comparison of oral misoprostol and vaginal prostaglandin e2 tablets for induction of Labour at Term

To compare the efficacy and safety of oral misoprostol with prostaglandin E2 vaginal tablets for ripening of cervix and induction of labour at term. A non blinded, randomised, controlled trial. Department of Obstetrics and Gynaecology, Pakistan Air Force Hospital, Air Headquarters Islamabad from July 2005 to January 2006. Hundred pregnant women with a singleton live pregnancy, at term [37-42 weeks] with cephalic presentation were selected for induction of labour for various indications having a Bishop's score of < or =5. These women were randomly allocated to receive either 100microgm of misoprostol orally repeated four hourly to a maximum of four doses or a 3mg PGE2 tablet vaginally repeated six hourly to a maximum of two doses. Cervical score before and after oral misoprostol and prostaglandin E2 vaginal tablets, vaginal birth within 24 hours of first prostaglandin dose, no of patients having failed induction, caesarean sections [all], caesarean section for fetal distress and uterine hyperstimulation with associated changes in fetal heart rate. Over the period of one year 100 women were recruited for the study, 50 to the misoprostol group and 50 to the vaginal prostaglandin E2 group. There was no significant differences between the two treatment groups in the primary outcomes: improvement in bishops score in both the groups, no of patients with failed induction in both the groups misoprostol 2/50 [4%] v PGE2 3/50 [6%], vaginal birth achieved in 24 hours misoprostol 27/50 [54%] v PGE2 29/50 [58%], caesarean sections 14/50 [28%] v 12/50[24%] caesarean section for fetal distress 4/50 [8%] v 5/50[9%]; uterine hyperstimulation with fetal heart rate changes 2/50 [4%] v none in the PGE2 group.]. Neonatal outcomes were not significantly different in the two groups. Oral misoprostol in strength of 100 microgm has similar efficacy to vaginal PGE2 tablets for ripening of cervix and induction of labour, although difference in outcomes between the two routes is not significant but data on optimal dosage regimes and safety are still lacking

To study the role of metformin on outcomes of pregnancy in patients with polycystic ovarian syndrome

Objectives: To evaluate the effects of Metformin on outcomes of pregnancy in patients of polycystic ovarian syndrome who conceived on Metformin and then continued it till they delivered, compared to patients where use of metformin was stopped on conception

Study design: This open label randomized study was conducted from October 2010 to October 2012 at the outpatients department of Maroof International Hospital, Islamabad

Place and duration: 46 patients with polycystic ovarian syndrome who conceived on Metformin [both with and without the help of ovulation inducing agents] were included in the study. Out of these 23 patients discontinued the use [of Metformin] and remaining 23 never stopped using Metformin throughout pregnancy, both these groups were compared to each other in their outcomes

Methodology: Forty six patients having polycystic ovarian syndrome and infertility were treated with Metformin1gm/day with or without other ovulation induction agents [Clomiphene and injections of Human Menopausal Gonadotropins]. Twenty three patients were continued with Metformin 1gm/day throughout pregnancy [group A], and in the second group consisting of twenty three patients [group B] Metformin was discontinued after they conceived. The were first trimester abortions, preterm delivery, Live birth rate, Birth weight, gestational diabetes and fetal anamolies

Results: The incidence of first trimester abortions in group B patients of polycystic ovarian syndrome was 34.7% as compared to group A where the incidence was 4.3% [where Metformin was continued throughout pregnancy].The incidence of gestational diabetes was 8.6% in group A [when Metformin was continued] and 26 % in group B [when Metformin was not continued]. There were no fetal anomalies in the women receiving Metfromin during pregnancy

Conclusion: Metformin reduces the incidence of first trimester abortions gestational diabetes and impaired glucose tolerance, when the drug was continued throughout pregnancy in subjects with polycystic ovarian syndrome. In addition no adverse effects on the mother or fetus were seen

Preloading before spinal anaesthesia for caesarian section. A comparison between colloid and crystalloid preload

To compare the preloading effect of 500 ml hydroxyethyl starch [HES] 6% with 1000 ml of Ringer's lactate to prevent hypotension in spinal anaesthesia for elective cesarean section. Randomized clinical trial. PAF hospital Islamabad, from November 2005 to March 2006. The trial was conducted in two groups of healthy women, scheduled to have elective cesarean section with no fetal compromise. The first group received HES 6% 500 ml [HES group] [n=25] and the second group was infused with 1000 ml Ringer's lactate [RL group] [n=25], in 15 minutes before administering spinal anaesthesia. The incidence of hypotension [systolic B.P < 90 mm Hg or <80% of baseline], and incidence of nausea and/ or vomiting were recorded. Neonatal outcome was aasessed by apgar scoring at 1, 5 and 10 min. The incidence of hypotension was lower in HES group than RL group. Hypotension occurred in 9 out of 25 women [36%] who received HES 6%, while 15 out of 25 women [60%] of RL group developed hypotension. The incidence of nausea and or vomiting was also lower in HES group [24% vs. 40%]. Neonatal outcome was good and similar in both groups preloading preganant ladies undergoing elective cesarean section, with 500 ml HES 6%, 15 min before induction of spinal anaesthesia decreases the incidence of hypotension more than preloading with 1000 ml Ringer's lactate