BACKGROUNDHigh risk pregnancies poses a threat for fetoplacental vascular supply and are a risk for fetal growth retardation. Umbilical artery Doppler velocimetry is an important test among the invasive tests used for evaluating the fetal well-being. This study was taken to detect any abnormalities in fetoplacental unit and fetal circulation in high risk pregnancies, to identify the hypoxemic fetus and time the delivery before the occurrence of academia and to compare the perinatal outcome with doppler indices. STUDY DESIGN AND RESULTSThirty (30) patients with gestational age at or beyond 32 weeks of gestation who belong to high-risk pregnancies were included in the study and were subjected to clinical examination, biochemical tests, ultrasound and colour Doppler study. They were serially followed up with ultrasound and color Doppler at 34 and 36 weeks respectively. Findings of USG and Doppler studies were correlated with the perinatal outcomes. The uterine artery, umbilical artery and the Middle Cerebral Artery (MCA) Doppler indices for the corresponding gestational age were compared with the reference values. The middle cerebral artery Doppler index was considered abnormal, if the value was below the 5th percentile of previously published values for gestational age. A single cut off value (1.08) was used for Cerebroplacental Ratio (MCA PI/UA PI), above which the cerebro-placental ratio was considered normal and below which it was considered abnormal. CONCLUSIONSThe degree of abnormality in Doppler indicates the degree of fetal compromise. Absent End Diastolic Flow (AEDF) represents the extreme form of altered velocity in the umbilical arteries and it represents the fetus at highest risk of hypoxia. Reverse End Diastolic Flow (REDF) is an ominous sign indicating that the vascular resistance has reached a point where the blood flow is reversed during diastole indicating acidotic fetus. The foetuses with abnormal wave forms suffer from chronic hypoxia and are usually growth retarded. They are at increased risk for hypoxia and acidemia. The present study shows that in the high-risk pregnancies, serial Doppler velocimetry helps the obstetrician to identify fetus at hypoxia and timely delivery preventing acidemia.

Background: Induction of labour is a therapeutic option when the benefits of delivery outweigh risks of continuing pregnancy. There are several agents for induction of labour to achieve better outcome of labour. Acceptable methods for induction are oxytocin infusion, dinoprostone gel, misoprostol and mechanical cervical dilators. Prostaglandins are the preferred choice in unripened cervix. Objective of this study was to compare efficacy, safety of low dose oral misoprostol compared with intracervical dinoprostone gel for cervical ripening.Methods: One hundred women with single live fetus, term gestation, cephalic presentation, reactive fetal heart pattern and Bishops score <6 were included in the study. They were randomized to receive either 6 doses of 25ug oral misoprostol every 3rd hourly or 0.5ug intracervical dinoprostone every 6th hourly for a maximum of 3 doses.Results: Bishops score improvement after 6,12,18 hours in both the groups was statistically insignificant. Induction delivery interval was11.96±5.88 for misoprostol and 10.95±4.58 in dinoprostone group with P value 0.341 which was statistically insignificant. Need for oxytocin augmentation was less (18%) in misoprostol group as compared to dinoprostone group (44%). Caesarean section rate was slightly higher in misoprostol group (26% vs 24%). Meconium stained amniotic fluid was high in misoprostol group (16%) compared to dinoprostone group (8%). Maternal complications were minimal and neonatal outcome was good in both the groups.Conclusions: Compared to dinoprostone; misoprostol is easy to store, cost effective, stable at room temperature, can be easily administered and had better patient compliance and acceptability. It was found to be a better cervical ripening agent with similar maternal and fetal safety profile.

Background: Induction of labour is a therapeutic option when the benefits of delivery outweigh risks of continuing pregnancy. There are several agents for induction of labour to achieve better outcome of labour. Acceptable methods for induction are oxytocin infusion, dinoprostone gel, misoprostol and mechanical cervical dilators. Prostaglandins are the preferred choice in unripened cervix. To study the neonatal outcome in induction of labour with low dose oral misoprostol compared with intracervical dinoprostone gel and also to assess occurrence of meconium staining liquor.Methods: One hundred women with single live fetus, term gestation, cephalic presentation, reactive fetal heart pattern and Bishops score <6 were included in the study. They were randomized to receive either 6 doses of 25ug oral misoprostol every 3rd hourly or 0.5ug intracervical dinoprostone every 6th hourly for a maximum of 3 doses. Oxytocin was administered. Fetal outcome was assessed in terms of APGAR score, meconium staining and need for NICU.Results: Meconium stained amniotic fluid was high in misoprostol group (16%) compared to dinoprostone group (8%). NICU admissions were seen in 7 neonates in both groups.Conclusions: Low dose oral misoprostol is a safe method of labour induction. APGAR and NICU admission rates were comparable in both groups. Meconium staining was more in misoprostol group compared to dinoprostone group.