General Obstetrics and Gynecology: ObstetricsVaginal application of the nitric oxide donor isosorbide mononitrate for preinduction cervical ripening: A randomized controlled trial to determine effects on maternal and fetal hemodynamics☆
Section snippets
Methods
The study was performed at the Glasgow Royal Maternity Hospital between August 1998 and July 1999. Primigravid women who were to undergo induction of labor were asked to participate in the study. Approval was granted by the local ethics committee. Written informed consent was obtained from each participant before recruitment.
Women who wished to participate in the study were assessed by vaginal examination. Assessment of the cervix included an assessment of consistency, length, dilatation,
Results
By the end of the 1-year study period, 38 women had been recruited to the study. Two of the women recruited were excluded from the study after a treatment had been allocated but before its administration. One of these women was excluded because of breech presentation and the other because treatment administration was delayed and, in the interval, spontaneous labor ensued. These women were excluded from the analysis.
Thirteen women received isosorbide mononitrate, 20 mg. These women had a median
Comment
Nitric oxide, also known as endothelium-dependent relaxing factor, is an important biologic mediator in human beings.13, 14 Nitric oxide is a small, highly reactive free radical gas with a half-life of 4 seconds. Nitric oxide is synthesized from the amino acid L -arginine by the action of the enzyme nitric oxide synthase. There are 3 isoforms of the enzyme—neuronal, inducible, and endothelial (forms I, II, and III). Nitric oxide exerts its effects in part by stimulation of guanylate cyclase and
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Cited by (44)
Recent advances on the development of NO-releasing molecules (NORMs) for biomedical applications
2024, European Journal of Medicinal ChemistryIsosorbide mononitrate for cervical ripening during labour induction: A systematic review and meta-analysis of 23 randomized controlled trials
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :At present, the current evidence on IMN compared with control interventions in stimulating cervical ripening prior to labour induction is inconclusive. Due to these discrepant RCT results [15-36,38], the present authors conducted this up-to-date systematic review and meta-analysis to assess the efficacy and safety of IMN in promoting cervical ripening during labour induction. Such research is critical to synthesize solid and conclusive evidence-based recommendations.
Addition of vaginal isosorbide mononitrate for labor induction in pregnancies complicated by hypertensive diseases of pregnancy: a randomized controlled trial
2021, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :IMN remains an option for labor induction in these patients based on previous studies in which IMN has been safely used for cervical ripening. Maternal headache is not an unexpected finding in this cohort as this is the most common side effect of NO medications and it has been noted in previous studies using NO donors.16–19 Intracervical Foley catheter placement, duration of labor, and rate of AROM were similar between groups.
Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy in an outpatient setting
2012, International Journal of Gynecology and ObstetricsVaginal isosorbide mononitrate or misoprostol for cervical ripening in term pregnancies
2009, Clinica e Investigacion en Ginecologia y ObstetriciaOutpatient cervical ripening with nitric oxide donor isosorbide mononitrate prior to induction of labor
2008, International Journal of Gynecology and ObstetricsCitation Excerpt :Women with rupture of membranes after taking the study medication were offered the option of immediate augmentation with oxytocin or delaying augmentation with oxytocin until the next morning, depending on the condition of their cervix. IMN was given as a 40 mg dose because this dose has been reported in previous studies to be effective in inducing cervical ripening both in the first trimester [8,9] and at term [10] with no harmful effects on maternal hemodynamics [14] and without significant side effects [10]. An increase in the ripening effect of IMN would most likely occur if vaginal administration of the drug is repeated.
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