IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 3 Ver.13 March. (2018), PP 44-48 www.iosrjournals.org DOI: 10.9790/0853-1703134448 www.iosrjournals.org 44 | Page Comparitive Study of Efficacy of Intravaginal Isosorbide Dinitrate with Dinoprostone Gel on Cervical Ripening Prior To Induction of Labor Dr Neeraj Sharma 1 , Dr Anubha Jain Singhal 2 , Dr Dolly Chawla 3 , Dr Priya Shukla 4, Dr Neeru Malik 5 1 specialist, Obs and gynae, Dr Baba Saheb Ambedkar Hospital 2 senior resident, Obs and gynae, Dr Baba Saheb Ambedkar Hospital 3 senior specialist &Head of the department, Obs and Gynae, Dr Baba Saheb Ambedkar Hospital 4 dnb, wObs and Gynae, Dr Baba Saheb Ambedkar Hospital 5 senior medical officer, Obs and Gynae, Dr Baba Saheb Ambedkar Hospital Abstract: Labor is defined as the process of regular uterine contraction leading to progressive effacement and dilatation of the cervix and birth of the baby. Induction of labor is an intervention designed to artificially initiate labor. Induction should only be considered when it is felt that the benefits of the delivery outweigh the potential maternal and fetal risks of awaiting spontaneous labor. Several methods are available for cervical ripening like prostaglandins, misoprostol, oxytocin, nitric oxide donors, mechanical methods like hygroscopic cervical dilators and amniotomy. The ideal agent is yet to be found .This is a prospective randomized controlled study conducted in the department of OBS and GYNAE in BABA SAHEB AMBEDKAR HOSPITAL. 100 women were admitted in the labor ward for induction of labor, who were more than 40 weeks of gestation and divided into 2 groups. Group 1was given intravaginal isosorbide dinitrate and Group 2 was given intracervical dinoprostone gel respectively after taking baseline Bishops score and then results compared at 6 hours and 12 hours respectively for cervical ripening. The median of modified Bishop score in group 1, 12 hours and 18 hours after the medication was 1(0-7) and 3 (0-10) respectively (p=0.001) while in group 2, 12 hours and 18 hours after the medication was 1(0-7) and 3 (0-10) respectively (p=0.001).Thus the above study showed that PGE2 gel is more effective in cervical ripening than isosorbide dinitrate. -------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 12-03-2018 Date of acceptance: 28-03-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Labor is defined as the process of regular uterine contraction leading to progressive effacement and dilatation of the cervix and birth of the baby. Induction of labor is an intervention designed to artificially initiate labor. Induction should only be considered when it is felt that the benefits of the delivery outweigh the potential maternal and fetal risks of awaiting spontaneous labor. Induction of labor often is undertaken with an unfavourable and an unripe cervix. A considerable amount of research has been directed towards various methods to prepare or ripen the cervix before the induction of labor. These methods have attracted interest because cervical ripening is a reasonable predictor of a likelihood of a successful induction terminating in vaginal delivery. The goal of cervical ripening is to facilitate the process of cervical softening, thinning and dilatation with resultant reduction in the rate of failed induction and induction to delivery time. A number of scoring systems to characterize the cervix has been developed and the BISHOP SCORE is the most widely used scoring system. If the cervix is unfavourable ( BISHOP SCORE < 6), cervical ripening is warranted prior to induction of labor. Several methods are available for cervical ripening like pharmacological agents which include prostaglandins preparations in form of intracervical PGE 2 gel, intravaginal PGE 2 gel, controlled – release PGE 2 , misoprosrol, oxytocin, nitric oxide donors; mechanical methods like hygroscopic cervical dilators and transcervical dilators , and surgical methods like membranes stripping and amniotomy. Other methods are like herbal supplements, caster oil, hot baths and enemas, sexual intercourse, breast stimulation, accupuncture and transcutaneous nerve stimulation but at present evidence are lacking to support these as viable methods for cervical ripening. Steiner and Creasy in 1983 described the “ideal agent” for cervical ripening: it should cause cervical change in a physiological manner that is similar to the natural ripening process and exclusively effect in cervical changes, without uterine contractions or hyperstimulation 5 .