Labor induction with combined low-dose oral misoprostol and Foley catheter vs oral misoprostol alone at term gestation-a randomized study.

BACKGROUND: The ideal method for induction of labor is still not clearly defined. Recent reports in literature have shown that oral administration of low-dose misoprostol is as effective as vaginal administration for induction of labor. The use of vaginal misoprostol in combination with Foley catheter has been shown to shorten the period of induction. However, there are limited reports on the use of oral misoprostol in combination with Foley catheter. Given the convenience of oral administration, improved compliance relative to other methods is probable. This study proposed that the combination of oral misoprostol and Foley catheter would be a better means of inducing labor. OBJECTIVE: To compare the efficacy of combined low-dose oral misoprostol and Foley catheter with oral misoprostol alone for induction of labor at term gestation. The efficacy was compared in terms of the induction-to-delivery interval and the number of women delivering vaginally within 24 hours. The second objective was to document adverse events, if any, of the 2 protocols. STUDY DESIGN: The study was conducted at a tertiary care center and included 200 patients with indication for induction, randomly allotted to either of the 2 groups: group A (a combination of Foley catheter and 25-µg misoprostol every 2 hours orally) and group B (only 25-µg misoprostol every 2 hours orally), using computer-generated random number sequence. The obstetrical and neonatal outcomes were recorded and compared between the 2 groups. Quantitative variables were compared using unpaired and paired t-tests within the groups across follow-ups. RESULTS: Group A had significantly shorter mean induction-to-active-labor interval (10.67±1.75 vs 16.28±1.69 hours), mean induction-to-full-dilation interval (11.49 vs 19.00 hours), and mean induction-to-delivery interval (16.85 vs 21.90 hours). The proportion of women delivering vaginally within 24 hours was higher in group A (76 vs 57 women). In comparing maternal side effects, the only significant difference between the 2 groups was found in postpartum hemorrhage. A 5-minute Apgar score <7 was significantly more frequent in group B. CONCLUSION: The combination of oral misoprostol with transcervical Foley catheter reduced the induction-to-delivery interval significantly (P=.001). In addition, the proportion of women delivering vaginally within 24 hours was significantly higher. Hence, the use of oral misoprostol with Foley catheter for induction of labor would be beneficial for patients.

Randomised controlled trial to study the efficacy of exercise with and without metformin on women with polycystic ovary syndrome.

OBJECTIVES: 1. To study the efficacy of exercise in improving clinical symptoms, anthropometry, glucose tolerance and laboratory profile in women with Polycystic ovarian syndrome. 2. To study the combined efficacy of exercise and metformin on above parameters in women with polycystic ovary syndrome. STUDY DESIGN: A Randomised double blinded placebo controlled trial was performed at a district hospital in New Delhi. Sixty six women were included in the study. Block randomisation was done to divide the women into two groups. Women were treated with fixed exercise schedule along with oral placebo in Group A and exercise with oral metformin in Group B. Outcomes stated in objectives were studied and statistically analysed. Quantitative variables were compared using unpaired t-test and Paired t-test within the groups across follow-ups. Qualitative variable has been compared using Chi-Square test /Fisher's exact test. RESULTS: In Group A and B significant improvement was noted in menstrual cycles, mean waist circumference, mean waist-hip ratio and body mass index. The mean weight loss was 0.78 ± 0.19 kg and 1.71 ± 0.19 kg in group A and B respectively after 3 months. The mean weight loss was 1.08 ± 0.30 kg and 1.71 ± 0.19 kg in group A and B respectively. The mean difference in modified Ferriman Gallwey score at 0, 3 and 6 months were statistically significant in both groups. On comparing group A with group B at 6 months, significant improvement was found in menstrual cycle symptoms (55.17% vs 83.33%), mean weight loss (1.08 kg vs 2.5 kg), waist circumference reduction (2.56 cm vs 4.75 cm) and change in mean waist hip ratio (0.02 vs 0.04). Significant changes were noted in OGTT and Serum testosterone level at 6 months in Group B, but not in Group A. Statistically no significant differences were found in acne, acanthosis nigricans and other biochemical parameters. CONCLUSION: Regular exercise should be recommended for the women with PCOS. It results in statistically significant improvement in menstrual cycle pattern, hirsutism, body mass index, weight, waist circumference waist-hip ratio. Addition of metformin resulted in added benefits on menstrual cycle, hirsutism, weight, body mass index, waist circumference, waist hip ratio, serum testosterone and Oral Glucose Tolerance Test (OGTT).

Prong sign: a simple measure to enhance safety of laparoscopic sterilization.

Laparoscopic female sterilization is widely practiced and is very safe. However, mesosalpingeal tears and mesosalpingeal haematomas are common complications especially when performed by an inexperienced surgeon. It was found that the observation of a simple 'prong sign' could prevent these complications and possibly reduce failure rates.

Teenage pregnancies and their obstetric outcomes.

This study was conducted to evaluate the obstetric performance of teenage women in India. In total, 13,210 women were included in the study, of whom 840 were teenagers (<19 years) and 12,370 were > or =20 years. Antepartum, intrapartum and postpartum events were recorded and comparative analysis was done. We found that teenage women were at a significantly higher risk for development of severe anaemia (relative risk [RR] 1.61, P value <0.02), eclampsia (RR 1.95, P value <0.05), preterm labour (RR 1.25, P value <0.001), intrauterine growth retardation (RR 2.29, P value <0.001) and low birth weight (RR 1.24, P value <0.001). Assisted delivery (11.78% versus 2.23%, P value <0.001) was significantly more common and caesarean delivery (9.64% versus 17.18%, P value <0.001) was significantly less common in teenagers. Moderate anaemia, mild pregnancy-induced hypertension, preeclampsia, premature rupture of membranes, antepartum haemorrhage and post dates were all significantly higher in > or =20 years group. To conclude, we found that teenage women are a high-risk group, which is aggravated by social and cultural factors. Special attention is required to educate these women for more positive outcomes.

Early oral hydration and its impact on bowel activity after elective caesarean section--our experience.

AIM: To assess the effects of early oral hydration after elective caesarian section. METHODS: Hundred women were selected from the maternity wards of LHMC and SSK Hospital, and alternately assigned into control and study groups of 50 each. Women with medical complications and antepartum haemorrhage were excluded. In the study group, oral hydration was started 6-h postextubation irrespective of presence of bowel sounds. Solid food was started after bowel sounds appeared. In the control group, traditional regime of oral hydration after the appearance of bowel sounds and then a gradual shift to the solids was adopted. The return of bowel activity, time of ambulating and complications were compared. RESULTS: Bowel sounds appeared in a significantly shorter duration of time in study group, the mean being 7.4 h as compared to 11.5 h in the control group. Passage of flatus and bowel evacuation was earlier in the study group (9.14 and 23.7 h, respectively) than in the control (19.9 and 32.3 h, respectively). Women ambulated faster in the study group than the control group (15 h versus 25 h, respectively). Mean oral fluid intake was much more and return to soft and then full diet was faster in the study group. Sixty percent women preferred early feeding to the traditional one. CONCLUSION: Early oral hydration in the postoperative period helps in the faster recovery of the patient by means of quicker return to normal feeding habits and early ambulation, the two main concerns of any surgeon before discharging the woman after caesarian section.

A case of autoimmune myopathy in pregnancy.

Autoimmune diseases are not found frequently with pregnancy in clinical practice. Polymyositis Dermatomyositis have a prevalence of 2.4-10.7/ 100,000 in general population. This is further low in pregnant women. It is associated with 57% perinatal morbidity and increased maternal and fetal mortality. Literature suggests that pregnancy outcomes are poorer if it manifests early in gestation while development or exacerbation in second or third trimester is associated with a better fetal prognosis. Not many case reports are published where the disease was diagnosed in third trimester. We present a case detected in third trimester, which was initially mistaken as a case of allergic reaction, however timely diagnosis and adequate management resulted in good fetal and maternal outcome.

Clinical profile of women with severe anaemia in the third trimester of pregnancy.

Anaemia, the most common medical disorder associated with pregnancy, is a silent killer. Most severely anaemic pregnant women are asymptomatic and present late in the third trimester with medical and obstetric complications.

Prospective study of saline infusion sonohysterography in evaluation of perimenopausal and postmenopausal women with abnormal uterine bleeding.

AIM: To evaluate saline infusion sonohysterography as an investigative modality in abnormal uterine bleeding in perimenopausal and postmenopausal women. METHODS: Fifty-eight patients, 52 perimenopausal and six postmenopausal women, with abnormal uterine bleeding were selected from the department of Obstetrics and Gynecology of Shrimati Sucheta Kriplani Hospital. After complete work-ups, transvaginal examinations were performed followed by sonohysterographies. The sensitivity, specificity, positive predictive values and negative predictive values were calculated for transvaginal sonography (TVS) and saline infusion sonohysterography as compared with findings of hysteroscopy/hysterectomy. RESULTS: Saline infusion sonohysterography was performed in 56 cases. It could not be done in one perimenopausal and one postmenopausal woman. Cavity was normal in 41 perimenopausal and five postmenopausal women. Ten women displayed abnormalities. Two had submucosal fibroids, two had intramural fibroids, one had fibroid polyp, three had endometrial polyps and two patients had endometrial growths. We found that TVS missed three endometrial polyps and one endometrial growth and led to mislabeling two intramural fibroids as submucosal. On comparing the sonohysterographic findings with those of hysteroscopy or hysterectomy, one endometrial polyp and one endocervical polyp was missed on sonohysterography, and one false positive growth was observed on sonohysterography. The sensitivity, specificity, positive predictive value and the negative predictive value of TVS were 84.8%, 79%, 82.4% and 82%, respectively. The sensitivity, specificity, positive predictive value and the negative predictive value of saline infusion sonohysterography were 94.1%, 88.5%, 91.4% and 92%, respectively. CONCLUSION: Saline infusion sonohysterography is a safe, convenient, time conserving, cost effective, easily accessible and acceptable investigative modality. It definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.