Background: Induction of labour at term is a common obstetric intervention. Prostaglandin E2 has been the agent of choice for pre-induction of cervical ripening for several decades. In recent time, prostaglandin E1 analogue (misoprostol) is a preferred new agent for pre-induction cervical ripening and labour induction owing to inexpensive, stable in room temperature, administrable through several routes. The ideal dose, route, and frequency of administration of misoprostol are still under investigation.Methods: A double blind parallel group placebo control randomized clinical trial was done in the department of obstetrics and gynecology of Agartala Govt. Medical College among 130 pregnant women those required induction of labour. In this clinical trial, the women were allocated by lottery to receive oral misoprostol (25 μg) and vaginal placebo (same dosage) or vaginal misoprostol (25 μg) and oral placebo (same dosage. Both active and placebo drug (25 mcg) were repeated at 4 hours. interval till the parturient reached active labour (not exceeding 5 doses). Both primary (induction delivery interval) and secondary outcomes (failed induction, vaginal/caesarean delivery rate, maternal and foetal complications) were statistically analyzed.Results: The mean induction delivery interval (primary outcome) differences were insignificant among both groups (oral versus vaginal). Success rate of induction (56.9% versus 75.4%), mean dosage (misoprostol 90.5 mcg versus 96 mcg) requirement, maternal and foetal complications was indifferent among two groups. The rate of vaginal delivery (within 24 hours of induction) was significantly higher when misoprostol was used through vaginal route. Caesarean section rate trends to be higher when misoprostol was administered orally.Conclusions: Low dose of misoprostol (25 mcg) offer an additional statistically significant clinical advantage in successful vaginal delivery when used vaginally.
Background: Unwanted pregnancies in women and complications of induced abortions are an important health problem in the world. There is recent trend of self-induced medical abortion pill use over the counter without knowing the recommendations. Objectives of this study were to study socio demographic profile, presentations, management of hospitalized women for medical abortion related complications. To explore out contraceptive practices in those women. To way out the reasons for choosing medical abortion by women.Methods: Women of reproductive age group (15-45 years) who admitted in department of Obstetrics and Gynaecology Medical College with the complications following self-induced medical abortion were enrolled. Patients’ demographic profile, socio-economic status, obstetric profile, KAP of contraception, logical reasons for self-induced abortion were studied. Management of each case was done according to hospital protocols.Results: The total number of patients that were enrolled for the study period was 100. 37% of hospitalized women were between 18-25 years age group and 45 % of them had marriage at early age (15-20 years) and 46% were belonged to lower middle-class group. Majority of women with single living child with their last child <1-year age had taken abortion pills for unplanned pregnancy (49%). 74% women had taken abortion pills over the counter for the first time and 88% women did have idea about contraception but never used. 70% of the women had to undergo surgical evacuation and six of them had undergone emergency laparotomy for ruptured tubal ectopic pregnancy. Post abortion counselling successfully convinced to accept combined oral contraceptive (31%), followed by IUCD and permanent sterilization and 16% of women by medical abortion pill refused to accept contraception.Conclusions: Pregnancy termination should be done by qualified medical personal with accurate information about safe medical abortion. Counselling of each couple is must to enhance continuous and consistent use of family planning methods.
Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.
BACKGROUND Lancefield Group-B Streptococcus (GBS) emerged as a significant neonatal pathogen with mortality rates of 15 - 50 % in western countries during 1970s. In India, incidence of invasive neonatal GBS diseases is around 0.17 per 1000 live birth and probably is underestimated. Hence, the study was undertaken to evaluate the vaginal GBS colonization in pregnant women along with the neonatal outcome. METHODS The study was single centered, hospital based observational cross-sectional study done in the dept. of Obstetrics & Gynaecology at Agartala Government Medical College (AGMC), and GBP Hospital for one & half years (Jan’ 16 - June’ 17). 250 Pregnant mothers with 31 to 40 weeks of gestation with singleton pregnancy, delivering either by Caesarean section & Vaginal delivery, were included in this study. They were recruited from obstetrics OPD and casualty of AGMC & GBP Hospital. During 1 st pelvic examination, two low vaginal swabs were taken for Gram Staining, and for determination of ß-hemolytic colony in blood agar. After identification of GBS from genitalia, outcome of neonates in these positive cases were evaluated for up to 28 days after delivery. RESULTS GBS was found in 8.8 % of total women recruited and was more common in multi-gravida. GBS vaginal colonization was significantly associated with low birth weight, and preterm delivery (p value 0.01) which is significant. CONCLUSIONS Prevalence of vaginal GBS colonization is more in pregnant mothers, more in multigravidas & is associated with low-birth-weight neonates and preterm delivery. So, there is a need to formulate guidelines for incorporation of detection of vaginal colonization in multi gravidas to determine its prevalence. KEYWORDS Group-B Streptococcus (GBS), Multigravidas, Colonization, Neonates, Pregnant Women
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