A Comparative Study of Safety and Efficacy of Vaginal Isosorbide Mononitrate with Prostaglandin E2 for Cervical Ripening in Term and Post-Term Pregnancies

Objective: To compare the efficacy and safety of two cervical ripening agents, Prostaglandin E2 (PGE2) andIsosorbide Mononitrate (IMN), in post-term pregnancies.Material and Methods: A quasi-experimental study was conducted at Department of Obstetrics andGynecology Department of Lady Willingdon Hospital, Lahore, over six months. Sixty women with singletonpost-term pregnancies (≥40 weeks) and a Modified Bishop Score (MBS) <6 were recruited. Participants wererandomly assigned to two groups: Group A received Prostaglandin E2 (3 mg vaginally, repeated every 6hours), and Group B received Isosorbide Mononitrate (40 mg vaginally, repeated every 6 hours). The primaryoutcome was the induction-to-delivery interval, while secondary outcomes included maternal complications,neonatal outcomes, need for additional oxytocin, and operative delivery rates. Data were analyzed usingdescriptive statistics, chi-square tests, and propensity score matching.Results: The study found that IMN significantly reduced the induction-to-delivery interval compared toPGE2, with a mean of 15.2 hours in the IMN group versus 23.2 hours in the PGE2 group (p < 0.001). The IMNgroup also showed fewer maternal and neonatal complications, including a reduced need for additionaloxytocin and a lower rate of operative deliveries. Neonatal outcomes, including Apgar scores and NICUadmissions, were comparable between both groups. Propensity score matching helped control forconfounding variables, ensuring more accurate comparisons between the two groups.Conclusion: Isosorbide Mononitrate (IMN) appears to be a promising alternative to Prostaglandin E2 (PGE2)for cervical ripening in post-term pregnancies, with a shorter induction-to-delivery time and fewer adverseeffects. This study suggests that IMN may offer a safer and more efficient option for labor induction in posttermpregnancies, especially in settings with limited resources. Further large-scale, randomized trials areneeded to confirm these findings and refine clinical guidelines.Keyword: Post-term Pregnancy, Cervical Ripening, Prostaglandin E2, Isosorbide Mononitrate, LaborInduction, Maternal OutcomesHow to cite: Janjua M, Mubeen S, Ishfaq A, Ishfaq A, Ishfaq F, Amir H. A Comparative Study of Safety and Efficacy ofVaginal Isosorbide Mononitrate with Prostaglandin E2 for Cervical Ripening in Term and Post-Term Pregnancies.Esculapio - JSIMS 2026;22(02): 157-164DOI:10.51273/esculap.v22i02.1459