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.
|Number of pages||5|
|Journal||BJOG: An International Journal of Obstetrics and Gynaecology|
|Publication status||Published - 2001|
Bibliographical noteRIS file
- Abortifacient Agents, Nonsteroidal Abortion, Induced Adult Cervical Ripening Drug Therapy, Combination Female Humans Isosorbide Dinitrate Misoprostol Nitric Oxide Donors Pregnancy Treatment Outcome Vasodilator Agents
Ledingham, M. A., Thomson, A. J., Lunan, C. B., Greer, I. A., & Norman, J. E. (2001). A comparison of isosorbide mononitrate, misoprostol and combination therapy for first trimester pre-operative cervical ripening. BJOG: An International Journal of Obstetrics and Gynaecology, 108(3), 276-280.