Role of mifepristone in induction of labour in pregnant women with previous lower section caesarean section with IUFD in late preterm and term pregnancies

Background: The objective of the study was to evaluate efficacy and safety of oral mifepristone for preinduction cervical ripening and induction of labour in late preterm and term pregnancies with previous caesarean section with intrauterine fetal demiseMethods: This prospective short term study was conducted at Umaid hospital SNMC Jodhpur Rajasthan January 2016 to November 2016. 100 subjects with previous uses beyond 34 week with intrauterine fetal demise and bishop’s score<6 were included. Tablet mifepristone 200mg was given orally after taking written in informed consent. The same dose was repeated after 24 hour according to bishop’s score. Analysis was done with respect to maternal outcome of vaginal delivery, CS, duration of labour.Results: Among 100 subjects, 97 delivered vaginally (97%) delivered within 72 hour of 1% dose. Improvement of bishop’s score was observed in 1 subject (1%), which later required augmentation by oxytocin followed by vaginal delivery.1 subject (2%) failed to respond and required caesarean section, 72 hour after given of 1st dose.Conclusions: Mifepristone can be used safely and effectively for induction of labour in previous one and two LSCS near term and term pregnancies to avoid CS rates

Pregnancy in non-communicating rudimentary horn

A 25-year old G3P2L2 presented to casuality of OBG Dept, Ummaid Hospital, Jodhpur with5 months amenorrhea and bleeding per vaginum for last 5 days associated with abdominal pain. On per abdomen examination, a mass arising from pelvis corresponding to the size of a 16 weeks pregnancy was seen. A repeat ultrasound was performed in our hospital and the findings were - normally visualised uterus with a gestational sac with thin myometrium rim seen on right side with single dead fetus of gestational age 14 weeks 3 days, pregnancy in rudimentary horn, bicornuate uterus with pregnancy in right horn. Patient was counselled and prepared for laparotomy which was performed under general anesthesia. Intra -operative findings were normal sized uterus, right sided rudimentary horn pregnancy was seen. Both tubes and ovaries were normal. Hence, right sided rudimentary horn excision along with ipsilateral salpingo – oophorectomy was planned and done by clamping and cutting. Hemostasis was achieved. There was no communication between the rudimentary horn and the main uterus. The estimated blood loss was 200ml