A RECENT randomised placebo-controlled clinical trial reveals that isosorbide mononitrate (ISMN), a nitric oxide donor, may offer an effective and safe solution for cervical ripening, streamlining labour induction for pregnant individuals at term or post-term. The study included 160 first-time pregnant individuals with an unripe cervix (Bishop score <6) who underwent labour induction. Participants in the ISMN group received intravaginal doses of 40 mg every 4 hours, compared to a placebo group receiving pyridoxine placebos.
Results demonstrated that the ISMN group experienced a significantly shorter induction-to-delivery time (20.57 ± 4.64 hours) compared to the placebo group (23.15 ± 5.13 hours). While the caesarean section rate was lower in the ISMN group (29% versus 41%), the difference was not statistically significant.
These findings highlight ISMN as a potentially impactful addition to labour induction practices, promoting faster cervical ripening and reducing overall labour time. The safety and efficacy of this approach open new possibilities for managing term or post-term pregnancies with minimal risk to both mother and baby.
Aleksandra Zurowska, EMJ
Reference
El-Naggar RM et al. Isosorbide mononitrate for preinduction cervical ripening at or post-term pregnancy: randomised placebo-controlled clinical trial. GOCM. 2025;DOI: 10.1136/gocm-2024-000064.
