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Background: Induction of labor done, when the benefits to either mother or fetus outweighs those of continuing pregnancy. Pharmacological methods used for induction includes oxytocin, prostaglandin (E1, E2) and mifepristone. However the ideal dose, route and frequency of administration of misoprostol are still under investigation. Hence we plan to do a comparative study between sublingual and vaginal misoprostol for inducing labor.Methods: A prospective randomized interventional study was conducted on seventy pregnant women who met the inclusion criteria. They were explained about the study on admission and were randomized into two groups: Group I (sublingual) and Group II (vaginal). Bishop score at start of induction, number of pelvic examinations, doses required, mode of delivery, induction to delivery interval, duration of different stages of labor and perinatal outcome of the women were recorded followed by statistical analysis.Results: Patients in both the groups were comparable with respect to demographic data, period of gestation, gravidity and parity. There was no significant difference with regard to number of doses, p/v examinations and number of patients required augmentation. Mean induction to delivery interval, average duration of first, second and third stage was almost comparable. Out of 35 women in each group, 29 women (82.8%) in both groups had normal vaginal delivery, one woman in Group I and three women in Group II had instrumental delivery. Emergency LSCS was done in 5 women (14.28%) in Group I and 3 women (8.57%) in Group II.Conclusions: Sublingual misoprostol seems as effective as vaginal misoprostol for induction of labor at term. Sublingual route represents a valid alternative to vaginal route with the advantage of convenience of administration. In view of limited sample size, we cannot reach definitive conclusions in regard to the preference of sublingual or vaginal route of misoprostol for induction of labor.
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Background: Bleeding in first and second trimester of pregnancy is one of the common complications of pregnancy. there is evidence from various prospective and retrospective studies that first and second trimester vaginal bleeding which continue with pregnancy is associated with adverse pregnancy outcome, including preterm delivery, low birth weight babies, perinatal death and congenital anomalies. Objective of this study was to know the outcome of pregnancies who have bleeding in first and second trimester of pregnancy.Methods: This study was prospective study done in the department of obstetrics and gynaecology, Vanivilas Hospital, Bangalore from September 2018 to August 2019.Results: This study concludes that I trimester vaginal bleeding are at increased risk of abortion than in II trimester vaginal bleeding. Risk of placenta previa was more in II trimester vaginal bleeding than in I trimester vaginal bleeding.Conclusions: This study concludes that I trimester vaginal bleeding are at increased risk of abortion than in II trimester vaginal bleeding. Risk of placenta previa was more in II trimester vaginal bleeding than in I trimester vaginal bleeding. Bleeding in I trimester and II trimester call for special attention in view of increased risk of preterm birth and perinatal death. Recognition of these association will be useful for detection and follow up of pregnancies being at high risk.
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Background@#A prolonged interval from prelabor rupture of membranes to delivery is associated with an increase in the incidence of maternal and neonatal morbidities and mortality. Various agents have been tested to improve the cervical Bishop score to expedite the delivery of the fetus and lessen the maternal and neonatal complications.@*Objective@#To compare two protocols for labor induction in pregnant women with prelabor rupture of membranes (PROM).@*Population@#Subjects were recruited from the University of Santo Tomas Hospital (Private Division and Clinical Division). Pregnant women with a live, term, singleton fetus, cephalic presentation, a reactive Non stress test, who presented with PROM and a Bishop score of ?5, with no previous Cesarean section, or other uterine surgery.@*Methodology@#This is a two-arm superiority, open label, randomized controlled trial. Pregnant women with a live, term, singleton fetus, cephalic presentation, a reactive Non stress test, who presented with PROM and a Bishop score of ?5, and with no previous Cesarean section or other uterine surgery were randomly assigned to receive either intravenous (IV) oxytocin infusion or intracervical dinoprostone 0.5 mg gel followed 6 hours later by IV oxytocin infusion.@*Results@#Vaginal delivery within 24 hours of labor induction increased significantly with intracervical dinoprostone gel followed by IV oxytocin infusion (87% versus 61%; RR: 1.43; 95% CI: 0.99 – 2.06; P<0.044). Comparable result was observed for nulliparous women included in the study population. The time interval from labor induction to active phase was significantly shorter in the dinoprostone-oxytocin group than in the oxytocin alone group (2.4 ± 2.1 versus 6.3 ± 1.4 hours; p<0.001). The time interval from labor induction to delivery was also significantly shorter in the dinoprostoneoxytocin group (6.3 ± 1.5 versus 10.4 ± 1.4 hours; p<0.000). Cesarean delivery rates were statistically similar in the dinoprostone-oxytocin and oxytocin alone groups (17% versus 40%; p=0.102). The neonatal outcomes were comparable in both groups, except for birth weight.@*Conclusion@#Intracervical dinoprostone 0.5 mg gel followed 6 hours later by an oxytocin infusion in term women presenting with PROM and an unfavorable cervix (Bishop Score of 5 or less) was associated with a higher rate of vaginal delivery within 24 hours, shorter time interval from labor induction to active phase of labor, and shorter time interval from labor induction to delivery, and no difference in maternal and neonatal complications was observed compared with oxytocin infusion alone.
Sujets)
Dinoprostone , Ocytocine , Travail obstétricalRésumé
Introduction@#Prelabor rupture of membranes (PROM) occurs in 8% of all pregnancies and is a major cause of preterm birth and perinatal morbidity and mortality. In 47% of cases, clinicians are uncertain regarding the diagnosis of PROM based on examination and history alone. A misdiagnosis often leads to unnecessary interventions that may be detrimental to mother and fetus. There is currently no ideal noninvasive diagnostic test that can diagnose prelabor rupture of membranes with certainty. @*Objective@#This study aims to determine if a quantitative assay of vaginal fluid creatinine can correctly diagnose prelabor rupture of membranes in women with singleton pregnancies at 28-42 weeks age of gestation@*Methodology@#A prospective study was performed at a tertiary hospital from December 2015 to August 2017 with a computed sample size of 180 patients (60 per group). If a history of watery discharge was confirmed by egress of fluid, then the patient was included in the Ruptured membranes group. If despite a history of watery discharge, no egress is noted, then she was included in the Unsure membrane status group. 60 women with normal pregnancies were randomly chosen for the control group. Vaginal fluid was collected for Litmus Paper, Fern, and Vaginal Fluid Creatinine Tests.@*Results and Conclusion@#Vaginal fluid creatinine at 1.00 mg/dL has higher sensitivity, specificity, positive and negative predictive values, and a higher positive likelihood ratio than the litmus paper or ferning tests. High accuracy values, with a low false negative rate of 0, and a large AUC make vaginal fluid creatinine an excellent test for the detection of PROM, in accordance with previous studies.