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.