OBJECTIVE : To evaluate the efficacy of vaginal misoprostol in bringing about evacuation of uterus in early pregnancy failure.

METHODS : A prospective observational clinical trial was carried out on 60 patients admitted with missed abortion or blighted ovum of less than 14 weeks gestation during the period from October 1999 to July 2001. Four hundred micrograms of misoprostol was placed into the posterior vaginal fornix and the pa tients were examined 24 hours later. If there was no response, ie., no expulsion of products of conception the same dose was repeated after 24 hours. The primary outcome was complete expulsion of uterine contents within 24 hours of initial or repeat misoprostol. Side effects were also noted.

RESULTS : Out of the 60 patients, 46 (76.7%) expelled their products completely with misoprostol, out of whom 43 (71.7%) expelled with single dose administration thus showing that the insertion of the second dose of misoprostol was not of much use in bringing about expulsion in cases who did not respond to the first dose. The mean insertion expulsion time was 9.7 ± 5.6 hours. Even in the failed group of 14 patients (23.3%), 10 (71.4%) showed favorable cervical changes, which made subsequent evacuation much easier without dilatation.

CONCLUSION : The use of 400 Ilg of vaginal misoprostol for early pregnancy failure resulted in complete expulsion of the products of conception in 71.7% of the patients after single dose and in 76.7% after two doses thus reducing the need for surgical treatment. When complete drug induced expulsion did not occur within 24 hours of the second dose of misoprostol, the cervical ripening property of misoprostol helped in performing surgical evacuation without dilatation.

OBJECTIVES : To study the cases of obstetric hysterectomy over a 5-year period (June 1996-May 2001)in a teaching hospital to determine the incidence, indications and associated complications with a view to suggest ways of improving outcome.

METHOD : Twenty-six obstetric hysterectomies performed during the study period were analyzed.

RESULTS : During the study period there were 26 cases of obstetric hysterectomy out of 33371 deliveries giving an incidence of 0.0779%. The incidence of hysterectomy following vaginal delivery was 0.0106% and that of cesarean hysterectomy was 0.39%. Majority of the patients were unbooked (76.9%) and were in the age group of 26-35 years (65%). Common parity group was parity 3 and 4. Morbid adherence of placenta was the commonest indication contributing to 26% (7/26) of the cases. There was no maternal death in the study.

CONCLUSION : Emergency obstetric hysterectomy is a rare operation (1 in 1284 deliveries). In spite of intra-operative risk and possible postoperative complications, it remains a potentially life-saving procedure.

OBJECTIVE : To compare the effect of transcutaneous electrical nerve stimulation (TENS)with 100mg intramuscular tramadol for pain relief in labor.

METHODS : Thr ee hundred women wi th 37 to 42 weeks pregnancy in active phase of labor without any fetal or maternal complication were randomly alloca ted to thr ee groups. To 100 women TENS was applied, 100women received tramadol100 mg intramuscularly while 100were taken as controL

RESULTS : Eighty percent in the TENS gro up, 86% in the tramadol group and none in the control group achieved significant pain relief. Onset of analgesic effect started in 11.7 minutes and lasted for 3.96 hours in tramadol group while in TENS group it started in 5.18 minutes and lasted for 3.30 hours.Maternal and fetal complications were more in the tramadol group in comparison with other groups.

CONCLUSION : Pain relief in labor with TENS is as good as that with tramadoL TENS has hardly any side effects.

OBJECTIVE : To study the perinatal outcome after embryo reduction in multifetal pregnancy.

METHOD : Eig h t patients with hi gh order gestation (3 to 5) underwent fetal reduction by intracardiac injection of potassium chlori de under ultrasonic guidance.

RESULTS : In one woman with quintuplet pregnancy, the fetuses were reduced to two. Of the five women with quadruplet pregnancy, four were reduced to two and one was reduced to thre e fetuses. In two triplet pregnancies, the fetuses were reduced to two. One patient aborted at 21 weeks, two delivered at term and five delivered preterm. All babies did well.

CONCLUSION : Multiple pregnancy reduction is a safe proc edure and a viable option to reduce complication rates in high order preg nancies

OBJECTIVE : To find out whether socio-demographic det erminants are risk fac tors for pregnancy wast age.

METHODS : Retrospective study war done on women more th an 44 years old, of low socio economic status and living in an u rban community. Sampl e size was determined as 3236 pregnancies. The subjects were selected by systematic random samplin g. To obtain the desired sample size 476 women had to be interviewed. The different types of pregnancy wastage (PW) were analyzed according to some variables viz. age, literacy, occupation of the mother, birth order, and birth interval between pregnancies. Z test of proportion was employed where applicable. Predictive models were prepared for PW according to some of the studied va riables.

RESULTS : PW was observed to be maximum in the women ab ove 35 years of age (16.58%) and minimum in 20-24 year age group (7.73%). A second degree parabola was fitted in th e curve obtained: y = 0.382859867 - 0.02378328x + 0.00048543x2 , where y is the percentage of PW and x is th e age in ye ars. Lowest percentage was ob tained at 3rd order of birth( 6.62%) and highest at 8th and ab ove (22.60%). A second de gree parabola was fitted: y = 0.1330678 - 0.031077x + 0.0053374x2 , where y is th e per centage PW and x the birth order. PW amongst the illiterate mothers (12%) was significantly higher (Z = 2.90, P < 0.001) than that in lite rate mothers (8.01%). PW amongst women employed during pregnancy (17%) was significantly higher (Z = 5.98, p< 0.001) than that amongst pregnancies where the mother was not employed (9.30%).

CONCLUSION : Socio-demographic factors play a major role in causing pregnancy wastage.

OBJECTIVES : To study the effects of fibroid on pregnancy outcome and effect of pregnancy on fibroids.

METHODS : Analysis of nine cases of pregnancy with fibroids over a period of 5 years.

RESULTS : There were two primigravidas and seven multigravidas. Two patients aborted and two had preterm deliveries. There was one still birth and one neonatal death.

CONCLUSION : Pregnancy with fibroids results in poor outcome.

OBJECTIVE : To study th e problem of recurrent fibroids.

METHODS : Twelve patients ofrecurrent fibroids seen over a 12 year period from 1991-2002 were analysed.

RESULTS : of the 12 patients, three underwent hysterectomy, one is under treatment with GnRH analogues and one continues to have recurrent fibroids. Three patients have conceived with recurren t fibroids and tw o have delivered. Their fibroids are not growing. Five patients did not conceive.

CONCLUSION : Careful evaluation and individualization of treatment is necessary in tackling this challeng ing problem.

OBJECTIVE : To find out the role of colposcopy and colposcopy directed biopsy in evaluation of entire lower female genital tract in symptomatic women.

METHODS : Colposcopy was carried out on 175 consecutive, referred patients who presented with symptoms like vaginal discharge, postcoital bleeding and post-menopausal bleeding or were found to have abnormal cervix on inspection or had a suspicious cytology.

RESULTS : Colposcopy and colposcopy directed biopsy could pick up 18 cases of low grade and six cases of high grade squamous intra-epithelial lesion and one case each of adenocarcinoma of the cervix, squamous cell carcinoma of the cervix and squamous cell carcinoma of the vagina. Subclinical HPV infection of vulva was also detected in seven cases.

CONCLUSION : Colposcopy is an extremely useful examination tool, in selected cases, to evaluate entire lower female genital tract and not just the uterine cervix.

OBJECTIVES : To study the lesions encountered in the fallopian tube.

METHODS : Six hundred and eighty seven fallopian tube specimens either sent separately or along with oth er femal e genital tract organs were reviewed thoroughly on the basis of gross and microscopic findings. Data collected were anal yzed later.

RESULTS AND CONCLUSIONS : 33.48% cases had some tubal pathology, with inflammatory lesions forming the major group (124 cases) of tubal pathologies followed by tubal ectopic pregnancies (81 cases). Primary carcinoma of the fallop ian tube was a rare find ing.

OBJECTIVE : To find out if nafarelin acetate and triptorelin which are potent GnRHa are as efficacious as HCG in triggering ovulation in stimulated cycles,

METHODS : A prospective randomized comparative study was done. One hundred sixty-seven stimulated cycles in 66 infertile women undergoing intrauterine insemination were randomly assigned to receive either nafarelin or triptorelin, or HCG at the midcycle when the predetermined criteria were met. Various outcome measures were analyzed in 154 cycles which qualified for comparison.

Results and Conclusion : It was found that the agonist preparations under study were equally effective as HCG in achieving comparable rates of ovulation. Conception rates were slightly lower though not statistically significanty so. Absence of ovarian hyperstimulation syndrome is an advantage. However, high incidence of short luteal phase can be a cause for concern.

OBJECTIVES : To study the antimicrobial use in obstetrics and gynecology with emphasis on its timing, frequency, dosage, route, duration, cost and rationality.

METHODS : Case records of 453 patients admitted in the Department of Obstetrics and Gynecology from 1ST April 2002 to 31st May 2002 were analyzed using method of Gajjar' with some modifications. Rationality scores were assigned considering selected drugs, their duration, routes, dosages, frequency etc. Comparison was done with standard treatment protocol and unnecessary cost was derived by subtracting the cost of standard treatment from the cost of prescribed treatment.

RESULTS : Antimicrobials were used in 431cases out of 453 giving an overall incidence of 95.14%. For further analysis of rationality, 340 cases meeting with inclusion criteria were used. Out of these 340 in 42 cases the prescriptions were found to be rational, in 112 semi- rational and in 186 irrational. Out of the total cost, 72% was found to be unnecessary.

CONCLUSION : Antimicrobial use is very high and in many cases irrational. Apart from unnecessary cost this can increase chances of antimicrobial resistance.

OBJECTIVE : To evaluate avoiding the use of synthetic graft in repair of incisional hernia by utilizing redundant skin as autograft thereby increasing cost-effectiveness and at the same time relieving the patient from the psychological tension of retaining a foreign body inside.

METHODS : Seven women who had undergone either lower segment cesarean section and two who had abdominal hysterectomy and subsequently developed incis ional hernia were taken for th is study. Out of these nine women, three had transverse incis ion and six longitudinal one. Instead of using synthetic grafts, redundant skin was prepared and used as graft for repair of hernia.

RESULTS : One woman de veloped in fection which was cured with regular dressing and antibiotics. There was no rejection, rehernia, or re-stitching. One woman, the one who had developed infection, had fever. Two women complained of abdominal discomfort in the immediate post-operative period .

CONCLUSION : Use of redundant skin as autograft in repair of incisional hern ia is more cost-effective than synthetic grafts. The acceptance of the graft is satisfacto ry and complications are minimal.