Oral vs vaginal misoprostol for induction of labour at term

Background: to determine the efficacy of oral and vaginal Misoprostol in induction of labour at term. To compare maternal and total outcome in oral. and virginal Misoprostol in Labour induction. Study Design was interventional Experimental study. Setting was Department of Obstetrics and Gynecology. Divisional Headquarters Hospital Faisalabad

Results: 100 -pregnant women requiring induction of labour at term were, included. After complete evaluation the cases were divided into groups. Oral Misoprostol group A and vaginal Misoprostol Group B. Initial dose is 50ug repeated at 4 hour internal at maximum of 6 doses in24 hours till labour was established. Results were-observedand-recorded by total doses of Misoprostol required· duration of labour, need of augmentation; mode of delivery, maternal, complication and fetal outcome. Statistical analysis was carried out with the help of SPSS Obstetrics parameters like parity route of drug, mode of delivery need of augmentation were presentation as frequency and percentage. Total number of doses in Group A were 1-6 and in Group B 1-4. The mean induction to delivery internal was 14 hour in Group A and 9 hour in Group B. 88% delivered vaginally in Oral group and 12% by cesarean section. 72% delivered vaginally and 28% by caesarian section in Group B. Cesarean section rate for fetal distress was 6% Vs 23% in oral and vaginal group. Hyper Stimulation rate was 2% Vs 20% and Postpartum hemorrhage was observed 4% Vs 24% in Group A and B respectively. No neonatal death was noted in both groups

Conclusion: in this way our lyphthosis was proved that oral Misoprostol in better than vaginal route

effectiveness of uterine arteries ligation in management of refractory postpartum hemorrhage

Background: the objectives of study were to see the effectiveness of uterine arteries ligation in· cases of massive postpartum hemorrhage [PPHand which required surgical intervention and to determine the morbidity in these patients after uterine devascularization during their hospital stay

Material and Methods: it was a descriptive study which was carried out in Obstetrics and Gynecology Unit of Divisional Head Quarter Hospital, Faisalabad which is a tertiary care center. All patients booked or unbooked admitted in labour ward with PPH refractory to medical treatment were included in this study between January 2003 to December 2005. The main outcome measures were satisfactory homeostasis achieved in terms of control of PPH, length of operative time, post-operative morbidity, re-exploration, total units of blood transfused and total hospital stay

Results: there were 62 patients of PPH during study period of 2 years. Uterine artery legation was done in 20 of these patients as 1st line surgical option; in 15 out of 20 [75% and it was done during caesarean section whereas in 5 [25% and it was applied after vaginal delivery. In 4 patients [20% and-ovarian artery ligation was also done to control PPH and 2 patients [10% and ended up in per partum hysterectomy. Uterine devascularization successfully controlled PPH in 99% cases. Failure of uterine devascularization was associated with disseminated intravascular coagulation and placenta accretes. Post-operative morbidity was less in terms of anesthetic complications [11% and, pyrexia [33% and; paralytic ileus [16.5and, wound infection [22%]

Conclusion: postpartum hemorrhage is a life threatening condition. Uterine devascularization has proved invaluable in the control of refractory PPH as an alternative to hysterectomy

Present and severity of depressive symptoms in Schizophrenia

The present study aims to assess the presence and severity of depressive symptoms in persons suffering from schizophrenia as compared to normal healthy controls. This case control comparative study was carried out at the Department of Psychiatry, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January to December 2005. One twenty subjects were included in the study by non probability convenient sampling. Group 1 [the study group] included sixty patients suffering from schizophrenia between the ages of 15-60 and Group 2 [the control group] included sixty normal subjects without any major psychiatric disorder proportionally matched for age and gender. Those suffering from schizoaffective illness, major depression and organic brain damage were excluded. Hamilton Depression Rating Scale [HDRS], a 21 item scale was used to assess the presence and severity of depressive symptoms. The spectrum of depressive symptoms was broad in the schizophrenic sample. The difference in two groups was observed specially in depressed mood i.e., 19 patients in the study vs. 3 subjects in the control group with a p value of 0.0001 and in psychomotor retardation i.e., 19 patients in the study vs. 4 subjects in the control group, again with a p value of 0.0001. The results of this study suggest that depressive symptoms are a part and parcel of schizophrenia and every patient suffering from schizophrenia should be assessed in detail for the presence and severity of depressive symptoms