Outcome of early versus delayed oxytocin augmentation in nulliparous women on the duration of labour and other, obstetric and neonatal outcome - a randomized controlled ftrial

To determine the outcome of early versus delayed Oxytocin augmentation in nulliparous women on the duration of labor and other obstetric and neonatal outcomes. Aprospective randomized trial. The study was conducted at Pakistan Railways Hospital, for the duration of 1 year with effect from January 2010 January, 2011. It is 400 bedded teaching hospital affiliated with IIMC-Tof Riphah International University, Islamabad. In healthy nulliparous women with normal pregnancy.the progress of labor was thoroughly monitored and documented every 23 hours. If there was still no progress 1 hour after amniotomy, the woman was randomly allocated to either labor augmentation by oxytocin infusion or to postponement of oxytocin augmentation for 3 hours [expectant group, n = 158]. Women whose labors had progressed satisfactory [1 cm/hour] after amniotomy were not randomized. Participants were managed according to a standard protocol entailing continuous documentation of the progress of labour, the amount of oxytocin administered, and obstetrical and neonatal outcomes. Oxytocin infusion was started at 6 mil/minute and was raised by 6 mU/minute every 30 minutes until efficient contractions were established in the early oxytocin group. In the expectant group, if no progress occurred after 3 hours, the women were reassessed regarding the need for oxytocin augmentation. Data were analyzed with SPSS 15.0. The MannWhitney U test was used to compare means. Proportions of events were compared with Fisher's exact test or chi-square analysis. Statistical significance was set at a P value of <0.05. The caesarean section rate was 9% in the early oxytocin group and 10.7% in the expectant group [OR 0.8, 95% Cl 0.51.4], and instrumental vaginal delivery 17% in the early oxytocin versus 12% in the expectant group [OR 1.5, 95% Cl 0.972.4]. Early initiation of oxytocin resulted in a mean decrease of 85 minutes in the randomization to delivery interval. Early administration of oxytocin did not change the rate of caesarean section or instrumental vaginal delivery but shortened labor duration significantly in women with a 2-hour arrest in cervical dilatation. No other clear benefits or harms were seen between early and delayed administration of oxytocin

Role of transvaginal sonography in assessment of abnormal uterine bleeding in perimenopausal age group

Abnormal uterine bleeding [AUB] is a common problem which prompts more than 20% of all visits to outpatient clinics, and may account for more than 25% of all hysterectomies. The objective of this study was to determine the role of transvaginal ultrasonography in women of perimenopausal age group presenting with abnormal uterine bleeding. This descriptive study was conducted in Department of Obstructs and Gynaecology, Railway General Hospital, Rawalpindi. One hundred and forty-one women who attended the gynaecology clinic with abnormal uterine bleeding [menorrhagia, intermenstrual bleeding, or postcoital bleeding] between 40-47 years of age from January 2006 and April 2007 were included in this study. The mean age was 44 years. Among 141 women endometrial lesions were detected in 77 cases on histopathology after Dialatation and Curettage [D and C], while 57 [40.42%] of these were confirmed on transvaginal ultrasongraphy as an endometrial pathology prior to this invasive procedure. Among the 64 remaining patients, showing normal proliferative endometrium on histopathology, 46 cases [71.87%] showed no abnormality on tranvaginal examination. Transvaginal sonography can be safely used as an initial investigation in the management of abnormal uterine bleeding as it is a noninvasive procedure for the detection of endometrial pathology. The incidence of detection of an abnormal pathology by ultrasongraphy is high when focal lesions as fibroids, polyps or foreign body is concerned. Dilatation and curettage being a blind procedure requires hospitalization and general anaesthesia which can be safely replaced by an alternate valid, safe and non-invasive technique for evaluating the endometrial pathology in women of perimenopausal age group with abnormal uterine bleeding

Management of first trimester missed miscarriage with minimal surgical intervention

To observe the efficacy of Prostaglandin E1 analogue [misoprostol] in management of 1st trimester missed miscarriage. Observational study The study was done from June 2005 to June 2007 at Pakistan Railway Hospital Rawalpindi All patients presenting with 1st trimester missed miscarriage excluding suspected ectopic pregnancy, massive vaginal bleeding at admission, previous 3 scars, severe anaemia, history of handling before and history of bleeding disorders were subjected to the 1000 microgram regime of oral misoprotol in divided doses in 6 hours 400 micrograms orally stat and then 200 microgram 2 hourly 3 doses. After informed counselling and consent of the patient, a detailed Pelvic scan, blood complete picture, Hepatitis screening, blood sugar random and blood group was done. The patients were hospitalized and counselled as soon as first dose was given. The main outcome measures which were evaluated were complete abortion, incomplete abortion, severe haemorrhage, gastro-intestinal disturbances like nausea / Vomiting and any surgical intervention, if required like dilatation and curettage and evaculation and curettage. A total of 100 women were recruited to this study, 97% patients completed the 6 hours dosage regime and 3% patients expelled completely after initial doses. In 30% patients' evacuation was done which means that no cervical dilatation was required and the time of surgery/general anaesthesia was less than 6 minutes on average. Nausea and vomiting were seen in only 6% patients but considered as tolerable and transient. Only 1% patient had heavy bleeding and required an emergency evacuation, histopathology of which revealed molar tissue. None of them required blood transfusion. Majority of patients had no side effects. Patient satisfaction with oral misoprostol treatment was high, as many participants reported that they would prefer the same treatment if they have another miscarriage. Medical management of missed abortion is effective, reduces the need of dilatation and curettage, and is associated with high levels of patient satisfaction