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Ropivacaine in epidural anaesthesia is known to cause less motor blockade and high maternal satisfaction. ABSTRACTBackground: The pain of childbirth is one of the most severe types of pain that a woman experiences in her lifetime. Adequate analgesia during labour has a positive influence on the course of labour. For labor analgesia several nonpharmacologic and pharmacologic methods are adopted. The objective of the study is to compare parenteral tramadol and epidural ropivacaine with regard to maternal and labour outcome. Methods: This prospective, comparative, interventional clinical study was conducted at Kasturba Hospital, Daryaganj, Delhi, on the patients admitted in the labour room of the hospital during the period of September 2014 to July 2015. Various parameters of maternal condition and labour outcome in each group were monitored and compared. These included the degree of pain relief and patient satisfaction, duration of 1 st and 2 nd stage of labour, mode of delivery and duration of third stage and any third stage complication like post-partum haemorrhage (PPH) and retained placenta and side effect profile of both the drugs. Results: Epidural ropivacaine has significantly better analgesic efficacy and faster onset of action as compared to I/M tramadol and patients in epidural group were significantly better satisfied. Ninety-two percent of patients in tramadol group and eighty eight percent in epidural group underwent normal delivery. Duration of the three stages of labour, complications of third stage and side effect profile in both the groups were comparable. Conclusions: Maternal outcome in labour analgesia is similar with 100 mg I/M tramadol and epidural ropivacaine. There is no significant difference between duration of labour, rate of LSCS, incidence of instrumental delivery and neonatal outcome in the two modes of analgesia. Analgesic efficacy with epidural ropivacaine seems to be better compared to intramuscular tramadol.

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Background: Objective of the study was to compare the efficacy, outcome and side effects of sublingual and vaginal misoprostol for the medical management of missed miscarriage. Methods: Fifty women diagnosed as having missed miscarriage of gestational age less than 20 weeks were randomized to vaginal or sublingual route of drug administration by lottery method (random sampling) A total number of 25 cases in each of the two groups were considered. Women in Group A received 400 microgram of misoprostol sublingually every four hours for a maximum of 5 doses and those in Group B received 400 microgram of misoprostol vaginally every four hours for a maximum of 5 doses. The primary outcome measures were, complete evacuation of products of conception, mean induction to delivery time and the occurrence of side effects. Results: In complete evacuation rates between the sublingual misoprostol and the vaginal misoprostol groups there was no statistically significant difference. Mean induction to delivery time was also similar for both groups as was the total number of doses required. As far as Side effects were concerned, Diarrhea was the major frequent side effect of sublingual misoprostol seen in 32% cases against only 12% cases with vaginal misoprostol. Conclusions: The effectiveness of Sublingual misoprostol is comparable to that of vaginal misoprostol for medical management of missed miscarriage but is associated with an increased risk of side effects especially diarrhoea.