Sarp ÖZCAN, Mustafa UĞUR, Rana KARAYALÇIN, Tamsoy Seda ATLIMAN

Post term gebeliklerde doğum indüksiyonu öncesinde lokal isosorbid mononitrat uygulamasının servikal olgunlaşma ve doğum eylemi üzerine etkisi

Amaç: Post term gebeliklerde lokal olarak uygulanan nitrik asit donörü isosorbid di nitrat’ın servikal olgunlaşma üzerindeki etkilerini araştırmak. Metod: Çalışma prospektif randomize olarak planlaşmıştır. Post term 76 hastanın 36’sına servikal olgunlaşma için 40 mg. İsosorbid di nitrat uygulanmış, kontrol grubunda 40 hastaya oksitosin ile indüksiyon başlanmıştır. Sonuç: Çalışma grubunda 6. saatte Bishop skoru 5,39 ± 2,1 ; kontrol grubunda 4,7 ± 2 olarak saptanmıştır. Çalışma grubunda istatistiksel olarak anlamlı olmayan bir Bishop skoru artışı mevcuttur. Tartışma: Taşisistol ve uterin hiperstimülasyon prostaglandin analoglarının en önemli yan etkileridir. Bu yan etkilerden kaçınmak amacıyla son yıllarda nitrik oksit donörleri kullanıma girmiştir. Çalışmamızda serviksi matür olmayan post term gebelerde isosorbid di nitrat ‘ ın uterin hiperstimulasyon yapmaksızın serviks olgunluğunu arttırdığını gösterdik.

To assess the cervical ripening effect of nitric oxide donor isosorbid di nitrate in post term pregnancies.

Method: This is a prospective randomised study. We evaluated 76 post term pregnancy. On the study group 36 patients received 40 mg. Isosorbid di nitrate. In the controle group 40 patients received oxytocin for labor induction. Results: In the study group cervical Bishop score was 5,39 ± 2,1 in the control group 4,7 ± 2 respectively. This increase was statistically insignificant. Conclusion: We have documented the cervical ripening effect of local nitric oxide donor Isosorbid di nitrate in postterm pregnancies.

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1.Gabbe GC, Nielby RJ, Simpson JL: Labor and Delivery,Prolonged pregnancy.Normal and problem pregnancies 4th Edition. Churchill Livingstone 2002:353-394,931-942.
2.Chwalisz K, Shao-Qing S,Garfield RE, Beier HM: Cervical Ripening in Guinea pigs after local application of Nitric Oxide. Human Reprod.1997;12:2093-2101.
3.Chanrachakul B, Herabutya Y,Punyavachira P. Potential Efficacy of Nitric Oxide for cervicalkal ripening at term. Int J Gynecol Obstet. 2000;71:217-219
4.Chanrachakul B, Herabutya Y,Punyavachira P.Randomized trial of ısosorbide mononitrate versus misoprostol for cervical ripening at term. J Gynecol Obstet.2002;78:139-145.
5.Kierse MJ, Prostaglandins in preinduction of cervical ripening: Meta analysis of worldwide clinical experience. J Reprod Med.1993;38:89
6.Sanchez-Ramos L, Peterson DE,Delke I, Kaunitz AM: Labor induction with PG E1 ( misoprostol) compared with dinoprostone vaginal insert: a randomised trial. Obstet Gynecol 1998;91:401-5
7.Nicoll AE, Mackenzie F, Greer IA, Norman JE: Vaginal application of the nitric ozide donor iisosorbide mononitate for preinduction cervical ripening: A randomized controlled trial to determine effects on maternal and fetal hemodynamics. AM J Obstet GYnecol 2001,184;:958-964.
8.Ekerhovd E, Bullarbo M, andersch B, Norström A: Vaginal administration of the nitric oxide donor isosorbide mononitrate for cervival ripening at term .AM J Obstet Gynecol 2003;189:692-1697.
9.Thompson AJ, Lunan CB, Cameron AD, Cameron IT,Norman JE. Nitric oxide donors induce ripening of human uterine cervix: a randomized controlled trail. Br J Obstet Gynecol 1997;104:1054-1057.
10.Matthias D, Franck C, Chen K: Comparison of isosorbide mononitrate ( Mono Mack) and misoprostol ( Cytotec) for cervical ripening in the first trimester missed abortion. Arch Gynecol Obstet 2005;273:144
11.Ledingham MA, Thompson AJ, Lunan BC, Norman JE: A comparison of isosorbide mononitrate, misoprostol and combination therapy for first trimester pre-operative cervical ripening: a ran etdomized controlled trial. Br J Obstet Gynecol 2001;108:276- 280