Oral nifedipine versus nitroglycerine patch for tocolysis in preterm labour

Background: Preterm delivery is a major cause of neonatal mortality and morbidity. Various modalities have been used to prediction of patient at risk of preterm labor. But due to multi-factorial etiology these predictors are not always useful. Tocolysis has a major role in arresting preterm labor. The purpose of this study was to compare the safety and efficacy of oral nifedipine with transdermal nitroglycerine in the inhibition of preterm labour.Methods: This single blinded randomized control trial was conducted in the labour room of department of Obstetrics and Gynecology from January 2011 to June 2012. One hundred women with singleton pregnancy between 28 weeks to 34 weeks preterm labour and no contraindication for tocolysis were enrolled in the study. After taking the informed consent subjects were randomized into two groups. Randomization was done by random number table. Fifty-one subjects in nifedipine group received oral nifedipine (Tab Depin 10mg). Forty-nine subjects receiving transdermal nitroglycerine patch (Nitroderm Patch 10) were included in NTG group. The variables analysed were delay in delivery for 48 hours, 7 days or more than 7 days, period of gestation at delivery and side effect profile of drugs.Results: The percentage of women delivering after 48hours of administration of nifedipine group (52.9%) and nitroglycerine group (53.1%). Failure of tocolysis, defined as delivery within 48 hours, with nitroglycerine group (32.7 %) was comparable to nifedipine (33.3 %). Headache was significantly higher in nitroglycerine group as compared to nifedipine group (p≤0.001). Maternal tachycardia was more common in nifedipine group compared to NTG group (p=0.001).Conclusions: Oral nifedipine and transdermal nitroglycerine have similar efficacy as tocolytic agent in patients with preterm labour.

Randomised controlled trial to compare safety and efficacy of vaginal versus oral route of misoprostol for induction of labour in term pregnancy with unfavourable cervix

Background: The objective of the study was to compare safety and efficacy of vaginal versus oral route of misoprostol for induction of labour in term pregnancy.Methods: A total of 100 pregnant women with clinical indication for labour induction and poor bishops score were randomly assigned to receive vaginal or oral misoprostol. Group A received 25 μg of misoprostol vaginally (maximum up to 3 doses 4 hourly interval) and group B received 25 μg of misoprostol orally (up to 5 doses 2 hourly interval) in solution form. Maternal and fetal outcomes were compared in both groups to assess the safety and efficacy of vaginal versus oral route.Results: Fifty women received vaginal and 50 women received oral misoprostol. Average interval from induction to active stage was shorter in oral misoprostol (7.42±4.2 hours versus 10.30±5.1 hours) (p=0.006). There was no significant difference (p=0.272) in the average interval from induction to delivery between the vaginal group (14.42±5.01hrs) and oral group (13.14±5.5 hrs). No significant difference in caesarean section rates (p=0.42). Incidence of hyperstimulation was significantly higher (p=0.025) in vaginal group as compared to oral group (18 % vs 4 %). Incidence of nausea, vomiting, vaginal or cervical tears and postpartum hemorrhage were comparable in both the groups. There were no statistically significant differences in neonatal outcomes.Conclusions: Oral misoprostol has a better safety profile than vaginal route as the incidence of hyperstimulation and tachysystole was significantly more in vaginal group, although there were no significant differences in the maternal and neonatal outcomes

Uterine vascular lesions: a rare cause of abnormal uterine bleeding, reporting of two cases

Uterine vascular lesions in the form of arteriovenous malformation or pseudo aneurysm are rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manner are essential because instrumentation that is often used for other causes of uterine bleeding can lead to massive hemorrhage. We describe two cases of uterine vascular malformation, one presenting as postabortal hemorrhage and other as postpartum hemorrhage. Case one presented as postabortal hemorrhage after induced abortion following dilatation & curettage. Case two presented as delayed postpartum hemorrhage after six weeks following cesarean section. In both cases diagnosis of uterine arteriovenous malformation was made on Doppler ultrasonography which was subsequently confirmed on pelvic angiography. The embolization of affected uterine arteries was performed successfully in both cases. Uterine vascular lesion should be suspected in patient with abnormal vaginal bleeding, especially who has recent medical history of induced abortion or dilatation and curettage or cesarean section and so on. Although angiography remains the gold standard for making diagnosis, Doppler ultrasonography is also a good noninvasive technique for the same. Uterine artery embolization offers a safe and effective treatment

An observational study on extraperitoneal caesarean section in present era

Background: This study was designed to find out the maternal and perinatal outcome in cases of extraperitoneal caesarean section. Total 100 women undergoing extraperitoneal cesarean section were included in the study.Methods: A detailed history taking, examination done and intra and post-operative parameters as per protocols were noted.  Results: Success rate of extra peritoneal CS was 79.63%, Time taken from incision to delivery was ≤5 minutes in 60% cases, time taken from incision to closure was between 31-45 min in 67% cases, blood loss ≤500 ml in 58% cases, return of bowel function between 5-8 hours in 52%, mobilization within 24 hours in 52%, neonatal one minute APGAR score ≥7 in 90.91%.Conclusions: Extraperitoneal cesarean section can be applied as a surgical form of infection prophylaxis.Since it possesses a rational basis for the avoidance of serious post-operative pelvic infectious complications, this operation deserves reconsideration in the modern era

Spectrum of vulvar lesions: a clinicopathologic study of 170 cases

Background: A wide range lesions may occur in the vulvar region. The clinician is often confronted with the challenge to draw a distinction between normal variants, benign entities and a potentially serious pathology. The aim of the present study is to have an insight into the diverse morphologic spectrum of vulvar lesions.Methods: The present retrospective study was carried out by compiling the data from archival records over a period of eight years from January 2005 to December 2012. The vulvar biopsies/vulvectomy specimens were studied for histomorphological features. The lesions were categorized as non neoplastic, neoplastic and inconclusive; neoplastic ones were further divided into benign, malignant and premalignant.Results: The age of the women ranged from 6 to 80 years (mean 38.2±6.4) with the maximum number of patients between 31 to 40 years of age. Most common clinical presentation was itching and white plaque on the vulva (85 cases; 50%). The commonest site of vulval lesions was labia majora (87 cases, 51.18%). Non neoplastic lesions were more common (n = 94; 55.29%) than the neoplastic lesions (n =50; 29.41%). There were 23 (46%) benign lesions while 27 cases (54%) were malignant or premalignant ones. In 26 cases, no definitive histologic diagnosis could be rendered.Conclusion: Early recognition of vulvar lesions and a prompt biopsy diagnosis for all lesions with suspicious changes is of great significance. The term leukoplakia is imprecise and should be replaced by a precise histological description

Association of vitamin D deficiency during pregnancy with preeclampsia and eclampsia

Background: Vitamin D was considered important for bone and calcium. Historically thought to be important for bone and calcium metabolism but recent studies have redefined its role. There is some evidence now that low levels of Vitamin D are associated with the risk of preeclampsia but more studies are needed to prove the same. This study was done to determine whether vitamin D deficiency is an independent risk factor for preeclampsia/eclampsia.Methods: In this prospective case control study vitamin D levels were estimated in 92 women divided into two groups. Group 1(n = 42) included pregnant women with preeclampsia/eclampsia and group 2(n = 50) included uncomplicated pregnant women admitted in labour ward for delivery. The frequency of risk factors for preeclampsia/eclampsia were compared in two groups. Statistical analysis was done using the multivariate logistic regression analysis.Results: Almost 100% women in both groups had low vitamin D levels. Mean serum 25(OH)D levels were significantly less in Group 1(6.7236ng/ml) as compared to group 2(9.8862 ng/ml, p = 0.004). 83.3% of women in group 1 had severe deficiency (25(OH)D levels <10 ng/ml) compared to 68% women in group 2. All women (100%) in group 1 had vitamin D deficiency (<20 ng/ml) as compared to 92% in group 2 but this was not statistically significant.Conclusions: Although mean serum 25(OH)D levels were significantly less in preeclampsia/eclampsia group, prevelance of vitamin D deficiency was not significantly different in pregnant women with preeclampsia/eclampsia as compared to women who did not have preeclampsia/eclampsia

Ectopic pregnancy: a diagnostic dilemma

Background: To study the etiology, varied clinical presentations and misdiagnosis in ectopic pregnancy.Methods: A retrospective analysis of all operated ectopic pregnancies over a 7 year period at Government Medical College & hospital, Chandigarh was done.  Details of clinical findings and misdiagnosis were noted.  Surgically confirmed cases were included in this study. Expectant management and Medical management cases were excluded in this study.Results: Two hundred eighty two cases of ectopic gestation were analyzed. Identifiable risk factor present in 221 cases (78.3%). Pain was the commonest presenting symptom and 78 cases (27%) were misdiagnosed before the correct diagnosis was made by our department.Conclusions: Ectopic pregnancy can have varied presentations and misdiagnosis can be seen in Surgical, Medical and Gynaecology Departments. A young female with amenorrhea, pain abdomen with or without vaginal bleeding in early pregnancy diagnosis of ectopic pregnancy must be kept in mind. Early diagnosis would help early intervention and thus reduce the morbidity