Evidence-based recommendations on intrapartum care are important to ensure the safety of mothers and neonates. The objective of this study was to compare two established guidelines for intrapartum care to provide clinicians with more comprehensive recommendations on intrapartum management. We carried out a descriptive analysis of guidelines from the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines published by the World Health Organization, and the Perinatal Care Manual published by the Ministry of Health Malaysia, on intrapartum care to determine differences, if any, with regards to management. Latent, active and the second phase of labour are defined differently in both guidelines. Both guidelines showed high similarity in the steps of clinical management for all phases of labour but differed in foetal monitoring methods, indications for episiotomy, mood and behavior assessment, universal precautions, pain management, and placental disposal. Both guidelines had similar managements for most of the problems encountered during the intrapartum period except for preterm labour and multiple births which have substantial differences. Malaysian guidelines highlight additional systems such as the red alert system, and referral and retrieval system, which would enhance the quality of intrapartum management. The IMPAC guidelines emphasize supportive care, birth companionship, maternal care and monitoring up to one hour after placental delivery; and home birth management; these are inadequately explained or lacking in Malaysian guidelines. From the comparison, it was seen that substantial variation exists in intrapartum management between both guidelines that indicates the need for better evidences to synthesize a more comprehensive set of guidelines for the improvement in intrapartum care.
Introduction: Gestational diabetes mellitus is one of the most common complications during pregnancy which affects 15% of pregnant women globally. Gestational diabetes mellitus patients have seven times lifetime risk of developing type 2 diabetes compared to women with normal pregnancies. Despite these facts, gestational diabetes mellitus patients may not perceive themselves to be at risk for future diabetes. Thus, this study aimed to determine the perception of risk for developing diabetes and factors associated with high risk perception among gestational di-abetes mellitus patients in Johor Bahru. Methods: A cross sectional study was conducted between April to May 2019 among 200 gestational diabetes mellitus patients attending primary health clinics in Johor Bahru, Malaysia. Data was collected using Malay translated and validated Risk Perception Survey on Developing Diabetes questionnaire. Multiple logistic regression analysis was performed using SPSS version 24.0. Results: There were 200 cases which fulfilled the inclusion and exclusion criteria in this study. The mean (SD) age of gestational diabetes mellitus patients in this study was 32.2 (4.8) years. Majority of them were from Malay ethnicity (74.5%) and 42.5% obtained higher education. Of these, 77.0% perceived themselves as high risk for developing diabetes. Higher knowledge scores and greater personal control were significantly associated with high perceived risk for developing diabetes (Adj. OR 2.08; 95% CI: 1.02,4.25; p=0.045 and Adj. OR 2.32; 95% CI: 1.16,4.63; p=0.017 respectively). Conclusion: Majority of gestational diabetes mellitus patients in this study accurately perceived themselves as having a high risk to develop diabetes in the future. Nevertheless, health education needs to be individualized and strengthened to ensure more patients are aware of the risk. In addition, further studies are needed to translate perceived risk into preventive health behaviours.
Myth, believe in powerful ‘being’ commonly known as jinn and usage of ‘bomoh’ as the medium is still widespread in our community in Kelantan especially among the Malay community. This believe and practice of usin ‘bomoh’ to cure and help with known and unknown disease believe to be caused by the jinn, occasionally poses a significant complication and threat to the management of patient in the hospital. Our case is just one of many cases that happen in our local hospital, and we hope by sharing this case will illustrate how ethical discussion occasionally surpassed the four common ethical pillars.