Randomised Control Study of Misoprostol and Mifepristone versus Misoprostol Alone in Second Trimester Termination of Pregnancy.

Introduction: This study was done to assess and compare the efficacy and safety of mifepristone and misoprostol combination versus misoprostol alone for second trimester termination of pregnancy in relation to induction abortion interval, average amount of misoprostol required in each group, success rate and side effects. Materials and Methods: This randomised control study was conducted on 100 women admitted in the Department of Obstetrics & Gynaecology, S.C.B. Medical College & Hospital, Cuttack, for second trimester termination of pregnancy, divided into two groups, Group A and Group B of 50 patients each. Group A patients received 200 mg of oral mifepristone followed by 400 mcg of vaginal misoprostol after 48 h, and then 400 mcg of vaginal misoprostol every 3 hourly until complete expulsion or up to a maximum of 6 doses. Group B patients received 400 mcg of vaginal misoprostol every 3 hourly until complete expulsion or up to maximum 6 doses. Results: Complete abortion was seen in 92% and 72% cases in Group A and Group B, respectively. Mean induction abortion interval was 11.59 ± 2.71 h in Group A and 15.57 ± 2.27 h in Group B (p value < 0.001). The average dose of misoprostol required was less in combination regimen, i.e. 1128 ± 384 mcg compared to 1680 ± 302 mcg in misoprostol alone group (p value < 0.001). Side effects like nausea, vomiting and diarrhoea were less in combination regimen than misoprostol alone group. Conclusion: Mifepristone and misoprostol combination is more effective and safer alternative than misoprostol alone in second trimester termination of pregnancy.

A Study on Serum Lactate Dehydrogenase and Uric Acid in Preeclampsia and Eclampsia: Can they Predict Adverse Fetomaternal Outcome?

Background: Hypertensive disorders of pregnancy affect 3%-5% of all pregnancies, contributing immensely to maternal morbidity and mortality. According to the WHO, the incidence of deaths due to preeclampsia and eclampsia in developing and developed countries is 2.8% and 0.4%, respectively. Lactate dehydrogenase (LDH) and uric acid are good predictors of disease severity. Aim: This study aims to determine the fetomaternal outcome in relation to abnormal serum levels of LDH and uric acid. Materials and Methods: A cross-sectional study was carried out in 1200 patients with preeclampsia and eclampsia at a tertiary care center over 2 years. Patients were divided into - Group A: patients with normal LDH (≤300 IU/L) and uric acid (<6 mg/dl) (n = 300). Group B: patients with abnormal LDH and uric acid (n = 900), who were further divided into mild and severe preeclampsia and eclampsia. Abnormal serum values were stratified into groups for easier comparison. The results were compared in terms of maternal and perinatal outcomes. Results: The incidence of preeclampsia and eclampsia in our study is 3.14% and 1.57%, respectively. Significant changes in LDH and uric acid were associated with increased severity of the disease (LDH - 1116.94 ± 4.78; uric acid - 9.2 ± 2.89). Higher incidence of maternal and fetal complications was seen with severe preeclampsia and eclampsia with LDH >800 IU/L and uric acid >6 mg/dl. Conclusion: Standard antenatal follow-up should be carried out for early detection and prevention of preeclampsia, with strict monitoring of serum uric acid level and LDH. This may reduce the maternal and fetal complications due to preeclampsia.

Study of Association of Global Deoxyribonucleic Acid Methylation in Women with Polycystic Ovary Syndrome.

Background: Polycystic ovary syndrome (PCOS), a common endocrine disorder affecting 5%-10% of reproductive age women worldwide, associated with various metabolic morbidities. One potential molecular mechanism could be epigenetic modifications, such as deoxyribonucleic acid (DNA) methylation. Aims: The aim is to determine the association of global DNA methylation in peripheral blood leucocyte (PBL) cells and PCOS women. Also to assess abnormal lipid profile, insulin resistance, gonadotropins and reproductive markers in them. Settings and Design: The study design involves a hospital-based prospective case-control study. Materials and Methods: Fifty women with PCOS, diagnosed as per Rotterdam criteria and the rest 50 without PCOS or any disease, attending outpatient department were recruited. Serum biochemical markers and Global DNA methylation assay were done by using standardised kit. Statistical Analysis Used: Data were compared using Independent t-test or Mann-Whitney U test using IBM SPSS version 26.0. P < 0.05 was considered statistically significant. Results: Majority, 72% of PCOS and 82% non-PCOS women were between 20 and 25 years. Most common presenting symptom was menstrual irregularity. Women with PCOS have high serum cholesterol and triglyceride level, elevated serum luteinising hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio and testosterone but low estradiol levels as compared to non-PCOS. Statistically significant high mean Global DNA methylation percentage was found in PBLs of women with PCOS. Conclusion: Despite study limitations, this study provided insight into Global DNA methylation in PBLs was associated with PCOS. It requires further research to better understand the influence of epigenetic factors including genome-wide DNA methylation profiling in PCOS development.