Induction of labour; efficacy of sweeping of membranes at term in previous one C-section

It is now widely accepted that trial for vaginal delivery should be attempted unless a genuine indication exists for C- section. To determine the efficacy of membrane sweeping for onset of labor till 41 weeks of gestation and mode of delivery in patients with previous one cesarean section [C-Section]. Randomized control trial. Department of Obstetrics and Gynaecology, Benazir Bhutto hospital, Rawalpindi. Jan 2008 to Dec 2008. Pregnant women with previous one C- section were randomly allocated to Group-A [sweeping of membrane] and Group-B [no intervention] each having 55 patients. There was no absolute indication of cesarean section in present pregnancy. After complete antenatal examination, tests like CBC, urine DR, BSR, urea, creatitnine, screening for hepatitis B and C were done. In group A, digital sweeping of fetal membranes was started a 37 weeks and was done every 3rd day till she went into the labor or she reached 41 weeks. At 41 weeks of gestation, if she did not go into labor, induction with prostaglandin or elective C-section was done depending upon the bishop score. In group B, patients awaited spontaneous onset of labor till 41 weeks. After 41 weeks induction with prostaglandin or elective C- cesarean section was done. In Group A, 43 [78.18%] patients had onset of labour after sweeping of membranes while 12 [21.82%] patients had no onset of labour. In Group-B, 28 patients [50.90%] had spontaneous onset of labor while 27 [49.10%] had no onset of labours. In Group-A, 34 [61.82%] patients and in Group-B only 14 [25.45%] were delivered vaginally [p Value 0.001]. In Group-A, lower segment cesarean section was done in 6 [10.91%] patients while in Group-B, 23 [41.82%] had cesarean section [p Value 0.001]. Assisted vaginal delivery was done in 15 [27.27%] in Group-A while 18 [32.73%] patients in Group-B had assisted vaginal delivery [p Value 0.533]. In patients with previous one cesarean section, the efficacy of membrane sweeping in terms of onset of labor and normal vaginal delivery is significantly higher as compared to patients who had no sweeping of membranes

Maternal and fetal outcome in grand multipara

To compare maternal and fetal complications occurring in grand multipara and multipara patients. Case control study. Gynecology and Obstetric Unit-I of the Jinnah Post Graduate and Medical Centre Karachi, from February 2009 to January 2010. One hundred [100] patients of grand multipara [GMP], [parity >/= 5] and 100 patients of multipara [MP] [parity 2-4] were included in the study. Pregnant women with known medical conditions including essential hypertension, diabetes mellitus, epilepsy, primigravidas, women with previous caesarean section and twin pregnancies were excluded. Patients were admitted through antenatal clinic and emergency. A detailed history was taken and a physical examination was done with special emphasis on obstetrical examination. Investigations like blood CP, Urine D/R, blood grouping and sonogram were done. During labour, mother and neonates were managed according to ward protocols. Maternal and fetal outcomes were compared among GMPs and MPs. A high frequency of anaemia [81% vs 20%], pregnancy induced hypertension [45%, vs. 26%] and gestational diabetes [9%, vsl%] were seen in GMP as compared to MP group. Frequency of malpresentations [26% vs 15%], postpartum hemorrhage [15%, vs 10%] and intrauterine deaths [26%, vs 13%] were 1-ugher in GMP group along with a high caesarean delivery rate [GMP 21%, MP 14%]. A higher maternal mortality [GMP 4%, MP 1%] and low APGAR score [GMP 12%, MP 4%] were observed among babies born to grand multipara group. Grand multiparity is associated with adverse outcome for both mother and fetus. Effort should be directed to reduce high parity in the community through effective family planning initiatives. Specialized antenatal and obstetrical care facilities should be available

Induced abortion; maternal outcome

To determine the frequency and types of various complications and in- hospital maternal outcome in induced abortion. An observational descriptive study. Islam Medical College Sialkot, from January 2011 to January 2013. A descriptive study, 130 patients of induced abortion were selected by purposive convenient method. All patients with history of induced abortion were included. All patients with history of spontaneous or medically induced abortions were excluded. Patients were asked who performed the abortion, reason for seeking abortion, techniques and material used. Patients underwent a thorough clinical examination. Routine investigations, abdominal ultrasonography were performed. Evacuation of retained products of conception and Laparotomy was done if required. Pre-designed research proforma was used. SPSS-17 was used to analyze data. Frequency and percentages were calculated for categorical variables. Means and standard deviations were calculated for quantitative data like age, blood pressures, gestational age, and lab parameters. Majority of the patients 63/130 were in the age group 31years and above,123 patients were married while 07 patients were unmarried., 76.92% [100/130] patients were illiterate, , 52.30% [68/130]of patients were from the urban and 47.69% [62/130]were from the rural areas. In 126 [96.92%] cases, abortion was done to get unwanted pregnancies terminated. Majority of cases were induced by unskilled persons. Majority, 51.53%[67/130] were para 5 and above. Commonest method employed was instrumentation which was used in 93.07% cases. Hemorrhage was seen in 69.23%, fever in 50% abdominal pain in 16.19%. Evacuation and curettage was done in 91 [70%] cases, laparotomy in 25 [19.23%] and only 14 [10.76%] were managed conservatively. Twenty five patients who underwent laparotomy had gut and uterine injuries. Seven women [5.38%] died during the study due to septicaemia and DIC. Postoperative complications occurred in 8 [6.15%] patients. Maternal mortality and morbidity due to induced abortion is still very high. Being a preventable cause of death, it can be controlled by proper implementations of family planning programs, training of midwives and easy access to contraceptive methods