Pattern of perineal tears during vaginal delivery at a public sector university hospital of Sindh

To determine the pattern of perineal tears during vaginal delivery in a tertiary healthcare facility. It is a descriptive study done in the Department of Obstetrics and Gynaecology Unit-I at Liaquat University Hospital Hyderabad, Pakistan from 1st September 2004 to 31st August 2005. Women with full term singleton pregnancy either primi or multigravida, in active labour were selected for the study. An informed consent was taken from all the participants. Twin pregnancy and ante-partum haemorrhage were excluded Age, parity, type and degree of tear, mode of delivery, birth weight of baby, birth attendant, risk factors and complications were noted. There were 2563 deliveries, 256 patients had some degree of perineal injury giving a frequency of 9.9%. Out of them, 100 patients were selected, 37[37.0%] of multiparous and 63[63.0%] of primiparous sustained some degree of perineal injury. A higher incidence of first and second degree tears were noted and incidence was found to be more when vaginal delivery was conducted without episiotomy and fetal weight was more than 4kg. However duration of labour, perineal support, presence of perineal edema and experience of the birth attendant were important risk factors. Obstetric perineal tears are common as depicted by the high frequency in this study. Lack of perineal care, poor socio-economic conditions, poor intra-partum care with lack of experience were found to be contributing factors in the occurrence of perineal tears

Safety and efficacy of oral versus vaginal misoprostol use for induction of labour at term

To compare the safety and efficacy of Misoprostol through oral and vaginal routes for induction of labour at term. Quasi-experimental study. Department of Gynaecology and Obstetrics [Unit-IV], Liaquat University Hospital, Jamshoro, Pakistan, from January to December 2004. Eighty term patients who met the inclusion criteria were selected for induction of labour with [50 micro g] Misoprostol, either by oral or vaginal route. The patients were allocated in two groups-A and B, using non-probability convenient sampling technique. The dose was repeated at an interval of 6 hours upto maximum dose of 150 micro g. Improvement in Bishop's score, analgesic requirements, route of delivery, maternal complications, neonatal outcomes were noted. The commonest indication in group-A was premature rupture of membranes in 16 patients [40%] and in 8 [20%] patients of group-B. Mean improvement in Bishop's score after 6 hours was greater in group-A [3.6 +/- 3.09] than group-B [3.3 +/- 3.45, p=0.70]. Induction to delivery interval was less in group-A [6.7 +/- 4.4 hours] than group-B [7.5 +/- 4.3 hours, p=0.41]. Oxytocin augmentation was required more in group-B as compared to group-A. Normal vaginal deliveries were achieved in 95% of group-A and in 80% of group-B. The dose of 50 micro g was effective in 31[77.5%] patients of group-A as compared to 24 [60.0%] patients of group-B, while 100 micro g was needed in 6 [15.0%] patients of group-A as compared to 13 [32.5%] patients in group-B. There was no significant difference between both the groups with regard to analgesic requirement, instrumental delivery, maternal complications and neonatal outcome. Safety and efficacy was comparable between low-dose vaginal and oral Misoprostol uses for induction of labour. However, oral route was better with respect to treatment interval, number of doses required and route of delivery. Both routes of administration can alternatively be used for induction of labour in developing countries where cost of drug does matter