone [24.5N vs 18.5N; median difference (95% CI) 19N (-22 to 49)]. Pre-treatment with misoprostol used alone resulted in a lower cervical resistance than isosorbide mononitrate alone (18.5N vs 39N, P = 0.04, Mann-Whitney U test). There was no difference in the number of women remaining asymptomatic following either isosorbide mononitrate or misoprostol or combination therapy [14/22 (64%) vs 11/21 (52%) vs 11/22 (50%), Fisher's exact test].

CONCLUSIONS: We have not shown any advantage of combining misoprostol with the nitric oxide donor isosorbide mononitrate compared with misoprostol alone for pre-operative cervical ripening in the first trimester.

Original languageEnglish
Pages (from-to)276-80
Number of pages5
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume108
Issue number3
Publication statusPublished - Mar 2001

Keywords

  • Abortifacient Agents, Nonsteroidal
  • Abortion, Induced
  • Adult
  • Cervical Ripening
  • Drug Therapy, Combination
  • Female
  • Humans
  • Isosorbide Dinitrate
  • Misoprostol
  • Nitric Oxide Donors
  • Pregnancy
  • Treatment Outcome
  • Vasodilator Agents

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