Comparative study between vaginal isosorbide mononitrate and misoprostol for induction of cervical ripening prior to surgical evacuation of first trimester embryonic demise

Background: Objective: To compare the efficacy & safety of Nitric Oxide (NO) donor, isosorbide mononitrate (ISN) to that of misoprostol, applied vaginally as tablets for cervical ripening prior to suction evacuation of first trimester embryonic demise.Methods: This is a prospective, randomized, double blind controlled trial conducted at tertiary level teaching hospital. 50 women with first trimester embryonic demise with closed cervix requiring suction evacuation were divided randomly into two groups of 25 women each. In group A, tab. isosorbide mononitrate 80 mg and in group B, tab. misoprostol 400 µg was applied vaginally. Both the drugs were repeated every three hourly up to a maximum of four doses or until reaching cervical dilation of 8 mm. Cervical dilatation was assessed at baseline & every three hours after each dose. A set of questionnaire was used for the appearance of side effects. Once 8 mm cervical dilatation achieved, suction evacuation was done. Total volume of blood lost at suction evacuation was measured.Results: Frequency of doses, induction to ripening interval & intra operative blood loss was significantly higher with isosorbide mononitrate as compared to misoprostol. Headache & palpitation were main side effects of isosorbide mononitrate. The percentages of successful & failed inductions were comparable in both the groups.Conclusions: Misoprostol is better cervical dilator prior to suction evacuation in first trimester embryonic demise with minimal side effects which are acceptable to the patient

HELLP syndrome and its implications on maternal and perinatal outcome

Background: The HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). This syndrome in general complicates 0.2-0.6% of all pregnancies but its incidence increases to 4-12% in severe preeclampsia. In about 15% cases, HELLP syndrome presents without definitive criteria for preeclampsia (atypical preeclampsia). This present study will throw light on incidence, clinical and biochemical profile of patients with HELLP syndrome and maternal and perinatal outcome.Methods: A prospective study was conducted in the department of Obstetrics and Gynecology, Bebe Nanki Mother and Child Care Centre, Amritsar, India from January 2016 to August 2017 after approval from institutional ethics committee.Results: In the present study, total 2949 antenatal admissions were there during the course of study. Out of these patients, 352 patients had preeclampsia-eclampsia (11.93%). Out of these 352 patients, 71 complicated with HELLP syndrome (20.17%). 17.9% had partial HELLP and 2.3% had complete HELLP syndrome. 30.16% had only EL, 31.75% had only LP, 87.3% had elevated LDH (depicted hemolysis). 4.76% had both EL and LP, 30.16% had both EL and elevated LDH, 20.63% had both LP and elevated LDH levels. Majority of the patients presented after 36 weeks of gestation. Only 5 patients had HELLP syndrome in the postpartum period. Among partial HELLP patients, 59.02% delivered vaginally and 40.98% delivered by LSCS and among complete HELLP patients 28.6% delivered vaginally and 71.4% delivered by LSCS. Perinatal mortality rate was 43.7%. Severe maternal complications such as PPH, DIC, abruptio placentae, pulmonary edema and renal failure were seen high among HELLP patients.Conclusions: As the incidence is very high, one must be aware of its clinical and laboratory findings so that early diagnosis and treatment can be initiated. Close surveillance of the mother should be continued even after delivery

Study of prevalence of bacterial vaginosis in preterm and term labour patients

Background: Bacterial vaginosis (BV) is a clinical condition caused by replacement of the normal hydrogen peroxide producing Lactobacillus species with high concentrations of aerobic and anaerobic bacteria. Studies have shown that spontaneous abortion, preterm labour (PTL), premature birth, preterm premature rupture of membranes, amniotic fluid infection, and postpartum endometritis are increased because of infection with BV. In India, not many studies have been done to estimate the prevalence and association of BV with preterm labour, hence this study is being taken up to know the prevalence of BV in preterm and term labour patients and its relationship with preterm delivery, low birth weight of baby and puerperal sepsis.The objective of the present study was to observe the prevalence of bacterial vaginosis in women presenting with preterm and term labour, its impact on preterm and term delivery and to analyze the maternal and fetal complications associated with BV.Methods: An observational study involving 100 patients with preterm and term labour (50 patients in each group) was conducted at a BNMCCC, Government Medical College, Amritsar. Women fulfilling the Amsel’s criteria and/or a score of 7 or more on gram staining of vaginal smears (Nugent’s score) was considered to have bacterial vaginosis.Results: The proportion of patients, who fulfilled Amsel’s criteria and/or a Nugent’s score of 7 or more for the diagnosis of BV, was more in PTL group versus term labour group, and the difference was statistically significant. Prevalence of BV in preterm labour and term labour patients was 18(36%) versus 4(8%) respectively. In PTL group, 27.8% of low birth weight neonates were born to BV positive mothers versus 3.1% were born to BV negative mothers. Maternal postpartum complications observed were 33.3% with BV versus 6.25% without BV in PTL group.Conclusions: BV is major risk factor for PTL. Therefore, the testing and prompt treatment of BV may reduce the risk of PTL. This will also go a long way in the prevention of maternal morbidity and neonatal complications due to prematurity

HELLP syndrome and its implications on maternal and perinatal outcome

Background: The HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). This syndrome in general complicates 0.2-0.6% of all pregnancies but its incidence increases to 4-12% in severe preeclampsia. In about 15% cases, HELLP syndrome presents without definitive criteria for preeclampsia (atypical preeclampsia). This present study will throw light on incidence, clinical and biochemical profile of patients with HELLP syndrome and maternal and perinatal outcome.Methods: A prospective study was conducted in the department of Obstetrics and Gynecology, Bebe Nanki Mother and Child Care Centre, Amritsar, India from January 2016 to August 2017 after approval from institutional ethics committee.Results: In the present study, total 2949 antenatal admissions were there during the course of study. Out of these patients, 352 patients had preeclampsia-eclampsia (11.93%). Out of these 352 patients, 71 complicated with HELLP syndrome (20.17%). 17.9% had partial HELLP and 2.3% had complete HELLP syndrome. 30.16% had only EL, 31.75% had only LP, 87.3% had elevated LDH (depicted hemolysis). 4.76% had both EL and LP, 30.16% had both EL and elevated LDH, 20.63% had both LP and elevated LDH levels. Majority of the patients presented after 36 weeks of gestation. Only 5 patients had HELLP syndrome in the postpartum period. Among partial HELLP patients, 59.02% delivered vaginally and 40.98% delivered by LSCS and among complete HELLP patients 28.6% delivered vaginally and 71.4% delivered by LSCS. Perinatal mortality rate was 43.7%. Severe maternal complications such as PPH, DIC, abruptio placentae, pulmonary edema and renal failure were seen high among HELLP patients.Conclusions: As the incidence is very high, one must be aware of its clinical and laboratory findings so that early diagnosis and treatment can be initiated. Close surveillance of the mother should be continued even after delivery