Comparison of the Efficacy of Foley Catheter Balloon with Dinoprostone Gel for Cervical Ripening at Term

Objective: The purpose of this study was to compare the efficacy of extra-amniotic Foley catheter with intra cervical Dinoprostone gel for preinduction cervical ripening. Study Design: A randomized, prospective study was conducted in the Department of Obstetrics and Gynecology, PGIMS Rohtak on 100 pregnant women admitted for induction of labor. Fifty patients were randomized to receive Dinoprostone gel and 50 patients to receive intracervical, extra-amniotic Foley catheter. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.18 ± 1.81 and 4.6 ± 1.48 respectively, p < 0.001);however, there was no significant difference between the groups. Mean duration of induction to delivery was 18.51 ± 8.52 in Foley catheter group and 18.21 ± 11.13 in prostaglandin group, the difference being statistically insignificant. Among 50 cases of prostaglandin only single dose was sufficient for 23 (46%) cases to induce labor. But in 27 (54%) cases 2nd dose of prostaglandin were required. The expenditure of intervention showed that Rs. 325 were required for induction by prostaglandin as compared to Rs. 60/- for Induction by Foley’s catheter and the difference was highly significant statistically There was no difference between the groups in mode of delivery, infant weight, apgar score and intrapartum complications. Conclusion: In conclusion, although both Foley catheter and dinoprostone gel appear to be effective agents for cervical ripening. Foley catheter causes less fetal distress, cheap and safety profile of Foley catheter is such that it can be used on an out patient basis, but not dinoprostone gel. These results make Foley catheter comparable or even superior to dinoprostone gel for cervical ripening specially in developing countries.

A prospective randomized, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy

A prospective randomized, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy. Author: Dr Roopa Malik, Assistant Professor, Obstetrics and gynaecology department Pt BDS PGIMS Rohtak BACKGROUND: Vaginal misoprostol has been shown to be an effective single agent for medical agent for medical abortion. This randomized, placebo controlled trial compared a regimen of mefipristone and misoprostol with misoprostol alone for termination of early pregnancy. METHODS: 200 women with gestation <56 days were randomized by a random number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 ug vaginal misoprostol. Abortion success was defined as complete abortion without the use of surgical aspiration. RESULTS: Successful medical abortions occurred in 96 out of 100 subjects (96%) after mifepristone followed by vaginal misoprostol. In all, 79 out of 100 subjects (79%) successfully aborted after placebo and vaginal misoprostol. The higher success rate of complete abortion with mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen (p < 0.05). CONCLUSION: A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies <56 days than misoprostol alone. The misoprostol alone regimen for termination of early pregnancy is not a very good method for medical abortion but 79% efficacy obtained with vaginal misoprostol alone may clinically acceptable when mifepristone is not available.

Cord complications: associated risk factors and perinatal outcome

Objective: To assess the perinatal outcome in patients with cord presentation and cord prolapse over a period of 2 years and to assess the obstetric risk factors associated with these cord complications. Design: Retrospective case study. Setting: A tertiary health care centre of India. Sample: All cases of cord presentation and cord prolapse diagnosed in the department over a period of 2 years (2009-2010). Methods: The information regarding maternal presentation at the time of admission, mode of delivery, and neonatal outcome was retrieved from case sheets of patients available in Medical Record Department. Maternal factors in terms of age, parity, gestational age, mode of presentation, mode of delivery were analysed. Foetal outcome was assessed by Diagnosis to Delivery Interval, APGAR score at 0 minutes and 5 minutes, foetal weight and need for NICU admission. Results: There were 53 cases of cord complications, out of which 7 (13.20%) had cord presentation and 46 (86.80%) had cord prolapse. Among these 46 patients, 11 patients developed cord prolapse in labour room (3 after artificial rupture of membranes and 8 after spontaneous rupture of membranes), rest 34 patients presented in emergency with cord prolapse. There were 79.24% multiparous patients, 16 patients had malpresentations and breech was commonest malpresentation. Forty one patients had positive cord pulsations at the time of admission, all these patients underwent emergency caesarean section and all had live babies. Twelve patients reported to us with absent cord pulsation, 3 among these underwent section for obstructed labour with hand and cord prolapse, rest 9 delivered vaginally. The average DDI was 26.00 minutes, DDI in patients developed cord prolapse in hospital was 18.90 minutes ± 5.48 minutes, whereas in patients admitted with cord prolapse as emergency, the DDI was 29.34 minutes ± 6.37 minutes (p < 0.05). Conclusion: Analysis of the study concluded that the delivery interval between cord prolapse and delivery of the foetus is very important. Shortening of this interval can decrease neonatal complication at birth and reduce NICU admission.