Misoprostol for induction of labor in women with severe preeclampsia at or near term

To examine the misoprostol efficacy and safety in induction of labor of women with severe preeclampsia at or near term when the cervix is unfavorable. A prospective comparative study was conducted in Al Thawara General Hospital Sana'a, Yemen, from June 2009 to June 2010. One hundred and thirteen women met the inclusion criteria. They were divided into 2 groups. The study group [n=56] and the control group [n=57]. The study group were given 50 micro g of Misoprostol intravaginally every 4 hours to a maximum of 6 doses. Maternal age, gestational age, parity, initial cervical status, the rate of cesarean section, and neonatal outcomes were analyzed and compared to the control group. The vaginal delivery was achieved in 69.6% in the study group versus 15.8% in the control group [p<0.0001]. The overall cesarean section was performed in 30.3% of the study group versus 84.2% [p<0.0001]. The mean time from insertion to delivery was 12.12 +/- 2.1 hours and the mean dosing was 2.77 +/- 1.3. There were no significant differences between the 2 groups in the frequency of abnormal fetal heart rate, Apgar score and admission to the neonatal intensive care unit. Misoprostol when given intravaginally in 50 micro g 4-hourly dosing regimen is an effective agent for ripening the cervix in this group of women

Reverse breech extraction versus head pushing in cesarean section for obstructed labor. A comparative study in Yemen

To compare the maternal and fetal outcome of 2 different methods of delivering the baby during cesarian section when the fetal head is deeply engaged. A prospective case control study was carried out in the Obstetrics and Gynecology Department, Al-Thawra General Hospital, Sana'a, Yemen from January to December 2010. A total of 118 women who met our criteria were included in the study. They were divided randomly into 2 groups. A study group [n=59] was assigned to deliver the baby by reverse breech extraction, and control group [n=59] was assigned to deliver by the conventional method. The maternal and neonatal outcomes between the 2 groups were compared. Extension of the uterine incision occurred in significantly less women using reverse breech extraction compared to cephalic delivery [5% versus 40.6%; p=0.0001]. It was observed that the mean operation time and blood loss in the study group were lower than that in the control group [52.9 +/- 5.1, 787 +/- 519 versus 67.2 +/- 4.7, 1231 +/- 471; p<0.0001]. No significant difference between groups was noted in the maternal and neonatal outcomes. Reverse breech extractions is an attractive and safe alternative to the standard method for intraoperative disengagement of a deeply impacted fetal head in order to reduce maternal and fetal morbidity

Episiotomy is still performed routinely in Yemeni women

To examine the rate of episiotomy use among nulliparous Yemeni women, and to evaluate its impact on perineal tears. We retrospectively reviewed the delivery record for all nulliparous women with and without episiotomy and singleton spontaneous births at Al Thawra General Hospital, Sana'a, Yemen between January and December 2008. The womens' charts were retrieved, and the demographic characteristics were obtained. For women with episiotomy, the indication and type of incision were noted. The rate of the procedure and the perineal tears was recorded, and compared between women with and without episiotomy. A total of 2588 nulliparous women had singleton spontaneous births. Out of these, 1944 [75.1%] women had an episiotomy. Most cases [96%] had a mediolateral incision. Seventeen episiotomy cases [0.87%] were complicated by second and third degree perineal tears versus 12 cases [1.7%] with the same type of tear in women without the procedure. Episiotomy is still performed routinely in 75.1% of first-time births. This rate is higher than supported by the available evidence

Sublingual misoprostol for the prevention of postpartum hemorrhage

To compare the effectiveness of misoprostol [600 micro g] when administered sublingually with the same dose administered per rectum to patients, immediately after delivery in preventing postpartum hemorrhage [PPH]. This study was carried out in Al Thawra General Hospital, Sana'a, Yemen, from May 1, 2007 to April 31, 2008. A total of 215 women were recruited, and divided into 2 groups in a quasi-random fashion. Group I comprised 118 women, and was given 600 micro g misoprostol sublingually immediately after delivery. The other group comprised 97 women [group II], and was given the same dose of misoprostol per rectum. The blood loss was measured, and the side effects of the misoprostol were assessed. The need for additional uterotonic agents, blood transfusion, and the length of the third stage labor were recorded. Nine patients in group I, and 7 patients in group II had PPH. Of these patients, blood loss was >1000 ml in 4 patients in group I, but <1500 ml in 3 patients in group II, [relative risk - 1.05, 0.40 - 2.73 confidence interval [95%]. The mean blood loss was 362.3 +/- 170 ml in group I versus 342.3 +/- 154.7 ml in group II. Only 3 cases [3%] of the patients in group I were given additional uterotonic agents versus 2 cases [2%] in group II. Postpartum use of 600 micro g misoprostol by sublingual route has a comparable effect in reducing PPH, as that of rectal route. It was observed that severe PPH [1000 ml but <1500 ml] had been observed in 40% of those who developed PPH in both groups