Comparison of misoprostol with dinoprostone for induction of labor in postdated pregnancy

To compare the efficacy of misoprostol with dinoprostone in induction of labor in nulliparous women at and beyond 41 weeks of gestation. Experimental comparative study. Department of Obstetrics and Gynecology Unit-II, Jinnah Post Graduate Medical Center, Karachi, from September 2007 to October 2010. A total of 105 women with more than 287 days [41weeks] gestation with unfavorable cervix and intact membranes were selected for induction of labor. Dinoprostone was inserted in 41 patients while 64 patients were induced with intravaginal misoprostol. The primary outcome measures were induction-delivery interval, number of doses required for induction, rate of spontaneous vaginal delivery, C-section and instrumental delivery. Secondary outcomes were the incidence of meconium stained amniotic fluid, fetal weight at the time of delivery, fetal distress and need for admission to NICU. Out of 63 patients in the misoprostol group, 43 [67.1%] women had spontaneous vaginal delivery [SVD] while 26 [63.4%] patients out of 41 in dinoprostone group had SVD. The induction to delivery interval was 13.03 +/- 3.52 hours in misoprostol group while it was 14.12 +/- 3.31 hours in dinoprostone group. With misoprostol, induction of labor started in 18, 33 and 13 women with 1, 2 and 3 doses respectively within 24 hours but in dinoprostone group 16 women were successfully induced with 1 tablet only, while 21 patients required 2 doses for induction. The need for oxytocin infusion was the same in both the groups. The neonatal weight was 3.54 +/- 3.38 kg in misoprostol group as compared to 3.10 +/- 0.26 kg in dinoprostone group [p=0.41, t=1.57]. Four neonatal deaths were reported in the misoprostol group as compared to two with dinoprostone. Sixteen neonates were admitted to NICU in misoprostol group as compared to five patients in dinoprostone group. Twenty-eight [44.4%] patients in misoprostol group had meconium stained liquor as compared to 14 [34%] patients in dinoprostone group. Dinoprostone was most effective in comparison with misoprostol in gravida with 41 weeks and above gestation. Misoprostol though showed comparable results, but is not the drug of first choice

Efficacy of combined clomiphene citrate and gonadotrophin therapy

To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Observational analytical study. June 2009 to June 2010. In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin [CC - hMG] regime and maximum of three treatment cycle were given. Out of 100 patients in our study, 74% [2/3 rd] patients were less than 30 years of age and 26% [1/3rd] were between 30 - 40 yrs of age. Primary infertility was seen also in 2/3rd of patients [73%] and secondary infertility in remaining 1/3rd [27%] of patients. Polycystic ovary [PCO] was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown [unexplained infertility]. on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day [12.41 day] of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8% of patients refused further treatment and 4% did not report back. Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients

Comparison of cervical Foly's catheter and prostaglandin E-2 at term

Labor can be induced through a myriad of ways. The aim of this study was to compare the effectiveness of the intracervical Foley balloon catheter and intra vaginal 3 mg prostaglandin E2 tablet[s] in preinduction cervical ripening at term. Prospective analytic study of a cohort of 280 women selected through non probability sampling admitted in Obstetrics units, in two private hospitals one at Rawalpindi and the other at Mirpur [Azad Kashmir], from January 2009 to March 2010. All women were randomized to receive an intracervical Foley catheter or prostaglandin E2 tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. There were no differences in mean Bishop Scores between the prostaglandin and the Foley catheter groups. Bishop scores [mean +/- S.D.] after ripening were 6.6 +/- 0.81 and 6.7 +/- 0.86 for the Foley catheter and prostaglandin groups, respectively [P=0.54]. The prostaglandin group showed a statistically shorter induction to delivery time compared with the Foley catheter [16.5 +/- 2.2 and 20.51 +/- 3.89 h, respectively [P<0.01]. Both the groups showed no statistically significant difference between the occurrences of spontaneous vaginal delivery. Labor was established in 72% cases of cervical Foley group. On the other hand induction occurred in 76% cases in prostaglandin group. There was no statistical difference between the need of oxytocin infusion for labor augmentation between the two groups and fetal distress was equally frequent in both the groups. Foley catheter was as effective as Prostaglandin E-2 at term for induction of labor with additional advantage of being cheaper, readily available and had no systemic side effects

Misoprostol for the purpose of mid-trimester termination of pregnancy: a comparative study with prostaglandin f(2) alpha

To compare the efficacy of misoprostol verses prostaglandin F[2]alpha [PGF[2]alpha] in the medical management of termination of mid-trimester pregnancy due to medical reasons. This experimental study was conducted in Obstetrics and Gynaecology Department, Bahawal Victoria Hospital, Bahawalpur for a period of 6 months from April 2005 to September 2005. Time interval between induction with misoprostol or PGF[2]alpha and expulsion of foetus, number of tablets of misoprostol used and total dose of injection PGF[2]alpha used for termination of pregnancy as well as the complications experienced with both drugs. Fifty patients of 18-35 years of age were randomly selected who presented to Gynaecology and Obstetrics outdoor with mid-trimester foetal loss or congenitally malformed foetus incompatible to life, confirmed on ultrasonography. These women were randomised to receive either intravaginal misoprostol or extra-amniotic PGF[2]alpha. Ninety-six percent of cases were managed successfully with Misoprostol as compared to 92% where PGF[2]alpha was tried [p>0.5]. Mean induction to expulsion duration for misoprostol and PGF2alpha were 9.02 +/- 4.57 and 16.04 +/- 6.22 hours respectively [p<0.5]. Complications profile was low especially in cases of PGF[2]alpha and only one case experienced significant haemorrhage. Misoprostol and PGF[2]alpha were found to be of same success rate but former was found to be more efficacious in terms of induction to expulsion duration

Relationship between chronic hepatitis C and type-2 diabetes mellitus in Bhawalpurian patients

Objective: To establish a potential relationship between chronic hepatitis C virus infection and diabetes mellitus in Bahawalpur Design: Comparative study

Setting and Period: Bahawal Victoria Hospital and four different private clinics in Bahawalpur during 2002 to 2003

Material and Methods: 1. The case record files of 100 patients with chronic hepatitis C vs. 100 with chronic hepatitis B were reviewed and the laboratory and demographic data were extracted. 2. Anti-HCV and HBsAg were determined for 100 type 2 diabetes patients and 100 healthy adults by ELISA. The diagnosis of diabetes was based on the new WHO criteria. Pearson`s correlation coefficient was calculated and tested for significance

Results: 1. The occurrence of diabetes in patients with chronic hepatitis C was 19%, higher than 8% in patients with chronic hepatitis B [P<0.01]. Age and HCV infection were independent risk factors for diabetes. 2. Three patients with type 2 diabetes were anti-HCV positive while none of the 100 healthy adults was anti-HCV positive [P<0.05]. Four patients with diabetes and five healthy adults were HBsAg positive [P>0.05]

Conclusion: 1. Diabetes Mellitus was found to be significantly more frequent among HCV related liver disease patients when compared with HBV infected liver patients. 2. The frequency of anti HCV was higher in diabetes patients as compared to healthy adults. HCV can be a trigger factor in the development of diabetes mellitus

Chronic liver disease; precipitating factors for encephalopathy

Objective: To find out common precipitating factors leading to hepatic encephalopathy in selected known cases of cirrhosis of liver .Design: It is a descriptive study comprising patients selected through non-probability convenient sampling. Setting: Department of Medicine, Bahawal Victoria Hospital, Bahawalpur. Period: From January 2000 to December 2002

Subject: Fifty [50] known cases of cirrhosis of liver with encephalopathy

Main Outcome Measures: One or more precipitating factors leading to hepatic encephalopathy, grades of encephalopathy, etiology of cirrhosis of liver

Results: Thirty two [64%] patients were male and 18 [36%] females. The commonest age group involved was between 40-49 years [26%]. Most of the patients [46%] were in grade-IV encephalopathy. HBV [46%] was the commonest cause of cirrhosis. The most common precipitating factor of encephalopathy was gastrointestinal bleeding in 20[40%] patients. Other precipitating factors detected were, infections in 15[30%] patients, combination of gastrointestinal bleeding and infections in 7[14%], constipation in 3[6%], gastrointestinal bleeding and constipation in 2[4%], infections and constipation in 2[4%] and abdominal paracentesis in 1 [2%]patients

Conclusion: Gastrointestinal bleeding is the most common precipitating factor of encephalopathy followed by infections