Use of Misoprostol for Induction of Labour

Background: To find out safety and efficacy of Misoprostol in induction of labour at term in women with live fetus through vaginal versus sublingual route Methods: In this cross sectional study, total of 200 pregnant women at term (37-42 week) with live fetus were selected randomly for induction of labour with tab misoprostol. These women were divided in two groups with 100 women in each group. Misoprostol was administered in a dose of 50 microgram (1/4th tab),in group I through vaginal route and in group II through sublingual route. Maximum of three doses were given in 24 hours and resumed on next day if there was no improvement. Results: Number of doses of misoprostol used for induction of labour was less than two in 68% cases in group I and 78% cases in group II, while more than two doses were used in 32%cases in vaginal group and 22% in sublingual group. Administration to induction interval was less than 12 hours in 60% cases in vaginal group and 80% cases in sublingual group. Total duration of labour was less than 8 hours, seen in more cases of sublingual group than vaginal group i.e56% versus 40%. Vaginal delivery was achieved in 60% cases in vaginal group and 70%cases in sublingual group with rate of caesarean section 40% versus 30% respectively. Regarding fetal outcome, fetal distress and meconium stained liquor was seen in 26% and 24% cases in vaginal and sublingual groups respectively, showing no significant difference between two groups. However neonatal intensive care unit(NICU) admissions were more in vaginal group than sublingual group i.e. 30% versus 20%.There were 100% live births in both groups with ENND (early neonatal death)02% in each group. Maternal out come was good in both groups. Uterine hyperstimulation was seen in 02%cases in each group while only two cases of fever were seen in sublingual group. There was no case of post partum haemorrhage (PPH) and no maternal death in both groups.. Conclusion: Misoprostol is effective for induction of labour at term with live fetus, more through sublingual than vaginal route. Its safety and efficacy can be further ensured by using lower dosage regimes.

Effectiveness of Pipelle as Endometrial Sampling Procedure in Comparison with Dilatation and Curettage

Background: To determine safety and effectiveness ofpipelle for taking endometrial biopsy as out patientprocedure in comparison with dilatation and curettage(D&C).Methods: In this comparative study, detailed clinicalevaluation of 80 patients was done to establish indicationfor endometrial sampling. Subjects were divided into 2groups.In 1st group pipelle (n=40)procedure wasperformed as outpatient procedure without analgesiaunder aseptic conditions.Biopsies were taken and sent forhistopathology and for acid fast bacilli in cases ofinfertility .Subjects were retained for 30 min to observe forany complication. In 2nd group (n=40) patients wereadmitted from out patient department and D&C done onvery next day in operation theatre as formal procedureunder anaesthesia .Patients were retained in ward afterprocedure to observe any post operative complications forone day. Samples were sent for histopathology . ChiSquare test was used for statistical analysis.Results: There was no case of perforation in bothgroups.In first group of Pipelle 36 cases had nopain.When compared to second group statisticalsignificance was .000. Mild bleeding was observed in 2cases of pipelle as compared to 4 cases of 2nd group.Sample was adequate in 37 cases of pipelle while in 39cases of D&C .Histopathology report when compared in 2groups showed statistical significant difference was 0. 05.Conclusion: Endometrial Biopsy with Pipelle is safe,efficient and cost effective means of evaluating uterineendometrium It is associated with minimal discomfort,adequate sampling without need of anaesthesia