A comparative study of maternal & neonatal outcome and patient satisfaction with intravaginal misoprostol versus intravenous oxytocin in patients with premature rupture of membranes beyond 36 weeks gestation

Background: Premature rupture of membranes (PROM) occurs in about 10% of patients beyond 36 weeks of gestation. In this situation, labor induction with prostaglandins, has been proved to be beneficial and results in decreased chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. Many techniques for induction of labor are available. This prospective randomized comparative study was thus taken up to compare the outcomes of misoprostol versus oxytocin with respect to the maternal and neonatal outcomes and patient satisfaction.Methods: A prospective randomized study was carried out where 200 women admitted to department of obstetrics & gynecology, Pravara Rural Hospital, PMT, Loni with PROM beyond 36 weeks of gestation were included where 100 each were included in two groups- vaginal misoprostol group & oxytocin infusion group.Results: Nearly 58% of the cases of PROM were in the age group 21-25 yrs. Vaginal deliveries were 42% in misoprostol group, where as 44% in oxytocin group; whereas LSCS were 7% in misoprostol group and 5% in oxytocin group. Maximum number of cases had APGAR score between 7-10 in both the groups. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction.Conclusions: Labor induction with oxytocin infusion for PROM beyond 36 weeks in an unfavorable cervix is associated with longer duration of the second stage and a higher risk of cesarean delivery for failure to progress in comparison to those with transvaginal misoprostol. Patients with misoprostol induction were more satisfied as compared to patients with oxytocin induction

Partographic analysis of labour by modified WHO partograph in tertiary care centre

Background: The partograph is a simple, inexpensive tool to provide a continuous pictorial overview of labor. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical changes, fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. Methods: A hospital-based observational study involving prospective review of partographs for births that occurred in 2020 was conducted in 2 hospitals including SVP Hospital and V.S hospital Ahmedabad. A partographic analysis of labour was done in randomly selected 200 patients using modified WHO partogram. The study population was divided into Primigravida (96) and Multigravida (104) term patients. partograph recording were commenced at 4 cm dilatation. close maternal and fetal monitoring was done throughout the labour and partogram was plotted to detect any deviation from normal course.Results: Patients were grouped into primigravida and multigravida and based on partogram finding divided into mode of delivery. 22 of total 96 primigravida underwent caesarean section and 74 delivered vaginally. 8 of total 104 multigravida underwent caesarean section and 96 delivered vaginally. Out of 200 newborn only 11 had Apgar score <7 at 5 minutes.Conclusion: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary. It is effective in preventing prolonged labour, obstructed labour, reducing operative intervention and improving neonatal outcome

An analytical study of 50 women presenting with an adnexal mass

Background: The aim of this study was to detect and determine the origin of adnexal mass and to narrow down the diagnosis. Also, to determine the reliability of the bimanual pelvic examination in diagnosing adnexal mass and to determine clinical, radiological and histopathological co-relation of adnexal mass. Adnexal mass lesions are fairly common among women (with a prevalence of 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women) of all age group but very common among reproductive age. Differential diagnosis of adnexal mass is difficult and complex. Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal.Methods: Prospective, observational study of 50 patients with suspected various adnexal masses were conducted for a period of 1.5yr i.e. from November 2014 to May 2016. All patients underwent pelvic and ultrasonography examination. All patients later underwent surgery. Results were correlated later.Results: The patient ages ranged from 19 to 58 with a mean age of 31.5. Most common site of origin of adnexal masses is the Ovary (Rt. 38% and Lt. 34%) Most common adnexal masses on histopathological diagnosis are mucinous cyst adenoma (20%), Benign and mature cystic teratoma (16% and 6%) and serous cyst adenoma (10%). About 92% patients with adnexal mass presents with abdominal pain as a chief complaint.Conclusions: Although bimanual palpation of the adnexal masses may not allow a very specific diagnosis, clinically useful information can usually be obtained and hence it is particularly useful as a first step in assessment of adnexal masses and as an adjunct to morphological assessment of ovarian lesions. Ultrasonography is an important noninvasive investigation and is helpful in diagnosing most of these cases, but the histopathological examination of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis

Role of dinoprostone gel in induction of labour

Background: Labour induction is one of the most common intervention in obstetric practice. A simple application of PGE2 intracervical gel can ripen the cervix effectively and improve Bishop’s score there by helping in successful vaginal delivery. Considering its good performance, the dinoprostone slow-release vaginal insert is the first choice for elective induction of labour in postdate pregnancy and in patients with term pregnancy of premature rupture of membranes.Methods: This was a single year retrospective study conducted in a tertiary care center of western India from May 2019 to May 2020.Results: In group I women who delivered within 24 hours were included, in group II women who required re-instillation were included. The most common indication for induction in both the groups was past dates (accounting for 36.1% in group I and 47.3% in group II). The success rate in group I was 68.1% while in group II was 36.8%.  The rate of cesarean delivery in group I was 25.9%, while in Group II, it was 60.1%. Negligible maternal and neonatal complications were seen in both the groups.  Conclusions: The study showed that intracervical application of prostaglandin E2 is an effective, safe and acceptable method for induction of labor in women with unfavorable cervix and indications for induction. All these effects were achieved without increasing maternal and neonatal morbidity

Maternal and perinatal outcome in severe pre-eclampsia and eclampsia: a study of 120 cases at a tertiary health care center in Western India

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. Pre-eclampsia accounts for the majority of referrals in a tertiary care center as it stands one of the major causes of maternal and perinatal morbidity and mortality. It complicates 6-10% of all pregnancies. In India, they account for the third most important cause of maternal mortality. Patients with PIH are at a greater risk of abruptio placenta, cerebrovascular events, organ failure and DIC. Fetuses are at a greater risk of IUGR, preterm birth, small for gestational age and IUD. This study aimed to determine the maternal and perinatal outcomes of hospitalized pregnant cases with severe preeclampsia and eclampsia.Methods: This was a single year retrospective study conducted in a tertiary care center of Western India from May 2019 to May 2020. Maternal and perinatal outcomes were analyzed among the severe preeclampsia and eclampsia groups.Results: A total 52 (43.33%) of the cases were in the age group of 21-25 years, 64 (53.33%) were primigravidae and the majority were referred from peripheral hospitals. Liver function tests were deranged in 26.68% of the patients and 32.5% had abnormal renal function. Labetalol was the most commonly used antihypertensive and magnesium sulphate was the anticonvulsant used in all the cases. Lower segment caesarean section was the mode of delivery in 62 (51.67%) of the cases. Commonest maternal complication was atonic PPH (12.5%). There was one maternal mortality due to aspiration pneumonia. 85 (70.83%) of the babies needed NICU admission. There were 5 (4.16%) perinatal deaths.Conclusions: Accessible health care and health education and awareness regarding antenatal check-ups for all women will lead to early detection of severe preeclampsia. Prompt treatment and management of its complications will certainly improve the maternal and fetal outcome

Analysis of ectopic pregnancy at a tertiary care hospital: one year study

Background: Ectopic gestation is the leading cause of maternal mortality and morbidity in first trimester and is a major cause of reduced child bearing potential. The aims of our study were to understand the clinical profile, risk factors, sites and management modalities of ectopic pregnancy at tertiary care hospital.Methods: This is a retrospective study carried out for one year at the department of Obstetrics and Gynaecology of our institute. Data of the women admitted for management of ectopic pregnancy during January to December, 2010 was collected and analysed.Results: The proportion of ectopic pregnancy was 0.7 % at our institute. Majority of women 45(83.2%) were between the age group of 21-30 years. Pelvic inflammatory disease (PID) contributed to ectopic pregnancy in 16(29.6%) women. The most common symptom was lower abdominal pain, in 50(92.6%) women. Marked pallor was present in 25(46.3%) women and 38(70.4%) women had cervical motion tenderness. Out of all women, 10(18.5%), 18(33.3%) and 26(48.1%) women were managed successfully with methotrexate, laparoscopy and laparotomy respectively. The success rate was 83.3%, 90% and 100% with methotrexate, laparoscopy and laparotomy respectively. Blood and blood products were given to 25(46.3%) women. Conclusion: Ectopic pregnancy is a growing problem of reproductive age group. Women should be encouraged regarding early reporting of missed periods and made aware of complications of ectopic pregnancy and necessity of seeking urgent medical help as early as possible so that early diagnosis and prompt conservative surgical or medical management of ectopic pregnancy can be done

A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral

A rare case of ribbing disease of the proximal tibia

Ribbing disease is a rare disease that causes bony growths to develop in long bones mostly the lower limbs. It often develops after puberty. The disease also goes by other names like multiple diaphyseal sclerosis. The disorder is caused by discrepancy in the osteoclast regulation process. Here in we report a 28 years old male presenting with a case of ribbing disease of right proximal tibia. A 28 years old male gives history of fall when he was 6 years old i. e., 22 years back. Now patient complaints of pain in right proximal tibia since last 6 months. Pain is of mild nature. It is most likely a case of ribbing disease based on the clinical, radiological findings. Ribbing disease is a disease of exclusion, needs high degree of suspicion for its diagnosis. However, patient should be advised for regular follow ups

Acute kidney injury and its outcome in obstetrics

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause)