Intravaginal Administration of Isosorbide Mononitrate and Misoprostol for Cervical Ripening and Induction of Labour: A Randomized Controlled Trial

Objective: Is to evaluate the efficacy and safety of intra-vaginal administration of nitric oxide (NO) donor isosorbide mononitrate plus misoprostol versus, misoprostol for cervical ripening and induction of labour. Setting: Department of Obstetrics and Gynecology, Wom-an’s Health Center, Assiut University. Methods: 290 women scheduled for labour induction were recruited were assigned randomly to isosorbide mononitrate or placebo followed by misoprostol 25 mg. The efficacy of the medication was evaluated by predetermined outcome variables for cervical ripening and induction of labour and delivery. Results: The two groups were comparable with respect to age, parity, gestational age, indication for induction, and Bishop score. Women receiving IMN plus misoprostol showed significant changes in the Bishop score 6 hours after admin-istration compared to misoprostol plus placebo (8.57±1.46 Versus 7.6±1.39 hours, p=0.001), significantly shorter intervals from the beginning of the induction to the beginning of the active phase of labour (10.97±2.87 versus 13.91±2.16 hours, p=.0004) and from the beginning of induction to the time of delivery (19.56±3.96 versus 23±2.62 p £0.001). No significant differences in the incidence of uterine hypersystole, tachysys-tole and hyperstimulation. Regarding headache, much more women suffer headache in the IMN group (51) with significant difference to placebo group (11). Conclusions: Using a combination of IMN and misoprostol is effective than misoprostol alone in terms of fast cervical ripening and shortening of induction-labour interval.