Vaginal Isosorbide Mononitrate Effective for Cervical Ripening and Labor Induction

[Dr. Nika]

By Will Boggs

NEW YORK (Reuters Health) Feb 09 - Vaginal isosorbide mononitrate can be safely used for cervical ripening and labor induction postterm, according to a report in the January American Journal of Obstetrics & Gynecology.

"Isosorbide mononitrate is not more effective as treatment for labor induction and cervical ripening than prostaglandins," Dr. Maria Bullarbo from Sahlgrenska University Hospital, Gothenburg, Sweden told Reuters Health, "but it seems to be of more advantage for the fetus, as there are no reports so far of uterine hypertonus from the treatment, and it seems that the patient convenience and satisfaction are much higher with the outpatient setting."

Dr. Bullarbo and associates investigated the effects of vaginally administered isosorbide mononitrate (40 mg) on cervical ripening and initiation of labor in 200 pregnant women of at least 42 weeks' gestation with an unripe cervix.

Twenty-two of 100 women treated with vaginal isosorbide mononitrate went into labor before the return appointment the following day, the authors report, compared with 8 of 100 women in the placebo group.

Twenty of the women in the isosorbide group who went into labor within 24 hours had uncomplicated vaginal delivery, the results indicate, and two underwent cesarean section due to fetal distress.

Neonatal outcomes did not differ in the isosorbide and placebo groups, the researchers note, but more mothers in the isosorbide group than in the placebo group reported headache after treatment. Nausea was also more common among women in the isosorbide group.

Most women in both groups were either positive or very positive to the treatment and would recommend the procedure to other women in their condition, the report indicates.

"Maybe the most important fact to stress is that this outpatient treatment most likely reduces hospital cost substantially," considering that labor induction is being performed more frequently, Dr. Bullarbo said.

"We were a little bit disappointed to get only 22% of treated women in labor," Dr. Bullarbo said. "However, it is likely that postterm women for some reason are more difficult to get in labor when induced."

Am J Obstet Gynecol 2007;196:50.e1-50.e5.



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