Jiji Elizabeth Mathews

Comparison of two World Health Organization partographs

Objective: To compare two World Health Organization (WHO) partographs — a composite partograph including latent phase with a simplified one without the latent phase. Method: Comparison of the two partographs in a crossover trial. Result: Eighteen physicians participated in this trial. One or the other partograph was used in 658 parturients. The mean (S.D.) user‐friendliness score was lower for the composite partograph (6.2 (0.9) vs. 8.6 (1.0); P = 0.002). Most participants (84%) experienced difficulty “sometimes” with the composite partograph, but no participant reported difficulty with the simplified partograph. While most maternal and perinatal outcomes were similar, labor values crossed the action line significantly more often when the composite partograph was used, and the women were more likely to undergo cesarean deliveries. Conclusion: The simplified WHO partograph was more user‐friendly, was more to be completed than the composite partograph, and was associated with better labor outcomes.

Uterine rupture in a multiparous woman during labor induction with oral misoprostol

A multigravida with gestational diabetes, mild pregnancy‐induced hypertension and a previous curettage received four doses of misoprostol (100 μg) at three hourly intervals for induction of labor at term. Vaginal delivery of a live healthy baby occurred 1 h after the fourth dose. Hindwaters were bloodstained. Three hours later, she had excessive bleeding. Examination showed that the left lateral uterine wall had ruptured. She recovered after hysterectomy and blood transfusions.

Comparison of neonatal outcomes in women with gestational diabetes with moderate hyperglycaemia on metformin or glibenclamide--a randomised controlled trial.

Two oral hypoglycaemic agents, metformin and glibenclamide, have been compared with insulin in separate large randomised controlled trials and have been found to be as effective as insulin in gestational diabetes. However, very few trials have compared metformin with glibenclamide.

Subclinical chorioamnionitis as a causal factor in unexplained stillbirths

Subclinical chorioamnionitis has been implicated as a cause for stillbirths 1 3 . However, it is unclear if chorioamnionitis is an independent risk factor for unexplained stillbirth. We used a prospective case control design to determine the role of subclinical chorioamnionitis in unexplained stillbirths in India. Women with unexplained stillbirths at or beyond 26 weeks gestation were the cases. Two controls were selected for each case, matched for gestation and sex of infant. The first group comprised women who had stillbirths with identifiable causes; the second included women who had delivered live babies. For each case, the next eligible women were selected as controls. Assuming a

Retrospective cohort study comparing neonatal outcomes of women treated with glyburide or insulin in gestational diabetes: a 5-year experience in a South Indian teaching hospital.

OBJECTIVE To assess the effectiveness of glyburide in preventing complications of gestational diabetes in neonates as compared to insulin. MATERIALS AND METHODS Information from birth register, maternal and neonatal records were obtained. Five hundred and seventy-seven gestational diabetics with moderate hyperglycemia i.e., with highest fasting plasma glucose value of ≤130 mg/dl and/or highest post-prandial value of ≤250 mg/dl treated with insulin or glyburide were included from a cohort of 769 women needing additional therapy to initial diet therapy during a 5-year period. Thus neonatal outcomes of 303 women treated with insulin and 274 women treated with glyburide were compared. RESULTS Baseline plasma glucose levels in the group treated with insulin were higher. The mean birth weight (SD) of the neonates in women treated with insulin was 3021.3 g (604.19) as compared to 3104.6 g (499.35, P = 0.07) in the group treated with glyburide. Neonatal outcomes such as hypoglycemia (4.9%, 3.6%, P = 0.44), hypocalcemia (1.3%, 0.7%, P = 0.48), polycythemia (1.7%, 0.7%, P = 0.31), macrosomia (11.6%, 8.7%, P = 0.26), congenital anomalies (2.1%, 2.3%, P = 0.87), birth trauma (1.4%, 1.2%, P = 0.79) were similar in both groups. Neonates of women treated with insulin were more likely to have hyperbilirubinemia (11.5%, 6.5%, P = 0.03). CONCLUSION Neonatal outcomes of women treated with glyburide were comparable to those in women treated with insulin. More number of neonates of mothers treated with insulin had hyperbilirubinemia compared to neonates of mothers treated with glyburide (11.5%, 6.5% P = 0.03).

Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction.

To compare 25 μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction.

A nested case–control study to evaluate the association between fetal growth restriction and vitamin B12 deficiency

To study the association between maternal vitamin B12 levels and fetal growth restriction.

Acromegaly in pregnancy

Pregnancy in a patient with acromegaly is a rare occurrence. Here in, we report a patient with acromegaly who presented to us in the 2nd trimester of pregnancy with visual loss in the right eye. Her vision improved after surgery. She went on to have an uneventful pregnancy and delivered a term baby, by caesarian section. One year following her delivery, she received stereotactic radiotherapy. Subsequent follow-up revealed that her tumor had regressed and her IGF-1 levels had normalized.

A randomised controlled trial comparing 30 mL and 80 mL in Foley catheter for induction of labour after previous Caesarean section

Inducing labour with a Foley balloon catheter rather than using oxytocin or prostaglandins is considered to be less risky if the uterus is scarred.1 It is not known if more fluid in the balloon is more effective without being more dangerous. Volumes of 80 mL and 30 mL were compared in 154 eligible women. Mode of delivery, duration of labour and delivery within 24 h were similar in both groups. However, the second group required oxytocin more frequently. Though more scar dehiscences occurred in the first group, the difference was not significant.

A Case Control Study to Evaluate the Association between Primary Cesarean Section for Dystocia and Vitamin D Deficiency.

BACKGROUND Milder forms of vitamin D deficiency could be responsible for poor muscular performance causing dysfunctional labor. The aim of our research was to study the association between vitamin D deficiency and primary cesarean section. MATERIALS AND METHODS This was a case control study. Forty six women who delivered by primary cesarean section with dystocia as primary or secondary indication after 37 weeks of gestation were taken as cases and a similar number of women who delivered vaginally were taken as controls. Vitamin D deficiency was diagnosed when the serum 25(OH)D level was ≤20 ng/ml and this was compared between cases and controls. RESULTS Median serum (OH) vitamin D levels was 23.3ng/ml among women who delivered by cesarean section and 26.2ng/ml among controls (p=0.196). Baseline characteristics were similar in both groups except for a strong association between Body Mass Index (BMI) and cesarean section, (29.7kg/m(2) in cases and 25.9kg/m(2) in controls p=0.001) seen in multivariate analysis. Vitamin D deficiency was seen in 34.8% of cases and 21.7% of controls (p=0.165). CONCLUSION This small case control study did not show a significant association between vitamin D deficiency and primary cesarean section.