Perinatal outcome of pregnancies with previous stillbirth: a prospective case control study in tertiary care center

Background: Aim was to examine the association between stillbirth in first pregnancy and adverse perinatal outcome in second pregnancy. To determine risk factors causing recurrent stillbirth. Methods: This study was conducted at Government Medical College, and hospital, Nagpur. It was prospective case control study with cases as patients who had stillbirth in previous pregnancy and control as patient who had live birth in previous pregnancy. Results: There was 10 fold increased risk of recurrent stillbirth in cases compared to control. Preeclampsia was major risk factor followed by placental abruption; congenital anomaly and preterm labour were responsible for recurrent stillbirth. Conclusions: History of stillbirth in first pregnancy is associated with adverse perinatal outcome in form of recurrent stillbirth, increased NICU admission and neonatal death. Risk reduction by elimination of risk factor, proper antenatal surveillance and close monitoring during labour helps to reduce recurrent stillbirth

Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial

Objective: To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low‐dose oral misoprostol is superior to intravenous oxytocin. Design: Open‐label, superiority randomised trial. Setting: Government hospitals in India. Population: Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Methods: Participants received misoprostol (25 micrograms, orally, 2‐hourly) or titrated oxytocin through an infusion pump. All women had one‐to‐one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Main outcome measures: Caesarean birth. Results: A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81–1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207–244 min, vs 194 min, 179–210 min; aOR 1.137; 95% CI 1.023–1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203–1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Conclusions: Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial