A Comparative Study of Intravaginal Misoprostol with and without Isosorbide Mononitrate for Induction of Second-Trimester Abortion (Code-T0143)

Introduction: Second-trimester abortions are associated with increased maternal morbidity and mortality compared to first-trimester procedures. Pharmacological agents such as misoprostol, a prostaglandin E1 analog, are commonly used for cervical ripening and uterine contractions. The addition of isosorbide mononitrate (IMN), a nitric oxide donor, may enhance cervical ripening and improve outcomes.

Aims and Objectives:

Aim:

1. To study the role of intravaginal misoprostol with and without isosorbide mononitrate intravaginally in the induction of second-trimester abortion

Objectives:

1. Evaluating efficacy of misoprostol plus isosorbide mononitrate in induction of second-trimester abortion.
2. To study the efficacy of only. misoprostol for terminating pregnancies in the second trimester
3. comparing efficacy of both the groups by analyzingdifferences in success rate of initiating abortion, induction-expulsion duration, need for operative interference and the rate of post-abortive haemorrhage.
4. To compare safety profile and overall patient satisfaction rate in both the group.

Methods: A randomized controlled trial was conducted involving women requiring second-trimester abortion. Participants were divided into two groups: Group A received intravaginal misoprostol alone, and Group B received misoprostol with IMN intravaginally. The primary outcomes were induction-to-abortion interval, success rate within 24 hours, and adverse events. Secondary outcomes included patient acceptability and need for surgical intervention. Data were analyzed using statistical software, with significance set at p < 0.05.

Results: Group B demonstrated a significantly shorter induction-to-abortion interval compared to Group A (p < 0.05). The success rate within 24 hours was higher in Group B. Adverse events, including abdominal pain and nausea, were comparable between groups. Patient acceptability was higher in Group B.

Conclusion: The combination of intravaginal misoprostol and IMN is more effective than misoprostol alone for second-trimester abortion, with a shorter induction-to-abortion interval and higher success rates, without an increase in adverse effects. Further studies are warranted to confirm these findings.

Keywords: Misoprostol, Isosorbide mononitrate, Second-trimester abortion, Cervical ripening, Induction-to-abortion interval, Randomized controlled trial.