ObjectiveThe objective of this study was to compare the effectiveness of vaginally administered misoprostol to that of vaginally administered dinoprostone at six-hour intervals in a well-homogenized cohort of full-term, nulliparous women with an unfavorable cervix and without any pregnancy complications.Materials and methodsA cohort of 100 nulliparous women at more than 40 weeks of gestation was included in this study. The primary outcomes to be measured were induction to delivery interval and incidence of vaginal births within 12 and 24 hours. Neonatal intensive care unit admissions for poor neonatal outcomes and obstetrical complications were secondary outcomes.ResultsA significant reduction in the induction to delivery interval was observed in the misoprostol group as compared to the dinoprostone group (10.2 ± 0.8 vs. 16.5 ± 0.7, p < 0.001). More women in the misoprostol group delivered within 12 hours as compared to the dinoprostone group (30 [60%] vs. 17 [34%], p < 0.001) and within 24 hours (48 [96%] vs. 39 [78%], p < 0.05). In the misoprostol group, spontaneous rupture of the membranes occurred more frequently (46 [92%] vs. 35 [70%], p < 0.05) with less need for oxytocin augmentation during labor (14% vs. 30%, p < 0.05). A significant reduction in additional dose requirement (7.5% vs. 22%, p < 0.05) and a lower rate of Caesarean section was observed in the misoprostol group (6% vs. 24%, p < 0.04). A statistically insignificant low Apgar score was noted in the dinoprostone group compared to the misoprostol group.ConclusionVaginally administered misoprostol is more effective than vaginally administered dinoprostone at six-hour intervals in nulliparous women beyond 40 weeks of gestation without pregnancy complications.

ABSTRACT   Objective To determine the frequency of meconium stained liqour in patients having gestation period of more than 40 weeks. Material and Methods This is a retrospective chart review of 495 patients treated at Khyber Teaching Hospital Peshawar Pakistan from September 2017 to September 2019. All the cases were identified from the medical record maintained at the Department. Laboring women having gestational age of more than 40 weeks were included in the study. Results A total of 495 patients were included in the study. The Frequency of meconium stained remained high (67.47%). Mean gestational age was 40 weeks with the SD of ± 1.084 weeks. With Primis (39.2%) and multis (60.8%), incidence of spontaneous labour was high (60%) as compared to induced labour (39.5%). Presence of meconium and fetal distress lead to high number of cesarean deliveries (64%). Out of total cases (334) delivered with meconium stained liquor, majority of cases (76%) were of grade 3MSL (39.5%) and grade 2 MSL (36.5%) respectively. 63.7% of cases led to cesarean deliveries. Conclusion Postdates pregnancy is a key factor causing meconium stained liqour. Timely induction of labour at 41 weeks of gestation is advised. Keywords Meconium stained liquor, postdates pregnancy, Meconium aspiration syndrome.

Objective: To determine the efficacy and safety of Foley’s catheter for uterine tamponade in the management of postpartum hemorrhage due to uterine atony. Material and methods: This observational study was conducted in the tertiary care hospital i.e. Department of Obstetrics and Gynecology Khyber Teaching Hospital Peshawar. A hundred patients with non-traumatic post-partum hemorrhage were enrolled from January 2021 to 31st July 2022. After the failure of medical therapy, Foleys catheter was placed in the intrauterine cavity for twenty-four hours to achieve uterine tamponade to stop bleeding in patients with postpartum hemorrhage. All the variables including vital signs and the amount of blood collected in the bag attached to the Foley’s catheter were noted and entered into a proforma. The main outcome measures were success rate in controlling hemorrhage, the time required to stop bleeding, and subsequent morbidity and technical difficulties. The average time taken to control bleeding was four minutes. Data were analyzed by SPSS 23. Results: The age of the patients ranged from 20-36 yearshile gestational age and parity were noted to be 37-39 weeks and 1-6 respectively. Foleys catheter for uterine tamponade was found successful in 98% of our patients who had uterine atony. Bleeding was stopped in 98 patients with this procedure. The Foleys catheter used was of 16 Fr size which is commonly available in our labor room setup. The total amount of fluid filled in the Foleys catheter was 240ml. The mean amount of time for which the catheter was in situ was 12.5 hours. Three patients had infective morbidity. Conclusion: The use of Foley’s catheter for uterine tamponade in the management of postpartum hemorrhage is a highly successful procedure. Key Words: Postpartum hemorrhage. Foleys catheter, uterine balloon tamponade.

Objective The study aimed to find the effect of 4 grams of intravenous bolus antenatal dose of magnesium Sulphate on maternal and neonatal outcomes in preterm births. Material and Methods In a one-year cross-sectional descriptive study,  patients with active preterm labor or those with planned preterm birth at 28-34 weeks of gestation were included. Antenatal magnesium Sulphate was administered as a 4gm IV loading dose over 30 minutes. The data was analyzed with SPSS (version 20), where mean ± standard deviation was used for numerical variables and frequency and percentages for categorical variables. The sample size was 88.  A P value <_0.05 is used as a threshold for statistical significance. Results The mean age of patients was 28.78 (± SD of 6.038) and the mean period of gestation remained 32.04 (±1.868). Similarly, the mean cervical dilatation at which magnesium Sulphate was given was 6.591 (±1.358), the mean baby’s weight was 1.655 (±0.508) kg, and the mean Apgar score at 5 minutes was recorded as 7.11 (±1.208). Regarding the period of gestation of the patients, 15 (17.04%) were at 28-30 weeks, 26 (29.54%) were at 30– 32 weeks and 47 (53.4%) were at 32– 34 weeks. Out of 88 patients, normal vaginal deliveries were conducted in 61 (69.38%) whereas, 27 (30.68%) patients had cesarean sections. Neonatal seizures were observed in 3 (2.6%), intraventricular hemorrhage in 2 (1.754%), Periventricular leukomalacia (PVL) 1(0.877%), and neonatal mortality in 5 (4.38%). Conclusion Magnesium Sulphate is a safe drug that plays an important role in protecting immature brains. Four-gram bolus is a sufficient dose as compared with infusion, which requires additional human resources and risks attached to prolonged infusions. Key Words: Magnesium Sulphate, Preterm Deliveries, Neonatal Neuroprotection, Intraventricular Hemorrhage