INTERRUPTED VERSUS CONTINUOUS SUTURES FOR REPAIR OF EPISIOTOMY OR 2N DEGREE PERINEAL TEARS.

BACKGROUND: Performing an episiotomy is generally reserved for complicated childbirths, in cases of foetal distress, or when tearing of tissues with serious consequences are foreseen. In addition to the extent of the trauma, the surgical skill, repair after childbirth can have an important effect on the magnitude and degree of morbidity experienced by women after repair. The best technique for this repair would be that which produces less pain in the short and long term. The study was done with an objective to compare the frequency and severity of pain (slight/severe) by using interrupted and continuous methods for repair of episiotomy or second degree perineal tears. METHODS: It is a randomized control trial. This study was carried out in a Gynaecology and Obstetrics department of Benazir Bhutto Hospital Rawalpindi which is a tertiary care hospital. The duration of study was six months. One hundred & thirty-eight primigravidas (69 in each group) were included in the study. RESULTS: Majority of the patients in both groups belonged to 20-25 years age group, i.e., 48.53% (n=33) in group-A and 50% (n=34) in group-B, mean and SD, was 27.69±3.21 in group-A and 28.16±3.89 in group-B, gestation age of the patients in group-A 77.94% (n=53) and 83.82% (n=57) in group-B between 37-40 weeks of gestation. Complication of pain and its severity in both groups at 24 hours and 10th day were compared which showed no significant difference at any severity (i.e., no pain, mild moderate/severe). CONCLUSION: There is no significant difference in frequency and severity of pain (slight/severe) in using interrupted and continuous methods for repair of second degree perineal tears or episiotomy

Fetomaternal Outcome In Women With Oligohydramnios Induced With Misoprostol.

BACKGROUND: Oligohydramnios, defined as an amniotic fluid index (AFI) of less than the 5th percentile (at term ≤5 cm, or at per-term ≤8.0 cm), has an incidence of 8.5-15.5%. It is associated with an increased perinatal morbidity and mortality. The objective of this study was to explore whether induction with misoprostol can safely be offered to patients with reduced amniotic fluid index and that vaginal delivery can be achieved without major adverse effects. METHODS: All women at term who gave consent to be part of the study and required labour induction were recruited. Total 120 women were included in study. They had a per-induction ultrasound to calculate amniotic fluid index (AFI). Based on AFI., the patients were divided into two groups: group 1, had AFI ≤5 cm and was oligohydramnios group. The other was group 2 with normal amniotic fluid, i.e., AFI >5 cm. Both these groups then underwent labour induction with misoprostol (cytotec-Pfizer) 50microgram. The dose was repeated 6 hourly for a maximum of three doses. The outcomes studied were number of tablets used, induction to labour interval, induction to the delivery interval and method of delivery. The foetal outcomes were meconium staining, Apgar score, NICU admission and advance neonatal resuscitation. RESULTS: In maternal parameters, it was observed that there was a significant difference in induction to delivery interval only and in foetal parameters it was observed that in group 1, there was statistical significance in meconium staining, Apgar score and NICU admission. CONCLUSIONS: Induction with misoprostol and vaginal delivery can safely be offered to women with oligohydramnios at term.