Compared with prostaglandin E(2), intracervical misoprostol is more effective in cervical ripening and labor induction at term. The higher frequency of uterine hypercontractility associated with the use of misoprostol did not increase the risk of adverse intrapartum and neonatal outcomes.
This is the first report to provide direct evidence for the major role of the oral route in vertical transmission of HBV during delivery. In addition to maternal serum HBeAg, HBsAg status in newborn's gastric aspirates is another important determinant for vertical transmission of HBV.
A 36-year-old woman presented with a 3-month history of pruritic blisters on her trunk and legs, which had appeared 4 months after she gave birth. She was breast-feeding and was not taking any medication. On physical examination, scattered erythematous crusted patches were seen on her trunk. Grouped vesicles and bullae had developed on well-defined erythematous patches on both lower legs ( Fig. 1a). Vesicles arranged in a herpetiform configuration were also found ( Fig. 1b). Nikolsky sign was negative. No mucosal lesions were present. Laboratory data, including blood cell counts and biochemistry, were unremarkable. The anti-nuclear antibody titre was undetectable.
Histopathological findingsSkin biopsy of the lesion over the anterior shin disclosed intraepidermal vesicles, showing significant spongiosis and abundant neutrophil infiltration, with micro-abscess formation (Fig. 2a). No acantholytic cells were identified. Direct immunofluorescence (DIF) showed intercellular deposition of IgG and C3 throughout the epidermis (Fig. 2b). Figure 1 (a) Erythematous, herpetiform vesicles on the lower legs, with crusting and hyperpigmentation in some areas; (b) vesicles in a herpetiform configuration on three partially overlapping patches. ª
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