A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices

Background: The induction of labor remains as one of the major challenges in obstetrics even in this modern era. The ideal priming agent is one that causes cervical change that is most similar to that seen in natural ripening process. This study was aimed to evaluate the safety and efficacy of intravaginal Misoprostol and compare its effects with intracervical dinoprostone gel for cervical ripening and labor induction in patients with unfavourable uterine cervices.Methods: This was a one-year prospective study conducted in the department of Obstetrics and Gynecology of a 800 bedded premier teaching hospital in Ludhiana. The study population consisted of all pregnant women admitted to the labor ward beyond 37 weeks of gestation and requiring induction of labor for various medical and obstetrical indications. Frequencies, proportions, mean and standard deviation were done while chi square and t-test were used for determination of significance.Results: A total of 153 mothers fulfilled the criteria to be included in the study of which 81 mothers were induced by misoprostol and 72 mothers by dinoprostone gel respectively. There was no statistical difference in the maternal age, parity and gestation at the onset of study in the two groups. The ANC complications were also statistically similar. There was no significant difference in the mean initial Bishop Score in the two groups. 3.42 in the Misoprostol group and 3.56 in the Dinoprostone group. The mean Bishop Score after 8 hour of the first dose was 7.86 in the Misoprostol group and 6.88 in the Dinoprostone group. The mean time taken from the induction to the onset of labor was 5.57 hours in the misoprostol group and 8.04 hours in the dinoprostone group. There were no cases of tachysystole or hyperstimulation in both the groups.Conclusions: Misoprostol is a more efficacious cervical ripening and labor inducing agent compared to dinoprostone gel and can be used safely in the North Indian setting

Genitourinary infections as a risk factor for preterm prelabour rupture of membranes: a hospital based case control study

Background: Preterm Prelabour Rupture of Membranes (PPROM) is a leading cause of maternal and neonatal morbidity and mortality. The objective of our study was to bring forward the association between genitourinary infections and PPROM in Indian scenario.Methods: This retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, in a tertiary referral teaching hospital in Punjab. A total of 150 women were evaluated for genitourinary infections and their association with PPROM. Cases group 1 (n=75) included pregnant females with diagnosis of PPROM based on history and vaginal examination. Control group 2 (n=75) included pregnant women admitted to labour room at 37 completed weeks of gestation or more and with no history of PPROM. The control group was matched to case group with respect to age and parity. Case to control ratio was taken as 1:1. A multivariate analysis was used to find the association between PPROM and genitourinary infections. Microsoft Excel and the Statistical Package for the Social Sciences (SPSS), Version 21 were used for data analysis. A P value of <0.05 was determined to be statistically significant.Results: In our study genitourinary infections were seen in 16 women in Case Group 1 (21.3%), compared to 7 women in Control Group (9.3%). Genitourinary infections were associated significantly with PPROM (p 0.02) (odds ratio [OR], 2.618; 95% Confidence interval [CI], 1.021-7.239).Conclusions: Screening for genitourinary infections should be considered especially in high risk cases. Early recognition and prompt treatment of genitourinary infections is the key to optimize the maternal and fetal outcome in PPROM

Audit into stillbirths: a tertiary hospital experience

Background: The objective of the study was to evaluate the prevalence, risk factors and causes of stillbirth.Methods: A retrospective cohort study was conducted from January 2014 until December 2014 in a tertiary referral teaching hospital in Punjab. The 2014 birth register from the department of Obstetrics and Gynecology was reviewed and the data was collected. The results were tabulated and data was analyzed as frequencies, percentages and descriptive statistics.Results: During the one-year study period, there were 1528 registered pregnancies in the hospital and 64 pregnant women were diagnosed to have stillbirth resulting in a stillbirth rate of 40.63 / 1000 live births. More than 75% of the stillbirths were noted in women between 21 to 30 years of age. Pregnant women who were unbooked (72.5%) had higher rates of stillbirths. More than 80% of the stillbirths were preterm. Anaemia (41.93%), pre-eclampsia (25.8%) and antepartum hemorrhage (24.19%) were the most common maternal risk factors noted in these patients. Maternal factors contributed to 37.5% of the causes of stillbirths. The other causes for stillbirths were placental factors (32.8%) and fetal factors (6.2%). In 23.43% of the cases the cause was unknown.Conclusions: India shares a high burden of stillbirths with priority gaps in reporting and recognizing at the health policy level. Better counting of stillbirths and improved cause-of-death data can advocate child survival strategies.

Clinico-biochemical correlation with special reference to oxidized LDL and small dense LDL in Indian women with CAD

In women with coronary artery disease (CAD), clinical presentation is different enough from men which lead to missed or delayed diagnosis of CAD. We therefore assessed the major risk factors and biomarkers in female subjects with CAD. Venous sample of control, unstable angina (UA) and myocardial infarction (MI) patients were taken. In Both UA and MI patients, predominant risk factor was menopause (76.7% UA, 86.7% MI) followed by hypertension (56.7% UA, 60% MI), central obesity (56.7% MI, 56.7% UA), dyslipidemia (50% UA, 50% MI) and diabetes mellitus (50% UA, 33.3% MI). Total serum cholesterol and LDL cholesterol were highly significant (p&lt;0.001) in MI and UA as compared to controls. LDL cholesterol was significantly increased (p&lt;0.05) in MI as compared to UA. Triglycerides and HDLCholesterol were also increased but not at the significant level (p&gt;0.05). Apolipoprotein (ApoB), small dense LDL and oxidized-LDL (Ox-LDL) were highly significant (p&lt;0.001) in MI and UA as compared to controls. Based on discriminate analysis ox-LDL is a potential marker to discriminate cases of UA from controls while ApoB is the reliable marker which can discriminate the cases of MI from UA and controls