Background: To compare intravenous labetalol with oral nifedipine in terms of rapidity at which they control blood pressure in acute hypertensive emergencies of pregnancy.Methods: A randomized controlled study. Pregnant women with severe gestational hypertension with BP ≥160/110 mmHg after ≥20 weeks of gestation were randomized with computer generated numbers, either to receive IV labetalol with an escalating dose of 20, 40, 80, 80 and 80 mg or nifedipine capsule orally in a dose of 10 mg every 15 minutes (upto 5 doses) until a BP of ≤150/100 mmHg is achieved. Crossover treatment was to be effected if initial treatment regimen was unsuccessful. Primary outcome was time taken and number of doses required to achieve the target BP of ≤150/100 mmHg. Secondary outcomes were volume of urine output, maternal heart rate changes, fetal heart rate abnormality, perinatal and maternal outcome and side effects.Results: Oral nifedipine achieved the target BP (≤150/100 mmHg) more rapidly in (26.25±12.60) minutes in comparison to (32.62±12.19) minutes with IV labetalol (p= 0.024). Nifedipine group also took less number of doses to achieve the target BP of (≤150/100 mmHg) mmHg than IV labetalol (1.75±0.840 vs. 2.18±0.83), p= 0.024. Volume of urine output was also significantly more in nifedipine group (94.90±1.84 ml) at 1 hour and thereafter till 24 hour of treatment in comparison to IV labetalol (41.28±2.14 ml), p= 0.000. Side effects are few and not serious. No patient required crossover treatment.Conclusions: Both the drugs are equally effective in controlling acute hypertensive emergencies of pregnancy, however oral nifedipine is more rapid in controlling severe hypertension and also it is associated with significantly increased urine output.

Background: To compare the efficacy of oxytocin, methylergometrine and misoprostol in active management of third stage of labour (AMTSL).Methods: A clinical study was conducted on 330 low risk pregnant women with a healthy singleton pregnancy and spontaneous onset of labour at term; allocated into three groups where active management of third stage of labour was done with either Oxytocin 10 IU intramuscular, or Methylergometrine 0.2 mg intramuscular, or tab Misoprostol 600µg sublingual on 110 women each group. Primary parameter was blood loss during labour. Secondary parameters were the duration of third stage of labour and changes in haemoglobin level.Results: Blood loss during labour in Oxytocin group was 145.86±11.53 ml, which was significantly less than that in Methylergometrine (164.02±9.36 ml) and Misoprostol groups (183.18±9.70 ml), but no patient in any of the groups had blood loss more than 200ml. Duration of third stage of labour was significantly less in Oxytocin group (5.13±1.91 mins) than in. Methylergometrine (6.16±1.85 mins), and Misoprostol groups (6.47±1.51 mins). No patient had prolonged third stage in any of the groups. There was no significant change in pre-and post-delivery haemoglobin levels in all the groups.Conclusions: Though injectable uterotonics are effective for active management of third stage of labour (AMTSL), misoprostol can also be effectively used, especially in settings where there is no adequate trained personnel and drug storage facility.

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Background: Childbirth is one of the most wonderful and anticipated moments in a woman’s life. But the excruciating pain associated with labour makes it a really undesirable one. Objective of present study was to compare the effects of programmed labour protocol and expectant management of labour.Methods: A clinical study was conducted on 120 low risk primigravida, 60 of them were managed with programmed labour protocol (group A) and the rest 60 (group B) were managed expectantly. Primary parameters were pain relief and changes in the mean duration of labour. Secondary parameters were changes in the amount of blood loss and APGAR score of delivered babies.Results: Among group A, 25% had good pain relief, 60% had moderate pain relief, 15% had mild pain relief and 0% had no relief of pain. The mean duration of labour from active phase through third stage in group A was 234.27±50.38 minutes and 304.58±41.72 minutes in group B. The average blood loss during labour was 89.33±19.06 ml in group A and 142.15±32.27 ml in group B. In group A, 4 babies had APGAR score less than 7 at 1 minute, but had score more than 7 after 5 minutes following resuscitation. In group B, 9 babies had APGAR less than 7 at 1 minute. Of these, 6 babies had score more than 7 after 5 minutes following resuscitation. 3 babies had score less than 7 even after 5 minutes and were shifted to neonatal ICU.Conclusions: Programmed labour protocol is an effective method to reduce the deleterious effects of labour on both mother and foetus.

Reduction of maternal death to achieve MDG -5 Target -6 is a challenge for most of the developing countries of the world in spite of steady decline in maternal death. There is a great difference in MMR of developing and developed countries as well as within the countries, states, districts depending upon the socioeconomic and educational status. This study was conducted to estimate the MMR, evaluate the causes of maternal death and to formulate strategies for reduction of maternal death at Assam Medical College and Hospital, Dibrugarh, Assam. MATERIAL AND METHODSA retrospective study of causes of maternal deaths from 1 st January 2012 to 31st August 2015 at Obstetrics and Gynaecology Department of Assam Medical College and Hospital, Dibrugarh, Assam, India. The records were collected from Maternal Death Register and analysis were made to find out the MMR, causes of maternal deaths and its contributing factors. OBSERVATIONSThere were 279 maternal deaths out of 33833 live births giving MMR of 824.64. Hypertensive disorder of pregnancy (37.63%) was the leading direct cause followed by infections (14.69%) and hemorrhage (12.90%) and the anaemia (24.73%) was the commonest indirect cause of maternal death. Contributory factors like age, locality, booking visit play a major rule in maternal death in our study.

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Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.