A Study of Induction of Labour with Intracervical PGE2 Gel

INTRODUCTION: Labour refers to the onset of effective uterine contractions leading to progressive effacement and dilatation of the cervix resulting in expulsion of the fetus, placenta and the membranes. Watchful expectancy had been the dictum from times immemorial, with regard to parturition. Patient waiting for spontaneous onset of labour was the rule and any intervention advocated, only if expectant management jeopardized either maternal health or when continuation of pregnancy endangered life and wellbeing of mother or the fetus. Although most patients experience spontaneous labour at term, induction of labour is the option of modern day obstetrics when indicated. Labour induction is a clinical intervention that has the potential to confer major benefits to the mother and newborn when continuation of pregnancy poses a risk or danger to the outcome of pregnancy. Thus induction of labour has become a common obstetric practice referring to the process of labour where the uterine contractions are initiated by medical and surgical means before the onset of spontaneous labour. AIMS AND OBJECTIVES: 1. To study the various indications for induction of labour at term. 2. To study the impact of induction of labour with intracervical PGE2 gel and its complications and mode of outcome seen as successful vaginal delivery, instrumental delivery or operative delivery. 3. To study the difference in response between primigravida and multigravida. 4. To study whether foley induction prior to intracervical gel instillation was helpful. 5. To study whether oxytocin augmentation was needed. 6. To study the correlation of induction of labour with induction to delivery interval. 7. To study the impact of induction of labour on maternal morbidity, evaluated in terms of PPH. 8. To study the effect of induction of labour on neonatal morbidity, evaluated in terms of whether or not the baby had NICU admission. 9. To study the factors for a successful induction of labourin terms of parity, gestational age, Modified Bishop’s score and mode of delivery. 10. To study the cost effectiveness and justification of induction of labour for logistic reasons. MATERIALS AND METHODS: The study was carried out at the Department of Obstetrics and Gynaecology, Chengalpattu Medical college and Hospital, Chengalpattu during the period of January 2018 to December 2018. STUDY DESIGN: Cross-Sectional Study. SAMPLE SIZE: 250. INCLUSION CRITERIA: 1. All inductions with intracervical PGE2 gel induction with gestational age > 37 weeks. 2. Medical disorders-GHT, GDM, Rh negative pregnancy, 3. Oligohydramnios, 4. Postdated pregnancy, 5. Intrauterine growth restriction. EXCLUSION CRITERIA: 1. All cases with gestational age <37 weeks. 2. Previous cesarian section/Hysterotomy 3. Cephalopelvic disproportion. 4. Antepartum haemorrhage. 5. Pelvic tumours. 6. Local infections. 7. Malpositions 8. Intrauterine fetal demise. CONCLUSION: ◈ Intracervical PGE2 is an effective method of cervical ripening. ◈ When PGE2 gel is combined with prior foley induction and oxytocin augmentation in an unfavourable cervix helped cervical ripening. ◈ The induction to labour interval and induction delivery interval was significantly less,ie,<12 hours. ◈ As the gestational age increases the favorability of cervix and the chance of successful vaginal delivery increases. ◈ The incidence of NICU admissions was less. ◈ The incidence of PPH with intracervical PGE2 gel was very less. ◈ There was no incidence of uterine hyperstimulation or uterine rupture. ◈ Hence intracervical PGE2 gel is safe for both the fetus and mother

Childhood Predictors of Desistance and Level of Persistence in Offending in Early Onset Offenders

Childhood predictors of adolescent offending careers were studied in 310 boys from the longitudinal Pittsburgh Youth Study who started offending prior to age 12. Three main groups were distinguished: serious persisters (n = 95), moderately serious persisters (n = 117), desisters (n = 63), and an intermittent group (n = 35). Group membership was predicted using risk and promotive factors measured in childhood. Serious and moderately serious persisters could be distinguished well from desisters (29.2% and 32.3% explained variance). Distinction between the two persister groups proved somewhat more difficult (20.9% explained variance). More serious persisters than desisters showed disruptive behavior, while moderately serious persisters fell in between. Further, more moderately serious persisters were marked by social disadvantage. Family involvement, small family and positive peer relationships were promotive of desistance. Concluding, early onset offenders show considerable heterogeneity in their adolescent offending careers which seem to some extent to be predicted by different sets of risk and promotive factors

Monitoring and Pay: An Experiment on Employee Performance under Endogenous Supervision

We present an experimental test of a shirking model where monitoring intensity is endogenous and effort a continuous variable. Wage level, monitoring intensity and consequently the desired enforceable effort level are jointly determined by the maximization problem of the firm. As a result, monitoring and pay should be complements. In our experiment, between and within treatment variation is qualitatively in line with the normative predictions of the model under standard assumptions. Yet, we also find evidence for reciprocal behavior. Our data analysis shows, however, that it does not pay for the employer to solely rely on the reciprocity of employees

Incommensurable worldviews? Is public use of complementary and alternative medicines incompatible with support for science and conventional medicine?

Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, ?conventional? medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research

Obeying the rules of the road: Procedural justice, social identity and normative compliance

Why do people comply with traffic laws and regulations? Road traffic policing tends to be premised on the idea that people comply when they are presented with a credible risk of sanction in the event of non-compliance. Such an instrumental model of compliance contrasts with the normative account offered by procedural justice theory, in which compliance is encouraged by legitimate legal authorities. Comparing these two accounts, we find evidence that both instrumental and normative factors explain variance in motorists’ self-reported propensity to offend. Extending the standard procedural justice account, we also find that it is social identity – not legitimacy – that forms the ‘bridge’ linking procedural fairness and compliance, at least according to a definition of legitimacy that combines felt obligation and moral endorsement. Fair treatment at the hands of police officers seems to enhance identification with the social group the police represent, and in turn, identification seems to motivate adherence to rules (laws) governing social behavior. These findings have implications not only for understandings of legal compliance, but also our understanding of why procedural justice motivates compliance, and the role of procedural justice in promoting social cohesion