scholarly journals Sublingual versus vaginal use of Misoprostol for induction of labor

Author(s):  
Mamta Bansal ◽  
Indu Sharma ◽  
Jyoti Lagoo ◽  
Harish Jadhav

Background: Induction of labor is one of the great challenges for obstetric care provider. Misoprostol is used for induction of labor by various routes with the advantages in being cheap and stable at room temperature and widely available even in resource-poor settings.Methods: A randomized controlled study was conducted in the obstetrics and gynecology department of Govt. Medical College and associated Maharani Hospital, Bastar, Chhattisgarh, India over a period of 1.75 years from September 2014 to May 2016. Study has comprised of 200 pregnant women admitted in the department for induction of labor fulfilling the inclusion and exclusion criteria. Data was collected and analyzed by SPSS 16.0. z-test and chi-square test to compare the safety and efficacy of both the routes of misoprostol use for IOL.Results: There were insignificant differences in number of doses required for induction with satisfactory maternal and neonatal outcome but shorter (12 hours) induction delivery interval with sublingual Misoprostol induction. Most of the cases of both the groups were delivered by vaginal route (86% and 62%) within 12 hours of induction(58% and 42%) yet significant (p value < 0.001) number of cases had undergone caesarean in group of vaginal misoprostol administration (29%) with major indications of meconium stained liquor (3% and 12%) and non assuring fetal heart rate (1% and 10%).Conclusions: Although both the routes of induction by Misoprostol are well tolerated by the women with satisfactory neonatal outcome, sublingual Misoprostol has an added advantage of quicker delivery, less caesarean and ease of administration indicates better safety and effectiveness.

2020 ◽  
pp. 9-11
Author(s):  
Madhu Kumari ◽  
Kumari Bibha ◽  
Abha Sinha ◽  
Debarshi Jana

Objective: The objective of this study is to find out association between scar thickness, assessed sonographically, and intraoperative findings (IOF). Study Design: Descriptive study. Place and Duration of Study: Department of Obstetrics and Gynecology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from June 2019 to May 2020. Methodology: A total of 70 pregnant patients were included in this study. Transabdominal ultrasound was done for scarred uteri. Sonographic findings were co-related with introperative findings. All the given data were entered on SPSS version 23. Age was expressed as mean ± SD. Parity, gestational age, and interval between cesarean sections were expressed as frequencies with percentages. Statistical analysis was done by using Chi-square test for categorical data for association between sonographic scar thickness and intraoperative findings. The statistical significance was set at p-value <0.05. Results: The age range of the patients was 20- 36 years with a mean of 27.91 ±3.690 years. Gestational age at the time of cesarean section was between 27-40 weeks of gestation with a mean of 37 ±2.126 weeks. The interval from previous cesarean was 10 months at the minimum, and 6 years at the maximum with a mean of 2.29 ±1.0 months. Mean scar thickness was 2.5 mm. Association between scar thickness (<1-3 mm) and intaoperative findings of dehiscence and rupture showed a p-value of <0.001. Conclusion: Sonographic assessment of a uterine scar has a practical application to determine the thickness of previous scar, and assess its integrity.


Author(s):  
Mallikarjuna Rao I. ◽  
Usha Kiran Prayaga ◽  
Dharma Rao Uppada ◽  
Ramachandra Rao E. ◽  
B. L. Kudagi

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.


Author(s):  
Sneha Gond ◽  
Partha Pratim Sharma ◽  
Narra Madhuri ◽  
Kasturi Barman

Background: Aim of the study was to find out foeto-maternal outcome of multifoetal pregnancy in relation to chorionicity and to analyse the associated risk factors.Methods: This study was a prospective observational study on multifoetal pregnancy conducted at Midnapore medical college and hospital. Statistical analysis was done by chi-square test and statistical significance was set at p-value<0.05.Results: Incidence of multifoetal pregnancy was 1.7%. Modal age group was 20-24 years age and 82% conceived spontaneously. Among chorionicity, Dichorionic diamniotic (DCDA) were 60% followed by 34% Monochorionic diamniotic (MCDA), 4% Monochorionic monoamniotic (MCMA) and 2% Trichorionic triamniotic (TCTA). Among maternal complications preterm labour were present in both twins and triplets followed by anemia. LSCS was required in 60.8 % of twins and common indication was malpresentation. Majority of MC and TC were delivered at gestational age of 31-33 weeks (47.1% MCDA, 50% MCMA and 60% TCTA) and dichorionic delivered at 34-36 week (48.7%). Statistical association between neonatal outcomes and chorionicity were significant in IUGR (p=<0.0001), stillbirth (p=0.0356), congenital anomalies (p=0.0017), discordant growth (p<0.0001), Apgar score <7 (p<0.0001), low birth weight (p=0.014), live birth (p≤0.0001) and NICU admission (p<0.0001).Conclusions: Maternal and perinatal outcome was significant in monochorionic and trichorionic pregnancies compared to dichorionic pregnancies with increased NICU admissions required in monochorionic and trichorionic gestations.


Author(s):  
Monika D. Akare ◽  
Purvi K. Patel

Background: To compare the efficacy and safety of sublingual route of misoprostol with vaginal route of administration.Methods: This study was conducted at Department of Obstetrics and Gynecology, Medical College, Baroda, Gujarat, India. 50 cases each with a singleton term pregnancy and a live fetus requiring induction of labor were allocated to sublingual and vaginal administration of misoprostol. Outcome measures related to labor and maternal and fetal side effects were compared between the 2 groups and evaluated using Chi square test and relative risk (RR) with 95% confidence intervals (CI).Results: The sublingual route of misoprostol was associated with a reduced risk of failed induction, reduced time from initiation to induction, reduced induction to delivery interval and a higher incidence of maternal and fetal side effects. However, the differences were not statistically significant.Conclusions: The sublingual route of administration of misoprostol is comparable in efficacy and safety to the vaginal route for induction.


JKCD ◽  
2019 ◽  
pp. 1-4
Author(s):  
Nadia Munir

Objective: This study aimed to find out the fr equency of the MB2 canal in maxillary first molars, using different diagnostic methods. Materials & Methods: 106 patients, clinically diagnosed with irreversible pulpitis and exposed pulp, requiring endodontic treatment were selected via random non-probability purposive sampling technique for the study . This cross-sectional study was conducted for 12 weeks in the dentistry department of Ayub Medical College from August 2018 to October 2018. A detailed history was taken and documented in the pro-forma. After administration of Local anaesthesia and rubber dam application, the access cavity was prepared and floor of the pulp chamber visualized. MB2 Canal location was done with a naked eye and under magnification (x2.0 to x6.0) Magnification and confirmed by inserting size 08 K file. The data obtained were analyzed using SPSS version 20. Chi-square test was run to determine the association of the presence of the MB2 canal with other variables. P-value of 0.05 was considered to be significant.


2019 ◽  
Vol 6 (6) ◽  
pp. 2571
Author(s):  
Anupama Vinayak Mauskar ◽  
Amrit Gopan

Background: India is the country with highest burden of TB. There is paucity of data as far as Pediatric TB is concern. TB in children directly reflects intensity of on-going transmission of TB in a given community. This study was done including indoor cases of Pediatric pulmonary TB in a medical college hospital, a tertiary care institute in the city of Mumbai. The aim and objectives of this study the clinical profile and outcome of Pediatric pulmonary tuberculosis/MDR TB in an indoor setting of a tertiary care center. It was a clinical observational study in a setting of medical college hospital.Methods: All admitted children with newly diagnosed pulmonary TB were included in study. A detailed clinical analysis was done. Statistical Analysis Association between two qualitative data was assessed by Chi-Square test, Fisher's exact test for all 2 X 2 tables where Chi-Square test was not valid due to small counts. Comparison of quantitative data measured between two outcomes was done using unpaired t-test. PSPP version 0.8.5 was used for statistical analysis.Results: Total of 41 patients with pulmonary TB were included in the study, making admission rate of 0.7% of total admission. Three out of 41 children had MDRTB making incidence 7% of total TB patients. Severe acute malnutrition was a major risk factor for dissemination of disease and mortality (p value 0.031and 0.0017).Conclusions: The study estimates 0.7% admission rate and 7% as incidence of MDRTB in indoor patients. Severe malnutrition was found to be risk factor for dissemination of disease [p value 0.031].


Author(s):  
Uzma Kauser ◽  
Anjali Chaudhari

Background: Hypertensive in pregnancy is the second most common cause of maternal mortality in India. Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. The majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications. Objectives of this study were to find out the effectiveness of intravascular and intramuscular magnesium sulfate in management of eclampsia. To compare the side effects and complications of intravascular and intramuscular magnesium sulfate in management of eclampsia.Methods: A total 100 patients presenting with eclamptic fits reporting to the center that has been included in the study. The study has been conducted in the labor room of Nehru Chikitsalaya of B. R. D. Medical College, Gorakhpur, Uttar Pradesh for 12 months duration period. Statistical analysis of observations has been done by Chi-square test with p-value <0.05 has been considered in the study.Results: Majority of eclampsia patients belonged to 20-25 years age group (63%) followed by above 30 years of age (22%).  Nearly 16% patients in IM MgSO4 group and 12% patients in IV MgSO4 received recurrence of seizure after starting of treatment (p value >0.5). About 26% patients in IM MgSO4 group and 18% patients in IV MgSO4 group had mild side effects of MgSO4 but no patients in both the group had major side effects of MgSO4.Conclusions: The study concludes that intramuscular injection of MgSO4 is painful and the chances of abscess formation that's why compliance of intramuscular MgSO4 is not very good in compared to intravascular infusion of MgSO4. The chances of Mg toxicity are more MgSO4 regimen because of the dose required in IM MgSO4 regimen is more (44gm) that of IV MgSO4 (28 gm).


2021 ◽  
Vol 8 (10) ◽  
pp. 37-44
Author(s):  
Dhrubajyoti Maulik ◽  
Debjyoti Mandal

Background: Ileosigmoid knotting (ISK) is one of the rare causes of acute intestinal obstruction. It has a rapid course for forming gangrene. In this condition, the ileum and sigmoid colon wrap around each other, causing a knot and strangulation of both structures. ISK is extremely rare in North America most cases are reported in Asia and Africa. This is a surgical emergency and an attempt to relieve the obstruction must be done promptly. The management may range from a resection and anastomosis of the ileum and Sigmoid Colon, ileostomy and Hartmann's procedure depending on patients condition and gangrenous bowel segment. Method: It is a retrospective study. Data collection was done for three years from September 2018 to August 2021 in Bankura Sammilani Medical College and Hospital in the Department of General Surgery. Result: In our study 26 patients (M: F ratio 3:1) was identified with ileosigmoid knotting. The mean age of the patients are 43 years (SD+/- 13) in the study population. It more commonly affects males (76.92%) who are in the fourth decade of life. About fifty percent patients (53.84%) presented with shock (chi square test p value <0.05). The double segment gangrene (69.23%) is the most common presentation than single segment. The most of the patients was operated with ileal and sigmoid colon resection and ileostomy and colostomy. The septicemia (23.07%) is the most common cause of mortality in the study (chi square test p value <0.05). Conclusion: Ileosigmoid knotting is a rare cause of intestinal obstruction and bowel ischemia. So the early diagnosis and prompt surgical intervention in general includes bowel resection with ileostomy and or colostomy and or primary anastomosis. Keywords: Ileosigmoid knotting, volvulus, gangrene, ileostomy, Hartmann’s procedure.


Author(s):  
Chibi R. Vairamani ◽  
Brogen S. Akoijam

Background: Health research is a low priority area in the developing world, mostly due to inadequate research budgets and financially not rewarding venture. Medical students have a limited understanding of research and what it entails. Training on research theory to application, is an important but neglected part of medical education curriculum in the country, which needs to be paid more attention. The objective of the study was to assess the knowledge, attitude and perceived barriers towards conducting research among medical students in a remote medical college of India. Methods: This cross sectional study was done in the easternmost medical college of India during November-December 2015. A self-administered questionnaire was used to collect data from postgraduates and interns. Data were summarized using descriptive statistics. Chi-square test was used for comparing proportions. A p-value of <0.05 was considered significant. Results: Out of the total 493 eligible participants, 440 responded to the questionnaire. More than 3/5th of the respondents had inadequate level of knowledge of conducting research. Inadequate training (87%), lack of funding (76%), lack of motivation (67%) and no mentorship program (66%), were the major reasons cited by the respondents for not participating in research projects. Ever conducted research was associated with better knowledge of research. Majority of the participants wanted to know more about research. Conclusions: The study revealed inadequate knowledge but a positive attitude towards research. Sufficient training in research methods, skills and institution of mentorship program can boost participation in research. 


Author(s):  
Tamojit Chatterjee ◽  
Shrutakirti Ghosh ◽  
Rinki Saha ◽  
Sandip Samaddar

Introduction: Conjunctiva is a transparent mucous membrane that lines inside of the eyelids and covers the sclera. It is composed of non keratinised, stratified columnar epithelium with goblet cells. Normal microbial flora constitutes organisms which are present in eyelids and conjunctiva without causing any disease. At birth eyes are sterile but they are later infected by various organisms. Gram positive organisms are mostly prevalent in ocular flora. Diabetes mellitus is a multifactorial disease that can affect all ocular structures. Aim: To compare the microbial flora between diabetic and non diabetic patients and to study there sensitivity to antibiotics. Materials and Methods: This was an analytical study conducted on a total of 100 patients attending Department of Opthalmology of Medical College and Hospital, Kolkata, India between June 2019 to July 2019. They were not using any topical ocular preparation. Conjunctival swab was taken from upper fornix of the patients and cultured and the results obtained were analysed using Chi-Square test. Results: Conjunctival flora of a total of 100 patients, 30 diabetic and 70 non diabetic, were screened. Among the 30 diabetic patients, there were 15 (50%) male and 15 (50%) female. The most common isolated bacteria in diabetic and non diabetic groups were staphylococcus aureus (diabetic 70%, non diabetic 85.7%). There was a statistically significant difference in microbial flora pattern between the diabetic and non diabetic group. There was higher proportion of staphylococcus epidermidis among diabetic patients compared to non diabetic patients (p-value<0.01) and there was a higher proportion of staphylococcus aureus among non diabetics (p-value<0.01). Conclusion: Present study found statistically significant difference in the microbial flora between diabetics and non diabetics. This will help the clinician to plan for the antibiotic prophylaxis before surgery for patients attending the Out Patient Department (OPD).


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