Nitric oxide donors induce ripening of the human uterine cervix: a randomised controlled trial.
OBJECTIVE
To determine whether nitric oxide donors can induce cervical ripening before surgical termination of pregnancy in the first trimester.


METHODS
Prospective, randomised controlled trial.


METHODS
Department of Obstetrics and Gynaecology, Royal Infirmary, Glasgow.


METHODS
Forty-eight primigravid women undergoing surgical termination of pregnancy before 12 weeks of gestation.


METHODS
The women were randomised to receive per vaginam before surgery either the nitric oxide donor isosorbide mononitrate, the nitric oxide donor glyceryl trinitrate, the prostaglandin analogue gemeprost, or no treatment.


METHODS
The cumulative force required to dilate the cervix to 8 mm was measured objectively and the cervical diameter before surgical dilatation was recorded.


RESULTS
Following isosorbide mononitrate or gemeprost, a lower cumulative force was required to dilate the cervix to 8 mm and a higher cervical diameter before dilatation was recorded. Pretreatment with glyceryl trinitrate reduced the cumulative force required to dilate the cervix but had no effect on cervical diameter.


CONCLUSIONS
Like the prostaglandin analogue gemeprost, the nitric oxide donors isosorbide mononitrate and glyceryl trinitrate can effect cervical ripening. Nitric oxide donors may provide an alternative to prostaglandins for cervical ripening before surgical procedures in the first trimester.
Thomson
A J
AJ
Department of Obstetrics and Gynaecology, University of Glasgow.
Lunan
C B
CB
Cameron
A D
AD
Cameron
I T
IT
Greer
I A
IA
Norman
J E
JE
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000328:Adult; D000527:Alprostadil / Q000031:analogs & derivatives; D002584:Cervix Uteri / Q000187:drug effects*; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives / Q000627:therapeutic use; D009569:Nitric Oxide / Q000627:therapeutic use*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies
D000020:Abortifacient Agents, Nonsteroidal; D009569:Nitric Oxide; C021182:gemeprost; D000527:Alprostadil; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate