***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE We aim ed to determine whether isosorbide mononitrate ( IMN ) given simultaneously with dinoprostone in term pregnancies is superior to dinoprostone alone to promote delivery . STUDY DESIGN One hundred and twenty nulliparous women at term were r and omly assigned to receive per vaginam IMN 40 mg or placebo in addition to 3 mg dinoprostone 2 times daily for up to 2 days . Analysis was by intention to treat . RESULTS Baseline characteristics of both groups were comparable . The induction to delivery intervals did not differ between the IMN and the placebo group ( 26.4 + /- 14.4 vs 23.4 + /- 14.8 hours , P = .408 ) . IMN result ed in more headache compared to placebo ( 32/55 [ 58.2 % ] vs 2/55 [ 3.6 % ] , P < .001 ) . CONCLUSION Vaginally administered IMN does not play a role in promoting delivery in term pregnancy if given at the same time as dinoprostone . This might reflect its relaxant effect on the uterine fundus , which may overcome its cervical softening effect Abstract Objective ( S ) : To compare the effectiveness and safety of intra-cervical Foley catheter combined with intra-vaginal isosorbide mononitrate ( IMN ) versus intra-vaginal misoprostol for cervical ripening and labor induction in pregnant women with unripe cervices . Methods : Open-labeled r and omized controlled trial in Cairo university hospital , Cairo , Egypt during 2012–2014 . Three hundred and ninety-five pregnant women at term or post-term with an indication for labor induction and unripe cervix were included in the study . The subjects were r and omly divided into two groups . Vaginal misoprostol was used in group 1 ( n = 197 ) and intra-cervical Foley catheter plus vaginal IMN in group 2 ( n = 198 ) . Our main outcome measure was cesarean section rate . Results : Among the 395 included patients there were significantly lower duration of induction of labor ( p < 0.001 ) in group 1with lower cesarean section rates [ 22.8 % in group 1versus 33.3 % in group 2 ; RR 0.7 ( 0.6–0.9 ) , ( p = 0.020 ) ] . Whereas the uterine hyperstimulation ( p < 0.001 ) was significantly higher in group 1 . There were no significant differences between both groups as regard patients ’ demographic characteristics . Conclusions ( s ) : Vaginal misoprostol is more effective but less safe than Foley catheter combined with vaginal IMN for induction of labor in term and post-term pregnancy To assess the efficacy and safety of isosorbide mononitrate ( IMN ) compared with misoprostol for cervical ripening and labour induction at term . In this comparative study two hundred term pregnant women with indication for induction of labour were r and omly divided to receive either 40 mg IMN tablet vaginally ( n=100 ) or 50 μg misoprostol tablet vaginally ( n=100 ) every 6 hours interval for a maximum of 4 doses . Progress & outcome of cervical ripening , labour induction and adverse effects were assessed . Change in cervical score was higher in misoprostol group than IMN group . Time from start of medication to vaginal delivery in IMN group was significantly longer , 28.66 ± 5.283 hours , than in misoprostol group , 16.12 ± 5.581 hours . Vaginal delivery occurred in 77 % in IMN group and 69 % in misoprostol group . There were no tachysystole or uterine hyper stimulation in the IMN group while in misoprostol group it was 17 % and 11 % respectively . Maternal satisfaction was higher in IMN  group . Cervical ripening is satisfactory with IMN . Though misoprostol is singly more effective than IMN but IMN with oxytocin results in more vaginal delivery . Fetal and maternal side effects are less in IMN group OBJECTIVE To determine the safety and effectiveness of self-administered treatment with isosorbide mononitrate ( IMN ) for cervical ripening in Indian women with post date d pregnancies . METHODS A r and omized , placebo-controlled study was conducted with 200 women with post date d pregnancies and unfavorable cervices who self-administered vaginally either 2 40-mg tablets of IMN or 2 40-mg tablets of pyridoxine as placebo prior to admission for induction of labor . The main outcome variables were change in Bishop score , time from admission to delivery , and presence or absence of fetal and maternal morbidity . RESULTS The Bishop score was significantly improved 24 hours after initiation of the outpatient IMN treatment ( P<0.001 ) and the needs for further cervical ripening and oxytocin infusion were less in the study than in the control group ( P<0.001 and P=0.008 ) . The time from admission to delivery was also less ( P<0.001 ) . Moreover , the IMN treatment had no major adverse maternal or fetal effects . The vast majority of women in both groups were either satisfied or very satisfied with the outpatient treatment . CONCLUSION The self-administration , at home , of isosorbide mononitrate leads to a safe and effective cervical ripening prior to labor induction in women with post date d pregnancies . CTRI Registration No.:CTRI/2011/091/000121 OBJECTIVE Our aim was to assess the effects of vaginally administered isosorbide mononitrate ( a nitric oxide donor ) on maternal and fetal hemodynamics in pregnant women at term . STUDY DESIGN We conducted a r and omized controlled trial . Women were r and omly selected to receive vaginally administered  isosorbide mononitrate , 20 mg ( n = 13 ) or 40 mg ( n = 11 ) , or to undergo  a vaginal examination only ( n = 12 ) . Maternal pulse , blood pressure , and fetal heart rate were recorded at baseline and then every 30 minutes until 360 minutes . Umbilical artery resistance index and pulsatility index measurements were performed at 0 , 180 , and 330 minutes . RESULTS Maternal pulse rate was greater after the administration of isosorbide mononitrate , 20 or 40 mg , compared with the pulse rate in the vaginal examination-only group ( greatest difference in means , 21 beats/min ; P < .01 ) . Maternal systolic and diastolic blood pressures were greater in the 20-mg and 40-mg isosorbide mononitrate groups than in the vaginal examination-only group ( greatest difference in mean systolic and diastolic blood pressure , 15 and 16 mm Hg , respectively ; P < .02 and P < .001 , respectively ) . Fetal heart rate was greater in the 40-mg isosorbide mononitrate group than in either the 20-mg isosorbide mononitrate group or the vaginal examination-only group ( difference in mean , 15 beats/min ; P < .05 ) . No woman required treatment for maternal or fetal tachycardia or maternal hypotension . Neither dose of isosorbide mononitrate had a significant effect on umbilical artery resistance or pulsatility index . CONCLUSIONS Vaginal administration of 20 or 40 mg isosorbide mononitrate to pregnant women at term has an effect on both maternal and fetal hemodynamics , but this effect is not clinical ly significant OBJECTIVE : To estimate whether vaginal isosorbide mononitrate , added to oral misoprostol for cervical ripening and labor induction , shortens time to vaginal delivery . METHODS : A prospect i ve , r and omized trial was conducted . Women scheduled for labor induction between 32 and 42 weeks and with unfavorable cervices ( modified Bishop score 6 or lower ) were r and omized to receive oral misoprostol every 4 hours , up to four doses , with or without isosorbide mononitrate every 6 hours , up to two doses . A strict protocol was used , including timing of oxytocin use and amniotomy . Side effects were assessed 6 hours after study initiation . One hundred forty-two patients were required to detect a change in time to vaginal delivery of 4 hours ( & agr;=.05 and & bgr;=.20 ) . Data were analyzed by intent to treat . Student 's t , chi square , Fisher 's exact , and Mann – Whitney tests were used where appropriate with P≤.05 deemed significant . RESULTS : One hundred fifty-six women were r and omized ; three were excluded after r and omization . Seventy-eight women received misoprostol  , and 78 received misoprostol with isosorbide mononitrate . Demographic characteristics were similar between groups . The time to vaginal delivery was not reduced when isosorbide mononitrate was added to misoprostol . Cesarean delivery rates and contraction and fetal heart rate abnormalities were similar between groups . Side effects were also similar between groups , except that women given isosorbide mononitrate experienced headaches more often . Neonatal outcomes were similar between groups . CONCLUSION : The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and was associated with a greater incidence of headache . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00374621 . LEVEL OF EVIDENCE : OBJECTIVE Nitric oxide donors have been shown to cause cervical ripening . The aim of this study was to determine whether sustained release isosorbide mononitrate ( ISMN-SR ) 60 mg administered vaginally is effective for pre induction cervical ripening at 41 weeks ' gestation . METHODS A double-blind r and omised controlled trial was carried out at the University Obstetric Unit , Galle , Sri Lanka for a period of 9 months , commencing 1st August 2003 . One hundred and fifty-six consecutive women with uncomplicated singleton pregnancies at 41 weeks ' gestation with a modified Bishop Score < 5 were allocated by stratified ( primip/multip ) block r and omization to receive either ISMN-SR 60 mg ( n = 78 ) or vitamin C 100 mg ( n = 78 ) vaginally . Modified Bishop Score at 41 weeks + 2 days ' gestation and the proportions establishing spontaneous labor or becoming favorable for induction of labor ( IOL ) by 41 weeks + 2 days ' gestation were evaluated in each group . RESULTS At the commencement of the study there were no differences between the mean age , parity or modified Bishop Score of the two groups . In the ISMN-SR group , there was a marked increase in the proportion establishing spontaneous labor ( 28 % vs 7.5 % , P < 0.01 ) and being favorable for IOL ( 40 % vs 9 % P < 0.001 ) , 2 days after therapy . In the ISMN-SR group , there was a significantly higher increase in the mean modified Bishop Score ( 3.8 , 95 % CI 2.3 - 5.3 vs 1.3 , 95 % CI 0.3 - 2.2 , P < 0.01 ) and a marked decrease in the proportion of subjects requiring further ripening of the cervix with a Foley catheter . ( 32 % vs 79 % , P < 0.001 ) . The cesarean section rates were similar in both groups . CONCLUSION Sustained release ISMN administered vaginally is effective for preinduction cervical ripening Background There is increasing interest in carrying out pre-induction cervical ripening on an outpatient basis . However , there are concerns about the use of prostagl and ins , the agents commonly used in hospital setting s for this indication , because prostagl and ins induce uterine contractions that may lead to fetal hypoxia . Indeed , in a recent study we demonstrated abnormalities in 9 % of fetal heart rate tracings performed following prostagl and in induced cervical ripening at term . In contrast , we confirmed in the same study that isosorbide mononitrate ( IMN ) ( administered on an inpatient basis ) was both effective in inducing cervical ripening at term , and was associated with no associated fetal heart rate abnormalities . Methods / design The aim of this study is to determine whether IMN self administered by women on an outpatient basis improves the process of induction of labour . Specifically , we hypothesise that the use of outpatient IMN will result in a shorter inpatient stay before delivery , decreased costs to the health service and greater maternal satisfaction with ripening and induction of labour , compared with placebo treatment . In the study described here ( the " IMOP " study ) , women scheduled for induction of labour at term , and who require pre-induction cervical ripening will be r and omised to self-administer at home either IMN 40 mg , or a placebo , each vaginally , at 48 hours , 32 hours and 16 hours before scheduled hospital admission . After admission to hospital , treatment will revert to the usual induction of labour protocol . We will compare the primary outcomes of the elapsed time interval from hospital admission to vaginal delivery , the costs to the health service of induction of labour , and women 's experience of induction of labour in the two groups . Discussion This trial will provide evidence on the efficacy of outpatient IMN for pre-induction cervical ripening at term . 
    Output:
    
One study of 75 participants did not contribute any data to the review .For all comparisons , women who received NO donors were more likely to experience side effects such as headache , nausea or vomiting .
AUTHORS ' CONCLUSIONS Available data suggests that  NO donors can be a useful tool in the process of induction of labour causing the cervix to be more favourable in comparison to placebo .