Laparoscopic supracervical hysterectomy compared with total abdominal hysterectomy

To assess if laparoscopic supracervical hysterectomy [LSH] had any advantage over traditional total abdominal hysterectomy [TAH] carried out for benign conditions. This prospective case control study was carried out between June 2005 and October 2006 in the Obstetrics and Gynecology Department of Zagazig University Hospitals, Zagazig, Egypt. Twenty-eight women operated upon by LSH were compared to 56 women who had undergone TAH. Variables compared were patient's age, weight, preoperative diagnosis, number of previous laparotomies, operative time, intra/post-operative complications, blood loss, uterine weight, hospital stay, need for analgesia, and resumption of normal activity. Patient's demographics were similar in both groups. The operative time was longer in the LSH group [93.7 +/- 5.7 versus 69.0 +/- 6.8 min, p=0.001]. Other operative and post-operative parameters were similar except that LSH patients showed shorter hospital stay [1.7 +/- 0.5 versus 4.0 +/- 0.7 days], time to resume normal activity [20.8 +/- 2.6 versus 50.0 +/- 7.9 days] and lower dose of post-operative analgesia [141.7 +/- 62.4 versus 282.0 +/- 87.4mg diclofenac], [p=0.001]. Laparoscopic supra cervical hysterectomy is a safe procedure and should be considered, if hysterectomy will be carried out for a benign condition with healthy cervix. A further larger study is needed to confirm these findings

randomized controlled trial of oral misoprostol for the third stage of labor

To compare oral misoprostol with conventional oxytocics in the management of the third stage of labor. In a controlled trial, 1574 women were randomized into four groups, as follows: Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 micro g. followed by two doses of oral misoprostol 100 micro g 4 hours apart: Group 2 received oral misoprostol 404 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 3 received intravenous infusion of oxytocin 10 lU; and group 4 received intravenous infusion of oxtytocin 10 lU plus intramuscular administration of methylergonovine maleate [Methergine] 0.2 ma. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures. The primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2. compared with 3.2% in group 1 and 3.5% in group 4 [P<.01, and P = .01, respectively]. There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 [5.9%, versus 2.2%: P = .01]. The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 [P < .01 and P = .01, respectively]. Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin

Labor induction with intravaginal misoprostol: randomized comparison of two regimens

to compare the safety and effectiveness of intravaginally administered misoprostol at doses of 25 micrograms and 50 micrograms for indicated labor induction in-patients with an unfavorable cervix. Study Ninety-nine patients received either 25 micrograms or 50 micrograms of misoprostol, placed in the posterior fornix. The dose was repeated every 3 hours until adequate labor was achieved at least three contractions in 10 minutes]. among 99 patients evaluated, 50 patients were allocated to the 25 microgram group and 49 patients to have 50 microgram group. The start to delivery interval was shorter in the 50 microgram group [11.4 +/- 5.9] hrs versus 18.9 +/- 12.7 hrs, P = 0.001]. the incidence of vaginal delivery after one dose was higher in the 50 microgram group [51% versus 28%, P = 0.039]. Patients receiving 25 micrograms required oxytocin augmentation more frequently than did those receiving 50 micrograms [55%] versus 23%, P 0.005]. No differences were noted in the cesarean or other operative delivery rates among patients in the two treatment groups. The incidence of newborns with Apgar score <7 was greater the 50 microgram group [12% versus 8%, P = 0.525]. Although the incidence of hyperstimulation was similar in both groups, the incidence of tachysystole was higher in the 50-microgram group [29% versus 18%, P < 0.25]. althugh a dose of 50 micrograms is associated with a shorter start to delivery interval and a higher incidence of delivery after one dose, 25 micrograms of intravaginal misophrostol is effective and associated with a lower incidence of tachysystole