Toxicological Impact of Bisphenol A on Females' Reproductive System: Review Based on Experimental and Epidemiological Studies.

The study encompassing research papers documented in the last two decades pertaining to the possible influence of bisphenol A (BPA) on the fertility of females are appraised with emphasis on the influence of BPA in reproductive organs (uterus and ovaries) and pregnancy outcomes including discussion on the reproductive process (implantation, estrous cycle, hormone secretion); outcomes reveal a connection amongst BPA and female infertility. Ovary, uterus, and its shape as well as function can alter a person's ability to become pregnant by influencing the hypothalamus-pituitary axis in the ovarian model. Additionally, implantation and the estrous cycle may be affected by BPA. However, more research is warranted to comprehend the underlying action mechanisms and to promptly identify any imminent reproductive harm.

Effects of sildenafil on Doppler parameters, maternal and neonatal outcomes in the active labor phase of low-risk pregnancies: a randomized clinical trial.

OBJECTIVES: The benefits of sildenafil by increasing blood flow in the improvement of Doppler parameters of umbilical (UA), uterine (UtA), and fetal middle cerebral arteries (MCA) remain uncertain. On the other hand, insufficient blood flow during uterine contractions in labor can lead to decrease blood supply and fetal distress. Therefore, we aimed to assess the changes in fetal Doppler indices and maternal and neonatal outcomes following the use of sildenafil in the active phase of labor in low-risk pregnancies with healthy fetuses. METHODS: This randomized double-blinded controlled trial was conducted on 70 pregnant single low-risk, pregnant women. The patients were randomly assigned into two groups receiving sildenafil (n=35) or placebo (n=35) when the active phase of labor was initiated. Doppler parameters were assessed at baseline as well as 3 h after that. Indeed, the maternal and neonatal outcomes were compared between groups. RESULTS: The Doppler parameters including the pulsatility index of MCA, UA, and left and right UtA remained unchanged after the administration of sildenafil. Neonatal outcomes including birth weight, PH of the umbilical artery, Apgar score, respiratory distress syndrome, and neonatal intensive care unit admission as well as maternal outcomes such as cesarean section rate and the occurrence of intrapartum/postpartum hemorrhage had no difference between groups. CONCLUSIONS: The use of sildenafil in the active phase of labor in low-risk pregnancies may not be beneficial in improving Doppler parameters in MCA, umbilical, and uterine arteries and thus may not improve pregnancy outcomes.

Intravaginal Isoniazid (INH) and Sublingual Misoprostol Versus Sublingual Misoprostol Alone for First-Trimester Induced Abortion: A Randomized Controlled Trial.

Background: This study aimed to compare sublingual misoprostol alone or combined with vaginal Isoniazid (INH) for first-trimester abortion. Methods: In this randomized controlled trial, 80 pregnant women with missed abortion candidates for first-trimester abortion were randomly assigned to two groups. The first group received 800 µg sublingual misoprostol every three hours maximum for three doses and the second group received 1500 mg vaginal INH followed by the same dose of misoprostol. Vaginal sonography was performed after 24 hours on both groups to observe any retained product of conception. In case of no response or incomplete abortion, the second course of misoprostol (with the same dose) was administered. The abortion (complete or incomplete) rate was reported within 48 hours after the first dose of misoprostol. Results: The rate of successful intervention (either complete or incomplete) abortion within 48 hours of misoprostol administration was 75% in both groups and was not significantly different (P value = 1). Also, hospitalization duration, abortion time, total misoprostol dosage, and the rate of side effects were similar in the two groups. Five patients in the misoprostol group and three in the misoprostol plus isoniazid group underwent emergent D&C because of heavy bleeding. Conclusion: A combined regimen of sublingual Misoprostol plus vaginal Isoniazid with the prescribed dosage has similar efficacy to sublingual misoprostol alone in first-trimester abortion.

Medical students' perceptions towards distance e-Learning in gynecology ward during the COVID-19 pandemic.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused serious public health problems and compromised the health of individuals and communities. This study aimed to evaluate a Distance e-Learning from the perspective of medical students in the Gynecology ward during the COVID-19 Pandemic. MATERIAL AND METHODS: This cross-sectional study was conducted at the Iran University of Medical from the September 2020 to September 2021. The study sample included 130 medical students who participated in distance training courses in the gynecology ward during the COVID-19 pandemic. All medical students were included for the study. Medical students (externs and interns), who received Distance eLearning in the gynecology ward during the study, were included. The self-administered questionnaire was used in this study. Questionnaires was developed through literature review and consultation with gynecology and eLearning experts. Face and content validity was established by eight experts. Internal consistency was assessed with Cronbach's alpha. RESULTS: The questionnaire was sent to 170 medical students. Of the 130 respondents 65% were female and 35% were male. There were 57 (43.8%) externs and 73 (56.2) interns. Most students agreed that mobile devices increase their learning and home is the preferred place for participation in DE. Most students (66.9%) either strongly disagreed or disagreed that Distance e-Learning was an appropriate method for learning basic clinical skills.72.3% of respondents strongly disagreed or disagreed that Distance e-Learning provided them an opportunity to practice clinical skills effectively. Most medical students (69.3%) strongly agreed or agreed that Distance e-Learning created more opportunities to apply theoretical knowledge directly to medical practice. DISCUSSION: The results of the online survey suggest that medical students have found both positive and negative aspects of clinical learning by DEL format in Gynecology ward.

Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies.

OBJECTIVES: This study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis. METHODS: Electronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5). RESULTS: Thirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group. CONCLUSIONS: Based on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

Isonicotinic acid hydrazide (INH) versus extra-amniotic saline infusion (EASI) for cervical ripening at term: a randomised controlled trial.

The purpose of this trial was to compare extra-amniotic saline infusion (EASI) and intravaginal isoniazid (INH) for cervical ripening. This randomised clinical trial included 150 pregnant women who were undergoing induction of labour and who required pre-induction cervical ripening. Patients were randomly assigned to receive EASI or intravaginal INH. Bishop's score at the beginning of the study and before oxytocin infusion was not significantly different between INH and EASI groups. However, the time from first intervention to the beginning of the induction and also to the beginning of the active phase were significantly shorter in EASI group (p value ≤.001). Moreover, INH did not influence the labour process after the beginning of the active phase of labour. In conclusion, INH could be used for cervical ripening especially in the outpatient setting; however, it is a slower ripening agent compared to EASI.Impact StatementWhat is already known on this subject? To date there has been only one study about the safety and effectiveness of isoniazid (INH) in cervical ripening at term pregnancy which has compared INH with misoprostol.What do the results of this study add? The results of this study showed that vaginal INH is an effective agent for cervical ripening at term but in comparison to extra-amniotic saline infusion (EASI) it takes a longer time.What are the implications of these findings for clinical practice and/or further research? INH can be used in outpatient settings for cervical ripening at term pregnancy which makes it convenient for patient and cost effective for both patient and health system. Further studies are needed to discover the clinical efficacy of INH in comparison to other ripening methods and also the best dosage of INH for cervical ripening.

Comparative evaluation of normal saline, 1/3-2/3, and ringer's lactate infusion on labour outcome, PH, bilirubin, and glucose level of the umbilical cord blood in nulliparous women with labour induction: a randomised clinical trial.

This study aimed to compare the effects of infusion of normal saline, 1/3-2/3, and Ringer's lactate fluids on labour outcome, pH, bilirubin, and glucose level of umbilical cord blood. In this randomised clinical trial, 450 nulliparous women with Bishop score ˂5 and indication of pregnancy termination were randomly divided into three groups to receive normal saline, 1/3-2/3, or Ringer's lactate infusion at a rate of 125 mL/h for hydration, upon starting induction of labour. Results of this study indicated that the incidence of hypoglycaemia (p = .19), hyper bilirubinemia (p = .87) and acidosis (p = .10) was similar in neonates of the three groups. Also, there were no statistically significant differences between the three groups with regard to the duration of labour; glucose, bilirubin and pH level of cord blood; and mode of delivery. It can be concluded that infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour is not associated with different maternal or foetal/neonatal outcomes, and none of the fluids has superiority to the others.Impact statementWhat is already known on this subject? Several studies have been conducted on the association between type and volume of infused fluid on labour duration and neonatal outcomes. However, there has been some controversy.What do the results of this study add? This is the first study that has investigated the association between infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour with labour outcome and pH, bilirubin, and glucose level of the umbilical cord blood and results showed that these fluids have no effect on maternal or foetal/neonatal outcomes and also none of these fluids has superiority to the others.What are the implications of these findings for clinical practice and/or further research? Due to contradictory results of previous studies, further research with greater sample sizes and different fluids type and volumes may be needed to examine the association between infusion of fluids and neonatal and labour outcomes more precisely.

Sestrin2 and Beclin1 levels in Polycystic Ovary Syndrome.

BACKGROUND: Sestrin2 and beclin1 are two newly found proteins that have essential roles in autophagy. This study attempted to evaluate the plasma concentrations of sestrin2 and beclin1 in women with polycystic ovary syndrome (PCOS) and healthy controls and to explore the clinical value of these proteins as novel biomarkers for PCOS. METHODS: In this case-control study, plasma levels of sestrin2 and beclin1, fasting blood sugar (FBS), lipid profile, insulin, and androgens were evaluated in 63 women (31 patients and 32 controls). Sestrin2 and beclin1 levels were determined using enzyme-linked immunosorbent assay (ELISA). Descriptive statistics, correlation coefficients, logistic regression, and ROC curve analyses were used in this study. RESULTS: Plasma sestrin2 levels of the subjects with PCOS (40.74 [24.39-257.70]) were significantly lower than those of healthy subjects (255.78 [25.46-528.66]; p-value = 0.040). ROC curve analysis showed that a cutoff value of 420.5 ng/L had an appropriate sensitivity (83.87%) and specificity (46.88%) for discriminating individuals with and without PCOS, with the area under the curve (95% CI) of 0.648 (0.518 to 0.764), p = 0.036. There were no statistically significant differences between the two groups concerning plasma levels of beclin1, biochemical parameters, blood pressure, and anthropometric features. CONCLUSION: Our findings highlight the dysregulation of sestrin2 as a marker of autophagy in PCOS and its potential usefulness as a novel biomarker for PCOS. Further research is needed to better understand the role of this protein in the pathophysiology of PCOS and its value as a diagnostic tool for the evaluation of PCOS patients.

The Impact of COVID-19 Pandemic on Stress and Anxiety of Non-infected Pregnant Mothers.

BACKGROUND: The newly emerging COVID-19 has caused severe anxiety around the world and it is infecting more people each day since there is no preventive measure or definite therapy for the diseases. The present study aimed to evaluate its effect on anxiety and stress of pregnant mothers during perinatal care. METHODS: Three-hundred pregnant mothers without COVID-19 infection who were referred to the hospitals affiliated to Iran University of Medical Sciences for delivery during April 2020, based on negative clinical symptoms and the results of polymerase chain reaction (rt-PCR) for COVID-19, were recruited by census method and asked to complete the Persian version of the perceived stress scale (PSS); participants views about their anxiety level and the role of COVID-19 as the source of their stress and worries were recorded. Women who refused to continue the study were excluded. The frequency of variables and mean scores were calculated using SPSS v. 21. RESULTS: Mean age of mothers was 30.20±16.19 years; 31.3% were primigravida and mean gestational age was 38.00±4.14 weeks. Moreover, 16.3% asked for earlier pregnancy termination and 39% requested Cesarean section (C/S). Assessing the mothers' anxiety revealed a high/very high level of anxiety in 51.3%. The majority felt worried and frustrated because of COVID-19 (86.4%). Social media had a great impact on the level of stress among these mothers (60.3%). CONCLUSION: COVID-19 pandemic is an important source for the increased anxiety and stress among healthy pregnant mothers.

A High Rate of Recurrent Vulvovaginal Candidiasis and Therapeutic Failure of Azole Derivatives Among Iranian Women.

Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifungal drug-related factors. Although multiple studies on host-related factors affecting the outcome have been conducted, such studies on Candida-derived factors and their association with RVVC are lacking. Thus, fluconazole-tolerant (FLZT) isolates may cause fluconazole therapeutic failure (FTF), but this concept has not been assessed in the context of Candida-associated vaginitis. Iran is among the countries with the highest burden of RVVC; however, comprehensive studies detailing the clinical and microbiological features of this complication are scarce. Therefore, we conducted a 1-year prospective study with the aim to determine the RVVC burden among women referred to a gynecology hospital in Tehran, the association of the previous exposure to clotrimazole and fluconazole with the emergence of FLZT and fluconazole-resistant (FLZR) Candida isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. Candida albicans and C. glabrata constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT C. tropicalis isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. C. albicans constituted 81.2% of FLZR (13/16) and 100% of the FLZT (13/13) isolates, respectively, and both phenotypes were likely responsible for FTF, which was also observed among patients with RVVC infected with fluconazole-susceptible isolates. Thus, FTF could be due to host-, drug-, and pathogen-related characteristics. Our study indicates that FLZT and FLZR isolates may arise following the exposure to over-the-counter (OTC) topical azole (clotrimazole) and that both phenotypes can cause FTF. Therefore, the widespread use of OTC azoles can influence fluconazole therapeutic success, highlighting the necessity of controlling the use of weak topical antifungals among Iranian women.

Two knots in an umbilical cord with seventy centimeter length: A case report.

Our case was a newborn with two umbilical knots that delivered 39 weeks gastation and did not experience any developmental disruptions. The risk factors of fetus for true knot formation in the umbilical cord were gender and the umbilical cord size.

The effect of antenatal magnesium sulfate on intraventricular hemorrhage in premature infants: a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. METHODS: Two review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, metaanalysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. RESULTS: In this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. RESULTS: of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610.

Intravaginal isonicotinic acid hydrazide (INH) versus misoprostol for cervical ripening prior to hysteroscopy.

OBJECTIVE: The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. METHODS: This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6-8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6-8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. RESULTS: Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43-0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). CONCLUSION: Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol. TRIAL REGISTRATION: Iranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4.

Bilateral Hyperplasia of Bartholin's Gland: A Case Report.

A 37-year-old woman underwent surgery to remove bilateral vulvar masses. The masses were firm, non-tender, and immobile. Pathologic finding was a well-delineated creamy grayish mass with a homogenous grayish solid surface and mild edema, chronic inflammatory infiltration, and focal dilation of the ducts with squamous metaplasia. The diagnosis was hyperplastic and hypertrophied Bartholin's gland. Hyperplasia is a rare etiology for an enlarged Bartholin's gland. Clinical presentation of Bartholin's gland nodular hyperplasia is rather specific, although inflammatory lesion is the most common cause of swelling of the Bartholin's gland in all age groups. Bartholin's hyperplasia should be considered in cases with a solid mass. Total surgical excision is required for diagnosis. Only a few cases of Bartholin's gland hyperplasia have been reported in the literature. Our patient has been receiving regular follow-up examination and there is no evidence of dyspareunia, perineal pain, and recurrent disease 12 months after surgery.

Maternal Asthma, Pregnancy, Delivery and Birth Outcomes: A Retrospective Cohort Study.

The aim of current study was to determine women´s maternal asthma in pregnancy, delivery and birth outcomes. Using a retrospective cohort design, data of 580 pregnant women were gathered form a large teaching hospital in Tehran, Iran. The medical records of pregnant women who had attended this hospital between 2009 and 2011 were assessed. Data of delivery and birth outcomes were gathered by observation and medical records of women. Multiple logistic regression and adjusted odds ratio (OR) were used to assess the independent association of asthma and outcomes. 274 patients (47.2%) were in "asthmatic group" and 306 patients (52.8%) were in the "non-asthmatic group". Basic and demographic variables showed the same distribution across two groups. Maternal asthma showed an adjusted relationship with gestational diabetes (OR=2.64), gestational hypertension (OR=3.79), cesarean delivery (OR=2.68), small for gestational age (OR=2.86), premature rupture of membrane (OR=2.18), preterm delivery (OR=1.74), abnormal vaginal bleeding (OR=3.75), and low birth weight (OR=1.78) significantly (p<0.05 for all associations). The majority of pregnancy, delivery and birth outcomes except fetal death, abortion, placenta previa and placenta abruption) were significantly associated with maternal asthma. The largest association of maternal asthma was with gestational hypertension and abnormal vaginal bleeding respectively.

Comparison of intramuscular progesterone with oral nifedipine for treating threatened preterm labor: A randomized controlled trial.

Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent. Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December 2011 to November 2012. Three hundred and fifteen singleton pregnant women aged >18 yrs at 26-34 weeks' gestation with the diagnosis of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant. IRCT registration number of this study is IRCT201112198469N1 Results: The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery, birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p<0.05). None of the two drugs caused any major side effects. Conclusion: Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the NICU stay.

Risk Factors and Consequent Outcomes of Placenta Previa: Report From a Referral Center.

 Because of an unknown factor, the frequency of complicated pregnancy with placenta previa has been raised during past decade. This study was designed to deepen our understanding of risk factors and outcomes of placenta previa in our country. This study investigated 694 cases of placenta previa comparing with 600 healthy pregnant women with not overlie placenta in two referral and tertiary Obstetrics and Gynecological Hospital in Iran on the basis of the clinical and para-clinical analysis, in order to find the probable risk factors for occurrence of placenta previa and its effect on maternal and neonatal complications. The most important risk factor for the occurrence of placenta previa was advanced maternal age (P<0.001) and history of stillbirth (OR=117.2, CI=58.3-236.0). In the other hand, the most substantial outcome of this disorder was a reduction of gestational age (P<0.001) and low birth weight neonatally (P<0.001). The conservative follow-up should be programmed for women with placenta previa based on the type of risk factors which can provide the best possible management to decrease the morbidity and mortality of their related complications.

Predictive value of 4-, 8-, and 12-h urine protein and protein-to-creatinine ratio for detection of pre-eclampsia.

OBJECTIVE: To evaluate the accuracy of protein measurement and protein-to-creatinine ratio (PCR) in 4-, 8-, and 12-h urine samples as compared with 24-h urine samples as the gold standard method for suspected pre-eclampsia. METHODS: In a prospective study, 120 women at more than 20weeks of pregnancy with high blood pressure and no history of hypertension were enrolled between April 2010 and December 2012. Net protein excretion and PCR were evaluated in urine samples collected over 4h, 8h, 12h (day), and 12h (night) and compared with 24-h protein excretion as the gold standard test. RESULTS: A significant positive correlation was found between the values of the 4-h, 8-h, 12-h (day), and 12-h (night) samples and the 24-h samples. The best cutoff point of the PCR to detect significant urine protein excretion was 0.28, 0.24, 0.25, and 0.23 for the 4-h, 8-h, 12-h (day), and 12-h (night) samples, respectively. CONCLUSION: Measurement of protein and PCR in 4-h, 8-h, and 12-h urine samples might provide an alternative test for detecting proteinuria among pregnant women with suspected pre-eclampsia when there is insufficient time to collect 24-h urine samples.

Comparing the effect of oral and vaginal isosorbide dinitrate in pre-induction cervical ripening in term pregnancy: A controlled clinical trial.

BACKGROUND: Cervical ripening for labor induction is one of the most important issues in midwifery. Isosorbide dinitrate (ISDN) is one of the most important choices that have been proposed for cervical ripening, but still there are controversies regarding its prescription. The present study aimed to evaluate the effects of vaginal and oral ISDN compared to the control group for pre-induction cervical ripening. MATERIALS AND METHODS: In this non-blinded clinical trial, 149 nulliparous women with term or prolonged pregnancy were randomly selected and divided into three groups by block randomization. The intervention group included vaginal (50 subjects, 40 mg) and oral (49 subjects, 20 mg) ISDN groups. The third group was the control group (50 subjects) which did not receive any medication. The amount of ripening was given by Bishop score evaluated before taking medication and 24 h after taking it. RESULTS: After 24 h, Bishop score in vaginal ISDN group significantly increased compared to the oral ISDN and control groups (P < 0.001 for both). Although the increase in Bishop score was lower in the oral ISDN group than in the vaginal group, it had a statistically significant increase in comparison to the control group (P = 0.001). All the three groups were matched regarding pregnancy termination and cesarean causes, and there was no statistically significant difference among the three groups (P > 0.05). CONCLUSION: Prescribing vaginal ISDN for cervical ripening was effective, and it can be used with confidence.