To compare the safety and efficacy of intravaginal administration of isosorbide mononitrate tablet as pre-surgical cervical ripening agent with those of intravaginal application misoprostol tablets before MVA for first trimester termination of pregnancy.

Methodology: It was randomized trial control study with conducted on 50 women, randomly divided into 2 groups- A and B. The women in group A were given Isosorbide mononitrate tablet(two 20 mg tablets) into the posterior fornix of vagina  3 hrs before MVA.

Results: In Group A 36% required further dilatation, in Group B 16% required further dilatation,  In Group A 64%  & Group B- 84% did not require further dilatation. And we have found statistically significant p value in Group B in respect of Group A i.e (0.02).

Conclusion: To conclude this study reveals that intravaginal Misoprostol can also be used as an effective and safe alternative to Isosorbide mononitrate for cervical ripening prior to first trimester surgical termination of pregnancy.

1. Das V, Jain S, Gupta H, Agrwal A, Pandey S, Amita. Evaluation of newer methods of early pregnancy termination. The Journal of Obst and Gynec. of India 2005;55(5):454-6.
2. WHO Safe Abortion: Technical and policy guidance for health systems. Geneva World Health Organization; 2003 Ipas. Abortion Care. Accessed April10,2007.
3. Kelly RW. Inflammatory mediators and cervical ripening. J Reprod Immunol 2002; 57:217-224.
4. Kierse M Prostaglandins in preinduction cervical ripening: meta-analysis of worldwide clinical experience. J Reprod Med 1993; 38:89-100.
5. Keirse M Any prostaglandin/any route for cervical ripening. 1995; Oxford, UK: Cochrane Collaboration.
6. Maymon R, Shulman A, Pomerans M, Holtzinger M, Haimovich L, Bahary C. Uterine rupture at term pregnancy with the use of intracervical prostaglandin E2 gel for induction of labor. Am J Obstet Gynecol 1991,165:368-370.
7. Herabutya Y, O-Prasertsawat P, Pokpirom J. A comparison of intravaginal misoprostol and intracervical prostaglandin E2 gel for ripening of unfavorable cervix and labor induction. J Obstet Gynaecol Res 1997; 23:369-374.
8. Thomson AJ, Lunan CB, Cameron AD, Cameron IT, Greer IA and Norman JE. Nitric oxide donors induce ripening of the human cervix; A Randomized controlled trail. Br. J. Obstet- Gynaecol 1997:104 (9) ; 1054-1057.
9. Suk Wai Ngai, Yik Ming Chan. Oi Shan Tang et al. “The use of misoprostol for preoperative cervical dilatation prior to vacuum aspiration: a randomized trial” Human reproduction, 1999; Vol 14 (8): 2139 – 2142.
10. Licf,Chan cw. Hopc. A comparison of ISMN and misoprostoln cervical ripening before suction evacuation obstel Gynecol. 2003 Sep; 102 (3) : 583-8.
11. Ziemann M, Fong SK, Benowitz NL, et al. "Absorption kinetics of misoprostol with oral or vaginal administration" Obstet Gynecol, 1997, Vol 90: 88-92.
12. Ngai SW, Yeung KC, Lao T, Ho PC. “Oral misoprostol versus vaginal gemeprost for cervical dilatation prior to vacuum aspiration in women in the sixth to twelfth week of gestation.” Contraception.1995 Jun; 51(6): 347-350.
13. Krishna U, Gupta AN, Ma HK, Manuilova I, Hingorani V, Prasad RN, et al. “Randomized comparison of different prostaglandin analogues and laminaria tent for preoperative cervical dilatation. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Prostaglandins for Fertility Regulation.” Contraception. 1986 Sep; 34(3): 237-251.
14. Bygdaman M. “Termination of second trimester pregnancy with laminaria and intramuscular 15-methyl PGF2 alpha or 16-phenoxy-omega-17,18,19,20-tetranor PGE2 methyl sulfonylamide. A randomized multicenter study.” Int J Gynaecol Obstet. 1988 Feb; 26(1): 129-135.

Dr P. B. Jaju

Professor Department of Obs & Gynaecology BLDE (Deemed to be University) Bijapur