Sildenafil citrate therapy in absent end diastolic flow in umbilical artery in an early onset fetal growth restriction (FGR) fetus

Fetal growth restriction (FGR), a pregnancy complication still poses as a challenge for obstetricians worldwide. This is because of its association with severe morbidity and mortality outcomes. Obstetrical management becomes a dilemma in determining the optimal time of delivery and weighing the risks of prematurity against the risks of a potentially hostile intrauterine environment. There may be placental insufficiency characterized by insufficient blood flow in the umbilical artery. This is termed as abnormal umbilical artery flow with absent or reversed end diastolic flow on Doppler USG. Worsening of this condition demands an earlier delivery of the fetus. Authors report a case of structurally normal foetus showing severe early onset FGR with absent end diastolic flow in umbilical artery on Doppler, which was managed using vaginal Sildenafil citrate. Sildenafil citrate led to improvement in uterine artery and umbilical artery Doppler parameters; thereby improving the utero-placental blood flow with a favorable fetal outcome at delivery. The gestation was prolonged by 51 days. Thus, Sildenafil citrate can be used as promising agent in early onset FGR in selected cases

Study of pre induction transvaginal ultra-sonographic cervical length and its comparison with bishop score in predicting successful labor induction

Background: Induction of labor means initiation of uterine contraction, after period of viability by any method (medical, surgical or combined) before spontaneous onset of labor for the purpose of vaginal delivery. The condition of cervix or favorability is important for successful labor induction. Assessment of cervix has been used as a predictor of successful vaginal delivery. Induction of labor carried out in approximately 20% of all pregnancies. Aim and objectives of the current study were to compare the predictive value of trans-vaginal ultra-sonographic measurement of cervical length versus Bishop score prior to induction of labor in predicting the mode of delivery and maternal and fetal outcome.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Sardar Patel medical college and associated group of hospitals, Bikaner between February to November 2020. Study group included 100 pregnant women in which induction of labor was performed at 37-42 weeks of gestation.Results: Bishop Score appears to be a better predictor than the cervical length with sensitivity of 1.00 and a specificity of 0.12 compared to 0.52 and 1.00 respectively. In the receiver operating characteristic curves, the cut-off point for the prediction of successful induction taken was 2.6 cm cervical length and >4 for the bishop score.Conclusions: TVS cervical length could be used as alternative to Bishop score for prediction of successful labor induction in the sitting where the appropriate equipment and expertise are available. Bishop score and TVS cervical length both are good predictors of successful induction of labor.

Comparative study of single versus double time application of dinoprostone E2 gel on the induction of labor in term pregnancy and it’s fetomaternal outcomes

Background: Labor is defined as a cascade of effective uterine contractions leading to progressive effacement and dilatation of cervix resulting in the expulsion of the fetus, placenta and the membranes. The aim of the study was to evaluate the effect of single time and double time application of dinoprostone E2 gel and to compare fetomaternal outcomes after single and double application of dinoprostone E2 gel and its complications.Methods: This was a prospective observational study conducted on 200 pregnant females with a period of gestation ≥37 completed weeks between 1st January 2020 to 31st January 2021. Group A included females undergoing single time application of PGE2 gel and in group B, second dose applied after 6 hrs of first dose if there was no improvement in Bishop score. If necessary, oxytocin for augmentation of labor was started only 6 hrs after the last dose.Results: Mean age in group A was 24.38±4.37 years and in group B was 24.02±3.76 years and this difference was not found statistically significant (p>0.05). Majority of cases had vaginal delivery. In group A, 28% cases had LSCS delivery while in group B, 17% cases had LSCS delivery (p>0.05). There was significant increase in mean Bishop score after second dose of PGE2 gel in double application group by 3.24 assessed at 12 hours after induction. Double times application of gel resulted in a smaller number of failed inductions i.e.; 23 out of 100 cases in single application group and 7 out of 100 cases in double application group. Main maternal complication was nausea and vomiting which was 5% cases in group A and 11% cases in group B.Conclusions: Double times application of dinoprostone gel resulted in improved Bishop score, facilitates the process of induction, increased number of successful inductions, shortened application delivery interval and decreased cesarean section rate compared to single application. There was slight increase in maternal and fetal complications with double times application

Pyometra in the postpartum: a forgotten complication

We report a case of 37 years old women who conceived after in vitro fertilization (IVF). Her antenatal course was uneventful. On delivery there was placenta acreta. She later presented in the postpartum period with pyometra. She was managed with conservative treatment. We believe that the placental bed sutures and the sloughing placenta could have led to sterile pyometra in this patient. This rare but important complication need to be kept in mind specially in high risk women with thin endometrium, h/o IVF, cervical encerclage, and placenta acreta

Formulation and Evaluation of Topical Polyherbal Antiacne Gels Containing Luffa Acutangula, Amaranthus Spinosus and Morus Alba

Anti-acne herbal formulations are used for the treatment of acne vulgaris with the added advantage of not producing adverse effects unlike synthetic drugs. Acne is an inflammatory skin disease that occurs due to blockages in polysebase and inflammation that are caused by bacteria. Topical and systemic antibiotics are always used for treatment of acne, but the gradual resistance to antibiotics can affect the success rate of acne cure. Medicinal plants play an important role in the development of potent therapeutic agents. Plant based drugs provide outstanding contribution to modern therapeutics as a source of many valuable secondary metabolites which serves as plant defence mechanisms against predator such as microorganism, insects and herbivores which have been proved to be potentially active compounds. There is a tremendous increase in search of antimicrobial plant extracts due to the fact that the resistance offered against antibiotic by the microorganism, in short the effective life span of any antibiotic is limited. Propionibacterium acnes are common pus-forming microbes responsible for the development of various forms of acne. In the present study anti-acne gels were prepared using polymer carbopol 940 along with the hydroalcoholic extracts of plants fruits of Luffa acutangula, leaves of Amaranthus spinosus and Morus alba and evaluated for their physicochemical properties, like pH, washability, extrudability, spreadability and viscosity. The formulations (PHG1-PHG6) were tested for the anti-acne activity by well diffusion method against Propionibacterium acnes. Results showed that the gels were non-irritant, stable and possess anti-acne activity. The efficacy when tested with a standard was almost same to that of Clintop (Marketed gel). This suggests that fruits of Luffa acutangula, leaves of Amaranthus spinosus and Morus alba have potential against acne causing bacteria and hence they can be used in topical anti-acne preparations and may address the antibiotic resistance of the bacteria. Keywords: Luffa acutangula, Amaranthus spinosus, Morus alba, Propionibacterium acnes, Acne vulgaris, Carbopol, Physicochemical properties