Compare the effectiveness of prostaglandin E2 vaginal gel versus vaginal tablets for the induction of labour at term

To compare the effectiveness of prostaglandin E2 vaginal gel versus vaginal tablets for the induction of labour at term. Retrospective comparative study. This study was conducted in Gynaecology and obstetric unit B, Lady Reading Hospital Peshawar, from 1st January 2013 till 31[st] December 2014. Study population was women with singleton, term pregnancy with cephalic presentation undergoing induction of labour after 37 weeks of gestation. Prostaglandin E2 [PGE2] vaginal tablets [3 mg] or vaginal [2 mg] was administered at 6-hourly intervals, two doses administered. Main outcome measured was rate of failed induction of labour, besides failed induction in primigravida and multigravida and mode of delivery was also observed in both groups. Descriptive statistics was used to analyze the data and the results are expressed in the form of frequency and percentages. The number of patients induced with PGE2 tablet [3mg] were 39.74 % [n=503] while 60.20 [n=761] were induced with PGE2 gel [2mg]. It was observed that failed induction was more in patients induced with PGE2 tablets14.11 % [n=71] as compared to PGE2 gel 8.67% [n= 66]. Sub analysis showed failed induction was more in primigravida as compared to multigravid women. Spontaneous vaginal birth was found to be the most common mode of delivery 75.31 % [n=952]. Prostaglandin E2 vaginal gel is superior to vaginal tablets for the induction of labour

audit of change in rate and indications of caesaren section in a tertiary care hospital of Peshawar

To compare the changes in rate and indications for caesarean section after a gap of ten years i.e., in 1996 and 2006 respectively. This comparative study was conducted in the Department of Obstetric and Gynecology at Lady Reading Hospital Peshawar in December 2006. Record of all the patients who delivered in Gynae B unit in 1996 and 2006 respectively was obtained. Out of all the deliveries, the details of the patients who had Caesarean section were recorded on a semi structured proforma which included the demographic details, gravidity and indication for which caesarean sections were performed. Statistical analysis was done by using SPSS version 10. Chi square test was performed for the comparison and a p value of <0.05 was considered significant for the study. During 1996, the caesarean section rate was 10.26% as compared to 25.10% in 2006 with a p value of <0.01 which was statistically significant for the increase in caesarean section rate. In 1996, the number of caesarean sections performed in multigravida were n=253 [59.81%], followed by grandmultigravida n=93 [21.98%] while n=77 [18.20%] were performed in primigravida. In comparison, during 2006, highest number of caesarean sections were still performed in multigravida n=680 [47.61%] but it was followed by primigravidas n=480 [33.61%] and least n=268 [18.76%] in grandmultigravidas During 1996, the commonest indications in order of frequency were dystocia n=120 [31.20%], previous caesarean section n=71 [16.78%], placenta praevia n=56 [13.23%] and fetal distress n=48 [11.34%] respectively while during 2006, they were dystocia 310 [21.70%], fetal distress n=197 [13.79%], previous caesarean section = 191 [13.37%] and breech presentation n=180 [12.60%] respectively A significant increase [14.84%] in the rate of caesarean section in the last ten years is observed and it has gone particularly high in primigravidas in 2006. The main indications mostly were similar but malpresentations emerged as an important indication in 2006

Outcomes of cervical cerclage in preventing pregnancy loss

This study was designed to know the outcome of cervical cerclage in preventing pregnancy loss in patients with cervical insufficiency. This is a prospective study. Patients with previous early pregnancy losses were included. Cervical length less than 2.5cm at 12-16 weeks was taken as an indicator of insufficiency. Cerclage was removed at 37 week and patient and neonate were followed till one week postnatal. A total of 32 patients were included in this study. Fifteen patients had emergency cerclage and 85% had elective cerclage. A total of 79% patient delivered at term and 9% had abortion. Among them 72% patients had normal vaginal delivery and others underwent ceasarean section. Maternal pyrexia was more in emergency group. Jaundice was seen in 62% of the neonates and 17% neonates had respiretory problems. Cervical cerclage has a preventive role in singleton pregnancies with short and insufficient cervix

analysis of direct causes of maternal mortality

This study was conducted to analyze the direct causes of maternal mortality during a period of seven years in a tertiary care hospital of NWFP. This retrospective, analytic study was conducted from 1998-2004, and included all the pregnant patients including miscarriage and ectopic pregnancies, presenting during this period to Gynae B Unit, Lady Reading Hospital Peshawar. The records of maternal deaths were reviewed from 19982004 retrospectively and causes of direct deaths were analyzed. Deaths in non-pregnant patients and indirect deaths in pregnant patients were excluded. Total number of live births during the time period was 23720 and total number of maternal. deaths was 311. The maternal mortality ratio [MMR] was calculated as 1311/100,000 live births. Out of 311 maternal deaths, 268 [86.2%] had direct causes and 43 [13.8%] had indirect causes of maternal mortality. Hemorrhage was responsible for 42.16% [113/268] of maternal deaths, followed by hypertensive disorders in 24.63% [66/268], ruptured uterus in 10.45% [28/268], septicemia in 9.7% [26/268], thromboembolism in 7.8% [21/268] and unsafe abortion in 3.4% [9/268] cases. The study shows a very high MMR as compared to national figures. The leading cause of direct maternal death was hemorrhage, followed by pregnancy induced hypertension, ruptured uterus and septicemia. These conditions can be prevented by good antenatal, intranatal and postnatal care

Perinatal and maternal outcome in retained second twin

To evaluate the perinatal and maternal outcome related to retained second twin. This study was carried out in Gynae 'B' Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2004 to December 2005. Patients presenting to the labour ward after having delivered the first twin at home and with retention of the second twin in-utero with time interval of more than 30 minutes after the delivery of the first twin were included in the study. A total number of 25 patients presented with retained second twin during the above mentioned time period. Malpresentation in 14 patients [56%] and uterine inertia in 7 patients [28%] were found to be the commonest reasons causing retention of second twin, while malpresentation and uterine inertia together was seen in 4 patients [16%]. The perinatal mortality was 76% [n=19/25]. Maternal morbidity like fever was seen in 12 patients [48%] while post partum hemorrhage occurred in six patients [24 N. Blood transfusion was required in 17 patients [68%]. In post partum period breast engorgement requiring treatment with bromocriptine was seen in 5 patients [20 N]. Retained second twin is associated with a hlgh perinatal mortality rate and also causes increased morbidity in mothers. Thus, patients with twin gestation should be referred earlier to a center equipped to handle such a high-risk pregnancy and its associated problems at birth