الفهرس 
Methods of cervicol ripenining
Patients and methodsOnly 14 pages are availabe for public view
 |  | from | 115 |  |  |
| | | from | 115 | | |
Abstract
The uterine cervix IS a unique organ composed predominantly of
extracellular matrix proteins, collagen, elastin and glycosaminoglycans.
During pregnancy and labor this organ is metabolically active. The
metabolism is under reproductive hormonal control and is more
complicated than was previously appreciated.
Cervical npenmg IS an active process involving remodeling of
cervical tissue. This process can be induced pharmacologically in the first
trimester to facilitate procedures such as surgical termination.
Preoperative cervical repmmg reduces the morbidity of surgical
termination; including hemorrhage, incomplete uterine evacuation,
uterine perforation and cervical trauma which may jeopardize the future
fertility.
Various methods were tried for cervical ripening as the search for
the ideal cervical ripening agent continues.
Nitric oxide is a free radical with a short half life. Animal studies
have shown that NO is a fundamental mediator of the ripening process.
Also, the NO generating system is present in rat cervix and is up
regulated during labor at both term and preterm. Recent studies have
shown that NO donors can induce cervical ripening before first trimester
surgical termination.
-70-
So, this study tried to investigate the role of vaginally administered
NO donor as a potentially beneficial drugs for the process of cervical
npenmg.
For this purpose the study included 60 patients who were admitted
to Benha University Hospital from November 1999 to April 2000.
The study group included 60 patients; all of them in first trimester
of pregnancy 30 of them primgravida (group A) while the other 30 were
multgravida (group B) of pregnancy. They were scheduled to have
termination of their pregnancy because of missed abortion.
Half of these patients were treated randomly by ISMN (NO donor)
40 mg vaginal tablet and the other half were also randomly treated by
placebo vaginal tablet.
For all patients in group A (n = 30) and B (n = 30), measurement of
the cervical canal diameter was done to be equal to the largest Hagar
dilator that could be introduced with no difficulty both pretreatment and 3
hours post treatment (preoperative).
The results of this study indicate that there was a highly significant
difference before and after treatment as regards the internal os diameter
measured by Hegar dilator in both group.
The results of this study indicate that NO donor (ISMN) can
provide a safe, cheap and effective cervical ripening agent before first
trimesteric surgical evacuation.
-71-
I
&/mmUo/ and conm/do/{,
from this study, the rnam side effect as regard ISMN was its
hypotensive effect affecting mainly systolic blood pressure which didn’t
need any interference and also headache which was mild and self limited.
-72-
RECOMMENDATIONS
Nitric oxide donors could be used as a safe and cheap method for
cervical ripening before termination of pregnancy in the first trimester.
The lack of uterotonic effect of use of nitric oxide donors provides
a merit. So could be used in cases of grand multiparity or presence of
uterine scars to ripen the cervix.