S Mitchell

Intravaginal misoprostol as a cervical ripening agent.

Objective To determine if misoprostol (exogenous prostaglandin E1 PGE1) used vaginally was of value in improving the Bishop score, leading to an early safe vaginal delivery in women in whom the cervix is unripe and delivery is indicated.

Postmenopausal uterine inversion treated by subtotal hysterectomy

Uterine inversion is extremely rare as a gynaecological complication with the majority of cases being reported as puerperal in the reproductive age group after a vaginal delivery. Non-puerperal cases are difficult to diagnose and most cases are diagnosed at surgery. Most of these reported cases are associated with uterine pathology, such as uterine fibroids, endometrial polyps, sarcomas or endometrial carcinomas. We report a case associated with multiple uterine pathology.

Induction of labour with intravaginal misoprostol versus dinoprostone in intrauterine death: A retrospective study

SummarySummaryBetween March 1992 and November 1994, 48 patients with intrauterine death had labour induced, 36 with the prostaglandin analogue misoprostol and 12 with the prostaglandin dinoprostone. Both were used as a single dose in 24 hours intravaginally. The patients were all of low parity and all but one were in the third trimester. Of those getting misoprostol, 92 per cent, and of those getting dinoprostone, 67 per cent, went into spontaneous labour. Eighty-one per cent of those getting misoprostol and 67 per cent of those getting dinoprostone delivered within 24 hours without the need for further prostaglandin or oxytocin, a difference that was not significant. No differences were found in other outcome variables such as diagnosis or induction to delivery time or need for oxytocin, between the two groups. Only one maternal medical complication occurred, chorioamnionitis in a patient who had misoprostol, and in whom labour was delayed 6 days.

Placental separation from a seat belt injury due to severe turbulence during aeroplane travel.

Introduction We present a case of a patient 14 weeks pregnant who while travelling by air sustained abdominal trauma from a lap seat belt during severe air turbulence. Clinical examination revealed lower abdominal tenderness and no vaginal bleeding. Ultrasonography revealed placental separation with a live fetus compatible with dates. We believe that, as in the case with car seat belts, shoulder restraints need to be provided for pregnant women who travel by air to avoid this and other obstetric complications.

Shoulder dystocia in a Jamaican cohort

To assess the risk factors for shoulder dystocia in Jamaica.

Outcome of radical hysterectomies performed by general gynecologists in Jamaica

To review the modified (type II) radical hysterectomy procedures performed by 4 general gynecologists at the University Hospital of the West Indies, and to compare the outcomes with those of other published studies.

Midazolam versus diazepam as premedication for gynaecologic laparoscopy done under local anaesthesia

SummaryA prospective randomised double blind trial was performed in 106 patients to compare the use of intravenous midazolam (mean dose 6·5 mg. range 4–9 mg) versus 10 mg diazepam. during gynaecologic laparoscopy under local anaesthesia. The parameters examined were: the ease of laparoscopy, patient tolerance, the amnesic effect and intra-operative blood pressure changes. Depth of sedation and recovery time were also measured, using the Trieger test. The preoperative demographic variables and the operators ability to perform the procedures were similar in the two groups. The patients were more deeply sedated with the midazolam but the recovery time was similar. The patients tolerated the procedure better with midazolam with fewer of them describing the procedure as unpleasant (22 per cent versus 53 per cent) (P<0·01), fewer of them had whole hod? movement during the procedure (24·5 versus 54·5 per cent) (P = 0·009) and more of them had amnesia for the procedure (85 per cent versus 36 per cent) (P < 0·4001...