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

Abstract

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

Efficacy and safety of isosorbide mononitrate plus misoprostol compared to misoprostol alone in the management of the first and second trimester abortion: a systematic review and meta-analysis

“…All seven included studies were randomized controlled trials. The studies were conducted in various countries, including India [ 16 , 17 ], Egypt [ 13 , 14 , 25 ], the UK [ 18 ], and Greece [ 15 ]. The studies were published from 2001 [ 18 ] to 2023 [ 13 ].…”

“…The studies were conducted in various countries, including India [ 16 , 17 ], Egypt [ 13 , 14 , 25 ], the UK [ 18 ], and Greece [ 15 ]. The studies were published from 2001 [ 18 ] to 2023 [ 13 ]. The sample sizes ranged from 54 [ 13 ] to 160 [ 14 ] per study.…”

“…The studies were published from 2001 [ 18 ] to 2023 [ 13 ]. The sample sizes ranged from 54 [ 13 ] to 160 [ 14 ] per study. The interventions included the combination of vaginal ISMN and misoprostol versus misoprostol alone for first and second-trimester abortions.…”

“…In three studies [ 13 , 18 , 25 ], women who were going to have an abortion in the first trimester of pregnancy were included in the study. Two studies were conducted on pregnant women at 12–20 weeks of gestation [ 16 , 17 ], and in the remaining two studies [ 14 , 15 ], women were included in the study from the 13th to the 24th week of pregnancy.…”

“…Previous clinical trials have confirmed that the combination of ISMN and misoprostol administration is associated with a higher chance of success for second-trimester abortions when compared to misoprostol administration alone [ 10 , 13 – 17 ]. However, a study from the UK in 2001 found that using misoprostol with nitric oxide donor was not better than using misoprostol alone for cervical maturation in the first trimester [ 18 ].…”