The effect of misoprostol on postpartum contractions: a randomised comparison of three sublingual doses.

OBJECTIVE: To compare the postpartum uterine activity and side effects of various doses of sublingual misoprostol and intramuscular oxytocin. DESIGN: Single centre, randomised trial. SETTING: Zliten Teaching Hospital in Libya. POPULATION: Forty-nine women who did not receive oxytocics in labour and who delivered vaginally. METHODS: Thirty-five women were randomised to receive 200, 400 or 600 mcg of sublingual misoprostol PPH prophylaxis immediately following delivery. These were compared with 14 consecutive women given 10 IU of intramuscular oxytocin. Immediately after placental delivery, a Koala intra uterine pressure catheter was inserted transcervically into the uterine cavity. MAIN OUTCOMES MEASURES: Main outcomes measures are the uterine pressure (in Montevideo units) measured over 120 minutes. Other outcomes included temperature and measured blood loss. RESULTS: Women's age, parity, gestational age and neonatal birth weight were not significantly different between the four groups. There was no difference in intrauterine pressure between the three misoprostol doses. However, the uterine pressure was significantly lower than oxytocin with all three doses for the first 10 minutes (P < 0.008) and significantly higher than oxytocin from 50 to 120 minutes (P < 0.008). A dose-related rise in the body temperature and chills was observed in the misoprostol groups, with 8.3%, 8.3% and 45% of women experiencing a fever >39 °C with the 200, 400, and 600 mcg doses respectively. CONCLUSION: Intramuscular oxytocin has the highest immediate post partum uterine activity. Lower doses of misoprostol may be as effective as high doses and with fewer side effects. Clinical outcomes with low-dose misoprostol should be further explored (ISRCTN97277056).

Evidence for high levels of vertical transmission in Toxoplasma gondii.

Toxoplasma gondii is a highly ubiquitous and prevalent parasite. Despite the cat being the only definitive host, it is found in almost all geographical areas and warm blooded animals. Three routes of transmission are recognised: ingestion of oocysts shed by the cat, carnivory and congenital transmission. In natural populations, it is difficult to establish the relative importance of these routes. This paper reviews recent work in our laboratory which suggests that congenital transmission may be much more important than previously thought. Using PCR detection of the parasite, studies in sheep show that congenital transmission may occur in as many as 66% of pregnancies. Furthermore, in families of sheep on the same farm, exposed to the same sources of oocysts, significant divergent prevalences of Toxoplasma infection and abortion are found between different families. The data suggest that breeding from infected ewes increases the risk of subsequent abortion and infection in lambs. Congenital transmission rates in a natural population of mice were found to be 75%. Interestingly, congenital transmission rates in humans were measured at 19.8%. The results presented in these studies differ from those of other published studies and suggest that vertical transmission may be much more important than previously thought.

Does vertical transmission contribute to the prevalence of toxoplasmosis?

Toxoplasma gondii is a ubiquitous parasite with a widespread distribution both in terms of geographical and host range. Although the definitive host is the cat, it is also a major health hazard to domestic animals and humans. Three routes of transmission are recognised (infection from the cat, carnivory and congenital transmission). We aimed to assess the relative importance of congenital transmission, using sheep as a model system, due to the lack of carnivory. We report, using PCR as a diagnostic tool, that congenital transmission occurs with high frequency (69%). If transmission from oocysts was important in sheep, we would expect sheep reared under the same environmental conditions (i.e. a single farm) to have a random distribution of Toxoplasma infection. Using breeding records in conjunction with PCR, some families were found to have high Toxoplasma prevalence and abortion while others were free of Toxoplasma infection and abortion (P < 0.01). This supports the notion that Toxoplasma may be transmitted vertically. In humans, we conducted a similar study and showed that Toxoplasma was transmitted from mother to baby in 19.8% of cases. Vertical transmission in Toxoplasma may be more important than previously thought and this knowledge should be considered in any eradication strategies.

Health education in the Libyan Arab Jamahiriya: assessment of future needs.

The aim of this study was to determine priority health issues, target groups and education media for future health education programmes in the Libyan Arab Jamahiriya. A questionnaire was addressed to 2 groups: health officials (n=60) and the general public (n=300). In their lists of health issues to focus on, 7 were the same although prioritization differed. Children and youth were considered the most important target groups and the school setting the most appropriate medium for them. Broadcast media were acknowledged as valuable for health education for the general public. We recommend systematic consultation across official and lay groups as a preliminary requisite for health education initiatives.

Role of health education programmes within the Libyan community.

The effectiveness of existing Libyan health education programmes was evaluated in order to assess how the service may be improved. A representative sample of the general public completed a questionnaire on health knowledge, healthy behaviours and the impact of various health education media. The 872 participants ranked health education media by effectiveness, with television ranked highest and booklets and leaflets lowest. We recommend reorganization of the use of different health education media in future planning.

Role of health education programmes within the Libyan community

The effectiveness of existing Libyan health education programmes was evaluated in order to assess how the service may be improved. A representative sample of the general public completed a questionnaire on health knowledge, healthy behaviours and the impact of various health education media. The 872 participants ranked health education media by effectiveness, with television ranked highest and booklets and leaflets lowest. We recommend reorganization of the use of different health education media in future planning

[A 1-year study of the management of fetal breech presentation by monitoring follow-up during second-stage labor instead of using external version, x-ray pelvimetry and ultrasonic assessment of fetal weight]. / Ednogodishno prouchvane na povedenieto pri sedalishtno predlezhanie na ploda chrez monitorno proslediavane na vtoriia etap na razhdaneto vmesto prilagane na vunshno verzio, rentgenova pelvimetriia i ultrazvukova pretsenka na masata na ploda.

The authors studied 246 parturients with breech presentation of the fetus. All women were examined by an obstetric monitor. Cesarean section was performed on 33 women/ = 13.41% of women with breech presentation). Perinatal morbidity and mortality were the same as those of women with vertex presentation. The frequency of cesarean section was 11.98% of multiparas and 31.57% of nulliparas. According to the authors careful observation of advancement of delivery as well as the state of the fetus (by an obstetric monitor) could lead to management of delivery with breech presentation just as that of vertex presentation. This management of breech presentations should reduce the fear of delivery, which is observed in most parturients with breech presentation of the fetus.