Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy in an outpatient setting

• Published in: International journal of gynecology and obstetrics Vol. 118; no. 3; pp. 205 - 209
• Main Authors: Agarwal, Kavita, Batra, Aruna, Batra, Achla, Dabral, Anjali, Aggarwal, Abha
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-09-2012; Elsevier
• Subjects: Adult; Antiarythmic agents; Biological and medical sciences; Cardiovascular system; Cervical Ripening; Cervical Ripening - drug effects; Delivery. Postpartum. Lactation; Female; Fetal Mortality; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Induction of labor; Isosorbide Dinitrate - administration & dosage; Isosorbide Dinitrate - adverse effects; Isosorbide Dinitrate - analogs & derivatives; Isosorbide mononitrate; Labor, Induced; Maternal Mortality; Medical sciences; Nitric Oxide Donors - administration & dosage; Nitric Oxide Donors - adverse effects; Obstetrics and Gynecology; Outpatient setting; Oxytocics - therapeutic use; Oxytocin - therapeutic use; Patient Satisfaction; Pharmacology. Drug treatments; Postdated pregnancy; Pregnancy; Pregnancy, Prolonged - drug therapy; Self Administration; Treatment Outcome; Young Adult; Isosorbide mononitrate; Cervical Ripening; Postdated pregnancy; Outpatient setting; Induction of labor; Antianginal agent; Human; Induction; Coronary vasodilator agent; Gynecology; Uterine cervix; Antiarrhythmic agent; Labor; Obstetrics; Pregnancy; Ripening; Organic nitrate; Delivery; Ambulatory; Triggering
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2012.04.017

Abstract Objective To determine the safety and effectiveness of self-administered treatment with isosorbide mononitrate (IMN) for cervical ripening in Indian women with postdated pregnancies. Methods A randomized, placebo-controlled study was conducted with 200 women with postdated pregnancies and unfavorable cervices who self-administered vaginally either 2 40-mg tablets of IMN or 2 40-mg tablets of pyridoxine as placebo prior to admission for induction of labor. The main outcome variables were change in Bishop score, time from admission to delivery, and presence or absence of fetal and maternal morbidity. Results The Bishop score was significantly improved 24 hours after initiation of the outpatient IMN treatment ( P < 0.001) and the needs for further cervical ripening and oxytocin infusion were less in the study than in the control group ( P < 0.001 and P = 0.008). The time from admission to delivery was also less ( P < 0.001). Moreover, the IMN treatment had no major adverse maternal or fetal effects. The vast majority of women in both groups were either satisfied or very satisfied with the outpatient treatment. Conclusion The self-administration, at home, of isosorbide mononitrate leads to a safe and effective cervical ripening prior to labor induction in women with postdated pregnancies. CTRI Registration No.: CTRI/2011/091/000121