Induction at poor bishop is justified

Objectives: To prove that induction at poor bishop is not justified

Study design: A Prospective study

Place and duration: Obstetrics and Gynecology Department of Military Hospital Rawalpindi from September 2011 to Feb 2012

Methodology: Total of 1852 women were included by non-probability consecutive sampling technique, irrespective of parity at term with singleton healthy pregnancy in vertex presentation and were divided into two groups on basis of their bishop score. Health volunteers, cases of uterine rupture, previous cesareans, uncontrolled medical disorder and pregnancy with fetal anomaly for termination were excluded. Ultrasound for fetal wellbeing were done and strict feto maternal monitoring was done during labor. Medical and elective indications and Bishop Scores were recorded before labor induction. Cervical foley no 16 was used in patients with B/S >3. [Group - A] and tablet Prostin E2 was used in patients with B/S< 3 [Group - B] as an initial agent to induce labor. Outcomes like mode of delivery, mean parity and mean age was analyzed by spss11 and P value was found out Performas were attached with patient's case notes

Results: The cesarean section rate was 32.6% [n=605], SVD were [n=1247]. Induction for medical reasons were 14.8% [n=275], with PROM 12.7% [n=237], women with fetal compromise were 11.7% [n=218], with macrosomia 9.07% [n=24], with mild pains 15.3% [n=285], with postdate pregnancy 16.4% [n=340], post term 18.4% [n=305] and patients with oligohydramnios were 1.2% [n=168]. Among 1852 from 38 week to 41 week, 1372 patients in group A, with bishop score >3. Rest of 480 were in group B, induced at bishop score <3. In group A, who were induced at B/S >3, total CS were 215, [150 with failed trial of labour] and 1157 were SVD. 65 CS were due to fetal distress. Total CS in group B, with failed trial were 300, C-Section due to fetal distress n=90. SVD were 90 and p=0.001. Mean age was 33.8 years. Mean parity found to be was 2.8 para. Difference in no of CS and SVD in both groups on basis of their bishop score was statically significant and was = 0.001

Conclusion: Bishop Score at time of induction should be >3 and induction at poor bishop should be avoided to control the rate of cesarean section

Continued professional development- learning in practice

Continued Medical Education [CME] and Continued Professional development [CPD] are the terms that are increasingly resonating these days among the medical communities. CPD is a commitment to being professional, keeping up to date and continuously seeking to improve.The recertification and renewal of Medical licenses are being increasingly linked with CPD programs. This article introduces the basic concept of CPD and CME, the difference between the two and how 'adult learning principals' can be applied to facilitate learning while being in active practice

Intrauterine growth restriction; relationship between abnormal umbilical artery doppler and adverse apgar score

To compare fetal outcome in normal umbilical artery Doppler findings to abnormal umbilical artery Doppler findings in pregnant women with fetal growth restriction Main outcome measures Umbilical artery Doppler studies apgar score at 1 minute and apgar score at 5 minutes after delivery. Cross sectional, comparative study. Department of Obstetrics and Gynaecology, Military Hospital and Combined Military Hospital, Rawalpindi From Jan 2005 to Jan2007. Patients with fetal growth restriction between 28 to 37 weeks of pregnancy were selected, in whom diagnosis was confirmed by ultrasonography. All patients were followed up with umbilical artery Doppler studies. The study group consisted of 48 women [group I], where the umbilical artery waveform was compromised. The outcome in these was compared with an equal number of controls, where growth restricted fetuses had normal Doppler waveforms [group II]. The mean age of patients in group I was 26.9 years and in group II was 28.6 years Fetuses with abnormal umbilical artery Doppler findings had higher incidence of maternal gestational hypertension and oligohydramnios. Rate of emergency cesarean section for fetal distress was also higher in this group. Growth restricted babies with abnormal umbilical artery Doppler waveforms had lower apgar scores. In babies with normal Doppler studies 91.6% had apgar score above 7 at 5 minutes after birth. In babies with raised RI 78.1%, in babies with abscent end diastolic flow 54.5% and in babies with Reversed end diastolic only 20% had apgar score above 7 at five minutes after birth. The difference was statistically significant [P=0.001]. Umbilical artery velocimetry can distinguish the group of growth restricted fetuses at risk of poor apgar. Growth restricted fetuses with normal Doppler studies are at a lower risk than those with abnormal Doppler findings in terms of poor apgar score

Intraumbilical veinous injection oxytocin in the active management of third stage of labour

To determine the role of intraumbilical vein oxytocin reducing blood loss during and after one hour of delivery of placenta and its efficacy in reducing the frequency of retained placenta. Randomized controlled trial. Combined Military Hospital, Multan, from June 2002 to October 2002. Five hundred parturient women with low risk singleton term pregnancy were enrolled in the study. Two hundred and fifty women each were included in the study and control group after randomization. The patients and health care providers both were blinded to the intervention. Primary outcome measures were kept as duration and amount of blood loss in third stage of labour. Secondary outcome measures included incidence of retained placenta, abdominal need for additional utero-tonics, frequency of postpartum pain, nausea and vomiting, fever, need for blood transfusion, establishment of breast feeding and total duration of hospital stay. Women in study group who received intraumbilical vein syntocinon lost 234.03 ml of blood while the control group lost 276.51 ml [p=0.001]. Mean duration of third stage was 2.59 minutes in the study group and 7.67 minutes in the control group [p<0.001]. The frequency of retained placenta was 1.2%, which involved only the control group. Abdominal pain was experienced by study group but the difference was not found statistically significant. Nausea and vomiting was more in study group [p=0.001]. No discernible difference was found in length of hospital stay, the need for blood transfusion, fever and establishment of breast-feeding in both groups. The addition of intraumbilical vein syntocinon 10 units resulted in marked reduction in amount of blood loss, duration of third stage and incidence of retained placenta in comparison to intravenous 5 IU oxytocin+0.5 mg ergometrine alone