Comparison of foley's catheter with extra amniotic prostaglandin F2 alpha in termination of second trimester pregnancy

The aim of this study was to compare the efficacy, safety, adverse effects and cost effectiveness of extra-amniotic Foley's catheter balloon alone [group-I], with the combined use of Foley's catheter balloon and extra-amniotic prostaglandin F2-alpha [group-Il] for termination of second trimester pregnancy. It was a experimental trial carried out in Obstetrics and Gynecology unit "A" of post-graduate medical institute, Lady Reading Hospital Peshawar, during September 2002 to September 2003. Hundred [100] patients having gestational age between 14-28 weeks and cervical score less than 4, were enrolled in the study, 50 patients for group-I and 50 patients for group-Il. Indications for termination were either intrauterine fetal death or congenital malformations incompatible with life. Foley's catheter 16fr was passed in both the groups intra-cervically. Group-Il patients in addition received extra amniotic PGF2 alpha, [0.25 mg/ml diluted solution], one ml at one hour interval, through the same catheter, till the expulsion of the balloon. The mean induction to products expulsion interval was significantly shorter in the combined use of Foley's catheter and extra amniotic PGF2 alpha [13.34 +/- 6.71 versus 33.74 +/- 8.941 hours]. The rate of successful uterine expulsion with in 24 hrs was also significantly higher in group-11 [92% versus 24%]. The frequency of diarrhea [04%], vomiting [06%,], and uterine pain [06%] in group -11 was not statistically significant [P > 0.05] but the frequency of temperature of 100 F was significantly higher in group-1 [78%] as compared to group-11 [18% Group-11 patients had shorter average hospital stay [1.53 +/- 0.57 days versus 2.766 +/- 0.567 ingroup-1 i.e. P < 0.1]. The combined use of Foley's catheter and extra amniotic PG F2 alpha is more rapid, safe, cost effective method for induction of therapeutic termination of second trimester pregnancy, resulting in greater number of successful uterine evacuation with in 24 hrs, than Foley's catheter balloon alone

Trial of scar in patients with previous one caesarean section

To assess the usefulness of trial of scar in patients with previous one cesarean section and to know the frequency of vaginal delivery and repeat caesarean section [CS] in these patients. This descriptive study was conducted from July 2001 to June 2002, at Khyber Teaching Hospital Peshawar on 50 pregnant women with a history of previous one cesarean section and with no contraindication for vaginal delivery. Patients with more than one CS and those with medical disorders were excluded. A detailed history and examination of each patient was done. The clinical data was recorded in proformas and the results were tabulated. Among 50 pregnant women with previous one CS, 36 [72%] patients were successfully delivered vaginally while 14 [28%] had emergency lower segment CS. Out of 36 vaginal deliveries, 27[75%] were normal vaginal deliveries while 9 [25%] were delivered with instrumental support i.e. 7[19.4%] with outlet forceps and 2[5.6%] by vacuum extraction. One patient [2%] developed scar dehiscence and lost her baby which resulted in one still birth [2%] in this study. One [2%] patient with imminent rupture underwent timely CS and baby was saved. A trial of scar may be given to all pregnant women with previous cesarean section except those with absolute contraindications. A woman with one previous cesarean section delivery with a low transverse incision should be counseled and encouraged to attempt labor in her current pregnancy