Introduction Gestational diabetes is a common medical disorder in pregnancy. So long, it has been usually treated by insulin. Now it has been found that oral glibenclamide can be used instead of insulin with similar glycemic control and without any adverse maternal and fetal effect. Methods A comparative study between oral glibenclamide and insulin for the management of gestational diabetes mellitus (GDM) was conducted. It was a prospective randomized study and patients attending the antenatal clinic were screened with 75 gm oral glucose between 20 to 28 weeks and GDM was diagnosed based on WHO criteria of 2 hours blood glucose ≥140 mg/dl. Women with gestational diabetes were given medical nutritional therapy (MNT) for 2 weeks. Out of this, 60 women did not achieve the target blood glucose. The goal of treatment was maintenance of mean plasma glucose (MPG) of about 105 mg%. For this the fasting plasma glucose should be around 90 mg/dl and postprandial peaks around 120 mg/dl. Patients were randomly assigned to receive glibenclamide (group A, n = 30) or insulin (group B, n = 30). In group A, glibenclamide was given 2.5 mg orally in morning and doses were increased weekly by 2.5 mg up to a maximum of 20 mg and doses >7.5 mg were given in two divided doses. In group B, insulin 0.7 units per kilogram of body weight at admission was given subcutaneously three times daily and increased weekly as necessary. Self monitoring of blood glucose with glucometer was done. Blood glucose was also measured from the laboratory every week. Glycosylated hemoglobin (HbA1c) was measured before initiation of therapy and repeated in the third trimester before confinement. Terminations of pregnancy in both the groups were done between 37 and 38 weeks. The infant birth weight, blood glucose and serum bilirubin were also recorded in all cases. Results The present study showed that the two groups had similar glycemic status (fasting blood sugar in group A was 103.5 ± 14.62 mg/dl and postprandial blood sugar was 184.1 ± 20.46 mg/dl whereas in group B it was109.3 ± 19.63 mg/dl and 194.3 ± 18.47mg/dl) at the time of entry into the study. The two groups also showed similar levels of glycemic control just before confinement (fasting blood sugar in group A was 88.23 ± 6.55 mg/ dl and postprandial blood sugar was 122.7 ± 10.3 mg/dl whereas in group B it was 88.17 ± mg/dl and 128 ± 12.38 mg/dl) and there was no significant statistical difference in the two groups (p > 0.05). The perinatal outcomes in both the groups were also nearly same. There was no significant difference in birth weight, blood sugar level of neonates and complications between the two groups. There was no case of macrosomia in the two groups and the number of infants large for gestational age (LGA) was four in group A and two in group B. Hypoglycemia in newborn was slightly higher in the group A compared to group B (4 and 3 respectively). Conclusion From our study, it is evident that the use of oral agents is a pragmatic alternative to insulin therapy in cases of gestational diabetes because of similar glycemic control, ease of administration and better patient compliance due to noninvasive treatment. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Saha DP, Khalid N. Oral Hypoglycemic Glibenclamide: Can it be a Substitute to Insulin in the Management of Gestational Diabetes Mellitus? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):28-31.

Objective: Second trimester medical termination of pregnancy (MTP) can be done by surgical or nonsurgical methods or by various combinations of the two. Every method has its advantages and disadvantages. An ideal method would be one which was safe, quick and 100% effective, inexpensive and without any immediate or late side-effects. However, in the absence of such, various methods in synergistic combinations have been tried to come close to an ideal method. The successes of medical method now appear to be useful in MTP even in second trimester of pregnancy. Our objective is to investigate the effectiveness of only vaginal misoprostol and compare with oral mifepristone plus vaginal misoprostol in second-trimester induction abortions (≥12 and ≤20 weeks). Methods:The patients are selected after careful examination and necessary investigations were divided into group A (n = 62) which received 400 µg of vaginal misoprostol followed by 200 µg vaginal misoprostol 4 hourly till expulsion of fetus or a maximum dose of 2000 µg and group B (n = 60) which received 200 mg of oral mifepristone followed 48 hours later by vaginal misoprostol as in group A. Main outcomes measured were efficacy, blood loss, induction-abortion interval and complication. Results:The present study showed that the both methods were effective in 2nd trimester MTP. Average blood loss was lesser in group B (131.66 ml) compared to group A (150 ml). Induction abortion interval was shorter in group B (6.62 hours) than in group A (12.19 hours). Ninty percent of group B and 80.7% of group A had no complications. Success rate was higher in group B.Conclusion: Therefore, in our study, pretreatment mifepristone followed by misoprostol was found to be a very effective regimen for 2nd trimester abortion with lesser complications and higher efficacy.

Objective:Increasing new blood vessel formation (neoangiogenesis) within tumors is one of the adverse prognostic factors for survival in several cancers. Neoangiogenesis in vivo can be assessed by Doppler ultrasonography by measuring uterine artery pulsatility index (UAPI) in patients with gestational trophoblastic neoplasia (GTN). In this study we assessed whether UAPI can be an independent prognostic factor predictive of response to chemotherapy. Methods:This was a prospective observational study conducted in Medical College, Kolkata from May 2011 to December 2012. Twenty-two patients of GTN had their FIGO prognostic scoring done, 19 patients were of low risk (scored 6) and three patients were of high risk (score > 6). The 3 high risk GTN patients were excluded from the study. The study population therefore consisted of 19 low risk (scored 6) patients of GTN who were treated with fortnightly cycles of 50 mg of methotrexate IM on days 1, 3, 5 and 7 and with 15 mg of folinic acid rescue IM on days 2, 4, 6 and 8. Treatment was continued in all patients till hCG values were negative and 2 further cycles of chemotherapy were given. The patients were followed up with UAPI and serum -hCG levels every 2 weeks following chemotherapy to assess whether fall in -hCG correlated with rise in UAPI values following chemotherapy. Data collected were analyzed using standard statistical protocol. Results:The -hCG concentration of these patients at the time of diagnosis ranged from 1400 to 210,000 mIU/ml and UAPI varied from 0.47 to 2.1. The mean  hCG of these 19 patients before chemotherapy (week 0) was 63705.47 mIU/ml and subsequently following chemotherapy at the end of 16 weeks was 1.64 mIU/ml. The mean UAPI before chemotherapy (week 0) was 1.33 and following chemotherapy at the end of 16 weeks was 1.952. All patients achieved complete remission with chemotherapy. The fall in beta-hCG levels corelated with the rise in UAPI values. Conclusion:This study provides proof of principle that the UAPI can serve as a noninvasive in vivo measure of functional tumor vascularity, which independently can predict the response to chemotherapy.

Uterine Arteriovenous Malformation (AVM) is a rare condition, with fewer than 100 cases reported in the literature. It is a potentially life-threatening condition, as patients may present with profuse bleeding. Vascular lesions of the uterus are rare and the vast majority reported in the literature are those of arteriovenous malformations. Uterine AVM can be congenital or acquired. This case reports a woman with Uterine AVM presenting with heavy menstrual bleeding and a history of recurrent pregnancy loss.