Comparative evaluation of 50 microgram oral misoprostol and 25 microgram intravaginal misoprostol for induction of labour at term: a randomized trial.

OBJECTIVES: To assess and compare the efficacy and safety of 50 µg oral misoprostol and 25 µg intravaginal misoprostol for induction of labour at term. METHODS: This non-blinded, randomized clinical trial included 228 pregnant women at term with obstetric or medical indications for induction of labour. Women either took 50 µg misoprostol orally (two 25 µg tablets) or had one 25 µg tablet of misoprostol inserted in the posterior vaginal fornix. In each group, misoprostol administration was repeated every four hours in the same dose until regular uterine contractions were established or to a maximum of five doses. Time to delivery and outcome data for each group were compared. RESULTS: Of the 228 women, eight (3.5%) were excluded from the analysis as they withdrew their consent after randomization. Mean induction-to-delivery interval was similar in both groups (21.22 hours in the oral group vs. 20.15 hours in the vaginal group; P = 0.58). There was no significant difference between the groups with respect to the number of women who delivered within 24 hours or who required oxytocin augmentation of labour, the mode of delivery, and neonatal outcomes (P > 0.05). Uterine hyperstimulation occurred in two women who received misoprostol vaginally, but not in any of the women in the oral misoprostol group. CONCLUSION: Oral misoprostol in a dose of 50 µg every four hours, to a maximum of five doses, has the potential to induce labour as safely and effectively as 25 µg misoprostol administered vaginally every four hours.

Objectifs : Évaluer et comparer l'efficacité et l'innocuité de 50 µg de misoprostol par voie orale et de 25 µg de misoprostol par voie intravaginale pour le déclenchement du travail à terme. Méthodes : Cet essai clinique randomisé n'ayant pas été mené à l'insu portait sur 228 femmes enceintes à terme qui présentaient des indications obstétricales ou médicales en ce qui concerne le déclenchement du travail. Ces femmes ont été affectées au hasard à un groupe devant prendre 50 µg de misoprostol par voie orale (deux comprimés de 25 µg) ou à un groupe devant se faire insérer un comprimé de 25 µg de misoprostol dans le cul-de-sac postérieur du vagin. Dans chacun de ces groupes, l'administration de la même dose de misoprostol a été répétée toutes les quatre heures jusqu'à ce que des contractions utérines régulières aient été établies ou jusqu'à l'administration d'un maximum de cinq doses. Le délai jusqu'à l'accouchement et les données quant aux issues ont été comparés chez ces groupes. Résultats : Huit (3,5 %) de ces 228 femmes ont été exclues de l'analyse puisqu'elles ont révoqué leur consentement à la suite de la randomisation. L'intervalle déclenchement-accouchement moyen était semblable dans les deux groupes (21,22 heures au sein du groupe « oral ¼ vs 20,15 heures au sein du groupe « vaginal ¼; P = 0,58). Aucune différence significative n'a été constatée entre les deux groupes en ce qui concerne le nombre de femmes ayant accouché dans les 24 heures ou ayant nécessité une accélération du travail à l'oxytocine, le mode d'accouchement et les issues néonatales (P > 0,05). Une hyperstimulation utérine s'est manifestée chez deux des femmes qui avaient reçu du misoprostol par voie vaginale; toutefois, aucune des femmes ayant reçu du misoprostol par voie orale n'a été affectée par un tel phénomène. Conclusion : Le misoprostol administré par voie orale à raison de 50 µg toutes les quatre heures, jusqu'à un maximum de cinq doses, présente le potentiel de déclencher le travail de façon tout aussi sûre et efficace que le misoprostol administré par voie vaginale à raison de 25 µg toutes les quatre heures.

Spontaneous Haemoperitoneum in Pregnancy with Placenta Percreta in Bicornuate Uterus with Successful Pregnancy Outcome: A case study.

Intraperitoneal haemorrhage during pregnancy or postpartum without any history of trauma (spontaneous haemoperitoneum in pregnancy [SHiP]) is a rare condition, causing significant morbidity and mortality for the mother and the neonate. We report a 27-year-old female patient with SHiP at 31 weeks of gestation who was referred to a tertiary care hospital in Muscat, Oman, in 2019, with right iliac fossa pain, pallor and tachycardia. Radiological investigations revealed intraperitoneal bleeding and a right adnexal haematoma. She was managed conservatively with blood transfusion and supportive care. At 36 weeks of gestation, lower segment caesarean section was done and a live baby with good Apgar score was delivered. Pre-operatively, she was found to have a bicornuate uterus, placenta percreta at the junction of the horns and a right adnexal haematoma. This case highlights the significance of thorough evaluation of acute abdominal pain in pregnancy in avoiding unnecessary surgical intervention and iatrogenic prematurity.

KAP Study on HIV/AIDS Among Antenatal Women Attending Central Referral Hospital of North East India.

BACKGROUND: This study was conducted to determine whether antenatal mothers in Sikkim have adequate knowledge about awareness, attitude, and preventive practices regarding HIV infection. METHODS: Cross-sectional study using structured questionnaire. 220 Antenatal mothers attending the outpatient department of Central Referral Hospital of Sikkim were taken for the study for a period of 1 year from April 2011 to April 2012. Questionnaire form filled by pregnant women during their first antenatal visit was the source of data for this study. Systematic sampling technique was used where every alternate pregnant women registering for ANC visit were voluntarily recruited into the study. RESULTS: 2.27 % (5) women had not heard about HIV. 84 % (38) women had the knowledge that HIV was related to STI, while 50 % (110) did not. Television was the best method of increasing the knowledge (48 %). 68 % (150) of the women were aware about mother-to-child transmission (MTCT) of HIV during antenatal period. Only 2.66 % (6) women knew that HIV can be transmitted to child through breast milk. 90 % (198) knew that HIV is spread by having unsafe sex, 48 % (106) women knew using condoms would protect against it. 69.4 % (153) women wanted partner testing, and 84 % (185) of women consented that all pregnant women should be tested for HIV. CONCLUSIONS: The current study revealed high levels of knowledge, positive attitude, and preventive practices regarding HIV; however, this population lacked knowledge about MTCT and its prevention.

Knowledge of, attitudes toward, and barriers to the practice of emergency contraception among women in Sikkim, India.

OBJECTIVE: To assess knowledge, attitudes, and barriers associated with the practice of emergency contraception (EC) among women from the state of Sikkim, India. METHODS: Between November 15, 2011, and June 14, 2012, trained female medical officers and interns used a standard questionnaire to interview 1474 women of reproductive age attending 2 outpatient gynecology clinics. RESULTS: Of those who agreed to participate, 40.6% had ever heard of EC, and EC awareness was particularly low (6.4%) among illiterate women. The most common sources of EC information were electronic media (77.1%), friends and relatives (33.8%), and health personnel (30.4%). Overall, 71.9% of the participants who had heard of EC did not know the timeframe when it should be used. Only 19.6% of the women who had ever heard of EC had adequate knowledge of it, and only 15.1% of these (or 6.1% of the total sample) had ever used EC. The most common barriers to using EC were inadequate knowledge of it, its perceived non-availability, considering it an abortifacient, and religious beliefs. CONCLUSION: Knowledge and practice of EC was low among the women interviewed. There is a need for intensive information EC on the available methods and their correct timing.

Malrotation of gut with volvulus in early pregnancy.

Intestinal obstruction in pregnancy is uncommon, but is associated with significant maternal and fetal mortality. The delay in diagnosis is due to nonspecific symptoms and a disinclination to carry out radiological investigations in pregnancy.We report a rare case of transverse colon volvulus due to malrotation of gut leading to intestinal obstruction in early pregnancy.Surgical intervention was done and the patient had a successful recovery.With this case we would like to emphasize the need for thorough investigations and clinical suspicion of rare causes of acute abdomen in pregnancy.