Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient setting

Background: The objectives of the study were to Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient. Methods: A randomized, placebo controlled prospective study was conducted with 120 women with term pregnancies and unfavorable cervices who self-administered vaginally either 2, 40-mg tablets of IMN or pyridoxine as placebo prior to admission for induction of labor. The main outcome variables were change in Bishop Score, time from admission to delivery, and presence or absence of fetal and maternal morbidity. Results: The Bishop score was significantly improved 24 hours after initiation of the outpatient IMN treatment. In study group change in Bishops score was 4.83±1.88 and in control group was 1.07±1.27. The needs for further cervical ripening and oxytocin infusion were less in the study than in the control group (P=0.001). The time from admission to delivery was also less (P ≤0.001). Moreover, the IMN treatment had no major adverse maternal or fetal effects. The vast majority of women in both groups were either satisfied or very satisfied with the outpatient treatment. Conclusions: IMN self-administered at home is safe and effective for cervical ripening prior to induction of labor in women with term pregnancies. It is the very effective method for cervical ripening in outpatient setup.