A comparison of orally administered misoprostol and membrane sweeping for labour induction in uncomplicated singleton post-term pregnancies

Objectives. This study assessed the efficacy of the two outpatient processes of single-dose 50 µg oral misoprostol (OM) and membrane sweeping (MS) on the outcome of labour induction and the possibility of reducing the need for hospital admission for cervical ripening/labour induction in uncomplicated post-term singleton pregnancies at a tertiary health institution in south-western Nigeria. Methods. A total of 100 patients were equally randomised into the two groups between April 2007 and March 2010. Primary outcome measures were delivery within 48 hours after the start of induction and route of delivery. Secondary outcome measures were time interval from induction to onset of labour (latency period), time interval from start of induction to delivery (duration of labour), need for oxytocin augmentation, labour complications, Apgar scores at 1 and 5 minutes, and need for neonatal intensive care unit (NICU) admission. Results. Both groups were similar at the baseline with regard to age, parity and days beyond 40 weeks' gestation. There was a significantly shorter induction to onset of labour (latency) interval in the OM group, with a mean of 17.0 hours compared with 31.9 hours in the MS group (p=0.005), with 82.0% of the patients in the OM group in spontaneous labour within the latency period of 18 hours as opposed to 32.6% of the MS group (p<0.005). Forty-two patients in the OM group and 40 in the MS group had a vaginal delivery (84.0% v. 87.0%, p=0.361), with 12 and 20 patients in the OM and MS groups, respectively, requiring oxytocin augmentation (p=0.023). The duration of labour was significantly shorter in the OM group, in which 78.6% of those who had a vaginal delivery achieved it within 9 hours, compared with 57.5% in the MS group (p=0.036). Overall, neonatal outcomes and need for NICU admission were similar and comparable in the two groups. On a preference scale, 43% of the women in the MS group felt positive about the intervention, compared with 92% of the women in the OM group. Conclusion. The study demonstrated a shorter latency period, less need for oxytocin augmentation and shorter duration of labour in patients who received OM. The two induction agents were similar with regard to neonatal outcomes and need for NICU admission. Both showed good safety profiles for outpatient care, although further assessment of the safety profile with larger studies will be needed. More patients felt positive about the intervention in the OM group than in the MS group

Factors predicting failure of labour induction.

Our objective was to identify risk factors for failed labour induction. From January 2001 to December 2005, we conducted a retrospective case-control study in a Nigerian University Hospital. Cases were women who failed to deliver vaginally after labour induction, and therefore had caesarean section. Controls were patients who were similarly induced and achieved vaginal delivery. Univariate followed by Logistic regression analysis were performed. Failed induction occurred in 37.6%. Variables significantly and independently associated with failed induction were cervical effacement < 70% (adjusted odds ratio [OR] 5.12; 95% confidence interval [CI] 2.65-9.90), Bishop's score < 6 (OR 3.47; CI 1.75 - 6.85), nulliparity (OR 3.91; CI 1.92 - 7.99). Prolonged pregnancy independently reduced failure rate (OR 0.44: CI 0.24 - 0.81). These variables can help determine patients that will require early recourse to caesarean delivery in order to avoid prolonged induction-delivery interval.

Antepartum myomectomy with a live term delivery--a case report.

We report a case of successful myomectomy in pregnancy. The patient, a 27 year old nulliparous, presented with 2 year history of progressive abdominal swelling and 13 weeks of amenorrhoea. Abdomino-pelvic ultrasonography revealed a viable intrauterine pregnancy at 18 weeks and 3 days; there was also a huge mass with cystic component, extending from the pelvis to the whole of the abdomen, with associated dilatation of the renal calyces bilaterally; sonographic diagnosis of ovarian mass in pregnancy was made. At exploratory laparotomy, a huge subserous leiomyoma coexisting with pregnancy was found; myomectomy was done. The rest of the pregnancy was uneventful, and the patient had spontaneous vertex delivery of a live infant at term.

Pregnancy outcome in asthmatic patients from high altitudes.

OBJECTIVE: To compare pregnancy outcome in asthmatic and non-asthmatic patients from high altitudes. METHOD: A prospective case-control study over a 4-year period. The setting was: Abha Maternity Hospital, south-west region of Saudi Arabia. Eighty-eight asthmatic pregnant patients were followed up on during their pregnancies and deliveries (cases). The control subjects were 106 non-asthmatic patients who delivered during the same period. RESULTS: There were no statistically significant differences in the mean age, parity and gestation at delivery between the cases and control subjects (P>0.05), while there were statistically significant differences in the mean birth weight, placental weight and number of abortions between the two groups (P<0.05). Antenatal complications occurred in 12.5% of the asthmatic patients and 1.9% of the control subjects. Pre-eclampsia was diagnosed in 7.9% of the asthmatic group but in none of the control subjects. Induction of labor, cesarean section rate, perinatal mortality, congenital malformations and Apgar score <7 at 5 min were significantly higher in the asthmatic patients. CONCLUSION: Asthma occurring in pregnancy was associated with increased antenatal complications, increased perinatal loss and congenital malformations in our study population.

A clinico-epidemiological review of cervical cerclage from the Assir region of Saudi Arabia.

A retrospective review was conducted on patients who had cervical cerclage performed because of suspected cervical incompetence over a 7-year period to assess the outcome of pregnancy and complications resulting from the cerclage. Other factors that could affect the outcome and complications were also assessed. Out of 196 patients who had the operation, 154 patients had adequate records available and therefore comprised the study population. There were 139 (90%) live births of which 76.6% weighed more than 2000 g. The outcome was not influenced by the experience of the surgeon, type of cerclage or the use of prophylactic antibiotics. There were no complications in 138 (90%) of the cases, and no cases of ruptured uterus, cervical lacerations and severe infections were encountered. The complications were seen more in multiple-order pregnancy and when the operation was performed as an emergency. The future role of cervical cerclage in the management of cervical incompetence in our community is discussed.

Teenagers obstetric performance.

OBJECTIVE: To study the pregnancy outcome in teenage primigravida women admitted and delivered in our unit between April 1997 and March 1998, and to compare the outcome with other primigravida above 20 years old. METHODS: Data was collected from primigravidae in respect of age, last menstrual period, history of booking at Primary Health Center and complications of pregnancies were identified. The process of labor and delivery were monitored and the outcome recorded. RESULTS: During the period of study, 2,650 women delivered in the unit, 171 (6%) were primigravida, out of which 116 (68%) were teenagers, ages between 13 and 19 years old, 55 (32%) were above 20 years of age. All the primigravidas were married and therefore had their husband and parental support. Forty three percent of the teenagers plan to return to school after delivery. The length of the 2nd stage of labor (67.7 minutes) in the young teenagers aged 13 to 15 years was significantly longer than of the older teenagers 16 to 19 years old and that of the control group ages above 20 years old, P<0.0001. The mean birth weight (2.45 kgm) in the younger teenagers were also lower than that of the older teenagers and the control group (3 kgm and 3.25 kgm) P<0.0001. There was no significant difference between the teenagers ages 13 to 19 years old and the control group regarding normal vagina delivery, lower segment cesarean, ventouse delivery, number of anemic patients and the mean birth weight as shown by the P-values. There was no significant difference in the numbers and types of medical complications identified between the teenagers and the control group. CONCLUSION: The younger teenage group (13 to 15 years) has been identfied as the high-risk group in this study but there was no significant difference in the pregnancy outcome of the teenagers (13 to 19 years old) in general compared with the control group. Attention must therefore be turned to the young teenagers pregnancy, labor and delivery. To avoid poor outcome in this age group, age at first pregnancy should be encouraged from 16 years and above.