Background: Efficacy of isosorbide mononitrate to reduce the interval of induction time in second trimester missed abortion .
Aim of the study: To compare efficacy and safety of Isosorbide Mononitrate (IMN) and misoprostol for cervical ripening in second trimestric abortion.
Patients and Methods: A randomized controlled prospective study was conducted. 160 patients aged between 18 & 35 years presenting with missed 2nd trimester abortion 13-26 wk gestation were included in this prospective clinical study. One group received only vaginal Misoprostol and the other group received combined vaginal Misoprostol with Isosorbide5-mononitrate. To determine the efficacy in form of (induction abortion interval) the duration interval between the beginning of the induction and the complete expulsion of the abortus and also the number of the doses of misoprostol needed to complete expulsion and also the adverse events that increased or newly discovered when prostaglandins and a nitric oxide donor used together such as severe bleeding, headache, abdominal pain, pelvic pain, sever hypotension, backache, fever, nausea and vomiting.
Results: It is proved in the study that combination between misoprostol and isosorbide mononitrate gives better results regarding to cervical consistency improvement, cervical dilatation, effacement, the whole induction time and the number of misoprostol doses needed to complete expulsion when compared to misoprostol alone and also fewer side effects such as abdominal pain.
Conclusion: Misoprostol is a good agent for cervical ripening when used alone but we can get a benefit from combining both misoprostol and isosorbide-5- mononitrate making a synergistic action with fewer side effects.