Hafizur Rahman

Comparative Evaluation of 50 Microgram Oral Misoprostol and 25 Microgram Intravaginal Misoprostol for Induction of Labour at Term: A Randomized Trial

OBJECTIVES To assess and compare the efficacy and safety of 50 µg oral misoprostol and 25 µg intravaginal misoprostol for induction of labour at term. METHODS This non-blinded, randomized clinical trial included 228 pregnant women at term with obstetric or medical indications for induction of labour. Women either took 50 µg misoprostol orally (two 25 µg tablets) or had one 25 µg tablet of misoprostol inserted in the posterior vaginal fornix. In each group, misoprostol administration was repeated every four hours in the same dose until regular uterine contractions were established or to a maximum of five doses. Time to delivery and outcome data for each group were compared. RESULTS Of the 228 women, eight (3.5%) were excluded from the analysis as they withdrew their consent after randomization. Mean induction-to-delivery interval was similar in both groups (21.22 hours in the oral group vs. 20.15 hours in the vaginal group; P = 0.58). There was no significant difference between the groups with respect to the number of women who delivered within 24 hours or who required oxytocin augmentation of labour, the mode of delivery, and neonatal outcomes (P > 0.05). Uterine hyperstimulation occurred in two women who received misoprostol vaginally, but not in any of the women in the oral misoprostol group. CONCLUSION Oral misoprostol in a dose of 50 µg every four hours, to a maximum of five doses, has the potential to induce labour as safely and effectively as 25 µg misoprostol administered vaginally every four hours.

Knowledge of, attitudes toward, and barriers to the practice of emergency contraception among women in Sikkim, India.

To assess knowledge, attitudes, and barriers associated with the practice of emergency contraception (EC) among women from the state of Sikkim, India.

Knowledge, attitudes and practice toward cervical cancer screening among Sikkimese nursing staff in India

Objectives: To assess baseline knowledge of cancer cervix, screening and practice of Pap smear screening among Sikkimese staff nurses in India. Materials and Methods: Between April 2012 and February 2013, a predesigned, pretested, self -administered multiple responses questionnaire survey was conducted among staff nurses′ working in various hospitals of Sikkim. Questionnaire contained information about their demographics, knowledge of cervical cancer, its risk factors, screening methods, attitudes toward cervical cancer screening and practice of Pap smear amongst themselves. Results: Overall, 90.4% nurses responded that they were aware of cancer cervix. Three quarter of the staff nurses were not aware of commonest site being cancer cervix in women. Of the 320 participants, who had heard of cancer cervix, 253 (79.1%) were aware of cancer cervix screening. Pap smear screening should start at 21 years or 3 years after sexual debut was known to only one-third of the nursing staff. Age was found to be a significant predictor of awareness of Pap smear screening among nursing staff. Awareness was significantly more prevalent among older staff (P < 0.007). Married nursing staffs were significantly more likely to be aware of screening methods, and nursing staff of Christian and Buddhist religion were 1.25 times and 2.03 times more likely to aware of screening methods than Hindu religion respectively. Only 16.6% nurses, who were aware of a Pap smear (11.9% of the total sample), had ever undergone a Pap smear test. Most common reason offered for not undergoing Pap smear test were, they felt they were not at risk (41%), uncomfortable pelvic examination (25%) and fear of a bad result (16.6%). Conclusion: Knowledge of cancer cervix, screening and practice of Pap smear was low among Sikkimese nursing staff in India. There is an urgent need for re-orientation course for working nurses and integration of cervical cancer prevention issues in the nurses′ existing curriculum in India and other developing countries.

Reliability of admission cardiotocography for intrapartum monitoring in low resource setting

Background To evaluate the role of admission cardiotocography in intrapartum patients in detecting fetal hypoxia already present and to correlate the results of admission cardiotocography with perinatal outcome. Materials and Methods: It was a cross-sectional study conducted in the Labor and Maternity ward during the period 2007-2009. The study included 176 pregnant women (both high risk and low risk), admitted to the emergency department or through the outpatient department with period of gestation ≥36 weeks, in first stage of labor with fetus in cephalic presentation. All of them were subjected to an admission test, a 20 min recording of fetal heart rate and uterine contractions on cardiotocograph machine at the time of admission. Results: The results of the admission test were ‘reactive’ in 82.38%, ‘equivocal’ in 10.22%, and ‘ominous’ in 7.38% women. Women with the reactive admission test had low risk of intrapartum fetal distress (6.9%) as compared to 39.9% in the equivocal and 84.6% in the ominous group (P<0.001). Incidence of moderate to thick meconium stained liqor were more in ominous (61.5%) and equivocal group (33.3%) in compared to reactive group (4.8%) (P<0.001). Incidence of NICU admission was also significantly high (62%) in babies delivered from mother with ominous test group compared to those with equivocal (28%) and reactive test (3.45%) group babies. Neonatal mortality was also seen in babies born to mothers with equivocal (5.5%) and ominous (7.6%) admission test groups. Operative delivery for fetal distress was required in only 5.5% (8 of 145) woman of the reactive group, in 27.8% (5 of 18) woman of the equivocal group and in 84.6% (11 of 13) women of the ominous group. Conclusion: The admission cardiotocography is a simple non-invasive test that can serve as screening tool to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. The test has high specificity and can help in ‘triaging’ fetuses in obstetric wards of developing countries with a heavy workload and limited resources.

Influence of Research on Health Policy and Clinical Practice

AbstractClinical research is a type of biomedical research conducted to aid and support the development of knowledge wherein there is involvement of patient. One of the key duties of healthcare professionals is to involve in research and change existing practice, when there is robust evidence in favour of new strategies that can have better patient care. Knowledge derived from research and experience may be of little value unless it is put into practice. Evidence-based medicine (EBM) is the diligent, clear, and wise use of current best research evidence in making decisions about clinical care of patients. The practice of EBM is incorporating clinician’s expertise with the best available clinical evidence from research. It leads to improved patient outcomes and promote critical thinking and reflective practice. Effective research utilization can enhance policy decisions, resource allocation for programmes, and decisions about how to deliver those services.

Fetus Papyraceous in Uniovular Twin; Death of One Twin in Early Third Trimester and Successful Outcome of Other Twin at Term: A Rare CaseReport

Fetus papyraceous is a rare obstetric complication in multiple gestations, the incidence of which in case of twin is 1 in 12,500. It may be associated with high maternal and fetal complications including disseminated intravascular coagulation induced death and organ damage. Fetus papyraceous can occur both in uniovular and binovular twin pregnancies. However intrauterine death is three times more common in case of uniovular twin because of frequency of vascular connections (85-98%) in monochorionic placenta. Here, we report a case of uniovular twin pregnancy with one twin fetus papyraceous in early third trimester and pregnancy continued till term with a successful outcome of surviving co-twin.

Ruptured Primary Ovarian Pregnancy Presented in Advanced Gestation without Amenorrhoea: A Rare Case Report

A 28 year old gravid 2 para 1 living attended emergency department of our hospital complaining of pain in the abdomen for one day and light vaginal bleeding for one hour duration. She did not give any history of amenorrhea even after repeated enquiry and her previous menstrual cycles were reported to be normal in amount, duration and flow. She gave no history of sexually transmitted disease, pelvic inflammatory disease or any previous gynecological surgery. Her first pregnancy was a spontaneous conception and she had a full term normal vaginal delivery which was a hospital delivery. There were no post partum complications and no history of contraceptive use.

Determinants of Stillbirths in a Teaching Hospital of Sikkim Province of India

Determinants of Stillbirths in a Teaching Hospital of Sikkim Province of India Every year millions of stillbirths occur and are not given enough importance in global policy. Stillbirths are becoming increasingly important as it is an indicator of quality of health service and delivery care provided. The present study evaluates the stillbirth rate and its changing trends over 10 years and its demographic and associated risk factors.