Comparison of isosorbide mononitrate (Mono Mack) and misoprostol (Cytotec) for cervical ripening in the first trimester missed abortion.
OBJECTIVE
The objective of this study was to compare NO-donor isosorbide mononitrate to misoprostol, both applied as vaginal tablets for cervical ripening prior to first trimester curettage in patients with missed abortion.


METHODS
Thirty women with missed abortion were assigned after a random list to be treated either with 200 microg gemeprost (Cytotec, Pfizer, Germany) or with 40 mg isosorbide mononitrate for cervical priming at least 3 h before curettage. Vaginal bleeding or the intracervical presence of products of conception was documented. The largest number of Hegar's dilator, which could be introduced without difficulty and the largest number of Hegar's dilator at which cervical dilation was performed and the ease of mechanical dilation was assessed.


RESULTS
There were no significant differences in cervical ripeness before procedure nor in ease of dilation. In the misoprostol group, the cervical canal was more dilated before any procedure (median of Hegar's dilator 6 vs. 5) and after dilation (median of Hegar's dilator 11 vs. 10), although this difference was not significant. Vaginal bleeding occurred in two patients in each group. Products of conception were only found in the cervix of one patient of the misoprostol group.


CONCLUSIONS
Vaginal application of isosorbidemononitrate in cervical priming prior to curettage abortion is as effective as vaginal application of misoprostol.
David
Matthias
M
Department of Gynecology and Obstetrics, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. matthias.david@charite.de
Chen
Frank C-K
FC
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000030:Abortion, Missed; D000282:Administration, Intravaginal; D020070:Cervical Ripening; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016595:Misoprostol / Q000008:administration & dosage*; D020030:Nitric Oxide Donors / Q000008:administration & dosage*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D020030:Nitric Oxide Donors; D016595:Misoprostol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate