Sublingual Misoprostol for labour augmentation

Background: Labour dystocia is associated with a number of adverse maternal and neonatal outcomes. Augmentation of labour is a commonly used intervention in cases of labour dystocia. Misoprostol is an inexpensive and stable prostaglandin E1analogue. Present study was done to see the effectiveness of sublingual misoprostol for labour augmentation and foeto-maternal outcome.Methods: Total 100 labouring women of term gestation were taken and divided in two groups: group A (study group) and group B (control group). In study group 25mcg sublingual misoprostol given 4 hourly till adequate uterine contractions developed, i.e. >3 contractions in 10 minutes, each lasting for 40-45 seconds. A maximum of 200mcg of misoprostol or 8 doses were used and in group B no drug was given for augmentation of labour. Maternal and foetal outcome were observed in both groups.Results: Augmentation to delivery interval was very short in group A in comparison to group B. Maternal and foetal outcome were almost same in both groups.Conclusions: Sublingual misoprostol is a safe and effective drug for augmentation of labour leading to early delivery without any major side effects

Role of TSH and O-GTT screening in pregnancy induced hypertension

Background: Objective of current study was to evaluate the prevalence of hypothyroidism and gestational diabetes in PIH patients and its impact on maternal and foetal outcome.Methods: A case-control study of 200 antenatal women; group A - PIH, 100 and group B normotensive - 100 women was carried out. Serum TSH and O-GTT screening was done in both groups.Results: In group A, 59% women had mild preeclampsia, 41% women had severe preeclampsia. Significantly raised TSH titre (>3 mIU/ml) was found in 36% women in group A and 9% women in group B (P value <0.0001). GDM was found in 33% women in group A and 8% women in group B (P value 0.0033).  Conclusions: Incidence of both hypothyroidism (subclinical and clinical) and gestational diabetes is significantly high in women with PIH.

Extraction and characterization of silk sericin

Study compares the quality and quantity of sericin obtained from four sources, namely mulberry silk cocoons, silk flats, reeling silk waste and woven silk fabric. Sericin has been extracted using the conventional HTHP machine as well as IR heating machine. Results show that among the four sources, the maximum yield of sericin (28%) is obtained from silk fabric followed by 25% sericin obtained from silk flats. IR machine extraction gives ~13 times higher yield of sericin as compared to that obtained by HTHP at 1000C for 60 min. Sample obtained from IR extraction is also compared with the standard sample in terms of its physical properties, morphological structure, protein quality, protein structure, molecular weight and thermal behaviour using various analytical methods. The study proposes a protocol for assessing the quality of sericin protein. Since the source as well as the method of extraction can affect the properties of sericin, this protocol can be used to assess and determine the quality parameters of various sericin samples

Analysis of clinico-sonological parameters of women with preterm pregnancy with complaint of lower abdominal pain

Background: Cervical length and dilatation are important parameters to be evaluated for the diagnosis of threatened preterm labor, and they may have an important role in the risk stratification of women presenting with preterm labor. Thus, the study was planned to analyse clinicosonological parameters in women with preterm pregnancy who came with complaint of lower abdominal pain.Methods: A total of 200 pregnant women with 28 to 35±6 weeks of gestation admitted with pain abdomen underwent complete history and examination, followed by relevant antenatal investigations. Transvaginal ultrasonic CL and dilatation measurement at the time of admission and after 4-6 hours of observation were done. The subjects were followed and admission-delivery interval was noted. Statistical analysis was done by applying the appropriate Chi-square test for the comparison of proportions.Results: Four percent of patients had a cervical length <2 cm at admission, 40% had a cervical length between 2-3 cm and 56% of patients had a cervical length ≥3 cm. The difference between the 3 groups was statistically significant (p value <0.000001) and 100% of patients with cervical length <2 cm were delivered within one week. Fifteen percent of patients had changes in cervical length after 4-6 hours of observation and 85% did not have any change in cervical length. The difference was statistically significant (p value <0.0000001).Conclusions: Cervical length and dilatation measurement by transvaginal sonography (TVS) has a positive correlation with the admission to the delivery interval

Evaluation of PPIUCD versus interval IUCD (380A) insertion in a teaching hospital of Western U. P.

Background: Comparative evaluation of PPIUCD and interval IUCD in terms of incidence of failure, expulsions, bleeding P/V and other complications.Methods: Total 300 willing women after counselling in antenatal, early labor or postnatal period were inserted PPIUCD after excluding chorioamnionitis, PROM >18hrs, Unresolved PPH, Puerperal sepsis. Another 150 willing women were inserted interval IUCD after excluding contraindications. All were followed up for 6 months.Results: Expulsion rate was significantly higher in PPIUCD as compared to interval insertions (4.3% v/s 2.0%; p value< 0.05). Number of removal of IUCD was almost similar in both groups(5.6% v/s 6.0%) but bleeding as a cause of removal was significantly more in interval group(23.5% v/s 88.5%). Common causes of PPIUCD removal were social.Conclusions: Postpartum insertion of IUCD is safe effective, feasible and reversible method of contraception

Comparative evaluation of sonohysterosalpingography (Sono HSG) to diagnostic laparo-hysteroscopy in infertility

Background: Aim was to study whether sonohysterosalpingography (sono HSG) can be used for tubal and uterine assessment in primary and secondary infertility instead of invasive methods like diagnostic largo-hysteroscopy (DLH). Methods: This was prospective interventional study. This study conducted at Obstetrics and gynecology Department, Lala Lajpat Rai Memorial Medical College Meerut, India in infertile women. Bilateral tubal patency and various uterine pathologies were first evaluated by sono HSG followed by DLH. The results were compared. Results: Sono HSG was found to be sensitive and highly specific in diagnosing tubal/uterine factors with a sensitivity of 86.6%/58.33% and specificity of 80%/97.22%. The positive and negative predictive values were 92%/93.33% and 66%/77.78%. Conclusions: Thus transvaginal sono HSG with its accuracy and safety, is a promising screening and diagnostic technique in the evaluation of tubal patency on an ambulatory basis. In the future, it can replace the hysterosalpingography

Conception rate with or without hCG trigger in clomiphene induced cycles

Background: Clomiphene citrate (CC) is still the most common drug for ovulation induction. Most physicians use hCG trigger routinely for follicle rupture. Ideally hCG is recommended only where there is no spontaneous LH surge. Hence this study was conducted to see the role of hCG for follicle rupture in CC induced cycle. Aims and objectives of the study were to compare the ovulation rate in CC induced cycle with or without hCG trigger and finally the conception rate.Methods: Study was conducted in the department of OBG, LLRM medical college Meerut on women with anovulatory infertility. All women were given 50-100 mg CC. Follicular study from D-9 was done till follicle rupture. Women in group A were observed without any trigger and women in group B were given inj. hCG trigger 10,000 IU when follicle size reached 20-22 mm.Results: Conception rates were 25% Vs 31% in group A and group B. Follicle rupture was seen in 84% cases in group A and 71% in group B. Results were comparable in both the groups.Conclusions: By adding inj. hCG for ovulation trigger does not increase the conception rate. LH surge is already there in CC induced cycles. It is having role only in cases where no LH surge is there.

Clinicopathological correlation of infective vaginal discharges in non pregnant sexually active women of reproductive age group in a tertiary care centre of Western UP

Background: The aim was to study the etiology of infective vaginal discharges prevalent in our area and to study its association with PID. Methods: A total of 500 patients were recruited for study attending Gynae OPD and presenting with vaginal discharge. After detailed history taking and physical examination three sterile vaginal swabs were taken from the posterior fornix and sent for culture of Candida and Trichomonas on Saborauds Dextrose Agar and Kufperberg media respectively and one was used for smear for gram’s staining to diagnose Bacterial vaginosis by Nugent’s scoring.Results: In this study, prevalence of BV, Candida and Trichomonas vaginalis was found to be 146 (29.2%), 106 (21.2%) and 15(3%) respectively out of 24 cases had mixed infections while no organism was found in 257 cases (51.4%). Candida infection was found to be significantly associated with presence of other complaints such as itching, burning micturition, dyspareunia etc (p1 abortions(p=0.015), presence of urogenital complaints (p5) (p5 (p=0.004).Conclusions: Bacterial vaginosis and candidiasis are the most common causes of infective vaginal discharges in our community than trichomoniasis

Efficacy and safety of oral mifepristone for cervical priming and induction of labor in term pregnancy

Background: The objectives of the study was to assess the efficacy of mifepristone in priming the cervix/inducing labor over next 96 hrs in term pregnancy.Methods: In this single blind randomized controlled trial 200 women with term pregnancy beyond 39 weeks and Bishop’ score <6 were randomly allocated into two groups. Tab Mifepristone 400 mg orally was given to women in study group (n=100) and no intervention in control group (n=100). On follow up one case was lost in control group. All women were observed for change in the bishop’s score or onset of labor in next 96 hrs. If Bishop’s score was <6, the choice of induction was left on the clinician/patient.Results: Mean induction to delivery interval, duration of active phase and improved Bishop score were 79.35±53.43 hr, 2.47±1.23 hr, 6.68±1.69 for study group versus 148±65.66 hr, 3.09±1.45 hr, 5.8±2.15  for control group (p value is <0.001) respectively.  Seventy one (71%) women in study group and 39 (39.3%) women in control group delivered vaginally within 96 hrs without any need of augmentation. There were 9 (9%) caesareans in study group and 24 (24.2%) caesareans in control group but no instrumental delivery in both groups. There was no statistically difference in perinatal outcomes between two groups.Conclusions: Mifepristone is an effective drug for cervical ripening and initiation of labor when given in term pregnancy beyond 39 weeks with poor Bishop’s score (<6) and appearing to reduce need for other agent for augmentation of labor

Role of anti-thyroid peroxidase antibodies in adverse pregnancy outcomes

Background: Because of the link of thyroid auto antibodies with various pregnancy related complications and anti-thyroid peroxidase antibody (TPO Ab) being most common of all of them, can be used as a surrogate marker for thyroid related adverse pregnancy outcomes. Hence, present study was designed to further elucidate any association of anti-TPO antibodies and serum thyroid stimulating hormone (TSH) levels with adverse pregnancy outcomes.Methods: This observational study has been conducted in the department of obstetrics and gynaecology at L. L. R. M. Medical College, Meerut, Uttar Pradesh, India. Five hundred randomly selected peripartum women from 20 weeks onwards have been included and divided into two main groups, anti-TPO Ab positive (group B) and anti-TPO Ab negative (group A). Serum TSH was done only in group B. These two groups were compared for age of the patient, period of gestation, number of abortions, pregnancy outcome, maternal and fetal complications.Results: Out of 500 women, 18.6% were anti-TPO Ab positive. Number of abortions ≥ 2 was found in 18% and 8% in group B and A whereas preterm delivery was found in 50% and 17% in the two groups respectively. In group B, 48% had increased TSH.Conclusions: Anti-TPO Ab presence was significantly associated with preterm deliveries, recurrent abortions, increased maternal and fetal complications