Intravaginal administration of isosorbide mononitrate for cervical ripening in prolonged pregnancy: a randomised clinical trial.

Prolonged pregnancies are associated with foetal and neonatal complications. This study was performed to evaluate the efficacy of intravaginal isosorbide mononitrate (IMN) for cervical ripening in prolonged pregnancies. 122 pregnant women were recruited. Women were assigned to 25 µg sublingual misoprostol plus 40 mg isosorbide mononitrate or placebo. Statistical analysis was done using SPSS software (version 23) and T-test, Mann-Whitney and Chi-square test. p ≤ .05 was considered significant. The mean time between beginning of cervical ripening to Bishop score >6 was significantly shorter in IMN plus misoprostol group when compared to misoprostol plus placebo group (p = .02). The mean time from beginning of cervical ripening to the beginning of active phase of Labour was comparable between two groups (p = .274). The misoprostol plus IMN group had significantly shorter interval from the beginning of cervical ripening to the time of delivery. Isosorbide mononitrate in combination with misoprostol has a promising effect on cervical ripening and progress in labour.IMPACT STATEMENTWhat is already known on this subject? Prolonged pregnancy is associated with foetal, neonatal, and maternal complications. Because of these complications, many obstetricians tend toward the induction of prolonged pregnancies to reduce perinatal morbidity and mortality. Isosorbide mononitrate is a nitric oxide donor agent which is used vaginally for cervical ripening in term pregnancies resulting in various outcomes.What do the results of this study add? Isosorbide mononitrate in combination with misoprostol had a greater effect on cervical ripening and progress in labour than misoprostol alone in prolonged pregnancies.What are the implications of these findings for clinical practice and/or further research? According to results of the current study; using isosorbide mononitrate in combination with misoprostol could enhance successful vaginal delivery in prolonged pregnancy. Evaluation of maternal satisfaction by using this protocol is recommended in future studies.

Effects of Phytoestrogens in Alleviating the Menopausal Symptoms: A Systematic Review and Meta-Analysis.

The aim of this study was to perform a meta-analysis of high-quality, randomized, controlled trials (RCTs), to investigate the effectiveness of phytoestrogens in alleviating the menopausal symptoms (vaginal atrophy). Variety of databases including PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CCRCT) were searched up to May 2015 according to the below-mentioned pre-specified search strategy and using the relevant MeSH terms. The mean difference was applied as an estimate of the main effect size. Moreover, due to the considerable heterogeneity among studies, the random-effects model was used to obtain the pooled effect size derived from primary studies. Results showed that while the standardized mean difference of vaginal cell maturation index was increased up to 0.164 percent (with the confidence interval at 95%: (-0.419-0.746), but this increase was not statistically significant (P=0.582). The absence of the publication bias was confirmed using the Egger's regression intercept test (P = 0.24). Also, meta-analysis of soybeans studies showed that while the standardized mean difference of vaginal maturation index increased 0.072% in (95% CI: -0.42 to 0.5.), this increase was not statistically significant (p = 0.777). The results confirm that soybeans and phytoestrogens have non-significant positive effects on the vaginal atrophy index. Hence, it is suggested that with regard to non-significant positive effects, non-hormonal treatments along with other treatments such as the vaginal gels and so on should be used more in cases with non-severe vaginal atrophy.