To assess the effectiveness and acceptability of twice versus once-only Artificial Sweeping of Membrane (ASM) among uncomplicated primigravidae at 40 weeks of gestation in a tertiary care hospital in Sri Lanka. Methods A randomized controlled trial was performed among 240 uncomplicated primigravidae with ≤5 Modified Bishop's Score (MBS) at 40 weeks of gestation at teaching hospital Kandy from August 2013 to May 2014. Following randomization both groups received ASM at 40 weeks of gestation and the intervention group received a repeat ASM after 48 hours (40 weeks +2 days). The MBS was reassessed at 40 weeks +5 days. Participants who did not have spontaneous onset of labor (SOL) at 40 weeks +5 days were managed according to the ward policy of cervical ripening and Induction of Labor (IOL). Perceived discomfort, acceptability of the method, neonatal, maternal and labour outcomes were assessed. Results More participants in the intervention group established SOL within 48 hours compared to the controls (61.6% vs. 45%, RR=1.37, 95% CI=1.1-1.7, NNT=6). However,

No abstract

CaseA 35 year old mother of one admitted from our antenatal clinic at 34 weeks of period of gestation for the tertiary care management of a dichorionic diamniotic (DCDA) twin pregnancy.At the age of 20 years, she was diagnosed to have a Rathke's pouch cyst, which was surgically drained and followed by radiotherapy. Post-interventional panhypopituitarism was diagnosed and she was on hormone replacement for hypocortisolism, hypothyroidism and hypopogonadotropic hypogonadism; while growth hormone was not replaced due to lack of funding. She was replaced with oral levo-thyroxine, hydrocortisone (20mg daily in split doses) and the combined oral contraceptive pill (OCP). The patient remained symptomfree and returned to full time work. Upon her request, at the age of 28 years as fertility treatment, induction of ovulation with gonadotrophins was done. During the second cycle of treatment with recombinant FSH for follicular development and maturation with subsequent human chorionic gonadotrophin (hCG) for ovulation following ultrasound ovum tracking coupled, with Intra Uterine Insemination (IUI) resulted in a singleton intrauterine pregnancy. AbstractPanhypopituitarism is characterized by inadequate or absent production of anterior pituitary hormones. This involves hypofunction of most of the major endocrine functions that affect fertility and reproduction. Deficiency of all six anterior pituitary hormones leads to deficiencies of gonadotrophins (FSH, LH), thyroid axis (TSH), adrenocortical hormones (ACTH), Growth Hormone (GH) and Prolactin (PRL). GH and gonadotrophin deficiency are commoner (1) than TSH and ACTH deficiency (2).Although pregnancy after complete loss of pituitary function is uncommon, advances in fertility treatment have led to increased pregnancy rates in these women. Problems related to pregnancy include infertility, lactation failure and increased risk of complications such as miscarriage, anaemia, pregnancy-induced hypertension, placental abruption, premature birth, and postpartum hemorrhage (3,4,5). Conception in this group of patients usually requires the support of assisted reproductive techniques. Induction of ovulation by means of human or recombinant gonadotrophins is widely used in current practice. Progestrogen support following conception, optimizing other hormonal replacement and careful monitoring throughout pregnancy play a vital role in successful pregnancy outcomes. We report a subject with panhypopituitarism who was managed in our Endocrine Antenatal clinic with successful outcome.

This is the fourth article in the series of articles unfolding avascular spaces of the pelvis. Authors recommend reading the series of articles starting from "Drive safely through the pelvis -know your pelvic roads: Retropubic space of Retzius" published in the Sri Lanka Journal of Obstetrics and Gynaecololgy 1 .

No abstract