Nivedita Sarda

Role of sublingual misoprostol for cervical ripening prior to vacuum aspiration in first trimester interruption of pregnancy

This is a prospective randomized clinical trial evaluating, for the first time, the effectiveness of sublingual route of misoprostol for cervical priming prior to vacuum aspiration (VA). The trial included 100 women seeking first trimester abortion who were sequentially randomized into two groups of 50 each. Patients of study group received 400 microg sublingual misoprostol 3 h prior to VA while those of the control group did not receive any premedication for cervical ripening. For all periods of gestation between 6 and 12 weeks, misoprostol significantly reduced pain score, blood loss, time duration and rate of complications without increasing the side effects. Sublingual misoprostol is an effective alternative to mechanical cervical dilatation. It can be self-administered and has a good patient-acceptability rate. As no study has evaluated the role of sublingual route of misoprostol for cervical priming before VA, wider studies should be done to advocate its routine use.

A randomised comparison between sublingual, oral and vaginal route of misoprostol for pre‐abortion cervical ripening in first‐trimester pregnancy termination under local anaesthesia

Objective:  To compare efficacy of sublingual (S/L), oral and vaginal routes of misoprostol administration for cervical priming before suction evacuation (SE) under local anaesthesia.

Impact of Injectable Progestogen Contraception in Early Puerperium on Lactation and Infant Health

INTRODUCTION Unmet need for family planning approaches 40% or higher and many women are at risk of unintended pregnancy. Progesterone contraception after birth is frequently recommended, but concern remain of inhibition of lactation or effects on infant health. In present study we aimed to evaluate impact of short term use of injectable depot medroxy progesterone acetate (DMPA) if given in early post partum period on infant health and breast feeding performance. MATERIAL AND METHODS A prospective case control study was conducted and 250 women immediately after delivery were recruited in the study. 150 women who were recruited as study group received Inj. DMPA 150 mg intra muscularly after initiation of lactation before discharge from hospital (Day 2-Day 10 of their delivery). 100 post partum women, not using hormonal contraception were taken as controls. All the subjects were followed to complete a full 6 months follow up. Duration and frequency of lactation, gain in weight, gain in height and any illness spells in the infant were noted at 6 weeks, 3 months and 6 months follow up. In the study group 100 subjects completed 6 months follow-up. The statistical analysis was carried out by using SPSS software version 7. The statistical technique used was z score(significance shown by z score> 1.96) and repeated measure analysis (two way Anova technique). RESULTS Hundred percent of primigravidas in the study group and 95% in the control group were satisfied with their lactation amount. The average gain in height was comparable in both study and control group {4.36±0.56 vs 4.33±0.54 (z score 0.38) at 6 weeks, 12.44±0.73 vs 12.40±0.71 (z score 0.39) at 3 months 17.30±0.91 vs 17.28±0.83 (z score 0.16) at 6 months}. Similarly average gain in weight was also not significantly different in two groups {0.89±0.11 vs 0.93±0.10 (z score 0.71) at 6 weeks, 1.77±0.17 vs 1.78±0.16 (z score 1.07) at 3 months and 3.53±0.30 vs 3.46±0.33 (z score 1.19) at 6 months}. The results were comparable with other studies. CONCLUSION Injectable DMPA use as a contraceptive in the immediate post partum period was found to be a safe and effective alternate method with no deleterious effect on mothers milk and infants growth.

Role of phosphorylated insulin-like growth factor-binding protein-1 and cervical length measurements in predicting pre-term delivery

Preterm birth is the leading cause of perinatal morbidity and mortality. It is of great clinical importance to find markers that could help in identifying women with threatened pre-term labor who have the highest risk of pre-term delivery and who might benefit from timely admission. The objective of the present study was to evaluate the use of cervical phosphorylated insulin-like growth factor-binding protein 1 (phIGFBP-1) in the prediction of pre-term delivery and to assess its association with cervical length measured by trans vaginal sonography (TVS), as a predictive diagnostic test. We enrolled 100 women between 20 and 35 weeks of gestation. Fifty subjects who had presented with symptoms of pre-term labor were recruited as Group A and another 50 with risk factors for pre-term birth but with no symptoms at the time of presentation as Group B. All the participants were subjected to cervical length measurement and rapid bed side test to detect phIGFBP-1 in cervicovaginal secretions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both tests were calculated and compared in terms of period of gestation at delivery and time lapse between test and delivery. Qualitative data were analyzed by using Chi-square test and Fisher′s exact test, whereas quantitative data were analyzed by using unpaired Student′s t test and Mann-Whitney test. P value < 0.05 was considered significant. In the symptomatic group, sensitivity, specificity, PPV, and NPV of phIGFBP-1 in predicting delivery within 48 h, 7 days, 14 days, and preterm delivery (≤37 weeks) was 100%, 100%, 100%, and 76% (sensitivity), 52.6%, 60.6%, 62.5%, and 56% (specificity), 40%, 56.7%, 60%, and 63% (PPV) 100%, 100%, 100%, and 70% (NPV), respectively. Sensitivity, specificity, PPV, and NPV of cervical length in predicting pre-term delivery in symptomatic group was 20%, 96%, 83.3%, and 54.5%, respectively. In the asymptomatic group, sensitivity, specificity, PPV, and NPV of phIGFBP-1 in predicting pre-term delivery was 0%, 87.5%, 0%, and 77.8% and that of cervical length was 0%, 95%, 0%, and 79.2%, respectively. The results of the present study suggest that phIGFBP-1 has high NPV for prediction of pre-term labor. Pre-term birth is very unlikely if the results of both tests, that is, phIGFBP-1 and cervical measurements are negative and therefore it could be of value in reduction of maternal morbidity by preventing unnecessary interventions.