To compare the effectiveness of nifedipine and glyceryl trjnjtrate patch jn prevention of preterm Labour

Objective: To assess the effectiveness of Nifedipine and Glyceryl trinitrate patch in prolonging the pregnancy for more than 48 hours

Methodology: This was a randomized control study. Fifty patients with preterm labour meeting the inclusion criteria were inducted in study and randomly allocated to the treatment group A [Nifedipine] and group B [Glyceryl trinitrate patch, GTN]. After taking consent from the patients, all the details were documented on a proforma and tocolysis was started with either of these tocolytics according to a preset protocol

Results: Nifedipine was found to be more effective than GTN, as prolongation of pregnancy beyond 48 hours was more frequent [74%] with nifedipine than GTN [40%] with P value <0.05 . Similarly prolongation beyond 7 days was also more frequent [32%] with nifedipine as compared with GTN [24%]. Most common adverse effect found with nifedipine was headache followed by palpitations and hypotension. GTN patch had a better side effect profile with most of the patients being asymptomatic. Fetal distress was noticed more in GTN group as compared with nifedipine

Conclusion: Nifedipine, as a tocolytic, is found to be more effective in pregnancy prolongation when compared with Glyceryl trinitrate but has frequent maternal adverse drug effects. Glyceryl trinitrate patch is well tolerated by the patients with preterm labour with relatively fewer side effects

Perinatal outcome of nuchal cord

To find out the perinatal outcome in cases of vaginal delivery with nuchal cord versus babies delivered by elective caesarian section with nuchal cord. A retrospective, cross-sectional, comparative study done between January to December 2011at Kalsoom Maternity Hospital where 1776 patients were analyzed for presence of nuchal cord prior to and at the time of delivery and perinatal outcome. The cases with nuchal cord undergoing vaginal delivery were 205 [study group] versus 85 elective caesarian section with nuchal cord served as control group. Outcome variables between the two groups were compared. Incidence of nuchal cord was 16.3%. Incidence of single nuchal cord was highest in normal delivery [73.9%]. No significant difference was found between the mean of both 1- and 5-minute Apgar scores [8 and 10, respectively] between the two groups, but infants born with nuchal cords vaginally, tended to have lower scores at 1 minute [p=0.008]. This trend was not evident in the 5-minute Apgar test. Two neonatal admission were done [in vaginal delivery group] for 24 hour and then discharged for babies with apgar score 3/10, 5/10 and 4/10, 6/10 respectively. Elective caesarian section cause an additional morbidity and does not justify in case of nuchal cord as outcome is almost same in both condition. Nuchal cord is not associated with adverse perinatal outcome therefore do not influence clinical management. Doing elective section is not justified as there is no difference in perinatal outcome