ABSTRACT
Background: Today, the availability of regional anaesthesia for labour is considered a reflection of standard obstetric care. This study is to be conducted in a tertiary care centre with all facilities available for proposed end of proving that epidural analgesia is a safe and effective method for both parturient and the foetus in abolishing pain during labour.Methods: A total of 60 parturients were studied. they were randomly divided into two groups Group 1 includes 30 parturients. In this group parturient received epidural analgesia. The loading dose consisted of 10 ml of Bupivacaine 0.1% and Fentanyl 0.0002% (20 mcg). The top up doses were 10 ml of 0.1% Bupivacaine and Fentanyl 0.0002%, administered whenever the parturient complained of pain. When parturients enters into second stage a further 12-15 ml was injected with parturient in sitting position or semi-sitting position. Group 2 - (control group) Includes 30 parturients. In this group parturient was monitored without any analgesia.Results: This prospective study was done to assess the effect of epidural analgesia on the progress of labour and its outcome, to evaluate its efficacy as an analgesic technique and to study the maternal and fetal outcome. The total number of 60 parturients were selected and randomly categorized into two groups. CASE-Those who received epidural analgesia, CONTROL-Those who did not receive any analgesia.Conclusions: Epidural analgesia provides a versatile method of administering effective and satisfactory pain relief to parturient women. The technique should not be considered as a single entity, because the type and the dose of epidural medication can be altered as needed.
ABSTRACT
Termination of a pregnancy in second and third trimesters involving a dead foetus or one with a lethal anomaly is a challenge for health-care professionals in any setting. In addition to the theoretical concern of the dead foetus inutero causing disseminated intravascular coagulation, continuation of such a pregnancy may not be psychologically and socially acceptable to many women, and both the woman and the caretaker are keen to terminate the pregnancy, preferably without an incision on the uterus. Mid-trimester termination of pregnancy is one of the most controversial areas of gynaecological practice. It has moral, emotional, social and technical issues. There is continuous need for termination of pregnancy in second trimester, more recently due to increase in the use of antenatal diagnostic procedures. Nowadays, majority of mid-trimester abortions are carried out medically. The development of prostaglandin analogues has been a major breakthrough in abortion technology. Natural prostaglandins such as PGE1, PGF2a, PGE2, PG analogues like 15-methyl PGF2a have been used by various routes such as intravenous, intramuscular, intra/extra amniotic, oral and vaginal. Ethacridine lactate works by producing prostaglandin from deciduas, whereas misoprostol being synthetic analogue of misoprostol is supposed to act directly. This study aims to evaluate the effectiveness and safety of the extra-amniotic instillation of ethacridine with vaginal misoprostol in comparison to extra-amniotic instillation of ethacridine lactate with oxytocin IV infusion in terminations of second and third trimester pregnanciesin a tertiary referral hospital catering for both rural and urban population. This study concludes that ethacridine lactate with misoprostol is as efficacious as ethacridineplus oxytocinin termination of second and third trimesters anamolus/IUD foetuses. Though there is no significant difference in efficacy between the two. The ethacridineplus misoprostol is slightly effective in reducing the I-A interval. The efficacy of ethacridine plus misoprostol is slightly higher in early second trimester and ethacridine plus oxytocin is effective in the third trimester.
ABSTRACT
Postpartum haemorrhage is the leading cause of direct maternal death in developing countries. The incidence of PPH may vary from less than 5% to more than 10%. About 30% of maternal deaths in India occur due to massive haemorrhage. Normal blood loss in a vaginal delivery may exceed 500 ml and can range from 500 to 1000 ml. A decline in hematocrit is a more reliable estimation of blood loss. Active management had definitely reduced third stage blood loss. World Health Organisation (WHO) recommends Intra muscular oxytocin in the third stage of labour. Misoprostol PGE1 is a potent uterotonic agent. Ergometrine is also an effective oxytocic. This study has been conducted to compare the efficacy and safety of oral misoprostol 600 mcg with parenteral syntometrine in the active management of third stage of labour in 100 pregnant women of low risk pregnancies by objective assessment of the difference in pre-and post-delivery haemoglobin values. This study concludes that misoprostol has the potential of an effective, stable oral oxytocic with rapid onset of action. Though this study was limited to low risk patients, misoprostol has scope for use even in high risk patients of bronchial asthma, gestational hypertension, pre-eclampsia and Rhesus (Rh) negative groups where syntometrine is contraindicated. Thus, misoprostol may be used as an alternative to IM syntometrine in the active treatment of third stage of labour.