Comparative study between misoprostol alone versus misoprostol with isosorbide mononitrate in case of second trimester termination of pregnancy in patients with previous caesarean section

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, Faculty of Medicine, Beni-Suef University, Beni-Suif, Egypt.

2 Department of Obstetrics and Gynecology, Fayoum Hospital, Fayoum, Egypt

Abstract

 Background: Misoprostol is a medication that is frequently used to end second-trimester abortions. Isosorbide mononitrate (ISMN), a nitric oxide donor, has been used to induce labor and ripen the cervix.
Objective: Our goal was to assess the effects of misoprostol alone vs misoprostol with ISMN on cervical ripening and abortion induction during the second trimester of pregnancy.
Patients and Methods: This was a randomized clinical trial performed on 100-second trimesters missed abortion pregnant females. Patients were randomly allocated to either group A (n=50) received combined ISMN 40 mg with Misoprostol 100 mcg or group B (n=50) received only vaginal Misoprostol 100 mcg. Ultrasound was performed to identify the gestational age, ensure that there was no cardiac pulsation of the fetus, the site of the placenta, and if there was placental hematoma or separation, any fetal anomalies, and the state of the previous scar (intact scar).
Results: The 2nd-trimester termination of pregnancy using ISMN plus misoprostol takes a significantly shorter time than misoprostol alone. In the misoprostol group, 6 women (12%) was significantly less than the ISMN + Misoprostol group where 15 (30.0%) aborted after the first dose. There was a non-significant difference after 2nd dose, further 18/44 (40.9%) women aborted in the misoprostol group and 16/35 (45.7%) women in ISMN with the misoprostol group.
Conclusion: The use of ISMN in addition to misoprostol in medical induction of second-trimester abortion may be more effective than misoprostol alone and was associated with fewer side effects such as vomiting and colic except headache was more with isosorbide mononitrate. 

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