Comparison of effect of nifedipine, labetalol and methyldopa in treatment of hypertension in pregnancy in a tertiary care government hospital

Background: To know the incidence & demographic aspects of hypertensive disorders in pregnancy and to compare effect of nifedipine, labetalol, methyldopa on various aspects of PIH such as control of BP, proteinuria, gestational age on admission & of delivery and maternal & perinatal outcome.Methods: Study was conducted in M.Y. Hospital, Indore for one year of period. Three groups each of 50 pts were given nifedipine, labetalol, and methyldopa. Groups were compared on basis of age, residence, parity, control of BP, proteinuria, gestational age of delivery maternal complication &perinatal outcome.Results: maximum patients were from younger age group and mostly are primigravida. Fall in systolic & diastolic BP is significant in all 3 groups. Incidence of decrease in albuminuria is max in labetalol group. Incidence of LSCS is maximum in nifedipine group. No statistically significant difference in three groups regarding foetal outcome.Conclusions: All three drugs are safe & effective drug in treatment of PIH. Labetalol is more effective in reducing albuminuria as compared to nifedipine & methyldopa

A cross sectional study to compare effects of mechanical dilatation and sublingual misoprostol on induction of labor in a tertiary level government hospital

Background: To compare sublingual misoprostol versus mechanical dilatation of the cervix with Foley’ catheter in induction of labor, the need for other method of augmentation of labor like oxytocin infusion, to find out maternal outcome and perinatal outcome and to find out rate of caesarean section in both the groups.Methods: The study was carried out in the department of obstetrics and gynaecology, M.Y. Hospital Indore, on pregnancies with an indication for induction of labor either with mechanical dilatation or with misoprostol. Two groups are made each of 100 cases. One group is induced with Foley’ catheter and other with 25 mcg misoprostol sublingually. Both groups are compared on the basis of age, parity, indication of induction, duration of cervical ripening and delivery, need of oxytocin augmentation. Maternal and foetal outcomes are also compared.Results: Most of the cases in both groups were primigravida, belong to 20-25 year of age group. Most cases were induced for postdatism followed by PIH. Induction delivery interval was short in cases received misoprostol. Also misoprostol group required less oxytocin augmentation, and has significant low rate of caesarean section. There was no significant difference in both cases in terms of maternal and foetal complications.Conclusions: Misoprostol is very safe and effective drug for induction of labour. It has property of collagenous remodelling of cervix along with stimulation of uterine contraction. Hence its induction-delivery interval is short with little requirement of oxytocin augmentation. Rate of failed induction is also low

A comparative study of misoprostol versus surgical management of incomplete and missed miscarriage

Background: The aim of this study is to assess the effectiveness and acceptability of using vaginal Misoprostol for management of spontaneous incomplete and missed miscarriage as an alternative to direct vaginal surgical evacuation in our setting and also to compare the efficacy and patient satisfaction of the medical method with surgical method in same.Methods: this is a prospective comparative study performed on randomly divided 200 patients in two groups. Each group of patients are case of missed or incomplete abortion in first trimester.(5-12 weeks). Group one received Misoprostol tablet 600 mcg single dose per vaginally, and second group underwent surgical vaginal evacuation directly under local anesthesia (para-cervical block . both groups were compared in terms of success, complications, pain and patient satisfaction.Results: 97% success rates were obtained in the medical treatment group. Surgical group had 95% success rates. 3 patients underwent repeat surgical evacuation in the medical group. Bleeding was more and prolonged in the patients managed by Misoprostol, 27% patients had moderate bleeding. Though bleeding was less in the surgical group but there was excruciating pain and weakness as the procedure being done under local anesthesia, 98% patients experienced pain in surgical group. Satisfaction rates in the misoprostol group were 100%.Conclusions: Misoprostol is effective in complete evacuation of uterus in incomplete and missed miscarriage. Patients are highly satisfied with the misoprostol treatment as they didn’t have to get hospitalized. The bleeding was more or less like menstrual bleeding which did not affect the daily chores of the women. It is as effective as surgical evacuation and patient satisfaction is much more than the surgical evacuation.

Comparison of effect of nifedipine, labetalol and methyldopa in treatment of hypertension in pregnancy in a tertiary care government hospital

Background: To know the incidence & demographic aspects of hypertensive disorders in pregnancy and to compare effect of nifedipine, labetalol, methyldopa on various aspects of PIH such as control of BP, proteinuria, gestational age on admission & of delivery and maternal & perinatal outcome.Methods: Study was conducted in M.Y. Hospital, Indore for one year of period. Three groups each of 50 pts were given nifedipine, labetalol, and methyldopa. Groups were compared on basis of age, residence, parity, control of BP, proteinuria, gestational age of delivery maternal complication &perinatal outcome.Results: maximum patients were from younger age group and mostly are primigravida. Fall in systolic & diastolic BP is significant in all 3 groups. Incidence of decrease in albuminuria is max in labetalol group. Incidence of LSCS is maximum in nifedipine group. No statistically significant difference in three groups regarding foetal outcome.Conclusions: All three drugs are safe & effective drug in treatment of PIH. Labetalol is more effective in reducing albuminuria as compared to nifedipine & methyldopa

A comparative study of misoprostol versus surgical management of incomplete and missed miscarriage

Background: The aim of this study is to assess the effectiveness and acceptability of using vaginal Misoprostol for management of spontaneous incomplete and missed miscarriage as an alternative to direct vaginal surgical evacuation in our setting and also to compare the efficacy and patient satisfaction of the medical method with surgical method in same.Methods: this is a prospective comparative study performed on randomly divided 200 patients in two groups. Each group of patients are case of missed or incomplete abortion in first trimester.(5-12 weeks). Group one received Misoprostol tablet 600 mcg single dose per vaginally, and second group underwent surgical vaginal evacuation directly under local anesthesia (para-cervical block . both groups were compared in terms of success, complications, pain and patient satisfaction.Results: 97% success rates were obtained in the medical treatment group. Surgical group had 95% success rates. 3 patients underwent repeat surgical evacuation in the medical group. Bleeding was more and prolonged in the patients managed by Misoprostol, 27% patients had moderate bleeding. Though bleeding was less in the surgical group but there was excruciating pain and weakness as the procedure being done under local anesthesia, 98% patients experienced pain in surgical group. Satisfaction rates in the misoprostol group were 100%.Conclusions: Misoprostol is effective in complete evacuation of uterus in incomplete and missed miscarriage. Patients are highly satisfied with the misoprostol treatment as they didn’t have to get hospitalized. The bleeding was more or less like menstrual bleeding which did not affect the daily chores of the women. It is as effective as surgical evacuation and patient satisfaction is much more than the surgical evacuation.

A cross sectional study to compare effects of mechanical dilatation and sublingual misoprostol on induction of labor in a tertiary level government hospital

Background: To compare sublingual misoprostol versus mechanical dilatation of the cervix with Foley’ catheter in induction of labor, the need for other method of augmentation of labor like oxytocin infusion, to find out maternal outcome and perinatal outcome and to find out rate of caesarean section in both the groups.Methods: The study was carried out in the department of obstetrics and gynaecology, M.Y. Hospital Indore, on pregnancies with an indication for induction of labor either with mechanical dilatation or with misoprostol. Two groups are made each of 100 cases. One group is induced with Foley’ catheter and other with 25 mcg misoprostol sublingually. Both groups are compared on the basis of age, parity, indication of induction, duration of cervical ripening and delivery, need of oxytocin augmentation. Maternal and foetal outcomes are also compared.Results: Most of the cases in both groups were primigravida, belong to 20-25 year of age group. Most cases were induced for postdatism followed by PIH. Induction delivery interval was short in cases received misoprostol. Also misoprostol group required less oxytocin augmentation, and has significant low rate of caesarean section. There was no significant difference in both cases in terms of maternal and foetal complications.Conclusions: Misoprostol is very safe and effective drug for induction of labour. It has property of collagenous remodelling of cervix along with stimulation of uterine contraction. Hence its induction-delivery interval is short with little requirement of oxytocin augmentation. Rate of failed induction is also low

Study of maternal and fetal outcome in elective and emergency caesarean section

Introduction: Caesarean section is one of the most performed surgical procedures all over the world. The present study was conducted to determine the maternal & neonatal outcome and complications in two groups of pregnancy among women with elective and emergency cesarean section. So that measures can be taken to reduce morbidity and mortality in near future. Material & Methods: A prospective observational study carried out in department of Obstetrics and Gynecology, M.G.M Medical College and M.Y. Hospital ,Indore (M.P). All patients who underwent caesarean section are divided into two groups as per the timing of procedure in emergency or electively. The two groups were compared on the basis of age, parity, indication, booking status, intra operative & post op complications, and maternal & fetal outcome. Results: The incidence of caesarean section was 30.25%. The proportion of elective and emergency caesarean was 21.63% and 78.37% respectively. All of the complications were significantly higher in emergency group in terms of both maternal and fetal outcome. Conclusion: The incidence of caesarean section is high in MGM medical college Indore and the overall complication rate is higher in emergency caesarean than elective caesarean section group

To Study effect of external cephalic version in breech pregnancy with respect to antenatal patient admitted in M.Y. Hospital, Indore

Background & Method: An interventional prospective study was conducted in Department of Obstetrics and Gynecology at M.G.M. Medical College and M.Y. Hospital Indore in women with breech pregnancy admitted, Minimum of 30 cases were screened by ultrasound, then presentation were confirmed. All the patients who are diagnosed with breech adviced to go for USG with colour doppler at term and their follow up till they deliver were recorded. Result: Total number of breech admitted was 679 out of which maximum in the age group of 22-26 i.e 49.6%. Maximum number of women 407(60%) were found be unbooked and 272 (40%) of women are booked. Total no. of deliveries and breech admitted in the hospital, in study period total no. of cases delivered during the study time found to be 17,308 out of which 679 patient were breech, so incidence of breech found to be 3.9 %. Among them 30 patient give consent for ECV. Conclusion: It was concluded that External Cephalic Version is a valuable though under used option in the management of breech presentation at term. It is a relatively safe procedure, complications were very rare, it is simple to learn and perform. Vigilance for searching breech presentation and counselling after 36 weeks is important. A proper understanding of the risk is essential for the obstetrician to allow accurate counselling. Breech presentation is associated with higher incidence of mortality and morbidity irrespective of the route of delivery as compared to cephalic presentation. Any complications associated with breech presentation can be reduced by converting it to cephalic presentation by ECV. Keywords: External, Cephalic, Pregnancy & Antenatal