Comparative study between vaginal isosorbide mononitrate and misoprostol for induction of cervical ripening prior to first trimester surgical abortion

Background: To evaluate the efficacy of the tab. isosorbide mononitrate 80 mg and tab. misoprostol 400 µg given transvaginal for cervical ripening before surgical evacuation in early embryonic demise upto 12 weeks of gestation (missed abortion). Methods: The present randomized controlled trial was conducted in Bebe Nanaki mother and child care centre, attached to govt. medical college, Amritsar, from August 2011 to September 2013 after approval of institutional research committee. All the 50 women were included after obtaining a written consent, and after proper history taking and examinations and were allocated randomly into two groups. In group A patients, tab. isosorbide mononitrate 80 mg was given and in group B patients, Tab. Misoprostol 400ug was given up to maximum of four doses until cervical dilatation of >8 mm has been achieved. Lack of cervical dilatation >8 mm after the 4th dose of medication was considered as a failure of treatment. Results: In this study, the success rate was more with tab. misoprostol group (96%) as compared to tab. isosorbide mononitrate group (80%), whereas the failure rate with tab. misoprostol group was 4% and with tab. isosorbide mononitrate group was 20%. Cervical ripening with tab. misoprostol was rapid with less frequency of dosage and less induction to ripening interval. Specific side effects are there for both the groups. Conclusions: In our study we observed that, tab. misoprostol appeared to be more effective than tab. isosorbide mononitrate.