Role of oral misoprostol 600 mcg in active management of third stage of labour: a comparative study with carboprost 125 mcg, intramuscular

Background: Objectives: To compare misoprostol 600 mcg, oral with carboprost 125 mcg, i.m., in the active management of third stage of labour.Methods: A total of 200 pregnant women of 38-42 weeks of gestation delivering vaginally in the Shivamogga institute of medical sciences, Shivamogga, Karnataka, India were selected for study. 100 women received misoprostol 600 mcg, orally and 100 women received carboprost 125 mcg, i.m. immediately after delivery of baby and cord clamping by the method of randomisation.Results: In the misoprostol group, mean blood loss is 134.9 ml, mean duration of the third stage of labour is 4.07 min and mean fall in hemoglobin is 0.34 g/dl. In the carboprost group, mean blood loss is 123.7 ml, mean duration of the third stage of labour is 3.73 min and mean fall in hemoglobin is 0.28 g/dl. There was no significant difference between the two groups with regard to the above mentioned factors. There were 5 cases of PPH in the misoprostol group and 3 cases in the carboprost group. 21 cases in the misoprostol group and 14 cases in the carboprost group required additional oxytocics. Unpleasant side effects like diarrhoea and vomiting were more in carboprost group.  Conclusion: Oral misoprostol is as effective as carboprost in AMTSL and can be used safely in vaginal deliveries for prevention of PPH, especially in non-institutional deliveries and in places of low resource settings.

Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic

Background: The objective of the study was to compare intravenous paracetamol and intramuscular tramadol as labor analgesics.Methods: This prospective-randomized study conducted in 200 primigravidae in active labor, distributed into two groups of 100 women each with one receiving intravenous 1,000 mg Paracetamol and other 100 mg intramuscular tramadol. Pain intensity is recorded by McGills scale before, one and 3 h after drug administration. Perinatal outcome is recorded.Results: No difference in pain intensity is seen before drug administration. After 1 h of drug administration, in paracetamol group, 4 % women had horrible pain, and 28 % had distressing pain, while in tramadol group, 30 % women had horrible pain, and 60 % had distressing pain. After 3 h of drug administration, in paracetamol group, 26 % had distressing pain, while in tramadol group, 50 % women had horrible pain, and 36 % had distressing pain. Labor duration in paracetamol and tramadol group was 4.6 and 6.0 h, respectively. In paracetamol group, nausea is seen in 2.2 % and vomiting in 1.1 %, while in tramadol group, nausea is seen in 6.4 % and vomiting in 4.3 %.Conclusions: Intravenous paracetamol is more effective labor analgesic with fewer maternal adverse effects and shortens labor as compared to intramuscular tramadol

PPIUCD versus interval IUCD (380a) insertion: a comparative study in a referral hospital of Karnataka, India

Background: Comparative evaluation of PPIUCD and interval IUCD in terms of incidence of failure, expulsions, bleeding p/v and other complications.Methods: Total 200 willing women after counseling in antenatal, early labour or post natal were inserted PPIUCD after excluding chorioamnionitis, PROM >18hrs, unresolved PPH, puerperal sepsis. Another 100 willing women were inserted interval IUCD after excluding contraindications. All were followed up to 6 months.Results: Expulsions rate was significantly higher in PPIUCD as compared to interval insertions (5.5% v/s 5%). Number of removal of IUCD was almost similar in both the groups (6.5% V/S 7%). Common causes of PPIUCD removal were social.Conclusions: Postpartum inserting of IUCD is safe effective, feasible and reversible method of contraception