Aims: This study was done to evaluate the effectiveness of subcutaneous injection of sterile water compared with placebo in reduction of labor pain. Methods: Two hundred and forty pregnant women at term planned for normal vaginal delivery during the first stage of labor were randomized to receive either subcutaneous injection of sterile water (study group, n=120) or normal saline as placebo (control group, n=120) at painful point in lumbosacral region. Pain score was measured before and 10, 45 and 90 minutes after the injections. Main outcome measured was reduction of low back labor pain using visual analogue scale. Results: The mean pain score was equal in both groups prior to the injection. The pain scores were significantly lower among the intervention group compared to the control group at 10, 45, 90 minutes after injection. There was no difference between the two groups with regard to rate of instrumental delivery, cesarean rate and neonatal outcome.Conclusions: The subcutaneous injection of sterile water administered at painful point in lumbosacral area was effective in reducing low back labor pain during labor. DOI: http://dx.doi.org/10.3126/njog.v8i2.9777

Scar endometriosis or incisional endometriosis is the presence of endometrial tissues with glands in the previous incision or scar. Its overall estimated incidence after post-cesarean and post-hysterectomy is 0.03–0.4% and 1.08–2%, respectively. The patient presents with non-specific symptoms such as cyclical abdominal pain at the site of a previous surgical incision and scar and an abdominal lump with a cyclical increment in size, which is tender. The diagnosis is made only after the surgical excision with confirmation by histopathological analysis. We present the case of a 31-year-old female complaining of cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months. She had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior. Surgical excision was planned with the corresponding clinical features and radiological data. After the surgical excision, the sample was sent for histopathological examination, and scar endometriosis was diagnosed.

Background: Eclampsia is a multisystem disorder that may lead to deterioration of maternal condition, hypoxia and acidosis of fetus. Objective was to evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia. Methods: All patients with eclampsia were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to the patients and attendants about antenatal visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate, then the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition and mortality were then noted. Results: Fifty-two patients with eclampsia were admitted in the study period. Thirty-one patients required mechanical ventilator support. Twenty-five (48.07%) patients were delivered by emergency cesarean section and 30(57.6%) babies were low birth weight and there were 11(21.1%) stillbirths. There was one maternal mortality and 45(86.5%) patients were discharged with improvement but 6(11.5%) patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Conclusions: Early detection of hypertension and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes. Keywords: Eclampsia; maternal mortality; risk factors.

Aims: This study was done to assess the main causes of maternal mortality and other co-morbid factors contributing to maternal death at a university teaching hospital.Methods: A retrospective study was carried out in the department of Obstetrics and Gynecology analyzing all case record of maternal deaths from April 2008 to April 2011.Results: Eclampsia, unsafe abortion, puerperal sepsis, hemorrhages were the leading causes of death. Majority of the patients were unbooked. Conclusions:Eclampsia, sepsis and hemorrhage were the main causes of maternal deaths. Elderly ages, illiterate status, rural residence, presence of prior medical disease were statistically significant factors contributing to maternal death.

Aims:The aim of this study was to evaluate the effect of preoperative administration of rectal misoprostol onblood loss during and after elective cesarean delivery.Methods:It was a randomized trial including 200 women, divided into two groups (group A and group B), who were planned for elective cesarean delivery and didn’t have risk of postpartum hemorrhage (PPH). Group A received 400μg misoprostol per-rectal preoperatively and intravenous infusion of oxytocin after delivery as hospital protocol.Group B received only intravenous infusion of oxytocin. Primary outcome measureswere the estimated amount of intraoperative and postoperative (24 hours) blood loss and changes in hemoglobin levels 48 hours after delivery.Results:Intraoperative and postoperative blood loss in rectal misoprostol and oxytocin group were significantly reducedin comparison to oxytocin only group. Mean blood loss in groupA was 326.9±116.2 mlwhereas; in group B was 397.7±110.1 ml with p value of < 0.001 which was significant.The difference between preoperative and postoperative hemoglobin level after 48 hours was also significant (1.10±0.51 vs 1.35± 0.49 g/dl with p value <0.001).Conclusion: Preoperative rectal misoprostol was found to be an effective measure to reduce the intraoperative and postoperative blood loss during elective cesarean delivery.