Intravaginal misoprostol 100 µg for cervical ripening and induction of labour in nulliparous women with term pregnancy and unfavourable cervix: a case series report

Cervical ripening is a prerequisite for induction of labour in women adjudged to have an unfavourable cervix. Misoprostol administered intravaginally has previously been shown to be effective for cervical ripening and labour induction. It is often used in dosages of 25 µg or 50 µg in single or repeated dose regimen as per guidelines. Higher doses or shorter dosing intervals were reportedly associated with a higher incidence of side effects, especially uterine hyperstimulation syndrome. Studies and clinical experience have shown that 50 µg dose was not as effective in nulliparous women as it was in multiparous women, which implies that this dose might not be optimal for nulliparous women. We report a series of seven carefully selected patients in whom we used 100 µg of misoprostol intravaginally for cervical ripening and induction of labour at term. We achieved a short induction delivery interval, had good improvement in Bishop’s score, with less need for oxytocin augmentation and good safety parameters.

Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia

Background: Preeclampsia is a multisystem disorder causing vascular endothelial damage and leads to leakage of lactate dehydrogenase (LDH) into maternal serum. This study evaluated the serum LDH levels in severe preeclamptic women to detect any correlation with adverse pregnancy outcomes.Methods: A prospective cohort study compared LDH levels of 68 severe preeclamptic women with 68 normotensives in the third trimester, matched for age, parity, and gestational age. The preeclamptic women were followed up until delivery to assess the maternal and neonatal outcomes. Data were analyzed with SPSS for Windows version 23. The level of significance was set at p<0.05.Results: Both groups were comparable in their characteristics. The mean LDH level for severe preeclamptic group (717.40 IU/L) was higher than for the normotensive group (162.90 IU/L) and this was significant (p=0.001). Cesarean delivery was less likely when LDH was >600 compared to ?600 (OR 0.31; p=0.049) indicating a potential protective effect. The likelihood of IUGR (OR 3.14; p=0.045), IUFD (OR 6.48; p=0.028), stillbirth (OR 7.06 p=0.007), perinatal mortality (OR 4.84; p=0.004) and low birth weight <2500 gm (OR 3.77; p=0.025) were all significantly higher with LDH levels >600 IU/L.Conclusions: Maternal serum LDH levels were found to be significantly increased in pregnant women with severe preeclampsia compared to their normotensive counterparts, and elevated levels >600 IU/L in the third trimester was associated with adverse perinatal outcomes.

Predictors of poor maternal and perinatal outcome among singleton maternal delivery referral cases to the obstetrics unit of a tertiary health facility in Port Harcourt, Nigeria

Background: The high maternal and perinatal mortality rates in Nigeria continue to be issues of concern. That antenatal care improves both perinatal and maternal outcomes is now well established. The study seeks to identify the predictors of poor maternal and perinatal outcome among singleton maternal delivery cases referred to Rivers State University Teaching Hospital (RSUTH).Methods: A longitudinal study was employed; the patients referred to RSUTH were followed up to ascertain maternal and neonatal outcomes. A sample size of 460 was used. Selection of cases was done by systematic sampling. Data obtained in the study were demographic, obstetric and perinatal findings. Maternal and perinatal outcome were dichotomized into poor and good outcomes. Bivariate and multivariate analyses were performed using SPSS version 20.0.Results: A total of 460 cases were recruited. The mean age±SD was 28.7±4.6 years. There was poor maternal outcome in 65 (14.1%) and poor perinatal outcome in 291 (63.3%). There was one maternal death (rate 0.2%), perinatal mortality rate was 26.5%, low birth-weight rate was 6.3% and asphyxia rate was 23.3%. There is an association of multiparity and unbooked status with poor maternal outcome, while poor perinatal outcome was influenced by unbooked status.Conclusions: Perinatal and maternal mortality were high amongst all referral cases. There is a positive correlation of multiparity with poor maternal outcome and between unbooked status and an increased risk of both maternal and perinatal adverse outcomes.

Determinants of cervical cancer screening via Pap smear among female staff in a tertiary hospital in Niger-Delta of Nigeria

Background: Cervical cancer remains a leading cause of death among women in the developing world, with poor prognosis attributed to lack of awareness about the disease and its prevention. Hospital workers’ attitude and practice to such an issue might positively or negatively influence people they come into contact with. This study is to assess the determinants of cervical cancer screening via Pap smear among Female Staff in a Tertiary Hospital in Nigeria.Methods: A hospital-based cross-sectional study was conducted between September and November 2015. A structured self-administered questionnaire was used to collect data from 265 female hospital workers on socio-demographic characteristics (age, parity, educational level and occupational category) and awareness and utilization of Pap smear test. The data obtained were analyzed using SPSS version 20.0.Results: Of the 265 respondents, only 40 (15.1%) had Pap smear test done at least once previously. Bivariate analysis of socio-demographic factors and Pap smear test uptake among the respondents was statistically significant for younger maternal age ≤35 years, not being married, higher educational level, professional occupation category and awareness of Pap smear. However, only maternal age, marital status and awareness of Pap smear remain statistically significant after multivariate analysis.Conclusions: Uptake of Pap smear test as a screening test for cervical cancer is low among female hospital workers. Identified determinants of cervical cancer screening via Pap smear test were younger age ≤35 years, not being married, higher educational level, professional occupational category and awareness of Pap smear.