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Hereditary angioedema is a potentially life-threatening condition which can complicate pregnancy. A 34-year-old patient with known C1 esterase inhibitor (C1INH) deficiency was managed successfully in our department and her management was a part of a shared care strategy with the medical and anesthetic departments. Peripartum management plans along with an anesthetic plan were drawn up and clearly displayed in her records. She was admitted three times with abdominal pain which were self-limiting before she was admitted at term. An aggressive management strategy with C1INH concentrate facilitated a normal vaginal delivery.

Objective To compare the effectiveness of oral misoprostol with vaginal misoprostol as a cervical priming agent prior to first trimester vacuum aspiration. Design Randomised study.Setting Scottish teaching hospital.Population Primigravid women at gestations up to 91 days requesting surgical abortion under the 1967 Abortion Act. Methods Sixty-four women were randomised to receive misoprostol 400 Ag orally at home or vaginally in hospital 2 -4 hours pre-operatively for cervical priming. Main outcome measures The main outcome measures were cumulative force required to dilate the cervix to 9 mm, baseline cervical dilatation, intra-operative blood loss and patient and staff acceptability. Results There was no significant difference in baseline cervical dilatation, peak force required to dilate the cervix at 8 and 9 mm and cumulative force required between the two groups. Operating time and intraoperative blood loss were not significantly different between the two groups. The priming to abortion interval was significantly longer with oral misoprostol when compared with the vaginal group ( P < 0.0001). Women receiving oral misoprostol were significantly more likely to experience nausea (OR: 3.9, 95% CI: 1.3 to 11.2), while women receiving vaginal misoprostol were more likely to complain of tiredness (OR: 0.2, 95% CI: 0.1 to 0.7) with no significant differences in other side effects between the two groups. There was no significant difference in patient acceptability in relation to the priming agent between the two groups ( P ¼ 0.96). However, majority of the nursing staff (83%) admitting women preferred the oral route of administration. Conclusion Cervical priming with oral misoprostol at home is effective with high patient and staff acceptability.

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