Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study

Authors

  • Pinkee Saxena Departement of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India
  • Neha Jaiswal Departement of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India
  • Shashi Lata Kabra Departement of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India
  • Vijay K. Kadam Departement of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, New Delhi, India
  • Vidushi Saxena Hamdard Institute of Medical Sciences and Research, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20210718

Keywords:

Isosorbide mononitrate, Misoprostol, Second trimester, Abortion

Abstract

Background: Aim of the study was to compare the efficacy of misoprostol   alone and misoprostol with isosorbide mononitrate in reducing the induction abortion time interval in second trimester termination of pregnancy.

Methods: A randomized control prospective study was conducted. Patients seeking second trimester abortions were randomized in to two groups. Group A received 400 ugm of misoprostol per vaginum every 4 hours up to maximum of 5 doses. Group B patients received 400 ugm of misoprostol and 40mg of isosorbide nitrate intravaginally. Repeat dose of 400 ugm misoprostol and 20 mg of isosorbide mononitrate was given every 4 hours up to a maximum of 5 doses. The induction to abortion interval and side effects of the drugs used were noted.

Results: A total 71 women seeking second trimester termination between 12 to 20 weeks gestation were recruited for the study. In group A, there were 36 patients and in group B there were 35 patients. In group A the mean induction abortion interval was 14.8±4.16 hours while in group B the mean induction-abortion interval was 12.45±3.9 hours. Patients treated with isosorbide mononitrate and misoprostol combination had statistically significantly lower induction abortion time interval when compared with misoprostol alone (p value 0.018).

Conclusions: The study demonstrates that the combination of isosorbide mononitrate and misoprostol is more effective for termination of second trimester pregnancy than misoprostol alone. 

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References

Medical management of abortion. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid‐trimester termination of pregnancy. Cochrane Library. 2011;(1):CD005216

Vargas J, Diedrich J. Second-trimester induction of labor. Clin obstetr gynecol. 2009;52(2):188-97.

Promsonthi P, Preechapornprasert D, Chanrachakul B. Nitric oxide donors for cervical ripening in first-trimester surgical abortion. Cochrane Database Syst Rev. 2009;1:4.

Abdellah MS, Hussien M, AboAlhassan A. Intravaginal administration of isosorbide mononitrate and misoprostol for cervical ripening and induction of labour: a randomized controlled trial. Arch gynecol obstetr. 2011;284(1):25-30.

Collingham JP, Fuh KC, Caughey AB, Pullen KM, Lyell DJ, El-Sayed YY. Oral misoprostol and vaginal isosorbide mononitrate for labor induction: a randomized controlled trial. Obstetr Gynecol. 2010;116(1):121-6.

Radulovic NV, Ekerhovd E, Abrahamsson G, Norström A. Cervical priming in the first trimester: morphological and biochemical effects of misoprostol and isosorbide mononitrate. Acta obstetricia et gynecologica Scandinavica. 2009;88(1):43-51.

Mousiolis A, Sindos M, Papantoniou N, Antsaklis A. Can isosorbidemononitrate be useful in second trimester termination of pregnancies? Contraception. 2013;88(1):41-4.

Sivakumar S, Fathima R, Radha R. Comparison of misoprostol and misoprostol with isosorbide mononitrate in second trimester termination of pregnancy. J Evidence Based Med Healthcare. 2016;3(63):3424-9.

Dickinson JE, Brownell P, McGinnis K, Nathan EA. Mifepristone and second trimester pregnancy termination for fetal abnormality in Western Australia: worth the effort. Aus N Z J Obstetr Gynaecol. 2010;50(1):60-4.

Duhan N, Gupta S, Dahiya K, Sirohiwal D, Rohilla S. Comparison of isosorbide mononitrate and misoprostol for cervical ripening in termination of pregnancy between 8 and 12 weeks: a randomized controlled trial. Arch gynecol obstetr. 2011;283(6):1245-8.

Agarwal K, Batra A, Batra A, Dabral A, Aggarwal A. Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy in an outpatient setting. Int J Gynaecol Obstet. 2012;118(3):205-9.

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Published

2021-02-24

How to Cite

Saxena, P., Jaiswal, N., Kabra, S. L., Kadam, V. K., & Saxena, V. (2021). Second trimester termination of pregnancy with misoprostol alone and misoprostol with isosorbide mononitrate: a comparative study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(3), 971–974. https://doi.org/10.18203/2320-1770.ijrcog20210718

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Original Research Articles