Comparison of Vaginal Birth Rate between Induction of Labour and Expectant Management at 40 Weeks in Women with a Previous Caesarean Section: A Pilot Randomized Controlled Trial.

Background: The optimum time of labour induction among women with a previous caesarean without any pregnancy complication and eligible and willing for vaginal delivery is not specified. This study compares the vaginal birth rates between induction at 40 weeks and expectant management till 41 weeks. Method: We conducted this parallel design nonblinded, randomized controlled trial in a tertiary care teaching institution in South India on women with a previous lower segment caesarean section eligible for a trial of labour with singleton foetus without any pregnancy complication at recruitment. We screened 1886 women. Sixty women underwent block (of 6 each) randomization into two groups of thirty each at 40 weeks. We induced the women in the intervention group at 40 weeks with oxytocin or a single 24-hour application of a Foley catheter followed by oxytocin infusion and amniotomy. The expectant group underwent maternal and foetal surveillance and induction at 41 weeks with the same protocol if not delivered by then. We compared the primary outcome of the proportion of vaginal birth rate with a chi-square test. Result: Data from all sixty women were analyzed. Twenty (66.67%) in the induction compared to ten (33.33%) in the expectant group delivered vaginally. This difference was significant (RR 2.0, 95% CI: 1.13-3.52; P = 0.016). One woman in the expectant group had scar dehiscence. Conclusion: Among women with a previous caesarean scar, labour induction at 40 weeks has a significantly higher vaginal birth rate than those managed expectantly till 41 weeks. More extensive trials are feasible and recommended. Trial Registry. The trial was prospectively registered with the clinical trial registry of India. This trial is registered with CTRI/2018/09/015719 (date of registration 14th September 2018).

Clinical Profile and Autopsy Findings in Fatal Head Injuries.

AIMS: This study aims to correlate the autopsy findings with the clinical picture and imaging report in fatal head injury patients. SETTINGS AND DESIGN: A descriptive study conducted at tertiary care hospital in South India from July 2015 to December 2016. PATIENTS AND METHODS: All patients with head injuries who were admitted to our Emergency and Trauma Centre and underwent autopsy were included in the study. A structured pro forma was used for collecting information. Autopsy findings were considered as a gold standard to correlate with antemortem findings in fatal head injury. The data were analyzed with EpiData and OpenEpi statistical analyzing software. RESULTS: Of the 303 fatal head injury patients, a majority were males and age group between 21 and 40 years. Eighty-eight percent (267/303) of fatal head injuries were due to road traffic accidents. Twenty-five of the 303 patients reached our center within 1 h (golden hour) of trauma. Of the 303 fatal head injuries, 153 (50.5%) died within 24 h of reaching our center. The most common autopsy finding in this study was subarachnoid hemorrhage (SAH) (247/303, 81.3%). Diagnostic accuracy of Epi dural hemorrhage (EDH) antemortem had the highest value (98.35%). SAH had least diagnostic accuracy value (45.72). subdural hemorrhage (SDH) had highest sensitivity (57.02%). EDH had higher specificity (100%). Significant SDH, SAH, and brain contusions were not detected during antemortem evaluation. CONCLUSIONS: Our study revealed that among fatal head injury patients, half of them died within first 24 h after reaching to tertiary care center. Diagnostic accuracy to detect extradural hemorrhage antemortem had the highest value and SAH had least diagnostic accuracy value. Significant subdural hemorrhage, subarachniod hemorrhage, and brain contusion were not detected during antemortem evaluation. Expertise in interpretation of imaging, adequate clinical examination, proper documentation, and early resuscitation may reduce the chances of missed injuries in head injury patients.