Mifepristone safety and efficacy in preinduction of labor: an observational study

Background: When the continuation of pregnancy adversely affecting the mother and fetus, termination of pregnancy is planned. Mifepristone as a method of pre-inducing agent in late pregnancy by increasing sensitivity of the uterus to the actions of prostaglandins and increasing uterine contractility. Objective of this study is to know the efficacy of mifepristone as a preinduction cervical ripening and induction of labor.Methods: In this prospective randomized study, 130 pregnant women are included and divided into two groups i.e. study group(n=65), has received tab mifepristone 200 mg and control group (n=65) has not received any drug.  After the end of 24 hours, Bishops score in both the groups are assessed and those not in labor or with unfavourable cervix are administered with intracervical dinoprostone gel every 6 hourlies for maximum of 3 doses or until pregnant woman entered into active labor. Statistical analysis regarding improvement in Bishops score, induction active phase interval, induction delivery interval is observed.Results: After 24 hours, observation in the mean Bishops score has showed significant improvement in the study group (72.33%), when compared to control group (54.58%). % woman has gone into spontaneous labor in study group (61.5%), and in control group (75.4%). Induction to active phase time duration is less in study group with mean (10.53), and in control group (17.4). Induction to delivery time duration is also less in study group with mean (15.100) when compared to control group (22.100). 67.7% of patients has delivered by vaginally in study group, and in control group 41%.Conclusions: Tab. mifepristone 200 mg has a pre inducing agent for cervical ripening, shown better improvement in Bishops score within 24-48 hours and decreases time duration from induction to active phase and induction to delivery

A randomized controlled trial of sublingual Misoprostol - 600µg versus intravenous Oxytocin - 10IU in prevention of post partum hemorrhage during cesarean section

Background: Mortality related to pregnancy and childbirth causes half a million women around the world to die annually. About 35% of these deaths are from postpartum hemorrhage (PPH). Prevention of PPH has been advised by the WHO by the use of Oxytocin 10 IU IM or IV and Misoprostol 600 µg in low resource settings in vaginal delivery. However there have been only a few reports on the use of Misoprostol during cesarean section. The best route and dose of Misoprostol is still being debated.Methods: One hundred women with term singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive either Misoprostol 600µg sublingually or intravenous oxytocin 10 IU soon after delivery of the baby. Estimated blood loss and comparative change in preoperative hemoglobin to post operative hemoglobin levels and side effects were evaluated.Results: Blood loss was found to be more in Misoprostol than Oxytocin. Eight patients of the Misoprostol group required additional oxytocics. Oxytocin group did not receive any additional drugs. No surgical intervention was made in either of the groups.  The most common side effect with Misoprostol was shivering (46%) and in Oxytocin group fever (4%).Conclusions: Sublingual Misoprostol of 600µg works to prevent postpartum bleeding. In our study Oxytocin was more effective than Misoprostol in preventing PPH during cesarean section. Late onset of action of Misoprostol in comparison to Oxytocin may render suturing of the uterus difficult due to pooling of blood. In settings in which use of Oxytocin is not feasible, Misoprostol might be a suitable alternative for post-partum hemorrhage

Antenatal dexamethasone for early preterm birth in low-resource countries

BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P=0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P=0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection.Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; ArgentinaFil: Vogel, Joshua P.. Organizacion Mundial de la Salud; ArgentinaFil: Piaggio, Gilda. Organizacion Mundial de la Salud; ArgentinaFil: Nguyen, My-Huong. Organizacion Mundial de la Salud; ArgentinaFil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Metin Gülmezoglu, A.. Organizacion Mundial de la Salud; ArgentinaFil: Bahl, Rajiv. Organizacion Mundial de la Salud; ArgentinaFil: Rao, Suman P.N.. Organizacion Mundial de la Salud; ArgentinaFil: de Costa, Ayesha. Organizacion Mundial de la Salud; ArgentinaFil: Gupta, Shuchita. Organizacion Mundial de la Salud; ArgentinaFil: Shahidullah, Mohammod. No especifíca;Fil: Chowdhury, Saleha B.. No especifíca;Fil: Ara, Gulshan. No especifíca;Fil: Akter, Shaheen. No especifíca;Fil: Akhter, Nasreen. No especifíca;Fil: Dey, Probhat R.. No especifíca;Fil: Abdus Sabur, M.. No especifíca;Fil: Azad, Mohammad T.. No especifíca;Fil: Choudhury, Shahana F.. No especifíca;Fil: Matin, M.A.. No especifíca;Fil: Goudar, Shivaprasad S.. No especifíca;Fil: Dhaded, Sangappa M.. No especifíca;Fil: Metgud, Mrityunjay C.. No especifíca;Fil: Pujar, Yeshita V.. No especifíca;Fil: Somannavar, Manjunath S.. No especifíca;Fil: Vernekar, Sunil S.. No especifíca;Fil: Herekar, Veena R.. No especifíca;Fil: Bidri, Shailaja R.. No especifíca;Fil: Mathapati, Sangamesh S.. No especifíca;Fil: Patil, Preeti G.. No especifíca;Fil: Patil, Mallanagouda M.. No especifíca;Fil: Gudadinni, Muttappa R.. No especifíca;Fil: Bijapure, Hidaytullah R.. No especifíca;Fil: Mallapur, Ashalata A.. No especifíca;Fil: Katageri, Geetanjali M.. No especifíca;Fil: Chikkamath, Sumangala B.. No especifíca;Fil: Yelamali, Bhuvaneshwari C.. No especifíca;Fil: Pol, Ramesh R.. No especifíca;Fil: Misra, Sujata S.. No especifíca;Fil: Das, Leena. No especifíca