To compare the effectiveness of nifedipine and glyceryl trjnjtrate patch jn prevention of preterm Labour

Objective: To assess the effectiveness of Nifedipine and Glyceryl trinitrate patch in prolonging the pregnancy for more than 48 hours

Methodology: This was a randomized control study. Fifty patients with preterm labour meeting the inclusion criteria were inducted in study and randomly allocated to the treatment group A [Nifedipine] and group B [Glyceryl trinitrate patch, GTN]. After taking consent from the patients, all the details were documented on a proforma and tocolysis was started with either of these tocolytics according to a preset protocol

Results: Nifedipine was found to be more effective than GTN, as prolongation of pregnancy beyond 48 hours was more frequent [74%] with nifedipine than GTN [40%] with P value <0.05 . Similarly prolongation beyond 7 days was also more frequent [32%] with nifedipine as compared with GTN [24%]. Most common adverse effect found with nifedipine was headache followed by palpitations and hypotension. GTN patch had a better side effect profile with most of the patients being asymptomatic. Fetal distress was noticed more in GTN group as compared with nifedipine

Conclusion: Nifedipine, as a tocolytic, is found to be more effective in pregnancy prolongation when compared with Glyceryl trinitrate but has frequent maternal adverse drug effects. Glyceryl trinitrate patch is well tolerated by the patients with preterm labour with relatively fewer side effects

Outcome of syndromic management in cases of chronic vaginal discharge

To see the outcome of syndromic management in 100 patients of chronic vaginal discharge. This descriptive study was conducted in outpatient department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar from 1[st] January 2007 to 30[th] June 2007. Patients aged from 16 to 50 years with chronic vaginal discharge of more than 6 months duration were included in the study. Pregnant patients and those with the history of Cervical Intraepithelial Neoplasia [CIN], Carcinoma of the cervix, ovary or endometrium were excluded from the study. A detailed history and examination was done and a Proforma was filled. All these patients were treated with the syndromic management as recommended by the World Health Organization [WHO] in which no laboratory tests are done and patients are treated empirically with the antibiotics as per criteria of WHO. The mean age of the patients was 32 +/- 8.08 years. Vaginal infection improved in 56% of the cases with a single course of antibiotic, in 84% with a second course, 12 patients were lost to follow up and 5 patients who did not improve with two courses of antibiotics had big cervical erosions, were subjected to Cryo therapy. In settings, where bedside tests like microscopy Potassium Hydroxide, wet mount films and tests for Chlamydia and gonorrhea are not available, syndromic management is a reasonable way of treating cases of chronic vaginal discharge

Impact of external cephalic version [ECV] on mode of delivery of the term singleton breech

To assess the impact of external cephalic version [ECV] on the mode of delivery of the uncomplicated term, singleton breech at teaching hospital. This observational study was conducted in Obstetrics and Gynecology department, Hayatabad Medical Complex, Peshawar from 1st December 2003 to 31st January 2005 on all singleton term breech presentations from 37 to 41 weeks of gestation. Out of 265 women presenting with breech presentation at 37 completed weeks or more at our unit during the study period, 188 patients met the selection criteria. Of these only 40 patients [21.3%] had ECV. Twenty seven of these were successful [67%]. A total of 161 patients continued their pregnancies as breech. Of these the mode of the delivery was: Vaginal Breech Delivery in 97 cases [60.24%] and CSection in 64 [39.76%]. Reasons for failure to offer ECV included; 129 [80.12%] cases were unbooked and admitted in emergency when ECV services were not available. 145 [90%] were admitted in labour, and majority of these were in active and advanced labour. ECV was not found to decrease significantly the number of non-cephalic presentation at term. The reasons were that in spite of good success rates it was not feasible to perform enough ECV to have an impact on mode of delivery of singleton term breeches