Factors Leading To Meconium Aspiration Syndrome in Term- and Post-term Neonates.

Background Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age. Methods A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All neonates at ≥37 weeks of gestation with meconium-stained amniotic fluid (MSAF) detected during delivery were included in this study after obtaining informed consent from their parents. The demographic and factors related to MAS were recorded through predesigned proforma and analyzed using SPSS version 22. Mean and standard deviation were determined for quantitative variables whereas frequency and percentages were calculated for qualitative variables. Results Overall 136 neonates were included in the study. The mean gestational age was 38 ± 1.43 weeks. The major factors for MAS were detected as fetal distress (67.0%, n = 91), non-reassuring fetal heart rate (54.0%, n = 73), cesarean birth (48.0%, n = 65), intrauterine growth restriction (IUGR; 17.0%, n = 23), and post maturity (12.0%, n = 16). Conclusion We conclude that the major factors for MAS are fetal distress, non-reassuring FHR tracing, cesarean birth, IUGR, and post maturity. Screening of such patients at an early stage may minimize morbidity and mortality related to MAS.

Morbidity and mortality due to unsafe abortion in Pakistan.

OBJECTIVES: To determine the frequency of women who had undergone an unsafe abortion and attended a tertiary care hospital in Pakistan with complications. METHODS: Patients with a history of termination at a gestational age of less than or equal to 22 weeks were included in the study. RESULTS: Of 230 women who met the inclusion criteria, 50 (21.7%) patients had undergone an unsafe abortion and attended the hospital with associated complications. Unintended pregnancy was the reason for the abortion in 82% of women (n=41). Eighteen (36%) underwent terminations performed by doctors, 18 (36%) by Lady Health Visitors (n=18), 10 (20%) by an untrained birth attendant (Dai), and 4 (8.0%) by nurses. Dilatation and evacuation procedures were performed in 28 (56.0%) women, while a Laminaria tent prior to evacuation was used in 18 (36.0%). Major complications included uterine perforation and gastrointestinal injury, observed in 27 (54.0%) women. Hemorrhage was observed in 13 (26.0%) women with retained products of conception after incomplete abortion. Six (12.0%) women died. CONCLUSION: Healthcare providers performed the majority of terminations. To prevent maternal mortality, improved skills through refresher courses and workshops on safer methods are needed.

Safety and efficacy of oral versus vaginal misoprostol use for induction of labour at term.

OBJECTIVE: To compare the safety and efficacy of Misoprostol through oral and vaginal routes for induction of labour at term. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Gynaecology and Obstetrics (Unit-IV), Liaquat University Hospital, Jamshoro, Pakistan, from January to December 2004. METHODOLOGY: Eighty term patients who met the inclusion criteria were selected for induction of labour with (50 microg) Misoprostol, either by oral or vaginal route. The patients were allocated in two groups-A and B, using non-probability convenient sampling technique. The dose was repeated at an interval of 6 hours upto maximum dose of 150 microg. Improvement in Bishop's score, analgesic requirements, route of delivery, maternal complications, neonatal outcomes were noted. RESULTS: The commonest indication in group-A was premature rupture of membranes in 16 patients (40%) and in 8 (20%) patients of group-B. Mean improvement in Bishop's score after 6 hours was greater in group-A (3.6 +/- 3.09) than group-B (3.3 +/- 3.45, p=0.70). Induction to delivery interval was less in group-A (6.7 +/- 4.4 hours) than group-B (7.5 +/- 4.3 hours, p=0.41). Oxytocin augmentation was required more in group-B as compared to group-A. Normal vaginal deliveries were achieved in 95% of group-A and in 80% of group-B. The dose of 50 microg was effective in 31(77.5%) patients of group-A as compared to 24 (60.0%) patients of group-B, while 100 microg was needed in 6 (15.0%) patients of group-A as compared to 13 (32.5%) patients in group-B. There was no significant difference between both the groups with regard to analgesic requirement, instrumental delivery, maternal complications and neonatal outcome. CONCLUSION: Safety and efficacy was comparable between low-dose vaginal and oral Misoprostol uses for induction of labour. However, oral route was better with respect to treatment interval, number of doses required and route of delivery. Both routes of administration can alternatively be used for induction of labour in developing countries where cost of drug does matter.