Acute management of hypertensive emergencies in pregnancy: Oral Nifedipine versus Intravenous Labetalol

Objective: To compare the outcome of oral Nifedipine and intravenous Labetalol in severe pregnancy induced hypertension in terms of time taken to achieve the target blood pressure

Study Design: Randomized controlled trial

Place and Duration of Study: Conducted at department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Jan 2014 to Jun 2014

Materials and Methods: After taking ethical approval, pregnant women at >/=28 weeks of gestation with sustained blood pressures of >/= 160/110 mmHg were included in the study. Patients were randomly assigned into two groups to receive either oral Nifedipine or intravenous Labetalol. The data was collected and analyzed on SPSS version 20

Results: In oral Nifedipine group 64 percent patients were between 18-30 years while 36 percent were between 31-35 years of age. In intravenous Labetalol group, 58 percent patients were between 18-30 years while 42 percent were between 31-35 years of age. Fifty two percent patients in oral Nifedipine group and 54 percent cases in intravenous labetalol were between 29-34 weeks of gestation while 48 percent patients in oral Nifedipine and 46 percent in intravenous labetalol group were between 35-40 weeks of gestation. Time taken to achieve the target blood pressure is 31.14 +/- 3.14 minutes in Oral Nifedipine and 51.08+4.11 minutes in Intravenous Labetalol group. A p-value was 0.011671 which was significant

Conclusion: Nifedipine is more effective in severe pregnancy induced hypertension to achieve the target blood pressure as compared to labetalol. It is more suitable in our setup as it is economical and easy to administer

Maternal and fetal outcome in grand multipara

To compare maternal and fetal complications occurring in grand multipara and multipara patients. Case control study. Gynecology and Obstetric Unit-I of the Jinnah Post Graduate and Medical Centre Karachi, from February 2009 to January 2010. One hundred [100] patients of grand multipara [GMP], [parity >/= 5] and 100 patients of multipara [MP] [parity 2-4] were included in the study. Pregnant women with known medical conditions including essential hypertension, diabetes mellitus, epilepsy, primigravidas, women with previous caesarean section and twin pregnancies were excluded. Patients were admitted through antenatal clinic and emergency. A detailed history was taken and a physical examination was done with special emphasis on obstetrical examination. Investigations like blood CP, Urine D/R, blood grouping and sonogram were done. During labour, mother and neonates were managed according to ward protocols. Maternal and fetal outcomes were compared among GMPs and MPs. A high frequency of anaemia [81% vs 20%], pregnancy induced hypertension [45%, vs. 26%] and gestational diabetes [9%, vsl%] were seen in GMP as compared to MP group. Frequency of malpresentations [26% vs 15%], postpartum hemorrhage [15%, vs 10%] and intrauterine deaths [26%, vs 13%] were 1-ugher in GMP group along with a high caesarean delivery rate [GMP 21%, MP 14%]. A higher maternal mortality [GMP 4%, MP 1%] and low APGAR score [GMP 12%, MP 4%] were observed among babies born to grand multipara group. Grand multiparity is associated with adverse outcome for both mother and fetus. Effort should be directed to reduce high parity in the community through effective family planning initiatives. Specialized antenatal and obstetrical care facilities should be available

Comparison of prostaglandin E[2] gel, prostaglandin E[2] pessary and extra-amniotic saline infusion with oxytocin for induction of labour

Induction of labour is the intentional initiation of cervical ripening and uterine contraction for the purpose of accomplishing delivery, prior to onset of spontaneous parturition. This study was conducted to compare maternal and neonatal outcome in women induced with Prostaglandin E[2] gel, Prostaglandin E[2] pessary and extra-amniotic saline infusion with oxytocin at Bishops score <5. It was a quasi-experimental which was conducted at the Department of Gynaecology and Obstetrics Unit-I, Mother and Child Health Care Centre, Pakistan Institute of Medical Sciences, Islamabad during one year of time. Eighty cases in each group [prostaglandin gel, prostaglandin E[2] pessary and extra-amniotic saline infusion with oxytocin] were collected. Systematic sampling was done. First woman admitted was induced with prostaglandin gel, the second one with prostaglandin pessary and the third was induced with extra amniotic saline infusion and oxytocin. The most common indication for induction was post dates followed by PIH. The induction labour interval was less in EASI with oxytocin group [5.18 +/- 3.4] hours, as compared to prostaglandin pessary [8.81 +/- 5.60] hours and prostaglandin gel [8.32 +/- 5.18] hours. Induction delivery interval in EASI with oxytocin was [10 +/- 5.6] hours as compared to prostaglandin pessary [14 +/- 6.3] hours and prostaglandin gel [13 +/- 7.1] hours. This difference was statistically significant. The primigravidas had longer duration of labour than multigravidas. Induction labour interval in primigravidas was [8.2 +/- 5.1] hours while in multigravidas it was [6.7 +/- 5.02] hours. Induction delivery interval was also more in primigravidas [13.6 +/- 6.80] hours as compared to multigravidas [11.4 +/- 6.20] hours. Vaginal delivery rate was 89.2% while the caesarean section rate was 10.4%. The most common indication for caesarean section was foetal distress. There was no significant difference in perinatal morbidity and mortality in the three groups. EASI with oxytocin is a better method of induction than prostaglandin E2 gel and pessary. Moreover it is more economical in our country.

Comparison of diagnostic accuracy of core biopsy for breast lesions with fine needle aspiration cytology

To assess and compare the diagnostic usefulness of fine needle aspiration cytology [FNAC] of trucut biopsy of breast lesion. A comparative cross sectional study. The study was conducted in the surgical and pathology department of CMH Peshawar from February to August 2007. The first eighty two consenting female patients presenting with palpable breast lumps were subjected to FNAC then Trucut biopsy under local anaesthesia and later excision biopsy. Finally the results of FNAC and Trucut biopsy were compared in the light of excision biopsy results. There were 18 malignant and 64 benign cases on histopathology. On FNAC there were 5 in C5 category [confirmed on histopathology], 12 in C4 category [10 malignant on histopathology], 22 in C3 category [1 malignant on histopathology], 27 in C2 category [confirmed on histopathology] and 16 in C1 category [2 malignant on histopathology]. On Trucut 60 were benign and 17 malignant all of which were confirmed on histopathology. Five specimens were inadequate on Trucut [1 malignant on histopathology]. Sensitivities of FNAC and Trucut biopsy were 93.75-% and 100% and specificities were 96% and 100% respectively. Area under Receiver Operating Characteristic [ROC] curve for Trucut biopsy was found to be more than that of FNAC, showing that Trucut biopsy was more accurate than FNAC. Trucut biopsy has significantly higher diagnostic accuracy as compared to FNAC