Evaluation of isosorbide-5-mononitrate as a cervical ripening agent prior to induced abortion in contrast to misoprostol- a randomized controlled trial
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ObjectiveTo determine whether vaginal application of 40 mg isosorbide-5-mononitrate (ISMN) has a comparable cervicalripening efficacy to and lesser side effects than 400 μg misoprostol in women scheduled for the first trimester inducedabortion using a manual vacuum aspirator (MVA). MethodsWe conducted a prospective randomized open-label study in 70 women at 6–12 weeks of pregnancy at the R G KarMedical College and Hospital, Kolkata, India, over a period of two years from 2015 to 2017. Forty milligrams of ISMNand 400 μg misoprostol were vaginally applied for cervical priming. The primary outcome measure was the cervicalresponse assessed by the passage of the appropriate and largest sized MVA cannula through the internal os withoutresistance, at the beginning of the procedure. ResultsThe base line cervical dilatation was found to be significantly higher in the misoprostol group than in the ISMN group(7.65±1.38 vs. 6.9±1.26 mm; P=0.025, 95% confidence interval, −1.4046 to −0.953). However, when the women weresub-analyzed based on parity, there was no statistically significant difference in the same parameters among themultigravid women. The need for further cervical dilatation was significantly higher in the ISMN group when theprimigravid women were compared, although the multigravid women responded favorably to ISMN. ConclusionIn the primigravid women, misoprostol appears to exert a higher efficacy as a cervical ripening agent in contrast toISMN. However, ISMN can be used in multigravid women for the same purpose as in this group, misoprostol did notshow any significant improvement in efficacy over ISMN.
Abstract
ObjectiveTo determine whether vaginal application of 40 mg isosorbide-5-mononitrate (ISMN) has a comparable cervicalripening efficacy to and lesser side effects than 400 μg misoprostol in women scheduled for the first trimester inducedabortion using a manual vacuum aspirator (MVA). MethodsWe conducted a prospective randomized open-label study in 70 women at 6–12 weeks of pregnancy at the R G KarMedical College and Hospital, Kolkata, India, over a period of two years from 2015 to 2017. Forty milligrams of ISMNand 400 μg misoprostol were vaginally applied for cervical priming. The primary outcome measure was the cervicalresponse assessed by the passage of the appropriate and largest sized MVA cannula through the internal os withoutresistance, at the beginning of the procedure. ResultsThe base line cervical dilatation was found to be significantly higher in the misoprostol group than in the ISMN group(7.65±1.38 vs. 6.9±1.26 mm; P=0.025, 95% confidence interval, −1.4046 to −0.953). However, when the women weresub-analyzed based on parity, there was no statistically significant difference in the same parameters among themultigravid women. The need for further cervical dilatation was significantly higher in the ISMN group when theprimigravid women were compared, although the multigravid women responded favorably to ISMN. ConclusionIn the primigravid women, misoprostol appears to exert a higher efficacy as a cervical ripening agent in contrast toISMN. However, ISMN can be used in multigravid women for the same purpose as in this group, misoprostol did notshow any significant improvement in efficacy over ISMN.
참고문헌 (22)
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