A study of vaginal misoprostol tablet versus intra cervical dinoprostone gel for the induction of labour

Background: This was a comparative study conducted to compare the effectiveness of 25 microgram of intravaginal misoprostol with intracervical dinoprostone gel in terms of efficacy of drug, feto-maternal outcome, side effects and complications of drugs.Methods: 400 nulliparas at term, admitted for induction of labor were included in this study. They were randomly selected to receive either intravaginal misoprostol or intracervical dinoprostone gel. Group A (200 women) recieved tablet misoprostol 25 micrograms vaginally 4 hrly to a maximum of 3 doses and Group B (200 women) received dinoprostone gel 0.5mg intracervically 6 hrly to a maximum of 3 doses. Comparison was done in terms of Induction to delivery interval, need for augmentation, LSCS and instrumentation rate, need for NICU admissions and cost effectiveness.Results: The mean induction to delivery interval was less in the misoprostol group than dinoprostone group (12.5 hrs vs. 20 hrs). 78% patients delivered in the first 24 hrs in misoprostol group compared to 52 % patients in dinoprostone group. Group A had a higher success rate (81% vs.76%) and also required less augmentation of labor ( 30% vs. 60%) compared to group B. Need for LSCS was also lower in misoprostol group (11% vs. 16%). Need for instrumentation and incidence of NICU admission was similar in both groups. Misoprostol was more cost effective compared to dinoprostone.Conclusions: The misoprostol group had a shorter induction to delivery interval, more number of deliveries in the first 24 hrs of induction and a reduced need of augmentation of labor with oxytocin. There was no significant difference in the rate of caesarean section, hyper-stimulation syndrome, neonatal and maternal morbidity between the two groups. Thus, misoprosol appears to be safer, cheaper and more efficacious alternative for induction of labor especially for non-fetal indications as compared to dinoprostone gel

A prospective study to compare levonogestrol intrauterine system and trans-cervical resection of endometrium for treatment of abnormal uterine bleeding

Background: This article is a study comparing the two most accepted forms of treatment for abnormal uterine bleeding - levonorgestrol intrauterine treatment and transcervical resection of endometrium, with regards to its acceptability, efficacy, adverse effects and user satisfaction. Aim of this study was to compare the acceptability, efficacy, adverse effects and user satisfaction of LNG-IUS and TCRE for treatment for AUB.Methods: A prospective observational study conducted in SKNMC and GH. Forty-nine women with abnormal uterine bleeding after hysteroscopic evaluation were included in this study; where 17 opted for LNG-IUS; 32 opted for TCRE with bipolar electrode. 15 patients in LNG-IUS group and 28 pts in TCRE group completed follow up. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, acceptability, satisfaction and reason for discontinuation were recorded at 6 weeks, 6 months and 12 months after the procedure. Prior to LNG-IUS insertion or endometrial ablation, endometrial and cervical pathology were excluded by D and C and cervical smear, respectively. TVUS was used to exclude possible causes of menorrhagia, including myomas and endometrial polyp as well as adnexal pathology. LNG-IUS insertion was performed as an office procedure one day after cessation of menstrual bleeding with a negative urine pregnancy test.Results: Menstrual blood loss reductions in TCRE and LNG-IUS groups were by 85.7% and 87.6% respectively after a year. Amenorrhoea was more common in TCRE group while spotting and systemic effects were more common in LNG-IUS group. Satisfaction and acceptance rates are higher in TCRE group.Conclusions: The TCRE and LNG-IUS are equally effective in reducing bleeding in AUB patients. Acceptance and satisfaction are better with TCRE, as a modality of treatment for AUB

Complications of gynaecologic laparoscopy: an audit

Background: Minimal access surgery as a modality of treatment for various gynecologic conditions is rapidly gaining grounds in the recent years1. Approximately 30 years after its introduction; the use of laparoscopy in gynecology has evolved from diagnostic purposes into a more coordinated system for the repair or removal of diseased abdominal and pelvic organs. The rapid increase in the number of procedures being performed, the introduction of new equipment, and variability in the training of surgeons all contribute to the complication rate. The objective is to review complications associated with laparoscopic gynecological surgeries and identify associated risk factors.Methods: Hospital based descriptive observational study performed between January 2013 to December 2017 which included all gynecologic laparoscopies performed in present institute. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, conversions to laparotomy and postoperative complications. The laparoscopic procedures were divided into three subgroups: Diagnostic cases, tubal sterilization and Advanced operative laparoscopy.Results: Of all 3724 laparoscopies included, overall frequency of major was 1.96 %, and that of minor complications was 3.51%. Of 3724 laparoscopic procedures, 214 complications occurred (5.8% of all procedures) and one death occurred. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy.Conclusions: Laparoscopic surgery has many advantages, but it is not without complications. Despite rapidly improving technical equipment’s and surgical skill; complication rates and preventable injuries demonstrate continuous pattern. Delayed recognition and intervention add to morbidity and mortality. Each laparoscopic surgeon should be aware of the potential complications, how they can be prevented and managed efficiently