role of amniotic fluid index in the management of postdate pregnancy

To evaluate the role of amniotic fluid index as a reliable fetal surveillance test in the management of postdate pregnancy. Cross-sectional analytical study. Hamdard University Hospital from May 2000 till May 2003. A total of 210 patients were studied. The antenatal fetal surveillance in these patients was based on ultrasound assessment of AFI twice weekly after 41 weeks. An abnormal AFI was defined as > 6 cm, between 6-8 cm as equivocal and more than or equal to 8 as normal. Delivery outcome and early neonatal complications were main outcomes. Rate of caesarean section [35.8%] in the women with AFI > 6 cm was found significantly higher than 8.9% rate of caesarean section of the women having AFI > 6 cm [p = 0.001]. Proportion of early neonatal complications was also significantly higher in the women with AFI > 6 cm [p = 0.03]. Out of a total 210 fetuses, 38 [18.1%] neonates were found with early complications, of these, 24 [63.2%] neonates were those whose AFI was > 6 cm. Sensitivity of AFI was 63.2% while specificity was 83.1% as the power of reliable fetal surveillance. AFI is a reliable fetal surveillance test. It may allow the conservative approach till 42 weeks to reduce the caesarean section rate due to failed induction of labour as well as perinatal morbidity and mortality

comparison of oral misoprostol tablets and vaginal prostagl and in E2 pessary in induction of labour at term

To compare the cost-effectiveness, mode of delivery, fetal and maternal outcome of oral Misoprostol and vaginal prostagl and in E2 pessary in induction of labour at term. R and omized clinical trial. Hamdard University Hospital, Imam Clinic and General Hospital from February 2002 to January 2003. The trial was conducted over two groups of patient for labour induction such that Group A received 50 micro g oral Misoprostol 4 hourly to a maximum of four doses. Group B received prostagl and in Es vaginal pessary at 6 hourly intervals up to two doses. Labour induction, number of doses, need of augmentation, induction to delivery time interval, mode of delivery and neonatal outcome were the main outcomes. Test of proportions was used to compare the significance between both managements. Out of a total of 214 women, 106 received oral Misoprostol and 108 received PGE2 vaginal pessary. Ninety-three percent women in misoprostol group were successfully induced compared with 91% in PGE2 group. A significant response of labour induction with the minimal dose [58%, p = 0.001] and earlier induction to vaginal delivery [74%, p=0.01] was observed in Misoprostol group. Rate of operative delivery was also less [16%, p = 0.16] compared with PGE2 group [25%]. Oral Misoprostol administration was more efficient and cost-effective than PGE2 vaginal pessary for induction of labour due to earlier response with minimal dose and less number of operative deliveries