ABSTRACT
Background: Gestational Trophoblastic Diseases (GTD) encompass a wide spectrum of proliferative disorders of trophoblast tissue, which hold a good prognosis if diagnosed and treated on time. A close understanding of the disease spectrum is therefore needed to reduce morbidity and mortality.Methods: This is an observational study (both prospective and retrospective analysis) conducted in Rajendra Institute of Medical Sciences, a tertiary care teaching hospital in Ranchi, Jharkhand over a period of 2 years from 1st January 2017 to 31st December 2018.Results: A total of 162 cases of GTD were identified during the study period. Disease spectrum comprised of complete molar pregnancy in 146 (90.12%) and partial molar pregnancy in 7 (4.3%), GTN in 9 out of 162 cases (5.5%). Bleeding per vaginum preceded by amenorrhea was the most common symptom, observed in 95.4% of the cases. Uterine size was more than period of amenorrhea in almost 50% of the cases. Theca lutein cysts were found in 39.8% of the cases, hypertension in 21.5%, hyperthyroidism in 6.5% cases. Overall, there were nine (5.56%) cases of choriocarcinoma and six (3.7%) cases of Invasive mole. Remission rate in GTN was 86.7% with chemotherapy.Conclusions: Women complaining of vaginal bleeding in first half of pregnancy with uterine size more than period of amenorrhea must be evaluated for GTD by ultrasound and serum beta HCG. For cases of molar pregnancies, suction and evacuation remains the treatment of choice but need for regular follow-up and strict compliance to contraception during entire follow up has to be emphasized. Cases of GTN have excellent remission with chemotherapy.
ABSTRACT
Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.