Efficacy of cervical cerclage in sonographically shortened cervix in women at moderate risk of preterm delivery

To compare the efficacy and safety of cervical cerclage following objective shortening of cervix by endovaginal ultrasound with elective cerclage in women at high risk of midtrimester miscarriage or preterm delivery. Quasi experimental. Place and Duration of study: Military Hospital Rawalpind., January 2005 to July 2008. Material and Cases of elective cerclage were matched for maternal age, previous history of single mid trimester loss or preterm delivery or preterm rupture of membranes before 34 weeks with women who had selective cerclage if cervical length became < 25mm. All patients were followed up till delivery and outcomes in the two groups were assessed in terms of duration of gestation and neonatal survival. 23 cases of elective cerclage were matched to 24 cases of selective cerclage. Transvaginal ultrasound indicated cerclage was performed in 50% of the control group due to decrease in cervical length. There was no significant difference in the number delivering before 25 weeks 2[8.6%] versus 3[12.4%], those delivering at gestation>35 weeks 17 [73%] versus 16[66.6%][p=0.94]. Neonatal survival was also similar 18[78%] versus 19[79%] p=0.96. Cervical length as measured by TVS is the best available technique for predicting preterm labour. In women deemed moderately high risk on the basis of history, sonographic cervical length indicated cerclage appears to reduce cerclage rates without comprising pregnancy outcome

Effects of obesity on pregnancy and its outcome

The objective of study was to find out adverse effects of obesity on pregnancy. A case - control study comparing outcome of pregnancy in obese women with a control group of non obese. Obstetrics unit of Military Hospital Rawalpindi from 20th December 2004 to March 2006. The study included 100 obese ladies with body mass index [BMI] 28-35 and 100 non obese ladies with BMI 18-25. Pregnancy in obese women associated with increased risk of complications. These women had a higher frequency of pregnancy-induced hypertension [RR 1.75; 95% CI 1.08 - 2.81] and gestational diabetes mellitus [RR 3.0; 95% CI 1.13 - 7.94], a higher cesarean section rate [RR 1.78; 95% CI 1.91 - 2.67], increase in postpartum hemorrhage [RR 3.50; 95% CI 1.19 - 10.27] and higher babies weight [RR 2.83; 95% CI 1.50 - 5.15]. This study concluded that obese woman were at high risk of antepartum, intrapartum and postpartum complications with an increased risk of operative delivery

Abdominal sacrocolpopexy vs vaginal sacrospinous ligament fixation for vaginal vault prolapses

To compare the success rate and outcome of two operations for vaginal vault prolapses-Vaginal Sacrospinous Ligament Fixation [SSL] versus Abdominal Sacrocolpopexy [SCP]. Prospective randomized controlled trial. Department of Obstetrics and Gynaecology CMH Peshawar between Jan 99 to Sep 2003 and Department of Obstetrics and Gynaecology MH Rawalpindi between Sep 2003 to Feb 2008. Thirty Women were randomly allocated to either procedure. There were a total of 15 patients in either arm. Follow up was at 3 and 6 months. Thirty women with vault prolapse were selected and out of these, 15 each were randomized to SSL and SCL. The mean age of women was 54 years [range 42-70], mean weight 68 Kg [range 50-95 Kg], the duration of surgery was longer for SCP [46.1 versus 75.3 min, [p<0.001] versus SSL. Average blood loss was also more for SCP versus SSL [320.2 versus 407 ml [p<0.001]. Post operative hospital stay was less for SSL [3.4 days] versus SCP [6.1 days] [p<0.001]. Regarding symptoms of persistent prolapse at 3 and 6 months only one patient had symptoms in sacrocolpopexy arm due to cystocoele. There was no evidence of recurrent vault prolapse. Objective assessment of prolapse was superior for abdominal surgery, but patient satisfaction was equal. Anatomical result of abdominal procedure seemed superior with vault mean vaginal length [5.09 versus 6.8 cm [p<0.001], but sexual function was preserved equally in both h arms. SSL is a patient friendly operation with shorter operation time and hospital stay. The anatomical results of SCP seem superior whereas functional results were equal in both arms

Update on misoprostol

Misoprostol, a drug primarily developed for the treatment of peptic ulcer is now being widely used for ever increasing indications in obstetrics and gynaecology due to its uterotonic action. The drug has come a long way following off label use and warning from manufacturers and FDA. Initially introduction of drug led to a flurry of adverse reports due to publication bias and also the fact that optimal dose and route was yet to be determined. There are more randomized controlled trials on use of this novel drug compared to any other drug in obstetrics and gynaecology. Finally after federal drug agency [FDA] approval in USA and recommendation the drug is used widely. Due to low cost, ease of storage and multiple routes of administration- oral, sublingual, vaginal and rectal uptake was very rapid. Misoprostol has changed the face of 1 st trimester medical termination an also 2 nd trimester induction. As an alternative to dinoprostone the safety of the drug has been validated along with great cost savings. Except for prophylaxis of post partum haemorrhage where the drug was less effective compared to counterparts there is evidence in favour of misoprostol for all other indications