Arrest of preterm labour by nitroglycerine patch

Preterm labour and delivery before 37 weeks of gestation is a major cause of perinatal morbidity and mortality. To delay preterm delivery, we need a tocolytic agent which is uterospecific with few fetomaternal side effects and which can significantly improve perinatal outcome. Since long the search for such a tocolytic agent that is effective and safe for both the mother and fetus has been frustrating. Recently attention has focused on the use of Nitroglycerine, a nitric oxide donor in the treatment of preterm labour as it has a uterine smooth muscle relaxant properties. This study was conducted to assess the effectiveness of nitroglycerine patches in the treatment of preterm labour. Quasi - Experimental study was conducted in Obstetrics and Gynaecology Department of Abbasi Shaheed Hospital in Karachi. Duration of study was from March2005 to March2006. Women in preterm labour with alive singleton pregnancy, uterine contractions of at least 1 in 10 minutes, intact membranes and cervical dilatation of no more than 2 cm were recruited. Women with premature rupture of membranes, ante partum hemorrhage, hypotension, and chorioamnionitis were excluded from the study. Those women who fulfilled inclusion criteria were included in the study. History and examination were done at the time of admission and baseline observations were made. Nitroglycerine patch delivering 10mg/24 hours was applied on abdominal skin and if needed another 10mg patch applied after 1 hour. After 24 hours previous patches replaced with a new patch for next 24 hours. During treatment two doses of Inj. Dexamethasone were given for fetal lung maturity. Efficacy of transdermal patches were measured in terms of cessation of uterine contractions, cervical dilatation of not more than 2 cms, allowing prolongation of pregnancy for at least 48 hours without significant maternal side effect like headache, nausea, tachycardia and hypotension. Data was analyzed on SPSS version 10.0. 60 patients were enrolled in the study. Mean maternal age was 24.60 +/- 2.25 and mean parity was found to be 1.96 +/- 1.96. Out of them 47 [78.3%] had cessation of uterine contractions for more than 48 hours where as 13 [21.6%] failed to stop contracting. Progressive cervical dilatation of more than 2 cms was found in 29 [48.3%] in less than 48 hours, where as in 31 [51.6%] cervical dilatation remained same after 48 hours. Pregnancy was prolonged for more than 48 hours in 40 [66.6%] patients and 20 [33.3%] delivered in less than 48 hours P = 0.0098. Headache was present in 17[28.3%], nausea 7 [11.6%], tachycardia 8 [13.3%] and hypotension in 3[5%] patients. Transdermal Nitroglycerine Patches were effective tocolytic agents allowing prolongation of pregnancy for at least 48 hours

Risk factors in relation with uterine rupture

To determine the risk factors in relation with uterine rupture in patients coming to Abbasi Shaheed Hospital. Case Control Study. The department of Gynecology and obstetric Abbasi Shaheed Hospital Karachi from January 2001 - December 2002. All cases of ruptured uterus who were either admitted with or who developed this complication in the hospital were included in the study. These cases were compared with their control i.e. women who delivered normal at Abbasi Shaheed Hospital in the same period and did not develop rupture uterus; matched by same age parity socioeconomic status and area of residence. The cases were further divided in two groups, those with previously scarred uterus [n=20] and those with unscarred uterus [n=23]. Risk factors associated with uterine rupture included injudicious use of oxytocin by traditional birth attendants [TBAs] or unskilled persons [88%] no antenatal care [79%] or late referral by TBAs or Dais [58%] and obstructed labour [25.5%]. All cases referred by Dais had crossed the partographic alert line. In unscarred group oxytocin used injudiciously in all cases with no antenatal care [ANC] at all and late referral by Dais in 78% cases. Injudicious use of oxytocin and late referral by TBAs [Dais] and lack of Ante Natal Care are the significant risk factors for uterine rupture