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Fulltext The role of traditional birth attendants in family planning programs in Southeast Asia

Peng JY

Int J Gynaecol Obstet, 1979 9 1;17(2):108-13.

PMID: 41751 DOI: 10.1002/j.1879-3479.1979.tb00128.x

The training and utilization of traditional birth attendants (TBAs) in maternal and child health and family planning programs in Indonesia, the Philippines, Thailand and Malaysia are discussed. Special efforts to organize and train TBAs for family planning in Malaysia are examined in detail. Import factors for successful utilization of TBAs include: (a) definite assignment of functions and tasks, (b) organization of good operational steps and (c) implementation of good supervisory activities.

Maternal mortality in Nigeria compared with earlier international experience

Hartfield VJ

Int J Gynaecol Obstet, 1980 7 1;18(1):70-5.

PMID: 6106608

Coagulation studies in Asian women using injectable progestogen for contraception

Tsakok FH, Koh S, Yuen R, Ratnam SS

Int J Gynaecol Obstet, 1980 9 1;18(2):105-8.

PMID: 6108245 DOI: 10.1002/j.1879-3479.1980.tb00256.x

Coagulation, fibrinolytic activity and platelet function were studied in 104 Asian women volunteers who received 150 mg of depot medroxyprogesterone acetate intramuscularly every three months for two years or more. The results were compared with those in matched controls. There was a paucity of change in coagulation factors. The fibrinogen levels were increased and prothrombin time was shortened. The fibrinolytic activity, as shown by the euglobulin clot lysis time, was significantly increased. This latter change contrasts with the many reports concerning Caucasian women and may reflect an increase in fibrinolytic potential in Asian women.

Recurrent uterine myomata in three sisters--an uncommon occurrence

Kulenthran A, Sivanesaratnam V

Int J Gynaecol Obstet, 1988 Oct;27(2):289-91.

PMID: 2903099

Three sisters who developed recurrent uterine myomata from a very young age are presented. Despite repeated attempts at myomectomy, all three cases had hysterectomies ultimately. Complications encountered during surgery were severe hemorrhage, inadvertent injury to bladder and bowel in two patients and a rare complication of colonic-uteric-cutaneous fistula occurring post-operatively in one patient. Histology of the final hysterectomy specimens in two cases showed low grade leiomyosarcoma and cellular myoma, respectively.

Torsion of ovarian tumors: a clinicopathological study

Lee CH, Raman S, Sivanesaratnam V

Int J Gynaecol Obstet, 1989 Jan;28(1):21-5.

PMID: 2565826

Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. The major presenting symptom was pain but an abdominal mass was palpable in 79.4% of cases. Torsion was more common on the right ovary and 50% were gangrenous at laparotomy. Most of the tumors were benign cystic teratomas. Only 8.7% of the tumors were malignant.

Transient blindness in pregnancy induced hypertension

Nalliah S, Thavarashah AS

Int J Gynaecol Obstet, 1989 Jul;29(3):249-51.

PMID: 2569423

Transient blindness associated with pregnancy induced hypertension without neurological symptoms is a rare phenomenon. The blindness in these cases is postulated to be of "cortical blindness". Two such cases occurring immediately after childbirth are presented. The ophthalmic manifestations of this complication of pregnancy induced hypertension and the importance of an urgent evaluation are discussed.

Ethnic and other factors affecting birthweight in Singapore

Viegas OA, Ratnam SS, Cole TJ

Int J Gynaecol Obstet, 1989 Aug;29(4):289-95.

PMID: 2571528

Data on 1800 term babies, 600 from each of the Chinese, Malay and Indian racial groups, were used to identify the factors affecting birthweight in Singapore. After adjustment for gestation, maternal height and other variables, the mean Indian birthweight was 100 g less than for the Chinese (P less than 0.001), 0.001), while the Malays averaged 33 g less than the Chinese. The shortfall in Indian birthweight is thought to be due, at least partly, to environmental factors.

Ovarian fibroma--clinical and histopathological characteristics

Sivanesaratnam V, Dutta R, Jayalakshmi P

Int J Gynaecol Obstet, 1990 Nov;33(3):243-7.

PMID: 1977643

Twenty-three cases of ovarian fibroma, comprising 3% of all benign tumors seen over a 20-year period, were analyzed. It was unilateral in all cases affecting more commonly the left ovary (70%). Whilst a majority of cases (77%) were encountered in the reproductive age group, the tumor was rare before the second decade. Only in 13% of cases was ascitis clinically detectable. This was not influenced by the size and weight (average of 9.3 x 10.8 x 11.1 cm and 959 g, respectively) of the tumors; a smooth-surfaced tumor was, however, associated with a greater amount of peritoneal fluid. Varying degrees of calcification in some tumors are detectable on ultrasonography and occasionally on abdominal radiography. The classical Meig's Syndrome was seldom encountered. The histopathological features, diagnostic problems and management are discussed.

Uterine leiomyomata in pregnancy

Hasan F, Arumugam K, Sivanesaratnam V

Int J Gynaecol Obstet, 1991 Jan;34(1):45-8.

PMID: 1671020

Sixty cases with uterine leiomyomata in pregnancy are presented. The incidence was 1 in 1033 deliveries. The median age of the patients was 33.4 years. The majority were primigravidae (60%). A significant number of patients gave a history of infertility (43%) and spontaneous abortions (25%). The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than 6 cm. Typical features of red degeneration occurred in 10% of cases. The cesarean section rate was 73%, the commonest indication being obstructed labor. Severe hemorrhage was encountered at cesarean section in 10 patients, 3 of whom needed hysterectomy. There were no perinatal deaths.

Trends in selected obstetric complications from University Hospital, Kuala Lumpur, Malaysia

Zulkifli SN, Paine LL, Greener DL, Subramaniam R

Int J Gynaecol Obstet, 1991 May;35(1):29-36.

PMID: 1680072

Trends in selected pregnancy complications from 1969 to 1987 in a tertiary hospital in Malaysia are presented. Complications reviewed were abortion, ectopic pregnancy, anemia, hypertension, hyperemesis, antepartum and postpartum hemorrhage. Possible explanations for the observed trends were discussed, including the role of improved obstetric care and changes in the characteristics of the childbearing population. The data presented give some indication of maternal morbidity in the childbearing population served by this tertiary center and should lead to improvements in provision of services as well as in health data collection in the future.

Histiocytosis X and vulvar ulceration

Wong KK, Lin HP, Looi LM

Int J Gynaecol Obstet, 1992 Oct;39(2):131-4.

PMID: 1358712

Vulvar ulceration is a rare manifestation of histiocytosis X. A 13-year-old girl had a nonhealing vulvar ulcer for 1 year. She had been in remission from histiocytosis X and the ulcer was not recognised as a sign of disease recurrence until tissue biopsy was obtained for histopathological and immunohistochemical studies. This article stresses the importance of establishing an accurate diagnosis when chronic vulvar ulcers are encountered and reviews the literature on this uncommon presentation of histiocytosis X.

Pulmonary hypertension, cardiac disease and pregnancy

Tahir H

Int J Gynaecol Obstet, 1995 Nov;51(2):109-13.

PMID: 8635630

OBJECTIVE: To ascertain the significance of coexisting pulmonary hypertension in cardiac disease in pregnancy.

METHODS: Over a 3-year period a group of pregnant women with cardiac disease was followed until 6 weeks postpartum. Twenty women with pulmonary hypertension were compared with 20 controls without pulmonary hypertension with particular reference to maternal and fetal outcome. Analysis of data was carried out using Fisher's exact test and Student's t-test.

RESULTS: Except for Eisenmenger's syndrome, there were no differences in maternal morbidity and mortality between the two groups. There were more low birth weight babies but no significant differences in premature delivery rate, mode of delivery or perinatal mortality.

CONCLUSION: Except for Eisenmenger's syndrome, coexisting pulmonary hypertension complicating cardiac disease in pregnancy generally has a favorable outcome for both mother and fetus.

Growth patterns of the humeral and femur length in a multiethnic population

Raman S, Teoh T, Nagaraj S

Int J Gynaecol Obstet, 1996 Aug;54(2):143-7.

PMID: 9236312

OBJECTIVES: To study whether there are any differences in growth of the femoral and humeral length between the three major ethnic groups in Malaysia viz Malays, Chinese and Indians. The effect on fetal growth by gender of the baby and parity of the mother was also studied.

METHODS: The setting was the University of Kuala Lumpur. Thirty-four Malay, 35 Chinese and 34 Indian normal pregnant middle-class women were studied longitudinally by monthly ultrasound scans for 18 to 38 weeks of gestation. The data were subjected to regression analysis; the quadratic curve was found to be the most adequate. Dummy variables were used to determine any effects by gender, parity as well as ethnicity on the length of limb growth. There was no difference in birth weights of the three ethnic groups studied, nor in gender or parity.

RESULTS: There were found to be significant differences in limb lengths of the Indians (longer) when compared with the Malays and Chinese. Parity seems to affect only Indians in whom the multiparous fetuses have shorter limb lengths than the primaparous. There appears to be no effect by gender.

CONCLUSION: There appear to be definite differences in growth of limb length between the different Malaysian ethnic groups and this should be taken into account when growth charts are used and when fetal weight formulas are calculated using limb lengths. The limitation of this study was that the numbers of subjects studied were small. Larger studies will be able to confirm or refute the findings.

The management of gestational trophoblastic disease in developing countries such as Malaysia

Sivanesaratnam V

Int J Gynaecol Obstet, 1998 Apr;60 Suppl 1:S105-9.

PMID: 9833622 DOI: 10.1016/S0020-7292(98)80012-X

Gestational trophoblastic disease is a common gynaecological problem in Malaysia. The incidence of molar pregnancy is 2.8 per 1000 deliveries, being more common amongst the Chinese. The preferred method of evacuation is suction curettage; complete evacuation of the uterus was not achieved at the first attempt in 25 per cent of cases. Partial moles in our centre comprised 30 per cent of all moles. This is potentially malignant and needs follow-up for a complete mole. In the management of an invasive mole, chemotherapy should not be withheld in the presence of metastases and failure of regression of hCG. The role of prophylactic hysterectomy and prophylactic chemotherapy in the management of molar pregnancy is discussed "Selective preventive chemotherapy" in patients at "risk" appears appropriate. Chemotherapy remains the main modality of treatment for gestational trophoblastic tumours (GTT). We categorised our patients into low, medium and high-risk groups; survivals were 100, 98, and 61.7 percent respectively. These patients when categorised according to FIGO staging had survivals of 100, 80, 78.6 and 68.2 per cent respectively for stages 1, 2, 3 and 4 respectively. The reasons for the poor survival in the 'high-risk' group are discussed. Colour doppler blood flow studies are now being carried out; its role needs further evaluation. Surgery and radiotherapy have only a limited role in the management of these cases.

Pregnancy-induced hypertension and placenta previa: a racial and geographical perspective

Wang JC, Hin LY, Ng KB

Int J Gynaecol Obstet, 1999 Dec;67(3):177-8.

PMID: 10659902

Risk factor screening for abnormal glucose tolerance in pregnancy

Shamsuddin K, Mahdy ZA, Siti Rafiaah I, Jamil MA, Rahimah MD

Int J Gynaecol Obstet, 2001 Oct;75(1):27-32.

PMID: 11597616 DOI: 10.1016/s0020-7292(01)00468-4

OBJECTIVES: To assess the prevalence and association of frequently used screening risk factors for gestational diabetes mellitus (GDM) and to compare the validity and cost of universal screening with risk factor screening.

METHOD: A cross-sectional survey of 768 pregnant women at > or = 24 weeks' gestation who were attending the antenatal clinic at the Hospital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were determined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2-h post-prandial blood sugar level of > or = 7.8 mmol/l.

RESULTS: A total of 191 pregnant mothers (24.9%) had GDM. The most commonly identified screening factors were positive family history of diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vaginal discharge and pruritus vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8%) had at least one risk factor. All screening risk factors, except past history of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Risk factor screening gave a sensitivity of 72.2% and a specificity of 35.0%. Universal screening would cost RM 12.06 while traditional risk factor screening would cost RM 11.15 per identified case and will have missed 53 of the 191 cases.

CONCLUSIONS: Risk factor screening scored poorly in predicting GDM. Cost analysis of universal compared with traditional risk factor screening showed a negligible difference. Thus universal screening appears to be the most reliable method of diagnosing GDM.

Tocolysis in term breech external cephalic version

Nor Azlin MI, Haliza H, Mahdy ZA, Anson I, Fahya MN, Jamil MA

Int J Gynaecol Obstet, 2005 Jan;88(1):5-8.

PMID: 15617697

To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre.

The evidence for emergency obstetric care

Paxton A, Maine D, Freedman L, Fry D, Lobis S

Int J Gynaecol Obstet, 2005 Feb;88(2):181-93.

PMID: 15694106

We searched for evidence for the effectiveness of emergency obstetric care (EmOC) interventions in reducing maternal mortality primarily in developing countries.

Indicators of prolonged hospital stay in hyperemesis gravidarum

Tan PC, Jacob R, Quek KF, Omar SZ

Int J Gynaecol Obstet, 2006 Jun;93(3):246-7.

PMID: 16682037

Universal reporting of maternal mortality: an achievable goal?

Graham WJ, Hussein J

Int J Gynaecol Obstet, 2006 Sep;94(3):234-42.

PMID: 16836998

This paper aims to highlight the importance of aspiring to achieve universal reporting of maternal deaths as a part of taking responsibility for these avoidable tragedies. The paper first discusses the reasons for reporting maternal deaths, distinguishing between individual case notification and aggregate statistics. This is followed by a summary of the status of reporting at national and international levels, as well as major barriers and facilitators to this process. A new framework is then proposed - the REPORT framework, designed to highlight six factors essential to universal reporting. Malaysia is used to illustrate the relevance of these factors. Finally, the paper makes a Call to Action by FIGO to promote REPORT and to encourage health professionals to play their part in improving the quality of reporting on all maternal deaths - not just those directly in their care.

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