Mifepristone as pre-induction cervical ripening agent: a review article

Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome

Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding

Background: Intra-cavitary uterine pathology is the commonest cause of abnormal uterine bleeding. Hysteroscopy is considered as the gold standard for uterine cavity examination. However, in resource limited set-ups saline infusion sonography is an effective alternative to hysteroscopy. The current study aims to compare the accuracy of saline infusion sonography with hysteroscopy in identifying intra-cavitary lesions in women with abnormal uterine bleeding.Methods: 52 patients with abnormal uterine bleeding underwent saline infusion sonography followed by hysteroscopy. The parameters studied were endometrial thickness, presence of sub-mucosal fibroid and endometrial polyp.  Results: Upon comparison of saline infusion sonography with hysteroscopy, for detecting endometrial hyperplasia the  sensitivity, specificity, positive and negative predictive value were 100%, 94%, 40% and 100% respectively. For endometrial polyp the sensitivity, specificity, positive and negative predictive values were 90.90%, 92.68%, 76.92% and 97.43% respectively. Similarly, the sensitivity, specificity, positive and negative predictive values for sub-mucosal fibroid were 86.36%, 83%, 79.16 % and 89.28% respectively.Conclusions: Saline infusion sonography is a less invasive alternative to hysteroscopy for diagnosis of intra-cavitary lesions in women with abnormal uterine bleeding.

Mifepristone as pre-induction cervical ripening agent in term pregnancy

We hereby report the results of a prospective randomized study where we compared efficacy of mifepristone and prostaglandin (PGE2) gel for pre-induction cervical ripening

Adolescent pregnancy: an overview

A pregnancy can take place at any time before or after puberty. Adolescent pregnancy is defined as pregnancy under the age of 20 years. It is a problem in both developed and developing country. It raises various human right issues i.e. an adolescent pregnant girl is forced to leave school, depriving her right to education; she is prevented from using any contraception or reproductive health related information, so she is also denied her right to health. As many adolescents are neither physically nor psychologically ready for pregnancy or childbirth, this reproductive event makes them more vulnerable to complications resulting in devastating health consequences for them. Early drop out from the school and health problem jeopardize their income-earning potential

Comparison of maternal and neonatal outcome in elective lower segment cesarean section done at 38 and 39 weeks

Background: Time to perform elective LSCS is a relevant issue related to mother and foetus. LSCS can be done from 37 weeks onwards because foetal lungs mature by then. But foetuses born at 37 weeks of gestation have more risk of developing respiratory problems, transient tachypnoea of new born, hypothermia, hypoglycaemia and NICU admission.The purpose of this study is to find out appropriate gestational age at which elective LSCS can be performed without adverse maternal and neonatal outcome.Methods: This is an observational comparative study done on 209 antenatal women who underwent elective caesarean section from December 2014 to January 2016.Patients were divided into two groups after taking consent. Maternal parameters like formation of lower uterine segment need for blood transfusion. Neonatal parameters like Apgar score, respiratory distress syndrome and NICU admission with indication and duration were analyzed by chi-square test. Gestational Age and Pre-Op Hb and Post-Op Hb were analyzed by independent ‘t’test.Results: In this study 55% of the pregnant women belong to 38 weeks,45% belongs to 39 weeks. The formation of lower uterine segment was statistically significant and the need for blood transfusion was slightly increased at 39 weeks. But there was no significant difference in Apgar score, Respiratory distress, NICU admission comparing both study groups.Conclusions: Elective caesarean section can be done safely at 38 weeks without affecting maternal and perinatal outcome

Paraurethral leiomyoma in a woman: a case report

Paraurethral leiomyomas are rare, benign smooth muscle tumours of the urogenital tract. Most para-urethral tumours occur in the reproductive age group. Its etiology is uncertain and its presentation is variable. Here we present a 45 year old multiparous lady, who approached the out-patient department, with complaints of profuse foul-smelling discharge and a mass per vaginum for 10 days

Caesarean section scar endometriosis: a case report and review of literature

Endometriosis is described as the presence of functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare event which usually develops after pelvic operations involving the uterus and fallopian tubes. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. Its diagnosis can sometimes be difficult and may be confused with various other surgical conditions. We present here a case of abdominal wall scar endometriosis in a woman who has undergone caesarean delivery three years prior to her current presentation. The epidemiology, pathogenesis, clinical features, diagnosis, treatment and methods of prevention of this somewhat rare condition are discussed

Clinical study of primary caesarean section in multiparous women in a tertiary care hospital

Background: The objective of this study was to find the incidence and indications of primary caesarean section in parous women and evaluate the maternal and perinatal outcomes there from.Methods: Prospective study of primary caesarean sections in parous women at our institute from June 2013 to May 2014 was done. Age, indications and the maternal as well as perinatal outcomes were analyzed. Data was expressed as number and percentage.Results: Out of 1124 caesarean deliveries, 68 primary caesareans in parous women were done.  The most common age group was 21-30 years. The majority of parous women who underwent primary caesarean section, were para 2. Booked cases constituted the maximum number of such women at 97.1 % (n=66). In parous women undergoing primary caesarean section, the number of spontaneous onset of labour was significantly more than those undergoing induction of labour. The most common indication for caesarean section in this group of patients was fetal distress. There was no neonatal mortality or adverse maternal outcome.Conclusions: Fetal distress was the most common indication for primary caesarean section in the parous woman, although malpresentation also contributed significant numbers. Primary caesarean sections in women with previous vaginal deliveries, were not associated with any significant neonatal or maternal complications

Comparison of the efficacy of extra amniotic Foley catheter, intravaginal prostaglandin E1 tablet and intracervical prostaglandin E2 gel for pre induction cervical ripening: a randomized comparative study

Background: To compare the efficacy, efficiency and safety of extra amniotic Foley catheter with intracervical PGE2 gel and intravaginal misoprostol tablet for pre induction cervical ripening. Design of the study was to prospective randomized comparative study. Settings includes, this study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry during November 2009 to May 2011.Methods: Participants for pre induction cervical ripening were randomized to receive either extra amniotic Foley catheter, intravaginal misoprostol tablet 25µg every four hours or intracervical PGE2 gel 0.5mg every six hours. The post ripening Bishop Score at 12 hours and 24 hours were assessed. The outcome measured was the time taken by the participants to achieve Bishop Score >5. The other outcomes included induction ripening interval, induction delivery interval, mode of delivery, requirement of additional agents, maternal and fetal complications.Results: The post ripening Bishop Score was significantly higher in PGE2 gel group with statistical significance. The induction ripening and the induction delivery interval was significantly shorter in misoprostol tablet group with a ‘p’ value <0.001. The incidence of NICU admission and other complications like meconium stained liquor, respiratory distress and maternal fever were more associated with misoprostol tablet group.Conclusions: PGE2 gel is an efficient agent for pre induction cervical ripening when compared to Foley catheter and misoprostol tablet though it is expensive, unstable and requires refrigeration. Tablet misoprostol significantly reduces the ripening duration, ripening delivery interval and the total duration to delivery. Misoprostol tablet is inexpensive, stable at room temperature and easy to administer. It also reduces the need for oxytocin augmentation. However the safety of misoprostol is still a concern due to increased maternal and neonatal complications. Foley catheter alone is not a good cervical ripening agent

Pregnancy of unknown location (PUL): a case report and review of literature

While most pregnancies are obviously within the uterus, Pregnancy of Unknown Location (PUL) is used to describe cases where, there is a positive pregnancy test but no sign of a pregnancy inside or outside the uterus, on transvaginal ultrasound or even at laparoscopy. We report a case of multigravida with history of disturbed tubal ectopic pregnancy in previous pregnancy presented with lower abdominal pain and spotting per vaginum following 6 weeks amenorrhoea. The patient was clinically stable with no evidence of intrauterine or extrauterine pregnancy in transvaginal sonography with serum beta human chorionic gonadotropin (beta-hCG) above descriminatory levels. Provisional diagnosis of Pregnancy of Unknown Location (PUL) was made and serial beta-hCG levels shows increasing levels. Endometrial curettage done with histopathology report showed product of conception following which there was a fall in serum beta-hCG. She was finally diagnosed as a case of silent miscarriage. Expectant management has been shown to be safe and effective in reducing the need for surgical intervention but does require close surveillance of patients who present with PUL