ABSTRACT
Background: Authors estimate that 15.6 million abortions (14.1 million-17.3 million) occurred in India in 2015. Incomplete abortion is a known disadvantage of medical method of abortion reported in 0.2-3% of cases. Though Misoprostol can be used with different routes including oral, sublingual and vaginal, few evidences are available in drug effectiveness as well as its related side effects when used through different routes and more so in India. The present study is aimed to compare the efficacy of misoprostal in first trimester abortion when taken vaginally as compared to orally. Thus, whichever route results in lower rates of incomplete abortions, can be employed in our health set up, minimizing the complications of failed first trimester MTP.Methods: An experimental study was conducted on 74 women seeking termination of pregnancy within 9 weeks of amenorrhea during the period of 9 months in a tertiary care institute. Tablet mifepristone 200 mg was given to all participants. After 48 hours, 37 women were given 800 mcg tablet of Misoprostol for oral consumption while other 37 women were given 800 mcg Misoprostol for self-administering vaginally. Abortion status and complications were checked.Results: The complete abortion rates in vaginal group and oral group were 97.3% and 86.49 % respectively. Satisfaction was more in case of vaginal misoprostol, while side effects were similar in both groups.Conclusions: Mifepristone with vaginal misoprostol was more effective as compared to oral misoprostol for first trimester abortion.
ABSTRACT
Background: All-natural birth has a purpose and a plan; who would think of tearing open the chrysalis as the butterfly is emerging? Who would break the shell to pull the chick out?” ~ Marie Mongon. It is of particular interest, in light of increased incidence of abdominal delivery throughout the country and in the world, to judge the validity of this procedure when used for the first time in the multipara.Methods: All the cases of Primary caesarean delivery in multipara over a period of 18 months were studied with regards to the indication, associated risks factors, and perinatal morbidity and mortality. The primary objective of the study was to find out the status of primary Lower Segment Caesarean Section (LSCS) in multipara in tertiary care center.Results: The overall incidence of LSCS was 30.7%. The incidence of Primary LSCS in multipara was 23.4%. The most common indication of LSCS was Foetal Distress i.e. 40.8%. Almost all caesarean sections were done in Emergency (99.2%). 12.3% of patients underwent PPH intra-operatively with 0.7% patient requiring Obstetric hysterectomy. Majority of the neonates were admitted in NICU for Respiratory Distress (30%). Major cause of Post-operative morbidity was wound gape seen in 10.8% patients.Conclusions: The fact that a multipara has had one or more vaginal deliveries should be regarded as an optimistic historical fact, not as diagnostic criteria for spontaneous delivery of the pregnancy at hand. Hence a multiparous woman in labour requires the same attention as that of primigravida and may still require a caesarean section for safe delivery. Good antenatal and intrapartum care and early referral will help reduce the maternal and perinatal morbidity.