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Randomized Comparison of Glyceryl Trinitrate and Prostaglandin E2 for Cervical Ripening at Term

From the Department of Obstetrics and Gynecology, Division of Obstetrics and Gynecology, Department of Nursing, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Address reprint requests to: Boonsri Chanrachakul, MD Department of Obstetrics and Gynecology Ramathibodi Hospital Mahidol University Rama VI Road Bangkok, 10400 Thailand E-mail: rabcr{at}mahidol.ac.th

Objective: To estimate the adverse effects of glyceryl trinitrate compared with prostaglandin (PG) E2 vaginal tablet for cervical ripening in term pregnancy.

Methods: One hundred ten women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly assigned to receive a 500-µg glyceryl trinitrate tablet vaginally (n = 54) or a 3-mg PGE2 tablet vaginally (n = 56), every 6 hours for maximum of two doses. Subjects were sent to the labor ward for amniotomy or oxytocin if their Bishop scores were more than 6 or their cervices were not ripe 24 hours after treatment. Adverse effects, changes in the Bishop scores, progress, and outcomes of labor were assessed.

Results: Glyceryl trinitrate was associated with fewer episodes of uterine tachysystole (0% versus 9%; P = .02). The median Bishop score after 12 hours was lower in women given glyceryl trinitrate compared with those given PGE2. Adverse effects, including headache and palpitations, were more frequent with glyceryl trinitrate than with PGE2. The cesarean rate was not significantly different between groups.

Conclusion: Cervical ripening with glyceryl trinitrate resulted in fewer episodes of tachysystole, but there were significantly more minor side effects. It can be used for cervical ripening at term, but it was not as effective as PGE2.