Comparison of 2% vaginal clindamycin with oral metronidazole for treatment bacterial vaginosis at services hospital Lahore

Objective: to compare the efficacy and safety of local application of 2% vaginal clindamycin with oral metranidazole for treatment of bacterial vaginosis

Methods: two hundred married women were included in the study in which bacterial vaginosis was diagnosed by standard criteria. Patients were randomized to two groups with 100 patients in each group. One group [A] were treated with oral metronidazole, 400mg, three time daily for seven days, while group [B] patients were treated with intravaginal clindamycin 2% cream for seven days. The symptomatic response of the both groups was checked by follow up after one week, 3 month and then 6 months after completion of treatment

Results: in group A14 [14%] patients were free of symptoms within seven days 68 [68%] patients after seven days and 18 patients [18%] had no alleviation, while in group B 20 [20%] patients were free of symptoms within seven days, 74 [74%] patients after seven days and 6[6%] patients had no alleviation of problem. In group A 10 patients [10%] had vomiting and diarrhea, 14 [14%] patients had abdominal pain. In group B, 2 [2%] patient had abdominal pain and 10 [10%] patients had local irritation and swelling. There were 18 [18%] patients who had failure of response of treatment in group A and 6 [6%] patients in group B had failure. In group A 16 [16%] patients had recurrence after three months and 12 [12%] patients in group B

Conclusion: it is concluded from our study that 2% intravaginal clindamycin; is better than oral metronidazole in the treatment of bacterial vaginosis in term of improvement / cure rate, side effect, failure rate and recurrence rate

Outcome of trial of labour after previous single caesarean section

Background: Trial of labour after caesarean section is a significant issue faced in obstetrics practice

Objective: To determine the frequency of success of trial of labour after previous one caesarean section

Subjects and Methods: This descriptive case series study was conducted at Department of Obstetrics and Gynaecology Unit-1, Sir Ganga Ram Hospital, Lahore, from 1[st] July to 31[st] December 2010. One hundred seventy five patients of trial of labour after previous one caesarean section were included who fulfilled the inclusion and exclusion criteria. The data was entered and analyzed by SPSS version 16

Results: The mean age of patients was 26.73+2.90 years. The age range was from 20 to 30 years. The mean gestational age was 38.15+0.76 weeks. After trial of labour, 72% of patients delivered spontaneous vaginally, 22% has caesarean section, 4% has vacuum delivery while 2% has forceps delivery

Conclusion: It is concluded that the present study showed that trial of labour in patients with previous one caesarean section due to non recurrent cause is safe and has success rate of 78% which is encouraging

Vaginal birth after caesarean section; to evaluate factors for successful out come

Vaginal birth after caesarean section is currently the preferred method of delivery for pregnant women who had previous one lower segment caesarean section. This common practice warrants some reconsideration in light of recent clinical data on the risks associated with VBAC To evaluate conditions which can achieve successful vaginal birth after one caesarean section. Cross-sectional analytic study. Department of Obstetrics and Gynaecology, Unit-l, Services Hospital, Lahore. Study was carried out over a period of six months from 08-06-2006 to 07-12-2006. One hundred pregnant women meeting inclusion criteria were included. During trial of labour patients were closely monitored by vital signs, fetal cardiac activity, lower abdominal pain and tenderness, fetal distress, vaginal bleeding and loss of presenting part. Mean age of the patients was 34.27 + 6.45. According to distribution of cases by parity, maximum number i.e 64 [64.0%] was P 3-6.79 patients [79.0%] had prior vaginal delivery. Maximum 41.0% patients were due to fetal distress while in 28% indication for previous caesarean were breech presentation. In 71% patient membranes were intact while 29.0% patients presented with per vaginal leaking. 51.0% had dilatation between 3-4cm. VBAC was more successful in patients 58.0% with favourable Bishop score. BMI <20, prior vaginal delivery, non-recurrent indication for previous caesarean, spontaneous onset of labour, cervical dilatation or favourable Bishop score, weight of baby < 3.5kg predict an individual's likelihood of successful VBAC

Management prelabour rupture of the membranes at term; Induction of labor compared with expectant

To find out maternal and fetal outcome in induction of labour compared with expectant management for prelabour rupture of membranes at term. Open randomized comparative study. Gynae Unit- II Services Hospital, from 1st April 2007 to 30 September 2007. 100 patients at > 37 weeks with ruptures membranes with no contraindication to vaginal delivery were enrolled in the study. 50 patients were in the expectant group while 50 patients were in the induction group. Both groups had the same general characteristics but the Misoprostol group had a significantly shorter latancy period [10-16 hour Vs 20-24 hours], shorter period of hospitalization, lesser LSCS rate [24% Vs 34%] lesser need of augmentation [40% Vs 62%], choroamnionitis [3% Vs 7.8%], and postpartum fever [1% Vs 1.8%] when compared with expectant group. Rate of infected wound after LSCS were compared in induction and expectant groups [2.2% Vs 2.6%], also there was no difference between them regarding neonatal morbidity and nursery admission. So it was concluded that there was slightly high maternal complications in expectant group but no long-term maternal morbidity. Both groups have no effect on neonatal morbidity and mortality however the duration between PROM and delivery effect the neonatal admission in nursery and antibiotic requirements.