Misoprostol and Oxytocin in induction of labor

Background: Induction of labor is defined as the process of artificially stimulating the uterus to start labor. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes. Objective: Main objective of the study was to find out are there any differences in maternal and neonatal / fetal outcomes after induction labor with misoprostol and oxytocin beyond 37 weeks of gestation. Materials and methods: This was a hospital-based study carried out in 431 inductions of labor during the study period. Total 327 women met the criteria and were enrolled into study. Misoprostol of 25 μg was inserted in posterior fornix of vagina or oxytocin infusion was started from 2.5 units on whom induction was decided. Maternal and fetal/ neonatal outcomes were observed. Collected data were analyzed using SPSS and MS Excel. Results: Analysis of onset of labor led to the finding that mean onset of labor was much rapid in oxytocin (7.2 h) than misoprostol (12.7 h). However, there is similarity in induction–delivery interval in both groups. Overall, the rate of normal delivery and caesarean section was found to be 64.8% and 38.2%, respectively. Fetal distress was found as the most common reason for caesarean section. The overall occurrence of maternal complication was found to be similar in misoprostol and oxytocin groups, nausea/vomiting being the most common complication followed by fever. Besides this, the most common neonatal complication found in overall cases was meconium stained liquor. K. Sharada, Hema Warrier, Ajay Kumar Reddy, P. Thulasi. Misoprostol and Oxytocin in induction of labor. IAIM, 2018; 5(3): 97-105. Page 98 Conclusion: It was found that misoprostol was used most frequently for induction of labor compared to oxytocin. The onset of labor was found to be rapid in oxytocin than misoprostol. However, the occurrence of side effects was found to be similar in both misoprostol and oxytocin groups.

Brugada syndrome unmasked by sodium channel blockade.

We report the case of a 29-year-old male suffering from recurrent syncope and palpitations. He had a structurally normal heart and his baseline electrocardiogram was normal. His electrophysiologic study revealed an inducible, nonsustained polymorphic ventricular tachycardia on programmed electrical stimulation. With the administration of intravenous Flecainide, there was typical ST-segment elevation in leads V2 and V3, indicative of the Brugada syndrome. He underwent an implantable cardioverter defibrillator implantation. The cardioverter defibrillator delivered an appropriate shock when the patient suffered ventricular fibrillation during follow-up one year later. This report illustrates the role of pharmacologic challenge in the diagnosis of the Brugada syndrome.

Successful radiofrequency catheter ablation of recurrent atrial fibrillation due to left inferior pulmonary vein tachycardia.

This report illustrates the case of a young lady evaluated for drug-refractory symptomatic paroxysmal atrial fibrillation. Successful isolation of left inferior pulmonary vein was achieved by segmental ostial ablation and circumferential Lasso mapping catheter. Patient is now free of symptoms and is off all anti-arrhythmic drugs.

Non-surgical transpericardial catheter ablation of post-infarction ventricular tachycardia.

Non-surgical transpericardial approach for catheter-based epicardial radiofrequency ablation of post-infarction left ventricular tachycardia has been described as an alternative and additive procedure to standard endocardial technique for delivery of radiofrequency energy in difficult situations. We report our initial experience with this approach in three patients of post-infarction recurrent ventricular tachycardia, refactory to multiple antiarrhythmic drugs. Ablation was successful in terminating the tachycardia in two and in modifying the circuit to be amenable for control with single antiarrhythmic drug in one patient. There were no serious acute or long-term complications related to the procedure. Epicardial approach is an effective and safe adjunct to standard endocardial ablative technique for patients of post-infarction ventricular tachycardia.

Refractory adenosine-sensitive congenital His bundle tachycardia: response to calcium-channel blockers.

The congenital form of His bundle tachycardia is an uncommon pediatric arrhythmia. We report the case of a 7-year-old child with tachycardiomyopathy. The incessant arrhythmia, detected in infancy, was resistant to amiodarone and beta-blockers. During electrophysiologic study, the tachycardia converted to sinus rhythm with intravenous adenosine and diltiazem. Subsequently, the child is maintaining sinus rhythm on oral verapamil. Calcium-channel blockers should be considered for the treatment of this arrhythmia, which is often resistant to multiple antiarrhythmic drugs.

Common supraventricular arrhythmias in Indian population and their management.

Supraventricular tachycardias (SVTs) present as recurrent palpitations. Unlike ventricular tachycardias, these arrhythmias usually carry a benign prognosis. It is important to exclude structural heart disease in these patients. Though vagal manoeuvres and drug therapy are useful for acute termination of SVTs, recurrences are common. Catheter ablation is safe, highly effective and has a curative potential. It obviates the need for long-term medical therapy as it eliminates the arrhythmia in these patients.

Absent coronary venous sinus: a rare anomaly.

A 42-year-old man, presenting with dyspnea on exertion and ST segment depression on treadmill test, was found to have absent coronary venous sinus on coronary angiography. We report this case of isolated congenital absence of coronary venous sinus because of its rarity.

Significance of tumour markers in colorectal carcinoma associated with Schistosomiasis.

Schistosomiasis as well as Colorectal Carcinoma are equally prevalent in Egypt. However, the role of Schistosomiasis as a risk factor for Colorectal Carcinoma is not well established. Three tumour markers have been assessed in 69 patients with large bowel disease. They were classified into five groups. Group 1 (A) included 21 cases with Schistosomal hepatic fibrosis. Group 2 (B) included 6 cases of ulcerative colitis. Group 3 (C) included 10 cases of adenomatous polypi of which 12 cases had Schistosomiasis. Group 4 (D) consisted of 21 cases of colorectal carcinoma, 12 cases had schistosomiasis in association with colorectal carcinoma constituting group 5 (E). Elevated CEA was observed in benign tumours but showed non significant difference in G4 and G5. Significantly increased AFP levels were evident in G1, G4, and G5. Significant increase of B-HCG was observed only in G4 and G5 indicating its significance as diagnostic index in case of malignancy. It has been observed that Schistosomal hepatic fibrosis induced increased levels of some of the tumour markers. Therefore, the factor of Schistosomal hepatic fibrosis should be considered during the assessment of tumour markers in colorectal carcinoma cases.