Résumé
Background: Obstetric haemorrhage is the leading cause of preventable maternal mortality worldwide. One of the major contributors to obstetric haemorrhage is antepartum haemorrhage which is mainly caused by placenta praevia and abruptio placenta. The study aims to quantify the risk of placenta praevia based on the presence and number of caesarean sections and to assess other risk factors.Methods: This study was a prospective case control study conducted in the department of obstetrics and gynecology, Lalla Ded hospital, Srinagar, Jammu and Kashmir, India from August 2009 to October 2010. As per the inclusion and exclusion criteria of study 100 cases and 200 controls were selected and the association of placenta praevia with proposed risk factors was analysed statistically.Results: Present study showed that the risk of developing placenta praevia in future pregnancy increased steadily as the number of previous caesarean sections increased, risk being 2.1, 2.8 and 4 times with previous one, two and three caesarean deliveries respectively. Similarly, the risk of developing placenta praevia was more in women with history of previous abortion (risk being 2.8 and 6.5 times more in women with one and two abortions in the past). Previous dilatation and curettage and age more than 30 years also proved to be independent risk factors.Conclusions: To conclude advanced maternal age, previous abortion, dilatation and curettage and a history of previous caesarean section appear to increase the occurrence of placenta praevia. The study strongly emphasises the need to decrease the primary caesarean section rate.
Résumé
To compare efficacy, safety and tolerance of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labour induction in women with unfavorable cervices.Two hundred women requiring induction of labour at or beyond term were randomized to receive one of the two methods: intravaginal misoprostol 25 ug every 4 hours up to a maximum of eight doses and intracervical diniprostone gel 0.5 mg every 6 hours up to a maximum of three doses. Induction delivery interval was significantly shorter (p< 0.01) in the study group 10.86 hours (651.470 minutes) versus 13.31 hours (798.625 minutes). The proportion of women delivering vaginally within 24 hours was 84% in misoprostol group and 69% in dinoprostone group. The rates of women who needed oxytocin (28% versus 48%) were higher in dinoprostone group. Cesarean section rate in the study group was lower than in control group but not significantly so (15% versus 24%; p=0.09). Foetal distress was more common in the study group than in the control group but not significantly so (23% versus 18%; p=0.38). Neonatal outcome was comparable in the two groups. There were no significant maternal complications in both the groups. Intravaginal misoprostol 25 ug every four hours was more effective for cervical ripening and labour induction than intracervical dinoprostone 0.5 mg every six hours.
Résumé
This randomized controlled prospective study was conducted on 100 patients admitted in various units of Lalla Ded Hospital Govt. Medical college Srinagar Kashmir, India during period 2004-06. Among these patients 50 had eclampsia (Group -I) and 50 had severe preeclampsia (Group-II). The patients in each group were then randomly divided into two subgroupsA and B of equal numbers. Subgroup-A was managed with magnesium sulphate and subgroup B was managed with phenytoin. The efficacy in seizure prevention and control of drug regimens used in each subgroup was then compared.Among eclamptic patients treated with magnesium sulphate, there was no recurrence of convulsions, however among those treated with phenytoin, 6 patients (24%) had recurrence of convulsions out of which one had >3 convulsions while others had 1-3 convulsions. The difference in seizure recurrence rate in the two subgroups was found to be statistically significant (p= 0.033). Among severe preeclamptic patients managed with phenytoin, two patients progressed to eclampsia, where as no preeclamptic patient allocated magnesium sulphate progressed to eclampsia; the difference between two subgroups being statistically non significant.