Naima Fathima

Abstract

Introduction: The aim of induction is to achieve successful vaginal delivery where continuation of pregnancy is not desirable. Unfavourable cervix is one of the main causes of failed induction. Introduction of prostaglandins has revolutionised the scenario of cervical ripening. More than one dose of Prosta glandin E2 (PGE2) gel may be necessary to facilitate cervical ripening and increase the chances of vaginal delivery. Materials and Methods: This retrospective study was done to find the efficacy of multiple instillations of intravaginal Prostaglandin E2 gel and to compare the maternal and fetal outcome between the single instillation group and multiple instillation group. The women who went into labour or achieved cervical ripening with a single instillation of Prostaglandin E2 gel forms Group A. Those who required more than one instillation of prostaglandin E2 gel forms Group B. Both groups were compared for specific parameters. Results: Primigravidas required multiple instillations. Postdated pregnancy was the most common indication for Induction of Labour. 45.2% of primis had only single dose and 54.8% required multiple doses. About two third (77.8%) of multipara required only one dose and a third of multipara needed multiple doses. In Group A 90.7% had vaginal delivery, 9.3% had Caesarean section. Group B 95.7% had vaginal delivery and 4.3% had Caesarean section. Conclusion: Though PGE2 0.5mg gel is recommended to be used intracervically, it is equally effective intravaginally. Three doses of intravaginal PGE2 can be safely used without the risk of uterine hyperstimulation. There is no increased fetal risk with multiple instillations of intravaginal PGE2 gel. Keywords: Prostaglandin E2, Bishops score, Induction of Labour, Hyperstimulation.

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Abstract

Introduction: PPIUCD is a very safe, reversible, long term contraceptive. The recommended interval between pregnancies is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes. In our district the usage of PPIUCD is 0.1% and 60% of deliveries take place in private health facilities. This preliminary study is conducted in a private teaching hospital with the aim to determine proportion of women accepting PPIUCD and to develop our own data regarding immediate complications to guide us in counselling the women and to implement PPIUCD services. Materials and Methods: This prospective feasibility study was done from July 2017 to January 2018. 100 women attending the for antenatal checkups were counselled for PPIUCD. The women who consented were inserted with PPIUCD. Results: Acceptance rate was 30% and most of the women who accepted PPIUCD were primiparae (58.3%). An analysis of the reasons for acceptance of PPIUCD showed that long term efficacy (33.3%), safety (20%), fewer clinic visits (16.6%) and non hormonal (13.3%) were the most common reasons for acceptance. Conclusion: The PPIUCD is safe having no reported incidence of perforation with low rate of expulsion, pelvic infection and few lost strings and these complications can be reduced further with training and practice. The acceptance and continuation rates can be improved with counselling and strategic follow up protocols in our district with very low rate of PPIUCD usage. Keywords: Postpartum intra uterine contraceptive device, Long acting reversible contraceptives, Acceptance, Complications.

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