Subcuticular skin closure at cesarean delivery with poliglecaprone-25 vs polyglactin-910: a randomized controlled trial.

BACKGROUND: Cesarean delivery is a commonly performed surgical procedure worldwide. There is limited good-quality evidence regarding subcuticular skin closure with absorbable sutures in transverse incisions after cesarean delivery. OBJECTIVE: This study aimed to compare poliglecaprone-25 (3-0) and polyglactin-910 (4-0) sutures for subcuticular skin closure in Pfannenstiel incisions among women undergoing cesarean delivery. STUDY DESIGN: In this double-blind, single-center, randomized controlled trial among women undergoing cesarean delivery (elective and emergency), 200 women were randomized (Group 1-subcuticular skin closure with poliglecaprone-25 [3-0] vs Group 2-subcuticular skin closure with polyglactin-910 [4-0]). All women received similar preoperative and postoperative care. A sample size of 200 women was selected with the aim of reducing the composite wound complication rate from 15.8% to 3.6% with a power of 0.80 and a 2-tailed α of 0.05. Thus, 90 women were required in each group, but 100 were selected to account for attrition. RESULTS: Composite wound complications (including surgical site infection, hematoma, seroma, need for resuturing or readmission for wound complications) were similar in the 2 groups (Group 1 vs 2: 16 vs 10; P=.293; relative risk, 1.28; 95% confidence interval, 0.91-1.79). Surgical site infection (8 vs 7; P=1.000; relative risk, 1.08; 95% confidence interval, 0.64-1.83), hematoma (1 vs 2; P=.561; relative risk, 0.66; 95% confidence interval, 0.13-3.31), seroma (8 vs 2; P=.052; relative risk, 1.65; 95% confidence interval, 1.17-2.33), need for resuturing (4 vs 3; P=.700; relative risk, 1.15; 95% confidence interval, 0.60-2.22), and need for readmission (4 vs 4; P=1.000) were similar in the 2 groups. Pain score on the visual analog scale at 3 days (3.2±1.0 vs 3.6±1.2) and 6 weeks after operation (1.6±0.8 vs 1.7±0.9;) was significantly lower in Group 1 (P=.023 and P=.033, respectively). There was no difference between observer and patient scar assessment scores measured at 6 weeks after operation (P=.069 and P=.431, respectively). CONCLUSION: Poliglecaprone-25 (3-0) and polyglactin-910 (4-0) subcuticular sutures were comparable regarding composite wound complications (surgical site infection, hematoma, seroma, wound separation or re-suturing, need for readmission) and cosmetic appearance (patient scar assessment score & observer scar assessment score) related to skin closure among women undergoing cesarean delivery through a Pfannenstiel incision in nonobese women (average body mass index, 25).

Foley catheter (80 vs 60 mL) and misoprostol for labor induction in nulliparous women: a randomized controlled trial.

BACKGROUND: Induction of labor is a common intervention in obstetrics worldwide. Foley catheter is a commonly used mechanical method for labor induction in nulliparous women with an unfavorable cervix at term. We hypothesize that a higher volume of Foley catheter (80 mL vs 60 mL) will shorten the induction-delivery interval for labor induction in nulliparous women at term with an unfavorable cervix with simultaneous use of vaginal misoprostol. OBJECTIVE: This study aimed to evaluate the effect of transcervical Foley catheter (80 mL vs 60 mL) with simultaneous use of vaginal misoprostol on the induction-delivery interval in nulliparous women at term with an unfavorable cervix for induction of labor. STUDY DESIGN: In this double-blind, single-center, randomized controlled trial, nulliparous women with a term singleton gestation with unfavorable cervix were randomized to either group 1 (Foley catheter [80 mL] simultaneously with vaginal misoprostol 25 µg every 4h) or group 2 (Foley catheter [60 mL] with vaginal misoprostol 25 µg every 4h). The primary outcome was induction-delivery interval. Secondary outcomes were duration of the latent phase of labor, number of doses of vaginal misoprostol required, mode of delivery, as well as maternal and neonatal morbidity. Analyses were based on the intention-to-treat method. A sample size of 100 women per group (N=200) was selected. RESULTS: Between September 2021 to September 2022, 200 nulliparous women at term with an unfavorable cervix were randomized to labor induction with either FC (80 mL vs 60 mL) and vaginal misoprostol. Induction delivery interval (in minutes) was statistically significantly shorter in Foley catheter (80 mL) (median [interquartile range], 604 [524-719] vs 846 [596-990]; [P<.001]). Median time to labor onset (in minutes) (240 [120-300] vs 360 [180-600]; P<.001) was also shorter in group 1 (80 mL). The number of doses of misoprostol required for labor induction was statistically significantly less than with 80 mL (mean±standard deviation, 1.4±0.7 vs 2.4±1.3; P<.001). There was no statistically significant difference in the mode of delivery (vaginal delivery: 69 vs 80; odds ratio, 0.55 [1.1-0.3]; P=.104 and cesarean delivery: 29 vs 17; odds ratio, 0.99 [0.9-1.1]; P=.063, respectively). The relative risk of delivery within 12 hours with 80 mL was 2.4 [95% confidence interval, 1.68-3.43], P<.001. Maternal and neonatal morbidity were similar across the 2 groups. CONCLUSION: FC (80 mL) simultaneously with vaginal misoprostol significantly shortens the induction-delivery interval (P<.001) in nulliparous women at term with an unfavorable cervix, as compared with Foley catheter 60 mL and vaginal misoprostol.

A randomized controlled trial comparing combined medical and mechanical method for early mid-trimester abortion (13-20 weeks).

OBJECTIVE: To examine the combined effect of a medical and mechanical method on induction-to-abortion interval (IAI) in women undergoing early mid-trimester abortion (MTA) (13-20 weeks of pregnancy). METHODS: A randomized controlled trial was conducted among women undergoing MTA. Primary outcome was IAI. At enrollment, 60 women were randomized (group 1: medical method alone [mifepristone 200 mg, then 48 h later vaginal misoprostol 400 µg every 4 h] versus group 2: combined medical and mechanical method [transcervical Foley catheter inflated with 60 ml of normal saline]). Demographic and clinical data were collected at enrollment and abortion. RESULTS: Women in group 2 had statistically significantly shorter IAI (mean ± standard deviation: 347 ± 130 min vs. 640 ± 242 min, for group 2 and group 1, respectively; P < 0.001). All the women in group 2 had complete abortion within 12 h, compared with 19 (63%) in group 1 (P < 0.001). Median number of doses of vaginal misoprostol (400 µg every 4 h) required in group 1 was 4 (interquartile range [IQR] 3-5) versus 1 (IQR 1-3) in group 2 (P < 0.001). Statistically significantly fewer women required additional oxytocin (group 1 vs. group 2; 4 vs. zero, respectively, P = 0.038). All women in the study had complete abortion. There was no significant difference with respect to maternal complications. CONCLUSION: A combined medical and mechanical method significantly shortens the IAI (P < 0.001) in women undergoing early MTA (13-20 weeks of pregnancy). TRIAL REGISTRATION: Clinical Trial Registry of India www.ctri.nic.in CTRI/2020/12/030077 (date; 28-12-2020).

Simultaneous use of high-volume Foley catheter (60 ml) and misoprostol for labor induction in nulliparous women: A randomized controlled trial.

OBJECTIVE: To examine the simultaneous effect of high-volume Foley catheter (HVFC) (60 ml) and vaginal misoprostol on labor induction in nulliparous women. METHODS: A randomized, double-blind, controlled trial was conducted among nulliparous post-date (>40 weeks) pregnant women between June and December 2019. At enrollment 100 women were randomized into each group (either HVFC and vaginal misoprostol or low-volume Foley catheter [LVFC] [30 ml] and vaginal misoprostol), for labor induction. Demographic and clinical data were collected at enrollment and delivery. RESULTS: Women in the HVFC group had statistically significantly shorter induction to delivery interval (median 860 min, interquartile range [IQR] 840-940 min vs. 1160 min, IQR 1080-1320 min, P < 0.001) and duration of labor (median 615 min, IQR 600-680 min vs. 750, IQR 692.5-800 min, P < 0.001). Mode of vaginal delivery (n = 94 vs. n = 78, P = 0.002), number of doses of misoprostol required (median 2, IQR 1-2 vs. 2, IQR 1-3), and need of oxytocin augmentation (n = 22 vs. n = 39, P = 0.014 and P < 0.001), was significantly better in the HVFC group. However, there was no significant difference with respect to other maternal or neonatal outcomes. CONCLUSION: Simultaneous use of HVFC and vaginal misoprostol for labor induction significantly shortens the induction to delivery interval and duration of labor in nulliparous women. TRIAL REGISTRATION: Clinical Trial Registry of India CTRI/2019/05/019394 (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=31554&EncHid=&userName=Foley%20catheter).

Improving the Breastfeeding Practices in Healthy Neonates During Hospital Stay Using Quality Improvement Methodology.

OBJECTIVE: To demonstrate the applications of the principles of Quality Improvement (QI) in a tertiary-care centre with the aim to improve the breastfeeding practices during hospital stay. METHODS: An operational team was formulated to identify the reasons for low proportion of exclusive breast feeding (EBF) in healthy neonates. Reason specific solutions were proposed, discussed, prioritized and tested using Plan-Do-Study-Act Cycle (PDSA Cycle). Strategies included clear departmental policy plan and creation of Breastfeeding support package (BFSP). PDSA cycles were tested and implemented over 6 weeks period and its sustainability was measured monthly for five months duration. RESULTS: After implementation of PDSA cycles, the proportion of neonates receiving early breastfeeding within one hour of birth increased from 55% to 95%, and the proportion of neonates on EBF during hospital stay increased from 72% to 98%. CONCLUSION: Quality Improvement principles are feasible and effective to improve breastfeeding practices in the hospital setting.

Hydralazine vs nifedipine for acute hypertensive emergency in pregnancy: a randomized controlled trial.

BACKGROUND: There is a paucity of good quality evidence regarding the best therapeutic option for acute control of blood pressure during acute hypertensive emergency of pregnancy. OBJECTIVE: We sought to compare the efficacy of intravenously administered hydralazine and oral nifedipine for acute blood pressure control in acute hypertensive emergency of pregnancy. STUDY DESIGN: In this double-blind, randomized, controlled trial, pregnant women (≥24 weeks period of gestation) with sustained increase in systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg were randomized to receive intravenous hydralazine injection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection every 20 minutes until the target blood pressure of 150 mm Hg systolic and ≤100 mm Hg diastolic was achieved. Crossover treatment was administered if the initial treatment failed. The primary outcome of the study was time necessary to achieve target blood pressure. The secondary outcomes were the number of dosages required, adverse maternal and neonatal effects, and perinatal outcome. RESULTS: From December 2014 through September 2015, we enrolled 60 patients. The median time to achieve target blood pressure was 40 minutes in both groups (intravenous hydralazine and oral nifedipine) (interquartile interval 5 and 40 minutes, respectively, P = .809). The median dose requirement in both groups was 2 (intravenous hydralazine and oral nifedipine) (interquartile range 1 and 2 doses, respectively, P = .625). Intravenous hydralazine was associated with statistically significantly higher occurrence of vomiting (9/30 vs 2/30, respectively, P = .042). No serious adverse maternal or perinatal side effects were witnessed in either group. CONCLUSION: Both intravenous hydralazine and oral nifedipine are equally effective in lowering of blood pressure in acute hypertensive emergency of pregnancy.

Mifepristone vs balloon catheter for labor induction in previous cesarean: a randomized controlled trial.

OBJECTIVE: To compare oral mifepristone (400 mg) with trans-cervical balloon catheter for induction of labor (IOL) in post date women with previous one cesarean section (CS). METHODS: In this randomized trial, post date pregnant women (gestation 40 weeks 5 days), with previous one low segment CS (no previous vaginal delivery) were induced either with oral mifepristone (400 mg) or balloon catheter [Foley's catheter (16 Fr); bulb filled with 30 ml normal saline]. They were re-assessed 24 and 48 h later. If at any time Bishop Score was >6; amniotomy was done, followed by oxytocin infusion. Primary outcome of the study was labor onset after first manoeuvre. Secondary outcomes were cervical ripening, need of oxytocin, vaginal delivery and CS, in two groups. RESULTS: From June 2012 to September 2015, we enrolled 107 women. Out of these, 57 received oral tablet mifepristone (400 mg) and 50 were inserted with balloon catheter. Labor onset after first manoeuvre was statistically significantly more in mifepristone group (37/57 vs. 13/50, respectively; p value 0.000). Bishop Score after 24 h was better in balloon catheter (p value 0.000). More women with balloon catheter required oxytocin for IOL (37/50 vs. 20/57, respectively; p value 0.000) along with higher dose [840 (320) mU vs 560 (120) mU, respectively, p value 0.000]. Failure of induction was statistically significantly higher in balloon catheter group (8 out of 50 vs. 2 out of 57, respectively, p value 0.043). There was no statistically significant difference in normal delivery or CS in either group (p value 0.242 and 0.331, respectively). CONCLUSION: Oral mifepristone (400 mg) is associated with statistically significantly higher incidence of labor onset in post date pregnant women with previous one CS, as compared to balloon catheter. Both methods are primarily for cervical ripening and oxytocin should not be delayed in the absence of onset of labor. CLINICAL TRIAL REGISTRATION: Clinical Trials Registry-India, www.ctri.nic.in , CTRI/2012/05/003634.

A Retrospective Case-Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section.

OBJECTIVE: To investigate the role of "mifepristone" for induction of labor (IOL) in pregnant women with prior cesarean section (CS). METHODS: In this retrospective study, all pregnant women with prior CS who received oral mifepristone (400 mg) for IOL (as per clear obstetric indications) [group 1] were compared with pregnant women with prior CS who had spontaneous onset of labor (SOL) [group 2], with respect to incidence of vaginal delivery, CS, duration of labor, and various maternal and fetal outcomes. RESULTS: During the study period, 72 women received mifepristone (group 1) for IOL and 346 had SOL (group 2). In group 1 after mifepristone administration, 40 (55.6 %) women had labor onset, and 24 (33.3 %) women had cervical ripening (Bishop Score ≥ 8) within 48 h. There were no statistically significant differences with respect to duration of labor (p value: 0.681), mode of delivery (i.e., normal delivery or CS-p value: 0.076 or 0.120, respectively), or maternal (blood loss or scar dehiscence/rupture uterus), or fetal outcomes (NICU admission) compared to women with previous CS with SOL (group 2). However, the need of oxytocin (p value 0.020) and dose of oxytocin requirement (p value 0.008) were more statistically significant in group 1. CONCLUSION: Mifepristone may be considered as an agent for IOL in women with prior CS.

Neglected vaginal foreign body leading to vaginolith, vesicovaginal fistula and vesical calculus formation in an adolescent girl.

Vaginal foreign body insertion is not an uncommon clinical entity; however, long-standing neglected vaginal foreign body causing vaginolith, vesicovaginal fistula and vesical calculus formation is unusual. We present a case of a neglected vaginal foreign body (plastic cap of a nail colour) leading to vesicovaginal fistula, vaginolith and vesical calculus formation in a 12-year-old female child presenting with continuous dribbling of urine per vagina. Diagnosis was confirmed on ultrasonography, non-contrast CT scan and MRI of the pelvis. The MRI demonstrated the exact size and site of the urinary bladder wall defect, besides the foreign body and the vesical calculus. The foreign body along with vaginolith and the vesical calculus were removed via suprapubic approach under general anaesthesia; the fistula was repaired by suturing the urinary bladder and vagina wall defect.

Sonographic prediction of scar dehiscence in women with previous cesarean section.

PURPOSE: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). METHOD: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV). RESULTS: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS. CONCLUSIONS: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.

A prospective observational study of trial of labor after cesarean in rural India.

OBJECTIVE: To determine the success rate of trial of labor after cesarean (TOLAC) in rural India. METHODS: The present prospective observational study enrolled pregnant women attending Dr Rajendra Prasad Government Medical College, Kangra, India, in 2013. Eligible women had a previous low-segment cesarean delivery and had a singleton pregnancy with cephalic presentation. Women in labor were managed as per the institutional protocol. RESULTS: In total, 482 women were included. TOLAC led to a vaginal delivery in 383 (79.6%) women. Overall, 2 (0.4%) women had scar rupture, and 4 (0.8%) had scar dehiscence. Fetal death was recorded in one woman with scar rupture, for whom peripartum hysterectomy was necessary. Blood loss was significantly lower among the 316 women with normal vaginal delivery than among the 99 who underwent cesarean (P<0.001). Blood transfusion was required in 2 (0.6%) women with normal vaginal delivery and 2 (2.0%) with cesarean delivery (P=0.05). The proportion of neonates who had to be admitted to intensive care did not differ significantly by mode of delivery (P=0.06). CONCLUSION: Under strict supervision, TOLAC is a reasonable option even in rural India.

Chondrocutaneous branchial remnants or cartilaginous choristoma: terminology, biological behavior and salience of bilateral cervical lesions.

OBJECTIVE: To present and critically examine the spectrum of chondrocutaneous branchial remnants or accessory pinna, including rare case of bilateral cervical lesions, and to explain the basis of the biological behavior. MATERIAL AND METHOD: Five cases of pediatric chondrocutaneous branchial remnants or accessory pinna were included. The ratios of the longest dimensions of the external ear to that of the accessory tragus/chondrocutaneous branchial remnants were calculated. RESULTS: The size and rate of growth of chondrocutaneous branchial remnants or accessory pinna were found to be inversely proportional to the distance between the lesions and the normal pinna. CONCLUSION: The current literature and norms of terminology dictate that two different terminologies for lesions that are essentially histologically identical should be avoided. Chondrocutaneous branchial remnants, accessory pinna/tragus and chondroid/ cartilaginous choristomas are identical lesions with similar pathogeneses and should be referred to as choristomas.

Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery.

OBJECTIVE: The aim of the study was to generate baseline data for indications of gynecological surgeries, and to assess route of surgery and histopathology correlation in women undergoing major gynecological surgery in a rural tertiary level teaching hospital in India. MATERIALS AND METHODS: Surgical indications, route of surgery and histopathology findings were reviewed and analyzed retrospectively, in 922 patients (≥35 years age) who underwent gynecological surgery at Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India from January 1, 2011 to May 31, 2013. RESULTS: Of 922 surgeries, 65 had malignancy (7%). Pelvic organ prolapse (POP) (32.3%) and leiomyoma uterus (29%) were two most common benign indications for hysterectomy. Ovarian tumors were present in 13% (25% of these were malignant). Postmenopausal bleeding (PMB) was seen in 5.5% (55% of these were malignant). CONCLUSIONS: All except 10% surgeries were done in the absence of definite histopathology diagnosis that is dysfunctional uterine bleeding (n = 42 [45%]), chronic pelvic pain/severe dysmenorrhea (n = 34 [36%]) and recurrent PMB (n = 17 [19%]). Majority of surgeries had histopathological correlation except for six cases (0.6%) of malignancy, which were missed on initial work-up. Majority of the surgeries were done abdominally. In rural areas of developing countries poverty, lack of regular follow-up, resource constraints and lack of technical skills (with respect to laparoscopic/robotic surgeries) pose major challenge in providing quality health care.

A randomized controlled trial comparing cosmetic outcome after skin closure with 'staples' or 'subcuticular sutures' in emergency cesarean section.

OBJECTIVE: To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections (CS). METHODS: One hundred and thirty women (undergoing emergency CS without previous abdominal delivery) were randomly assigned to either staples or subcuticular skin closure (monocryl 3-0). Primary outcome of the study was cosmetic outcome [as assessed by patient and independent observer: Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS), respectively], 6 weeks post-operative. Secondary outcomes were wound complications, operating time, post-operative pain (visual analogue scale day 3 post-operative and patient assessment of pain in scar 6 weeks post-operative), and duration of hospital stay. RESULTS: 112 women were available for evaluation of scar 6 weeks post-operative. Cosmetic result of staples was significantly better than subcuticular sutures (PSAS and OSAS: p value 0.022 and 0.000, respectively), with significantly lesser duration of surgery (24 vs. 32 min: p value 0.000) and comparable post-operative pain (pain on day 3 and 6 weeks post-operatively: p value 0.474 and 0.179, respectively) and wound complications (p value 0.737). However, duration of stay in hospital was increased (6 vs. 3 days: p value 0.001). CONCLUSION: Staples are the method of choice for skin closure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery. Post-operative pain and wound complications are comparable in two groups. However, staples are associated with significantly increased duration of hospital stay. Trial registered in clinical trial registry CTRI: REF/2013/05/005087.

Angioleiomyoma uterus in an adolescent girl: a highly unusual presentation.

BACKGROUND: Uterine angioleiomyoma is a very rare gynecologic tumor; only a few such cases have been reported to date and we have found no such tumor reported in an adolescent girl. CASE: We report the case of a uterine angioleiomyoma in an adolescent girl. It presented as a huge abdomino-pelvic mass. The girl had severe menorrhagia and severe anemia. Intra-operatively no distinct planes were found between myoma and myometrium. Due to severe hemorrhage, she underwent sub-total abdominal hysterectomy. SUMMARY AND CONCLUSION: Uterine angioleiomyoma is an extremely rare tumor since only 16 such cases have been reported to date. Its appearance in an adolescent girl seems to be the first case of its kind. So it is being reported not only to familiarize the managing physicians with the possibility of such a tumor and its variable presentation, but also to highlight the need for inclusion of this tumor in WHO classification of tumors of the female genital tract.

Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of orally administered nifedipine and intravenously administered labetalol for acute blood pressure control in hypertensive emergency of pregnancy. METHODS: In this double-blind, randomized, controlled trial, pregnant women with sustained increase in systolic blood pressure of 160 mm Hg or higher or diastolic blood pressure of 110 mm Hg or higher were randomized to receive nifedipine (10 mg tablet orally up to five doses) and intravenous placebo saline injection or intravenous labetalol injection in escalating doses of 20, 40, 80, 80, and 80 mg and a placebo tablet every 20 minutes until the target blood pressure of 150 mm Hg systolic and 100 mm Hg diastolic, or lower, was achieved. Crossover treatment was administered if the initial treatment failed. The primary endpoint of the study was time necessary to achieve target blood pressure. Secondary endpoints were number of dosages required, adverse maternal and neonatal effects, side effect profile, and perinatal outcome. RESULTS: From October 2012 to April 2013, we enrolled 60 patients. The median time taken to achieve target blood pressure was 40 minutes (interquartile range, 20-60 minutes) compared with 60 minutes (interquartile range 40-85 minutes) for nifedipine and labetalol, respectively (P=.008). The median dose required was two (interquartile range 1-3) compared with three (interquartile range 2-4.25) for nifedipine and labetalol, respectively (P=.008). No serious adverse maternal or perinatal side effects were witnessed in either group. CONCLUSION: As administered in this trial, oral nifedipine lowered blood pressure more quickly than did intravenous labetalol during hypertensive emergency in pregnancy. CLINICAL TRIAL REGISTRATION: Clinical Trials Registry-India, www.ctri.nic.in, CTRI/2013/02/003350. LEVEL OF EVIDENCE: I.

Cervical cancer screening: knowledge, attitude and practices among nursing staff in a tertiary level teaching institution of rural India.

BACKGROUND: Assessment of the nursing staff knowledge, attitude and practices about cervical cancer screening in a tertiary care teaching institute of rural India. MATERIALS AND METHODS: A cross sectional, descriptive, interview- based survey was conducted with a pretested questionnaire among 262 staff nurses of a tertiary care teaching and research institute. RESULTS: In this study 77% respondents knew that Pap smear is used for detection of cervical cancer, but less than half knew that Pap smear can detect even precancerous lesions of cervix. Only 23.4% knew human papilloma virus infection as a risk factor. Only 26.7% of the respondents were judged as having adequate knowledge based on scores allotted for questions evaluating knowledge about cervical cancer and screening. Only 17 (7%) of the staff nurses had themselves been screened by Pap smear, while 85% had never taken a Pap smear of a patient. Adequate knowledge of cervical cancer and screening, higher parity and age >30 years were significantly associated with self screening for cervical cancer. Most nurses held a view that Pap test is a doctor procedure, and nearly 90% of nurses had never referred a patient for Pap testing. CONCLUSIONS: The majority of nursing staff in rural India may have inadequate knowledge about cervical cancer screening, and their attitude and practices towards cervical cancer screening could not be termed positive.

Spontaneous viable birth in a case of stage III pelvic endometriosis with bilateral tubal damage following diagnostic intervention: who deserves the credit?

INTRODUCTION: We are reporting a case of spontaneous conception and viable birth in a woman diagnosed with stage III pelvic endometriosis and bilateral tubal blockade. CASE: A 30-year-old woman was investigated for primary infertility and was diagnosed with stage III pelvic endometriosis, extensive distortion of pelvic anatomy and bilateral tubal damage on diagnostic laparoscopy and chromotubation. Patient was advised in vitro fertilization; however, she chose otherwise and conceived spontaneously, delivering a healthy baby by cesarean section at term. DISCUSSION: Spontaneous conception rates amongst women with advanced endometriosis nearly approaches zero; hence, expectant management is not recommended for associated infertility. Despite being and isolated case, this report raises questions regarding the association of infertility even with advanced endometriosis and also highlights the beneficial effect pregnancy has on endometriosis.

Bilateral Ovarian Endometriomas Presenting as Nonprogress of Labor: First Case Report in the Literature Is Concomitant Surgical Excision during Cesarean Section Advisable?

Objective. To report the first case of bilateral ovarian endometriomas, leading to nonprogress of labour, successfully excised during cesarean section. Design. Case report. Setting. Department of Obstetrics & Gynecology of Dr. RPGMC Tanda, Kangra, India. Patients. A primigravida in labour at term gestation. Interventions. Surgical management. Main Outcome Measures. Description and treatment of a pregnant woman with bilateral ovarian endometriomas during cesarean section. Results. Successful excision of ovarian endometriomas and reconstruction of the ovaries during cesarean section. Conclusion. Management of incidentally detected endometriomas during cesarean section should be individualized, taking into account the symptoms, size, bilaterality, and adhesion with adjacent organs.

Ruptured noncommunicating rudimentary horn pregnancy at 19 weeks with previous cesarean delivery: a case report.

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. We report a case of ruptured non-communicating rudimentary horn at 19 weeks in a woman with previous Cesarean delivery. She had a routine malformation scan in which diagnosis was missed. Later she presented to emergency in shock, with massive hemoperitoneum and ruptured horn. So a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during nonpregnant state laparoscopically. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.