Comparison of misoprostol with dinoprostone for induction of labor in postdated pregnancy

To compare the efficacy of misoprostol with dinoprostone in induction of labor in nulliparous women at and beyond 41 weeks of gestation. Experimental comparative study. Department of Obstetrics and Gynecology Unit-II, Jinnah Post Graduate Medical Center, Karachi, from September 2007 to October 2010. A total of 105 women with more than 287 days [41weeks] gestation with unfavorable cervix and intact membranes were selected for induction of labor. Dinoprostone was inserted in 41 patients while 64 patients were induced with intravaginal misoprostol. The primary outcome measures were induction-delivery interval, number of doses required for induction, rate of spontaneous vaginal delivery, C-section and instrumental delivery. Secondary outcomes were the incidence of meconium stained amniotic fluid, fetal weight at the time of delivery, fetal distress and need for admission to NICU. Out of 63 patients in the misoprostol group, 43 [67.1%] women had spontaneous vaginal delivery [SVD] while 26 [63.4%] patients out of 41 in dinoprostone group had SVD. The induction to delivery interval was 13.03 +/- 3.52 hours in misoprostol group while it was 14.12 +/- 3.31 hours in dinoprostone group. With misoprostol, induction of labor started in 18, 33 and 13 women with 1, 2 and 3 doses respectively within 24 hours but in dinoprostone group 16 women were successfully induced with 1 tablet only, while 21 patients required 2 doses for induction. The need for oxytocin infusion was the same in both the groups. The neonatal weight was 3.54 +/- 3.38 kg in misoprostol group as compared to 3.10 +/- 0.26 kg in dinoprostone group [p=0.41, t=1.57]. Four neonatal deaths were reported in the misoprostol group as compared to two with dinoprostone. Sixteen neonates were admitted to NICU in misoprostol group as compared to five patients in dinoprostone group. Twenty-eight [44.4%] patients in misoprostol group had meconium stained liquor as compared to 14 [34%] patients in dinoprostone group. Dinoprostone was most effective in comparison with misoprostol in gravida with 41 weeks and above gestation. Misoprostol though showed comparable results, but is not the drug of first choice

Spontaneous rupture of primigravid uterus due to morbidly adherent placenta

Morbidly adherent placenta in a nulliparous woman is a rare phenomenon. An unusual case of a 20 years old primigravida presented in emergency with unstable haemodynamics and abdominal pain at 17 weeks of gestation is reported. She was found to have complete placental invasion and heamoperitoneum on laparotomy. Although there is an increased risk of placental invasion [increta and percreta] causing uterine rupture in previous caesareans but morbid adhesion resulting in placenta percreta without previous uterine surgery is a rarity. Exact pathogenesis is still unknown. Prenatal diagnosis with the help of Doppler ultrasound and MRI is important to reduce both fetal and maternal morbidity and mortality

Nutritional iron deficiency in women of child bearing age- what to do?

Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia [IDA] can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment