Labour induction at term; oral versus intravaginal Misoprostol

To compare oral misoprostol [100 ug] to vaginal misoprostol [25 uA] for cervical ripening and labor induction. Interventional study. The study was carried out at Lady Willingdon Hospital, Lahore, during August 2006 to January 2007. Fifty nine women with medical or obstetric indications for labor induction with undilated, uneffaced cervices were assigned randomly to receive 100 ug of oral or 25 ug of vaginal misoprostol every 4 hours for 24 hours. Intravenous oxytocin was then given using a standardized protocol. Among 59 subjects, 29 received oral and 30 received vaginal misoprostol. The mean interval from start of induction to delivery was 1240 + 845 minutes for orally treated women and 1381+802 minutes for vaginally treated women [P = .06]. More orally treated women delivered vaginally in 24 hours than vaginally treated women 17 versus 16 P= .14]. Twenty five women [86.2%] who received oral misoprostol delivered vaginally, compared with 26 women [86.7%] who received vaginal misoprostol [P = .07]. Oxytocin was given to 14 [49.6%] orally treated and 16[53.3%] vaginally treated subjects. More women in oral group had tachysystole, three compared with one [P = .06] and hyperstimulation. Frequencies of intrapartum complications and birth outcome were similar between groups. Oral misoprostol 100 ug and vaginal misoprostol 25 g were similarly effective for cervical ripening and labor induction. Oral administration was associated with trends toward higher likelihood of vaginal delivery and more uterine tachysystole

Assessment of tubal patency in infertile women: can hycosy be performed in place of Hysterosalpingography?

To determine the advantages and accuracy of hysterosalpingo-contrastsonography [HyCoSy] in the assessment of tubal patency with regards to conventional hysterosalpingography [HSG]. Interventional study. The study was conducted at Lady Willingdon Hospital Lahore. One year, from November 2003 to October 2004. Thirty infertile women were examined with hysterosalpingo-contrastsonography [HyCoSy] using air and saline as contrast medium. The results were compared with those obtained from conventional hysterosalpingography. [HSG]. Altogether 30 patients were included in the study. They were examined with both HyCoSy and conventional hysterosalpingo graphy [HSG] and the results were calculated. Of the patients investigated by salpingo-contrastsonography, 22 were found to have patent tubes whereas 8 were having blocked tubes. Unilaterality of bilaterality could not be detected by this method. Bilateral tubal patency was found by hysterosalpingography in 22 cases. Unilateral tubal patency was found in 5 cases. Bilateral tubal occlusion was detected in 3 cases using either technique. Sensitivity and specificity of HyCoSy was 90.9% and 89.4% respectively. Positive predictive value was 83.3% and negative predictive value was 55.55%. The outcome of the study shows that HyCoSy with combination of air and saline is cost effective, reliable and safe method and can replace conventional hystero salpingography as base line investigation of infertility on out patient basis

Dysfunctional uterine bleeding-association with bilateral tubal ligation?

To find an association between Dysfunctional uterine bleeding [DUB] and prior Bilateral tubal ligation [BTL]. Observational study. Unit II, Lady Willingdon Hospital, Lahore, from August to December 2006. Fifty two patients between the ages of 35 to 46 with abnormal uterine bleeding [AUB] were studied. Exclusion criteria included intrauterine device [IUD], evidence of pregnancy, leiomyoma or ovarian pathology on sonography, uterine size of greater than 10 cm, medical disorders and hormonal therapy. All patients were worked up for underlying cause of AUB, assessed for BTL and divided in two groups. Group A of 27 patients with previous history of BTL and Group B of 25 patients without previous history of BTL. In group A [with prior BTL], 22 patients [81%] had DUB as compared to 12 [48%] in group B [without prior BTL] and this difference was statistically significant [p<0.05]. In women undergoing diagnostic work up for AUB the likelihood of DUB being the underlying cause is greater if they have prior BTL