Isosorbide Mononitrate versus Misoprostol for Cervical Ripening in Early Missed Abortion

Abstract
Background: First-trimester pregnancy loss is the most common complication of human reproduction with an inci-dence ranging between 50 and 70% of all conceptions. The uterine cervix has to be firm enough to retain the conceptus through the pregnancy. Cervical ripening and maturation is very important prerequisite for the successful termination of pregnancy. Misoprostol softens the cervix and cause uterine contractions used for ripening of the cervix before surgical or for medical abortion. Isosorbide mononitrate promote cervical smooth muscle relaxation has been applied clinically as cervical ripening agents. First trimester abortion is termi-nated by surgical evacuation of the uterus.
Conclusion: Cervical preparation is beneficial prior to surgical abortion and should be routine if gestation more than 10 weeks using one of cervical ripening agents Misoprostol or IMN.
Aim of Study: To compare efficacy and safety of Isosorbide Mononitrate (IMN) and misoprostol for cervical ripening prior to surgical termination of missed abortion aged between 8 and 12 weeks.
Patients and Methods: Eighty patients aged between 20 & 35 years presenting with missed abortion in early weeks of gestation and requiring medical or surgical evacuation of the retained products of conception were included in this prospective clinical study. Number of doses required to achieve cervical ripening, Induction-Ripening interval (I/R) was recorded. Amount of operative blood loss and other safety indices were assessed.
Results: Number of doses to achieve cervical ripening using (Misoprostol) was significantly less than number of the (IMN) doses and with further analytical statistics about 66% of cases have successful ripening using (Misoprostol) compared to only 31% using (IMN). The mean (I/R interval) was as follows; 18.5 hours for (Misoprostol) and 22.5 hours for (IMN); with much less operative blood loss for the Misoprostol group than the IMN group.