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

Effectiveness and safety of vaginal misoprostol for induction of labour in unfavourable cervix in 3[rd] Trimester

The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasiexperimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery. This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness [delivery within 24-hours] and safety [uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity]. Secondary outcome measures included neonatal outcome. Out of 946 cases, successful vaginal deliveries were achieved in 843 [89.1%] cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 [12%] patients. Caesarean Section had to be done in 103 [10.8%] cases. The indications for Caesarean Section were foetal distress in 42 [40%], occipito-posterior position in 8 [7.7%], abruptioplacentae 2 [1.9%], cord around the neck 9 [7%], uterine hyperstimulation 6 [5.8%] and failure to progress in 20 [19%] cases. Admission to NICU was 28 [3.3%] and Neonatal deaths were 5 [0.5%]. Postpartum Haemorrhage [PPH] was observed in 22 [2.3%] patients. There was no case of rupture uterus. Vaginal Misoprostol appears to be safe and effective for cervical ripening in third Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory

audit of primary post partum haemorrhage

Postpartum haemorrhage [PPH] is one of the leading causes of maternal morbidity and mortality .Its causes and risk factors are important for its prevention and management. Poor, unhealthy, high parity women delivering away from health facility are usual victims. The purpose of this study is to determine causes of PPH, risk factors, preventable factors and to assess treatment measures adopted. This retrospective study is carried out in Gynaecology 'B' unit of Ayub Teaching Hospital Abbottabad. All patients admitted with PPH or developed PPH within hospital from 1st Jan-31st Dec 2006 are included. Exclusion criteria were patients with bleeding disorders and on anticoagulants. Records of admissions, deliveries, caesareans, major and minor procedures and history charts were thoroughly evaluated for details. Details included age, parity, socioeconomic status, transportation facility, distance from hospital, onset of labours, birth attendant skilled/unskilled, evaluation of risk factors, duration of labour and mode of delivery. Patient's general health, anaemia, shock, abdominal and pelvic examination and laboratory findings were also taken in to account. Treatment measures including medical, surgical, blood transfusions were evaluated. Results: The most important cause was uterine atony, 96 [70.5%] and traumatic lesions of genital tract, 40 [29.4%]. Factors causing uterine atony were augmented labour 20 [20.9%], prolonged labour 21 [21.9%], retained placental tissues, 11 [12.5%], retained placenta, 11 [11.4%] Couvelliar uterus, 10 [10.4%], placenta preavia, 8 [8.3%], placenta increta, 7 [7.3%], chorioamnionitis 5 [5.2%], and multiple pregnancy, 2 [2.1%]. Risk factors, grand multiparity 70 [51.5%], antepartum haemorrhage 12 [8.9%], instrumental delivery 10[7.3%], previous PPH, 6 [4.5%], choreoamnionitis, 5 [3.6%], multiple pregnancy, 2 [1.5%], no risk factor, 21 [15.4%]. Socioeconomic status was poor [75] and lower middle class [61]. Induced labour, 33 [24.3%], augmented labour 62 [45.5%].Uterotonics used for prophylaxis in 30 [22%], for treatment of PPH, 106 [78%]. Patients delivered by traditional birth attendants 70 [51.4%], lady health workers 40 [29.4%] and doctors 26 [19.2%]. Uterine massage performed in 30 [22%], minor surgical procedures 33 [24.3%], manual removal of retained placenta, 11 [8%], hysterectomy, 50 [36.7%], and compression sutures were applied in 3 [2.2%]. Maternal deaths due to PPH were 6 [40%]. PPH can be prevented by avoiding unnecessary inductions/augmentations of labour, risk factors assessment and active management of 3rd stage of labour. It needs critical judgment, early referral and early resuscitation by birth attendant. There is room for temponade and compression sutures. Hysterectomy should be the last option