Isosorbide mononitrate for cervical ripening during labour induction: A systematic review and meta-analysis of 23 randomized controlled trials

Abu‐Zaid, Ahmed; Alshahrani, Majed Saeed; Al-Matary, Abdulrahman; Khadawardi, Khalid; Miski, Najlaa Talat; Abuzaid, Mohammed; AlRasheed, May A; Baradwan, Afnan; Salem, Abdullah; Salem, Raghad Hany; Albadawi, Mohamed Ismail; Jamjoom, Mohammed Ziad; Almubarki, Abdullah AMA; Abdulmalik, Nadia Ahmed; Almugbel, Maisoon; Tulbah, Maha; Baradwan, Saeed; Alomar, Osama

doi:10.1016/j.ejogrb.2022.06.028

Cited by 2 publications

(2 citation statements)

References 40 publications

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“…Mirteimouri et al (10) stated that after receiving ISMN for cervical ripening at term, maternal blood pressure was shown to drop significantly. Abu-Zaid et al (11) stated that isosorbide dinitrate (ISDN) was proven to reduce both systolic and diastolic blood pressure more effectively than PG equivalents.…”

Section: Discussionmentioning

confidence: 99%

Use of Misoprostol versus Combined Misoprostol and Isosorbide Mononitrate for Cervical Ripening before Surgical Evacuation of Early Missed Abortion

Dayem¹,

Ahmed²,

Mohammed³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Prior to a first-trimester abortion, a vaginal misoprostol administration has been shown to have less adverse effects than either an oral or sublingual dose. Objective: The aim of the current work was to determine whether a combined therapy with isosorbide mononitrate and misoprostol for preoperative cervical ripening in the first trimester would result in improved clinical effectiveness and fewer side effects compared with misoprostol used alone. Patients and methods: This randomized clinical trial study included a total of 54 women with first trimester missed abortion between 7-12 weeks, attending at

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Section: Discussionmentioning

confidence: 99%

Use of Misoprostol versus Combined Misoprostol and Isosorbide Mononitrate for Cervical Ripening before Surgical Evacuation of Early Missed Abortion

Dayem¹,

Ahmed²,

Mohammed³

et al. 2023

The Egyptian Journal of Hospital Medicine

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“…45 Therefore, prospective research may include the need for more related RCTs on this matter. Highquality evidence from meta-analyses established the efficacy of isosorbide mononitrate as an effective cervical ripening agent during labor induction when compared with placebo 46 or dinoprostone 47 interventions. Hence, important future directions may entail head-to-head comparison between cervical osmotic dilators and other pharmacological agents (e.g., isosorbide mononitrate) for cervical ripening during labor induction.…”

Section: Future Directionsmentioning

confidence: 99%

Cervical Osmotic Dilators versus Dinoprostone for Cervical Ripening during Labor Induction: A Systematic Review and Meta-analysis of 14 Controlled Trials

et al. 2023

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Objective This study aimed to conduct a systematic review and meta-analysis of all randomized and nonrandomized controlled trials (RCTs and NCTs, respectively) that explored the maternal–neonatal outcomes of cervical osmotic dilators versus dinoprostone in promoting cervical ripening during labor induction. Study Design Six major databases were screened until August 27, 2022. The quality of included studies was evaluated. The data were summarized as mean difference or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model. Results Overall, 14 studies with 15 arms were analyzed (n = 2,380 patients). Ten and four studies were RCTs and NCTs, respectively. The overall quality for RCTs varied (low risk n = 2, unclear risk n = 7, and high risk n = 1), whereas all NCTs had good quality (n = 4). For the primary endpoints, there was no significant difference between both groups regarding the rate of normal vaginal delivery (RR = 1.04, 95% CI: 0.95–1.14, p = 0.41) and rate of cesarean delivery (RR = 1.04, 95% CI: 0.93–1.17, p = 0.51). Additionally, there was no significant difference between both groups regarding the mean change in Bishop score and mean time from intervention to delivery. The rate of uterine hyperstimulation was significantly lower in the cervical osmotic dilator group. For the neonatal outcomes, during cervical ripening, the rate of fetal distress was significantly lower in the cervical osmotic dilator group. There was no significant difference between both groups regarding the mean Apgar scores, rate of meconium-stained amniotic fluid, rate of umbilical cord metabolic acidosis, rate of neonatal infection, and rate of neonatal intensive care unit admission. Conclusion During labor induction, cervical ripening with cervical osmotic dilators and dinoprostone had comparable maternal–neonatal outcomes. Cervical osmotic dilators had low risk of uterine hyperstimulation compared with dinoprostone. Overall, cervical osmotic dilators might be more preferred over dinoprostone in view of their analogous cervical ripening effects, comparable maternal–neonatal outcomes, and lack of drug-related adverse events. Key Points

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Isosorbide mononitrate for cervical ripening during labour induction: A systematic review and meta-analysis of 23 randomized controlled trials

Cited by 2 publications

References 40 publications

Use of Misoprostol versus Combined Misoprostol and Isosorbide Mononitrate for Cervical Ripening before Surgical Evacuation of Early Missed Abortion

Use of Misoprostol versus Combined Misoprostol and Isosorbide Mononitrate for Cervical Ripening before Surgical Evacuation of Early Missed Abortion

Cervical Osmotic Dilators versus Dinoprostone for Cervical Ripening during Labor Induction: A Systematic Review and Meta-analysis of 14 Controlled Trials

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