Oral versus vaginal misoprostol for induction of labor

OBJECTIVES: The aim of this randomized controlled trial is to compare the safety and efficacy of titrated oral misoprostol with vaginal misoprostol for labor induction. METHODS: 778 patients at term meeting inclusion criteria for induction of labor were randomized by computer generated block randomization sequence. They were allocated into two groups to receive oral drug and vaginal placebo or vaginal drug and oral placebo given every 4 hourly until the patient entered active labor or the bishop score of the cervix was more than 6. The dosage of the oral drug was 50 mcg of misoprostol followed by 2 doses of 100 mcg each and that of the vaginal drug was 25 mcg in all three doses. The results were analyzed using SPSS version 17 software. RESULTS: 389 women were equally randomized to each arm. Vaginal delivery in 24 hours from induction was achieved in 67% and 66.8% of the vaginal and oral misoprostol group respectively. The rate of cesarean section rate, incidence of uterine hyperstimulation and meconium staining were similar in both the groups. The need for oxytocin augmentation was less in the oral misoprostol group (80.3% versus 73.4%, p=0.02). The incidence of maternal or neonatal outcomes was similar. Our study found that oral misoprostol is as safe and effective as vaginal misoprostol for cervical ripening. CONCLUSION: Our study found that oral misoprostol is as effective as vaginal misoprostol for cervical ripening and in achieving vaginal delivery within 24 hours. The rate of hyperstimulation and cesarean section was similar in both the groups. The need for oxytocin augmentation was less in the oral misoprostol group. Oral misoprostol had no increase in the incidence of maternal or neonatal outcomes compared to vaginal misoprostol

Pregnancy outcomes in non-gynecological and non-hematological cancers: a retrospective cohort

Background: Of all the cancers in women, about 10% manifest in the reproductive age group. These can be broadly classified as gynaecological cancers and non-gynaecological cancers; Among the non-gynaecological cancers besides haematological cancer, breast, thyroid, colon, bone and CNS are seen rarely. Clinical acumen in diagnosis and management of these rare cancers that appear during pregnancy or before pregnancy are difficult due to insufficient guidelines and rarity of the conditions.Methods: A retrospective analysis of rare cancers during a period of 10 years in this hospital was performed. Data concerning the gestational age at delivery, birth weight, mode of delivery and complications and the management of the cancers during the pregnancy were collected.Results: Among the 41 women with these rare non-gynecological, non-hematological cancers, 13 pregnancies were in women with prior history of cancers and 28 pregnancies were with current history of cancer. Majority of these cases with prior history were thyroid cancers who had uneventful pregnancies and delivered normally. Among pregnancies with current history of cancer, breast, CNS, GIT, and head and neck were the cancers with 5-6 cancers in each category. About 50% of these cancers were delivered early between 31-35 weeks to facilitate optimal treatment. Cancers with guarded prognosis diagnosed before 20 weeks had a termination of pregnancy.Conclusions: Cancers during pregnancies are rare and their care must be individualized

Chapter 10: Obesity and adolescent pregnancy

Adolescent pregnancy and obesity are conditions with multifactorial etiologies and adverse medical consequences, linked to underlying deep-rooted social problems. This chapter firstly discusses global trends, factors contributing to and the consequences of adolescent pregnancies, followed by a discussion of trends, etiology and complications of obesity. Lastly, the chapter describes the problems related to pregnancy in obese adolescents and the care options for obese pregnant adolescents