Use of misoprostol for induction of labour in unfavourable cervix

Objective of this study was to determine the maternal and fetal outcome after induction of labour with misoprostol in term pregnancies with unripened cervix. Experimental study. Non probability convenient, in the labour ward of Nawabshah medical college hospital Sindh, Pakistan from 6th April 2008 to 5th Dec 2008. Total 114 patients were induced with misoprostol who had singleton pregnancy of more than 36 weeks with cephalic presentation, reactive CTG and unfavorable cervix [Bishop Score <4]. Sampling strategy was non probability convenient sampling. However, patients with previous cesarean section, parity >4, nonreactive CTG, any contraindication to induction of labour and bishop score > 4 were excluded from the study. After taking an informed consent, patients were given 100mcg misoprostol in posterior fornix of vagina every 6 hour till 3 doses or initiation of labour. Labour was recorded on partogram. Maternal and fetal outcome were recorded on a self designed proforma. Majority of patients i.e. 63 [55.26%] belonged to age group of 23-30 years. Eighty seven [76.31%] patients who received induction were primigravida while 27 [23.68%] patients were P2-P4. Thirty six [31.57%] patients required single dose of misoprostol, 54 [47.36%] patients required two doses while 24 [21%] patients required three doses. Out of all these 114 patients, labour was successfully completed in 93 [81.57%] patients. While cesarean section was done in 21 [18.42%] patients. About 48 [42.10%] patients were delivered in 8 to 9 hours. Uterine hyper stimulation was seen in 9 [7.89%] patients. Apgar score was less than 7 in six [5.26%] newborns. Misoprostol is safe for induction of labour with an unfavorable cervix. The results were satisfying with minimal complications

Role of uterovaginal packing in postpartum hemorrhage

Objective: To find out the safety and efficacy of uterovaginal packing in postpartum hemorrhage in terms of complications and success to arrest bleeding

Place and Duration of Study: This study was conducted at Department of Obstetric and Gynecology Nawabshah Medical College Hospital, Sindh-Pakistan from 2[nd] January 2008 to 4[th] August 2009

Patients and Methods: In this prospective interventional study all patients presenting with postpartum hemorrhage who did not responded to medical treatment, placenta previa or coagulation failure, following vaginal delivery or cesarean section, were included. Multiparous women were also included in the study if they expressed strong desire to conserve uterus. Cases of ruptured uterus, perineal trauma, cervical trauma and vaginal trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding. Data were analysed by SPSS version 11

Results: During study period 138 patients of postpartum hemorrhage underwent uterovaginal packing. Uterine atony unresponsive to oxytocics was the commonest cause of postpartum hemorrhages [n=88, 63.76%] followed by coagulopathy in 25 [18.11%]. Uterovaginal packing was successful in 89.14% patients. Post-insertion morbidity included fever more than 100[degree sign] F in 25 [18.11%] and episotomy wound infection in 9 [6.52%] patients

Conclusion: Results of this study show that uterovaginal packing is effective in arresting the bleeding. Uterovaginal packing still retains an important role in emergency obstetrics

Emergency obstetric hysterectomy frequency and maternal outcome

To review the frequency, indications and maternal outcome of emergency obstetric hysterectomy. Descriptive study. In obstetrics and gynecology department of Nawabshah Medical College Hospital Sindh from 2nd May 2005 to 31st April 2008. During the study period total 3089 patients were delivered. Out of these, 37 patients underwent cesarean hysterectomy. Records of all the patients were analyzed. The parameter analyzed were age, parity, social status, booking status, indication for operation, operative notes, maternal outcome, complications and postoperative status. Mortality register was also checked for the causes of maternal deaths. During the study period, there were 3089 deliveries. Amongst these 37 had emergency obstetric hysterectomies giving rise to a frequency of 11.9 / 1000 cases. Regarding parity, 23[62.1%] were multiparous, 12 [32.4%] patients were grand multiparous and 2 [5.4%] patients were primiparous. Commonest indication of emergency obstetric hysterectomy was postpartum hemorrhage due to uterine atony which was seen in 13[35.1%] cases, followed by ruptured uterus in 11[29.7%] cases, placenta previa in 6[16.2%] cases, and couveliar uterus in 5 [13.5%] cases and placenta accreta in 2 [5.4%] cases. Commonest maternal complications were urinary tract infection in 6[16.2%] patients followed by DIC in 5[13.5%] patients. Maternal mortality was seen in 2[5.4%] patients. In our study frequency of emergency obstetric hysterectomy was high. Most common indication was rupture uterus, post partum hemorrhage due to atony uterus and placental causes. After UTI, disseminated intravascular coagulation was most common complication seen. 2patients were expired. Sever Emergency obstetric hysterectomy when performed in selected cases at an appropriate time helps in bringing down maternal mortality

Renal failure - a dreadful complication seen in patients with abruptio placentae

In a clinical study in the department of Obstetrics and Gynaecology at People's Medical College Nawabshah from 15th April 2000 till 30thAPril 2003, it was noted that 1662 patients got admitted in the maternity ward, amongst whom 340 [21%] patients came with the complaint of antepartum haemorrhage out of which 110 [7%] patients were found to have abruptio placentae. Amongst whom, in 72 [65%] patients the abruptio was severe enough to cause intra uterine death of the fetus and 15 [14%] patients developed acute renal failure. Five patients died due to the additive effects of various complications. 13 [12%] patients needed peritoneal dialysis out of them 7 patients subsequently improved and 3 patients required kidney transplantation and were referred to Karachi. Early diagnosis and quicker treatment saved the rest of the patients from developing dreadful complications