Data_Isosorbide dinitrate_Fetal intrauterine death_INPer.xls

The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilator drugs like isosorbide dinitrate has been showing to be potential inducers of cervical ripening prior to surgical evacuation of the uterus. Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate- (80 mg/1.5 mL; n=30) or misoprostol gel solution (100 mcg/1.5 mL; n=30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until the complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by taking the mean of the relative risk of the foetal expulsion that was based on a comparison of event rates and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects that included a headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting. The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point of time.The average delivery induction interval was significantly lower during the usage of isosorbide dinitrate-oxytocin (8.7 ± 3.1 h) over misoprostol-oxytocin (11.9 ± 3.1 h). This study indicated that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method that was used to induce labour in the medical management of foetal death in pregnancies post 20 weeks of gestación.