Background: There are multiple inducing agents available-pharmacological and non-pharmacological. The search for an ideal inducing agent continues worldwide. An ideal inducing agent should have less induction interval to delivery time, less side effects such as fetal distress and hyperstimulation, patient safety, economical, and have ease of administration. The two preparations of Dinoprostone (PGE2) gel and pessary were compared for efficacy in vaginal delivery, induction delivery interval (IDI), and cost effectiveness. Materials and methods: A prospective observational study was done in 100 patients in a tertiary level teaching hospital from 1 November 2019 to 31 March 2021. A total of 50 patients in group A received 0.5-mg PGE2 gel and 50 patients in group B had insertion of sustained release 10-mg PGE2 pessary for induction of delivery at term. The two groups were compared for the rate of vaginal delivery and IDI. Other variables, such as need of augmentation, fetal distress, postpartum haemorrhage (PPH), and neonatal intensive care unit (NICU) admission, were also compared. Results:The rate of vaginal delivery in both groups were similar. Mean induction to vaginal delivery interval was significantly lesser in the Dinoprostone pessary group (17.72 ± 6.81 hours for PGE2 pessary group vs 19.57 ± 5.46 hours for PGE2 gel group); duration of augmentation with Oxytocin was significantly lesser in the pessary group (5.68 ± 4.05 hours in pessary group vs 7.41 ± 3.44 hours in gel group). There was no significant difference in failed induction, uterine hyperstimulation, fetal distress, PPH, and NICU admission in the two groups. Conclusion: Dinoprostone gel and pessary are similar in rate of vaginal delivery. The IDI and need of oxytocin are less with PGE2 pessary. Failure rate is same for both PGE2 pessary and gel. In comparison, no marked superiority of pessary was seen over economical gel preparation.
Background: Ovarian torsion is a surgical emergency that can affect future fertility. Ovariopexy can be done to prevent recurrent torsion. However, despite ovariopexy, recurrent torsion can occur. Case description: On September 17, 2021, at 12 a.m., a 17-year-old unmarried girl presented to the gynecological emergency department. She gave a history of having had a sudden-onset of severe lower abdomen pain since 1 day. The patient gave a history of having had a laparotomy done for ovarian torsion 1 year back. On reviewing her discharge papers, it was seen that the patient had undergone right oophorectomy with contralateral ovariopexy 1 year ago. A provisional diagnosis of ovarian torsion was made, and at laparotomy, a torted left ovary was seen. Ovarian detorsion with oophoropexy using a new technique (hotdog in a bun) was done. Postoperatively, an ultrasound at 6 weeks follow-up showed a normal detorsion. Postoperatively, after ultrasound at 6 weeks follow-up, the patient is having normal ovary with normal AMH levels. Conclusion: Recurrence of torsion can occur even after oophoropexy. Timely intervention is a must to preserve ovarian function and future fertility.
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