Concurrent oxytocin in women needing second dinoprostone

To reduce average induction delivery internal in patients with poor Bishop score without compromising fetomaternal outcome [in terms of birth weight, NICU admission, maternal complications and mode of delivery]. A descriptive study. Department of Obstetrics and Gynaecology, Pakistan Atomic Energy Commission [PAEC] General Hospital, Islamabad, from February to December 2009. All patients needing 2nd dinoprostone pessary for induction of labour were included in the study. Patients with gestation below 37 weeks, those with intra-uterine growth restriction, bad obstetric history, previous uterine scar and patients in whom Bishop score improved for amniotomy after 1st dinoprostone pessary, were excluded. Data was collected on a special proforma where all variables were defined. Out of 90 patients, 44 [48.8%] had spontaneous vertex deliveries and 12 [13.3%] had instrumental deliveries so a total vaginal deliveries occurred in 56 [62.2%] patients. Thirty four patients [37.8%] had emergency caesarean sections. Main indication for cesarean was failure to progress in 1st stage of labour followed by fetal distress. There were 3 failed inductions. Only 2 patients had hyperstimulation. NICU admission were 8 and all babies were discharged healthy from nursery with no case of early neonatal death. Concurrent oxytocin with 2nd dinoprostone in patients with poor Bishop scores [initial scores 2 and 3] resulted in more vaginal birth and comparatively shorter induction delivery time with almost negligible fetomaternal complications

Induction of labour in postdates pregnant women

To differentiate the effect of gestation on the mode of delivery by analysing the difference in the mode of induction, length of labour and the difference in parity or Bishop score and their effect on the mode of delivery of postdates women. A cross-sectional observational study. PAEC General Hospital, Islamabad, from July 2006 to July 2008. Patients were induced at 41 weeks [Group B] and > 40 weeks [Group A] of gestation. Tab misoprostol and PGE2 tablets were administered according to amniotic fluid index [AFI] and parity. Study variables included duration of gestation, mode of induction, length of labour, difference in parity and Bishop score assessed before induction in each group. The outcome was assessed by applying Chi-square test by comparing mode of delivery with the study variables in both groups. A total of 78 patients were inducted in the study. They were divided in group B [n = 39] induced 41 weeks and group A [n = 39] induced at 40 weeks. Eighty four percent [n = 35] patients in group B delivered vaginally as compared to 71% [n = 28] in the 40 weeks group [p < 0.0001]. The higher number of vaginal deliveries in 41 weeks group was independent of association between the induction agent, parity and mode of delivery. The mean length of gestation was the single most important factor among the studied variables in predicting a vaginal delivery

Bleeding disorders in obstetrics and gynaecological practice

The objective of the study was to determine the frequency, types, presenting symptoms and management options in patients with bleeding disorders in the local obstetric and gynaecological practice. This was a descriptive study of one year duration conducted at the Pakistan Atomic Energy Commission General Hospital, Islamabad. Types of bleeding disorders in decreasing order of frequency were HELLP syndrome in 27.7% [n=5], gestational thrombocytopenia in 22% [n=4], Von Willbrand disease in 16.66% [n=3], Glanzmann's thrombesthenia in 11.11% [n=2], autoimmune haemolytic anaemia in 11.11% [n=2], post-transfusion purpura in 6% [n=1] and factor V deficiency in 6% [n=1]. HELLP syndrome and gestational thrombocytopenia were the commonest bleeding disorders in pregnant patients and Von Willebrand disease is the the commonest bleeding disorder in gynaecological patients with menorrhagia

Hyperreactio luteinalis associated with pregnancy induced hypertension

This is a unique case of hyperreactio luteinalis associated with partial HELLP syndrome, chronic superimposed hypertension, and intrauterine growth restriction. The cysts were managed conservatively. A caesarean section was performed at 34 weeks due to the deterioration of liver function tests, and intrauterine growth restriction. Multiple tissue biopsies of the ovaries were taken which showed theca leutein cysts. Her postoperative recovery was uneventful. The size of the cysts subsequently regressed to normal in 3 months postpartum