EVALUATION OF THE POSSIBLE ROLE OF NITRIC OXIDE DONOR IN CERVICAL RIPENING BEFORE FIRST TRIMESTER TERMINATION OF PREGNANCY IN CASES OF MISSED ABORTION : A PROSPECTIVE CLINICAL STUDY

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 npemng ts 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 repining 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.