Both sublingual and vaginal administrations of misoprostol are equally effective in inducing medical abortion during second trimester but sublingual route was preferred by the patients.

In a randomised control study, we evaluated the efficacy of intravenous low-dose magnesium sulphate for the management of eclampsia. A total of 144 women with eclampsia were divided into a study group and a control group of 72 women each. The study group received 0.75 g/h of magnesium sulphate intravenously after a loading intravenous dose of 4 g and the control group was given the standard intramuscular regimen as advocated by Pritchard. The primary outcome measure was recurrence rate of the seizures. The secondary outcome measures were development of magnesium toxicity if any, and maternal and perinatal outcomes. The difference in the incidence of fit recurrence was statistically insignificant when both groups were compared (7.46% vs 8.57%, p = 0.939). The total dose of magnesium sulphate was significantly lower in the intravenous group (p < 0.0001), in which no patient developed magnesium toxicity. Low-dose intravenous magnesium sulphate was found to be as effective as the standard intramuscular regimen, while maintaining a high safety margin.

Coiling is an important property of the umbilical cord and its vessels. The helical arrangement of the umbilical vessels makes the cord both strong and flexible, permitting it to resist external forces that otherwise might compromise blood flow. This study attempted to identify any adverse pregnancy outcomes associated with under-or overcoiling of the umbilical vessels. Coiling was examined in 565 consecutive cases with an indication for histological examination of the placenta. They represented about 10% of all deliveries during the study interval from December 1998 to May 2002. The umbilical coiling index (UCI) was determined as the number of complete coils divided by the length of the umbilical cord in centimeters, as estimated by an observer without knowledge of pregnancy outcomes. Undercoiling was a UCI less than the 10th percentile, and overcoiling, an index above the 90th percentile.Undercoiling of the umbilical cord was found in 18% of cases, and overcoiling in 13.5%. The mean UCI was 0.18, with a standard deviation of 0.12. The UCI was not associated with gestational age at delivery, infant gender maternal age or parity, smoking status, or the presence or absence of preeclampsia, gestational diabetes, or preexisting diabetes. Fetal death, chorioamnionitis, and fetal structural or chromosomal abnormalities were associated with undercoiling. The odds ratio (OR) for fetal death was 4.09, with a 95% confidence interval (CI) of 2.2-7.6. Numerous conditions were associated with overcoiling, including fetal death (OR, 3.7; 95% CI, 1.9-7.4), iatrogenic preterm delivery, an umbilical arterial pH below 7.05, fetal structural or chromosomal abnormalities, thrombosed fetal placental vessels, chronic fetal hypoxia/ischemia, and lower weight for gestational age.Both overcoiling and undercoiling of the umbilical cord vessels are associated with adverse pregnancy outcomes. The investigators propose that the UCI be a routine part of assessing the placenta after delivery. The logical next step is a prospective study to determine the significance of under-and overcoiling of the cord vessels in an unselected population.

The use of misoprostol for mid-trimester pregnancy termination is not contraindicated in women with Caesarean scar and is effective and comparable with those in women without scarred uteri.

Administration of prophylactic antibiotic at 30-60 min before skin incision resulted in better maternal outcome when infectious morbidity and postoperative hospital stay were concerned, without influencing the neonatal outcome.

In a prospective comparative study we screened 112 women with a past history either of pre-eclampsia, eclampsia, recurrent abortion, IUGR, IUFD or abruptio placentae, with no apparent aetiology and a demographically matched cohort of 106 women having a past history of uncomplicated pregnancy outcome for the presence of antiphospholipid antibodies (aPL) and their significance. In the former group, the prevalence of aPL ranged from 10-46.87% compared with 8.49% in the later group. In women with the presence of aPL, the incidence of pre-eclampsia, early onset pre-eclampsia and abruptio placentae were 25%, 14.58% and 18.75%, respectively. In the same group, the abortion rate was 25% and live-birth rate was 64.58% with IUFD rate of 10.42%. Fetal morbidity rates were also higher in the mothers with aPL positivity, the incidence of IUGR was 27.08% and oligohydramnios was 33.33% in them. All these complications were statistically significant when compared with those of aPL negative mothers.

Moistening misoprostol tablets with 5% acetic acid before vaginal application creates no difference in outcomes when compared with those after the vaginal application of dry tablets for the termination of second-trimester pregnancy.

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