Randomized Trial of Isosorbide Mononitrate for Cervical Ripening before First-Trimester Evacuation of the Uterus

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Introduction
Morbidity of surgical abortion depends on gestational age, the method of termination, age and parity. The complications of surgical abortion are infection, cervical laceration, incomplete evacuation, uterine perforation, hemorrhage and anesthetic complications [1, 2]. Surgical methods used for abortion are dilatation and curettage, dilatation and evacuation, hysterotomy and hysterectomy. Suction evacuation of the uterus remains one of the most popular options for termination of first trimester pregnancies. Cervical ripening before first-trimester surgical termination of pregnancy facilitates the procedure and reduces the operative morbidity [3, 4]. Various cervical priming agents have been evaluated and proven to be
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The studies have shown that nitric oxide donors can effectively be used for cervical ripening in term [12, 13, 14]. Although it is less effective than prostaglandin analogues but it has less side effects.
The current study was undertaken to investigate the efficacy of isosorbide mononirate (IMN) for cervical priming prior to first trimester evacuation of the uterus. The primary objective was to assess the efficacy of isosorbide mononitrate in dilatation of cervix. Duration of operation, blood loss during the operation and incidence of side effects were recorded as secondary objectives.
Materials and Methods This study was conducted at Ramathibodi Hospital, Mahidol University, Thailand, from October 2008 to June 2009. The protocol was approved by the Ethics Committee of the Faculty of Medicine, Ramathibodi hospital. Written informed consent was obtained from all women. Inclusion criteria were pregnant women with gestational age less than 12 weeks, undergoing suction evacuation under general anesthesia, no history of hypotension and ultrasonography confirmed non-viable pregnancy. Women who had previous cervical surgery, inevitable abortion, incomplete abortion, underlying medical diseases, allergy to isosorbide mononitrate and unwilling to participate in the trial were excluded. Sample size was calculated to have a power of 90%

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