Sublingual versus oral misoprostol for induction of labour in prelabour rupture of membranes at term

To compare the efficacy of sublingual with oral misoprostol for induction of labour in primigravida with pre- labour rupture of membranes at term. Randomized controlled trial. Department of Obstetrics and Gynaecology Unit-11, Sir Ganga Ram Hospital, Lahore, from June 2004 to January 2006. The study included 100 primigravidas with singleton pregnancy at term, having pre-labour rupture of membranes and unfavourable Bishop score with no contraindication of induction of labour, vaginal delivery or misoprostol use. The cases were randomized into two equal groups, A and B. Women in the group A were given 100 micro g of misoprostol orally at an interval of 4 hours to a maximum of 2 doses while patients in the group B were prescribed the medicine sublingually [50 micro g, 4 hourly, maximum of 2 doses]. Induction to delivery interval, mode of delivery and fetomaternal complications were main outcome measures of the study. In the sublingual misoprostol group [B], 92% women delivered within 12 hours of induction while 84% of subjects delivered in this time period in oral group [A, p < 0.05]. There was no failed induction in either group. Regarding dosage, 64% of women delivered with single dose in group B while only 32% delivered with single dose in group A [p < 0.05]. The frequency of vaginal delivery was 92% in group B versus 80% in group A, while rate of caesarean section was 8% in the group B and 20% in the group A, which is statistically insignificant. No significant fetomaternal complications were seen in both groups. The efficacy of sublingual misoprostol in the dosage of 50 micro g was comparable to 100 micro g oral dose for the induction of labour in the primigravidas at term with pre-labour rupture of membranes

Comparison of oral versus vaginal misoprostol for mid-trimester pregnancy termination

To compare the efficacy and safety of oral versus vaginal administration of misoprostol for second trimester pregnancy termination. Interventional, quasi experimental study. The Department of Obstetrics and Gynaecology Unit-II, Fatima Jinnah Medical College /Sir Ganga Ram Hospital, Lahore, from August, 2003 to October, 2004. Sixty pregnant women at second trimester of gestation who were candidates for therapeutic termination of pregnancy were recruited for the study. Grandmultipara, women who had scarred uterus and history of hypersensitivity to prostaglandins were excluded. The subjects were assigned into two groups. Group 1 [n=30] had misoprostol orally, while the group 2 [n=30] received the drug by the vaginal route. Dosage regimen was similar in both groups that was 200 micro g 4 hours apart till expulsion of fetus or maximum of up to 5 doses. Main outcome measures of the study were induction-expulsion interval, need for surgical evacuation and maternal complications. The mean induction-expulsion interval in the group 1 and 2 was 11.8 +/- 8.3 and 12.8 +/- 8.5 hours respectively, which was not different statistically. The process of expulsion was complete in 53.3% of subjects in both groups by misoprostol only, while 36.6% required surgical evacuation in oral group versus 33.3% in vaginal group. The rate of failed induction in groups 1 and 2 was 10% and 13.3% respectively. There was no reported case of nausea, diarrhea, headache, dizziness, shivering, pyrexia and hyperstimulation in both the groups. However, a case of vomiting [3.3%] was observed in the vaginal group. Oral and vaginal misoprostol for second trimester pregnancy termination is equally effective and safe agent

Risk factors for hepatitis C virus; obstetrics patients

To find out risk factors for hepatitis C infection in obstetric patients in a teaching hospital. Observational study. At Sir Ganga Ram Hospital, Lahore during a period of one year. Cases of hepatitis C infection, diagnosed on the basis of screening for antibodies for Hepatitis C were included in the study. A proforma was designed and details of each case including maternal demographics and associated risk factors were entered. Fifty three obstetric patients were positive for Hepatitis C virus antibodies in one year of study period. Majority of women were among 25-29 years of age, belong to low socioeconomic status, illiterate and among parity range of 2-5. Previous history of surgical procedures was in 66% of subjects while 62% had history of injections. Ear piercing in unsterilized conditions by non skilled person was also present in significant number [43%] while 17% had history of blood transfusions. Hepatitis C infection is linked to surgical procedures, injections and ear piercing in this study. However, to identify all associated maternal risk factors, larger studies at multiple centres will be required and strategies should be made to prevent its' transmission

Comparison of visual inspection of cervix and PAP smear for cervical cancer screening

To evaluate the performance of visual inspection of cervix [VIA] after application of 3% acetic acid in cervical cancer screening in comparison with Pap smear. Design: Comparative study. Place and Duration of Study: This study was conducted at Sir Ganga Ram hospital, Lahore, from January 1996-December 1999. Subjects and Speculum examination was carried out to see the cervix in 501 women. All subjects were screened simultaneously by Pap smear and VIA after application of 3% acetic acid. Positive cases by both screening methods and grossly abnormal cervix even with negative screen were subjected to colposcopy. In case of colposcopic abnormality of atypia or advanced lesions, biopsies were taken. Histology of colposcopically directed biopsy was taken as gold standard to evaluate the performance of the test. Out of 540 subjects, 356 were negative with both screening techniques. One hundred and fifty-six subjects were positive with VIA[28.9%] while Pap smear was positive in seventy-eight subjects [14.4%]. The sensitivity of VIA was 93.9% and of Pap smear was 46.9%. Corresponding specificities were 30.4% and 69.5%. There was no significant difference between the positive predictive value [PPV] of both test [p < 0.05]. The accuracy of VIA was 77.5% compared to 52.8% of Pap smear. The difference was highly significant [p < 0.01]. These results indicate that VIA is more sensitive and has a higher accuracy as compared to Pap smear. It could, therefore, be valuable in detection of precancerous lesions of cervix. Low cost, easy applicability and immediate results make VIA a useful screening test in developing countries like Pakistan as compared to Pap smear