A Study on Pre-Induction Cervical Ripening with PGE2 Vaginal Tablet One (3 mg) vs. Half (1.5 mg) in Low Risk Multi Parous Mothers at 40 Weeks of Gestation

Backgrounds: Induction of labor is a common practice. In women with immature cervix, PGE2 is commonly used for pre-induction. We hypothesized that PGE2 1.5 mg may be equally effective to PGE2 3 mg in multiparous women for labor induction. The present effort was an attempt to compare the efficacy and effects of pre-induction cervical ripening with PGE2 3 mg vs. 1.5 mg in multi-parous mothers (2nd and 3rd Pregnancy) at 40 weeks. Methods: A double-blind randomized controlled trial was carried out at Castle Street Hospital for Women, Colombo, Sri Lanka. Study subjects consisted of women with singleton pregnancy (no cesarean history) admitted for delivery at 40 weeks of their 2nd or 3rd pregnancy. PGE2 1.5 mg vs. 3 mg PGE2 vaginal tablet were used for treatment (n = 173) and control (n = 170) groups, respectively. Cervical ripening and maternal, fetal complications were observed. Unfavorable cervices were induced with the same PGE2 dose in the following day. Results: Study group, compared with the control group, achieved the same rate of favorable cervices in 1st and 2nd cycles (63.5% vs. 64%, respectively). Both groups showed the same rate of cervical dilatation achievement, and admissions to Special Care Baby Unit. Study group showed significantly less maternal complications (4% and 11%, respectively: p = 0.01). Conclusion: PGE2 of 1.5 mg is equally effective in achieving favorable cervices, adequate cervical dilatation with minimum maternal complications compared to the usual 3 mg dose in multiparous low-risk women.

Pseudoainhum Associated With Lepromatous Leprosy:A Very Rare Association in Modern World

Introduction:Pseudoainhum(dactylolysis spontanea)is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation.Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions.Here,we present a rare case of pseudoainhum patient,which describes a very rare association of pseudoainhum with leprosy.Case presentation:A 48 year old male with lepromatous leprosy,with resorption of digits,charcot joints and tropical ulcers was seen in the clinic.The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx.He could not recall the duration of the ainhum.He was not suffering from any pain.Discussion:The current report describes a very rare association of pseudoainhum with leprosy.The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum.Conclusion:This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits,especially in leprosy.