Surgical stump site pregnancy-an unusual case report

Ectopic pregnancy is an obstetrics emergency which we all encounter in our day-to-day practice. Though maternal mortality rate is decreasing worldwide, still ectopic pregnancy is an important contributor towards maternal morbidity and mortality. Ectopic pregnancy at surgical stump site after salpingectomy is extremely rare with reported prevalence of 0.4-1.2%. We report one of such unusual case of 30 years old female, who had history of left salpingectomy 5 years back and presented to our hospital with abdominal pain. On evaluation, ectopic pregnancy at ipsilateral tubal stump was confirmed and she was successfully managed with surgical intervention. As early diagnosis of tubal stump pregnancy holds the key in successful management, we should keep high suspicion and carefully examine the patients with history of salpingectomy for ectopic pregnancy.

Comparison of oral misoprostol versus intramuscular oxytocin for active management of third stage of labour: a single centre randomised controlled study

Background: This study was conducted to compare the efficacy and safety of oral misoprostol against intramuscular oxytocin in the active management of the third stage of labour, so that it can be widely used in the areas of limited resources to contribute in preventing post-partum haemorrhage and thus decreasing maternal mortality ratio. Methods: This was a prospective randomised controlled clinical study. Two hundred patients fulfilling inclusion criteria were randomized to receive either oral misoprostol (600 mcg) or intramuscular oxytocin (10 IU) in the active management of third stage of labour. Primary outcome measured was mean blood loss and incidence of primary PPH. Results: The mean blood loss during third stage of labour in oral misoprostol group and oxytocin group was 239.16±22.78 ml and 240.19±19.70 ml respectively with p value-0.7331 which was insignificant. Similarly mean fall in haemoglobin was also not significant. There was no significant differences between the two groups with regard to the incidence of PPH (3% vs. 2% respectively; p=0.651). Women experiencing side effects like shivering and fever were significantly higher among misoprostol group than in oxytocin group. Conclusions: In this study, oral misoprostol was found to be comparable to intramuscular oxytocin regimen, in terms of amount of blood loss, occurrence of postpartum hemorrhage, duration of third stage of labour, fall in hemoglobin and fall in blood pressure. However, shivering and fever were more common with misoprostol, but no other serious side effects were noted