BACKGROUNDOxytocin is used in more than 50% of the deliveries for induction of labour in many delivery units. Currently, there is no consensus whether oxytocin should be continued until delivery or can be discontinued after established active phase of labour. Theoretically, once labour contractions are established, the endogenous production of prostaglandin from the endometrium may be enough to maintain appropriate uterine activity without further stimulation with oxytocin. Our study was formulated to investigate whether discontinuation of oxytocin infusion has any effect on the duration of active phase of labour, mode of delivery, and maternal or neonatal morbidity. METHODSThis open-label prospective randomised controlled trial included 200 pregnant women at term with premature rupture of membranes. Primigravidas >/=18 years of age with a single viable foetus and cephalic presentation at term with cervical dilation =3 cm on internal examination were included in the study. 100 patients were allocated in each group after simple randomisation. Oxytocin infusion was initiated in both the groups for labour induction at a rate of 3 mIU/min and incremented by 3 mIU/min every 30 minutes till cervical dilatation of 5 cms was achieved. At this point, for those women who were allocated in Case group, oxytocin was discontinued. In Control group oxytocin was continued in the same dose until delivery. RESULTSDemographic characteristics of the participants (age, religion, residence, socioeconomic status, education) were similar in both the groups. The mean duration of active phase of labour in women who delivered vaginally (2.45 hours in discontinued versus 2.35 hours in continued group) and mean duration of second stage of labour (0.96 hours in discontinued versus 0.89 hours in continued) were similar in both the groups. The results of mode of delivery (80% vaginal delivery in discontinued versus 75% vaginal delivery in continued), maximum dose of oxytocin used (5.16 mIU/ min in discontinued versus 5.19 mIU/min in continued) and postpartum haemorrhage (15% in discontinued versus 18% in continued) were also similar. CONCLUSIONSDiscontinuation of oxytocin in the active stage of labour does not prolong labour and has no adverse maternal or neonatal outcome. Moreover, continuation of oxytocin in active stage of labour has increased incidence of uterine tachysystole and foetal heart rate abnormality. Therefore, it is an alternative and viable option to discontinue oxytocin in the active stage of labour. KEY WORDS
BACKGROUNDHypertensive disorders during pregnancy are the most significant and unresolved problems in obstetrics. Antihypertensive treatment is indicated for all pregnant women with blood pressure greater than or equal to 160 mmHg systolic or 110 mmHg diastolic. This degree of hypertension requires urgent assessment and management. In this study, we compared the effectiveness of oral nifedipine and intravenous labetalol in the control of hypertensive emergencies of pregnancy. METHODSIn this open-label randomised trial, 60 pregnant women with ≥28 weeks of gestation with sustained severe hypertension (systolic blood pressure of ≥160 or/and diastolic blood pressure ≥110 mmHg) were allocated to two groups in a randomised manner. One group (n=30) received intravenous labetalol and the other group (n=30) received oral nifedipine according to National Health Mission, Government of India protocol. Injection labetalol was given in repeated doses (20, 40, 80, 80, and 80) every 10 minutes and oral nifedipine capsule was repeated in 10 mg doses at 30 minutes interval until the target BP of ≤ 150/100 mmHg was achieved. RESULTSThe result of this study showed that after 30 minutes, more patients in the nifedipine group (66.6%) achieved the target blood pressure as compared to the labetalol group (46.6%). The mean time taken to achieve this target blood pressure was 30.6 ± 7.8 minutes versus 34 ± 7.7 minutes for nifedipine and labetalol group respectively (p=0.09). CONCLUSIONSBoth oral nifedipine and intravenous labetalol regimens are equally effective and well tolerated when used for rapid control of blood pressure in severe hypertension of pregnancy. Nifedipine may be preferred due to lesser repetition of doses, simple and flat dosage pattern, and ease of oral administration, low cost and wide availability.
AIM-The aim of this study was to compare the efficacy of induction of labour with Foley balloon inflation to 60ml with sublingual misoprostol. MATERIALS AND METHODS -This randomised controlled trial (n= 320) was performed on women with singleton pregnancy with cephalic presentation and unfavourable cervix admitted in RG Kar Medical College during the period of July 2011 to June 2012. In Foley group, labour was induced by placing No. 20 transcervical Foley catheter and inflating the balloon to 60 ml along with intravenous oxytocin. In Misoprostol group, sublingual misoprostol was used, 25 mcg every 4 hours to a maximum of 5 doses until adequate uterine contractions. Intravenous oxytocin was administered in patients with protraction or arrest disorders. RESULTS -The two groups were similar in demographic characteristics, indication for induction, pre-induction Bishop score, maternal and fetal complications. Time from induction to delivery was significantly shorter in Foley catheter group compared to misoprostol group(15.19+2.83 vs 16.16+3.35 hr, p<0.05). Mean post induction Bishop Score at 6 hours and 12 hours was significantly higher in Foley catheter group compared to misoprostol group (5.98+1.46 vs 4.95+1.33 and 8.45+1.5 vs 7.12+1.6, p<0.05). CONCLUSION -labour induction with Foley catheter is a safe and effective method of with less induction to delivery time. It avoids the side effects of misoprostol like nausea, vomiting, diarrhoea, fever shivering as well as uterine complications like tachysystole, rupture, and fetal death. CLINICAL SIGNIFICANCE -Induction of labour by Transcervical foley is a better alternative to misoprostol and should me more widely used.
A one year old pigeon was presented to the veterinary clinics, Belgachia with the history of leakage of feed and water from lower anterior side of neck area from past 3 days. Upon physical examination the case was diagnosed as acquired crop rupture due to trauma. Hence, the ruptured crop was repaired surgically and the pigeon recovered uneventfully. The present article describes successful surgical management of ruptured crop in a pigeon.
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