Addition of isosorbide mononitrate to misoprostol for cervical ripening in post-term pregnancy: A randomized controlled trial

ObjectiveThe purpose of this paper is to compare the effect of vaginal isosorbide mononitrate added to misoprostol versus misoprostol alone in cervical ripening and labor induction in post-term pregnancy.MethodsIn this double-blind controlled trial study, 150 pregnant women in post-term pregnancy who were candidates for labor induction were selected. The participants were assigned randomly to receive either vaginal isosorbide mononitrate (IMN) (40mg) or placebo. Misoprostol (25mg) was added to both groups as needed. Time to full cervical ripening, time to delivery, and the amount of misoprostol used in each group were assessed.ResultsThe time interval from the administration of IMN to full cervical ripening was shown to be significantly lower in the IMN+ misoprostol groups versus the comparison group (p=.032). The adjusted analysis of this time interval after controlling for age, BMI, gravidity, and Bishop score on administration remained significantly less (p=.045),the mean difference being −4.85h, CI 95% −9.58 to −.12. Isosorbide treatment resulted in significantly less misoprostol used versus misoprostol alone (2.37±1.02 versus 3.08±1.29), adjusted p-value=.001, CI 95% −1.09 to −.32. We found no significant increase in maternal–fetal outcomes or side effects of the IMN+ misoprostol group compared with the misoprostol group.ConclusionThis study found that intravaginal IMN added to misoprostol is more effective in reducing time to full cervical ripening versus misoprostol alone in post-term pregnancy. It also reduces the need for more misoprostol.

ObjetivoEl objetivo de esta investigación es determinar si el mononitrato de isosorbida vaginal, agregado al misoprostol, acorta el tiempo hasta la maduración cervical completa en el embarazo postérmino.MétodosEn este estudio de prueba controlado doble ciego, se seleccionaron 150 mujeres embarazadas en embarazo postérmino candidatas para la inducción del trabajo de parto. Los participantes fueron asignados al azar para recibir mononitrato de isosorbida vaginal (NMI) (40mg) o placebo. Se añadió misoprostol (25mg) a ambos grupos según fuera necesario. Se evaluaron el tiempo hasta la maduración cervical completa, el tiempo hasta el parto y la cantidad de misoprostol utilizado en cada grupo.ResultadosEl intervalo de tiempo desde la administración de la NMI hasta la maduración cervical completa se mostró significativamente más bajo en los grupos de NMI versus el grupo de comparación (P=0,032). El análisis ajustado de este intervalo de tiempo después de controlar la edad, el IMC, la gravidez y la puntuación de Bishop en la administración se mantuvo significativamente menor (P=0,045) con la diferencia media -4,85h, IC 95% -9,58 a -0,12. El tratamiento con isosorbida dio como resultado una menor cantidad de misoprostol usado significativamente en comparación con el misoprostol solo (2,37±1,02 versus 3,08±1,29), valor de P ajustado=0,001, IC 95% -1,09 a -0,32. No se encontró un aumento significativo en los resultados materno-fetales y los efectos secundarios del grupo de NMI en comparación con el grupo de misoprostol.

Does vaginal pH affect the efficacy of dinoprostone in cervical ripening/labor duration?

BACKGROUND: Prostaglandins are effective in the ripening of the cervix and facilitating labor induction. Vaginal pH is probably an important factor in the effectiveness of vaginal prostaglandins. The aim of this study was to evaluate the effect of vaginal pH on the function of prostaglandin vaginal tablet during labor. METHODS: This is a double-blinded clinical trial study of 147 pregnant primigravid trated in the Yahyanejad Hospital of Babol (Iran) from January 2006 to December 2007. Initial pH was measured during vaginal examination with nitrazin paper and the Bishop score was determined. All women received vaginal dinoprostone inserted in the posterior fornix of the vagina for cervical ripening and the second dose was administered if the uterine contractions were inadequate. Reassessment of the Bishop score after 12 hours, duration of latent and active phases, and also the duration of the second stage of labor were compared between the two groups with low or high vaginal pH. RESULTS: The incidence of Cesarean section was lower in women with high vaginal pH but was not statistically significant. The Bishop score after 12 hours, latent phase, and second stage durations were not different in the two groups of high or low vaginal pH, but active phase duration in patients with high pH was significantly shorter than those with low pH (p = 0.019). CONCLUSION: High vaginal pH influences the function of prostaglandin tablet as a reduction in duration of the active phase of labor.

Synthesis, conformational analysis and antidepressant activity of moclobemide new analogues.

Three new analogues of moclobemide are synthesized. Antidepressant activity of compounds assayed by the Porsolt method reveals that the morpholine ring in moclobemide is one of the key structural parts necessary for antidepressant activity. Superimposition of norepinephrine and gauche forms of serotonin and mociobemide suggest that the phenyl ring, electronegative group attached to the aromatic ring and the amine terminal group may serve as the recognition elements for binding to monoamine oxidase-A (MAO-A).

Metabolic and distribution studies with radiolabeled 5-fluorouracil.

5-Fluorouracil (5-FU) is an effective anti-tumor drug, which has been used both as a single agent and in combination with other chemotherapeutic agents for the treatment of tumors such as breast and colorectal carcinoma. We synthesized 5-FU with trace amounts of 18F-5-FU and administered the compounds intravenously to 6 cancer patients. The patients were scanned at 2 hr intervals for 12 hrs and their urine collected whenever possible. We also injected 5-FU with the tracer 18F-5-FU, at pharmacological doses, into non-tumored rats, and sampled their bile and blood for 95 mins post-injection. For comparison, 2-14C-5-FU was injected into non-tumored rats and their bile and blood sampled at the same intervals. Minute quantities of rat bile and serum were analyzed chromatographically by high-performance TLC. 5-FU and two of its metabolites (FBAL and FUPA) were identified and quantified by this technique. Both percentage and absolute amounts of 5-FU in the bile follow comparative kinetic patterns. While the liver and the urinary bladder were clearly observable in all 16 patients, the detectability of the gall-bladder was correlated to the inverse of the alkaline phosphatase level in the blood. This work suggests that the diversity of the 5-FU metabolism in cancer patients may allow the use of 18F-5-FU as a probe for understanding those individual variabilities in clinical situations.