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Isosorbide Mononitrate Versus Dinoprostone for Cervical Ripening During Labor Induction: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Reproductive Sciences volume 30, pages 380–389 (2023)Cite this article

Abstract

The objective of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated isosorbide mononitrate (ISMN) versus dinoprostone, a prostaglandin E2 (PGE2) analogue, in promoting cervical ripening during labor induction. We searched five major databases from inception till 02 May 2021. We assessed the risk of bias of included studies. We meta-analyzed various endpoints (n=12) and pooled the endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Overall, 4 RCTs met the inclusion criteria, comprising 818 patients; equally 409 patients were allocated to ISMN and PGE2 groups. Overall, the RCTs had a low risk of bias. The mean change in Bishop score at 24 h was significantly lower in disfavor of the ISMN group. The mean time from drug administration to delivery was significantly longer in disfavor of the ISMN group. The rate of oxytocin need was significantly higher in disfavor of the ISMN group. The rate of vaginal delivery at 24 h was significantly lower in disfavor of the ISMN group. The rates of headache and palpitations were significantly higher in disfavor of the ISMN group. The rate of abnormal fetal heart rate was significantly lower in favor of the ISMN group. There was no significant difference between both groups with regard to rates of cesarean delivery, postpartum hemorrhage, uterine hyperstimulation, and NICU admission. Compared with PGE2, ISMN appeared less effective for cervical ripening prior to labor induction and correlated with higher drug-related maternal toxicities.

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Data Availability

All data are available within the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia

    Ahmed Abu-Zaid

  2. College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Ahmed Abu-Zaid

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia

    Khalid Khadawardi

  4. Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia

    Abdulrahman Al-Matary

  5. Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia

    Majed Saeed Alshahrani

  6. Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia

    Najlaa Talat Miski

  7. Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia

    Mohammed Abuzaid

  8. Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia

    Mahir Khalifa

  9. Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Maisoon Almugbel & Maha Tulbah

  10. Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

    Saeed Baradwan

Authors
  1. Ahmed Abu-Zaid
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  2. Khalid Khadawardi
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  3. Abdulrahman Al-Matary
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  4. Majed Saeed Alshahrani
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  5. Najlaa Talat Miski
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  6. Mohammed Abuzaid
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  7. Mahir Khalifa
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  8. Maisoon Almugbel
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  9. Maha Tulbah
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  10. Saeed Baradwan
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Contributions

A Abu-Zaid contributed to study conception, data analysis, study supervision, and manuscript writing. SB, KK, A Al-Matary, MSA, NTM, M Abuzaid, MK, M Almugbel, and MT contributed to literature review, data collection, data interpretation, and revision of manuscript for editorial and intellectual contents. All authors read and approved the final draft of manuscript.

Corresponding author

Correspondence to Ahmed Abu-Zaid.

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The authors declare no competing interests.

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Abu-Zaid, A., Khadawardi, K., Al-Matary, A. et al. Isosorbide Mononitrate Versus Dinoprostone for Cervical Ripening During Labor Induction: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Reprod. Sci. 30, 380–389 (2023). https://doi.org/10.1007/s43032-022-00909-y

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  • DOI: https://doi.org/10.1007/s43032-022-00909-y

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