Displaying publications 1 - 20 of 52 in total

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  1. Ong AKW, Yee AL, Fong AJH, Arasoo VJT, Ramadas A
    Aust N Z J Obstet Gynaecol, 2023 Oct;63(5):625-637.
    PMID: 37283305 DOI: 10.1111/ajo.13706
    BACKGROUND: Ramadan fasting (RF) is mandatory for all healthy Muslims in the ninth month of the Islamic calendar. Although pregnant women are exempt from fasting, many make the decision to practise it. Concerns that fasting during pregnancy harms the fetus remain, as there are no firm recommendations regarding its safety.

    OBJECTIVES: To provide a systematic review on the effects of RF on fetal health.

    SEARCH STRATEGY: We conducted a literature search for peer-reviewed articles through Ovid MEDLINE, PubMed, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) until 31 December 2021.

    SELECTION CRITERIA: All case-control and observational cohort studies that reported on fetal outcomes of pregnant women who underwent RF for at least one day during pregnancy are included.

    DATA COLLECTION AND ANALYSIS: Two researchers independently reviewed the eligibility of all studies. A third researcher resolved any conflict between researchers. Findings are extracted from eligible papers and presented as narratives.

    MAIN RESULTS: Fourteen articles are included based on eligibility criteria, with a total sample size of 2889. Studies demonstrate negative associations between RF and neonatal weight, amniotic fluid index, preterm birth and growth parameters mainly during the second and third trimesters. However, the evidence is not strongly supported.

    CONCLUSION: There is limited data to elucidate the relationship between RF and fetal health, hence the need for more studies to provide a better understanding.

  2. Tan PC, Othman A, Win ST, Hong JGS, Elias N, Omar SZ
    PMID: 34089525 DOI: 10.1111/ajo.13377
    BACKGROUND: Induction of labour (IOL) in low-risk nulliparas at 39 weeks reduces caesarean delivery. Multiparas with ripe cervixes typically have vaginal delivery within eight hours. Delivery at night and weekend are associated with higher maternal and neonatal mortality.

    AIMS: To evaluate IOL in full-term multiparas with ripe cervixes to achieve delivery at normal working hours and improve maternal satisfaction.

    METHODS: A randomised trial was performed in a tertiary hospital in Malaysia. Low-risk multiparas with ripe cervixes (Bishop score ≥6) were recruited at 38+4 -40+0  weeks, then randomised to planned labour induction at 39+0  weeks or expectant care. Primary outcomes were delivery during 'normal working hours' 09:00-17:00 hours, Monday-Friday and patient satisfaction by visual numerical rating scale.

    RESULTS: For IOL (n = 80) vs expectant care (n = 80) arms respectively, primary outcomes of delivery at normal working hours was 27/80 (34%) vs 29/78 (37%), relative risk (RR) 0.9, 95% CI 0.5-1.7, P = 0.41, patient satisfaction was 8.0 ± 1.8 vs 7.8 ± 1.6, P = 0.41; presentation for spontaneous labour or rupture of membranes were 27/80 (34%) vs 70/79 (89%), RR 0.4, 95% CI 0.3-0.5, P 

  3. Donnan F, Senarathna SMDKG, Ware B, Rawlins MDM, Dontham C, Chuang VTG, et al.
    Aust N Z J Obstet Gynaecol, 2020 06;60(3):344-349.
    PMID: 31512230 DOI: 10.1111/ajo.13046
    BACKGROUND: Postpartum haemorrhage (PPH) kits containing uterotonics are used on obstetric units for the timely management of PPH. Visible discolouration of ergometrine and ergometrine-oxytocin injections was observed in PPH kits stored in medical refrigerators on the obstetric unit at our hospital.

    AIM: To investigate the stability of ergometrine and ergometrine-oxytocin injections in PPH kits under simulated clinical storage conditions and to determine the potency of ampoules quarantined from PPH kits on our obstetric unit.

    MATERIAL AND METHODS: Ergometrine and ergometrine-oxytocin injection ampoules were stored exposed to and protected from light at 4°C and room temperature (25°C) for up to three months, and assayed by high-performance liquid chromatography. Stability was based on the time for the ergometrine or oxytocin concentration to fall to 90% of the original concentration (t90 ). The potency of quarantined discoloured ampoules also was determined.

    RESULTS: Ergometrine was stable at both temperatures for >6 months, when stored protected from light in simulated clinical conditions. When exposed to light, ergometrine was stable for approximately 4 days at 25°C and 10 days at 4°C. Discoloured ergometrine and ergometrine-oxytocin injection ampoules were found to be <90% of the nominal concentration.

    CONCLUSION: Stability of ergometrine in PPH kits is largely unaffected by temperature fluctuations (at 4°C and 25°C) over 6 months when protected from light. Ergometrine and ergometrine-oxytocin ampoules should be inspected prior to use and any discoloured ampoules discarded.

  4. Krause HG, Wong V, Ng SK, Tan GI, Goh JTW
    Aust N Z J Obstet Gynaecol, 2019 08;59(4):585-589.
    PMID: 31146301 DOI: 10.1111/ajo.12990
    BACKGROUND: While pelvic floor ultrasound is commonly utilised in high-resource locations, our understanding of pelvic floor characteristics in women suffering with obstetric fistula and unrepaired fourth degree obstetric tears in low-resource areas is limited.

    AIMS: This study aimed to assess the pelvic floor ultrasound characteristics of Ugandan women suffering with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse, and determine whether obstructed labour resulting in obstetric fistula causes more levator muscle defects compared to parous women without a history of obstructed labour.

    MATERIALS AND METHODS: This was a prospective study in western Uganda assessing 82 women with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse with a pelvic floor ultrasound scan.

    RESULTS: Demographic characteristics were significantly different, with women suffering pelvic organ prolapse being older and more parous. Hiatal area on Valsalva was significantly smaller in the obstetric fistula group (mean 21.45 cm2 ) compared to non-obstetric fistula group (unrepaired fourth degree obstetric tears and pelvic organ prolapse; mean 30.44 cm2 ); a mean difference of 9.0 cm2 (95% CI: 5.4-12.6 cm2 , P 

  5. Lin S, Atan IK, Dietz HP, Herbison P, Wilson PD
    Aust N Z J Obstet Gynaecol, 2019 08;59(4):590-596.
    PMID: 30793279 DOI: 10.1111/ajo.12948
    BACKGROUND: Levator ani muscle (LAM) and anal sphincter injuries are common after vaginal birth and are associated with pelvic organ prolapse and anal incontinence.

    AIMS: Our objective was to investigate long-term association between delivery mode, LAM avulsion and obstetric anal sphincter injuries (OASIS) in women at least 20 years after their first birth.

    METHODS: All women recruited at 'index birth' of the Dunedin (New Zealand) arm of ProLong (PROlapse and incontinence LONG-term research) Study, were invited to have translabial and transperineal ultrasound assessment of LAM and anal sphincters. Post-processing analysis of imaging data was performed blinded against delivery data. Statistical analysis was performed using the χ2 test and results are expressed as odds ratios (OR).

    RESULTS: Of the initial 1250 participants, 196 women returned for examination. Mean age was 50.8 years with a mean body mass index of 27.6 and median parity was three. They were seen on average 23 years after their first delivery. Four data sets were unavailable and one declined ultrasound assessment, leaving 191 for analysis. LAM avulsion was diagnosed in 29 (15.2%), and 24 women (12.6%) had significant anal sphincter defect. LAM avulsion was associated with forceps delivery (OR 2.45, 95% CI 1.04-5.80, P = 0.041). Forceps conveyed a greater risk of OASIS (21%) compared to a spontaneous vaginal delivery (11%) but did not reach statistical significance.

    CONCLUSIONS: Forceps delivery is associated with long-term injurious effect on pelvic floor structures. Discussions of the long-term negative impact of pelvic floor structures and their functions are necessary to achieve an informed consent toward an operative vaginal delivery.

  6. Lo TS, Tan YL, Cortes EF, Lin YH, Wu PY, Pue LB
    Aust N Z J Obstet Gynaecol, 2015 Dec;55(6):593-600.
    PMID: 26299981 DOI: 10.1111/ajo.12397
    To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid-urethral sling surgery (MUS) for stress urinary incontinence (SUI).
  7. Guzmán Rojas R, Kamisan Atan I, Shek KL, Dietz HP
    Aust N Z J Obstet Gynaecol, 2015 Oct;55(5):487-92.
    PMID: 26172410 DOI: 10.1111/ajo.12347
    Rectocele is a herniation of the anterior wall of the rectal ampulla through a defect in the rectovaginal septum causing protrusion of the posterior vaginal wall. Common symptoms include symptoms of prolapse and obstructed defecation.
  8. Lo TS, Tan YL, Cortes EF, Wu PY, Pue LB, Al-Kharabsheh A
    Aust N Z J Obstet Gynaecol, 2015 Jun;55(3):284-90.
    PMID: 26044791 DOI: 10.1111/ajo.12340
    The Food and Drug Administration has recently highlighted an increase in reported complications associated with the use of transvaginal mesh.
  9. Tay SK, Tay YK
    Aust N Z J Obstet Gynaecol, 2009 Jun;49(3):323-7.
    PMID: 19566569 DOI: 10.1111/j.1479-828X.2009.01000.x
    To investigate the prevalence of high-risk human papillomavirus (HPV) and its associated cytological abnormalities among women attending cervical screening clinics in southern Malaysia and Singapore.
  10. Lim SS, Tan PC, Sockalingam JK, Omar SZ
    Aust N Z J Obstet Gynaecol, 2008 Feb;48(1):71-7.
    PMID: 18275575 DOI: 10.1111/j.1479-828X.2007.00808.x
    To compare oral celecoxib with oral diclofenac as pain reliever after perineal repair following normal vaginal birth.
  11. Tan PC, Ling LP, Omar SZ
    Aust N Z J Obstet Gynaecol, 2007 Jun;47(3):191-7.
    PMID: 17550485 DOI: 10.1111/j.1479-828X.2007.00717.x
    Background: The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population.

    Aims: To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT.

    Method: In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT >or= 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria.

    Result: Thirty-five per cent had GCT >or= 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was >or= 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT >or= 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM.

    Conclusions: Risk factors were not independent predictors of GDM in women with GCT >or= 7.2 mmol/L. GCT threshold value >or= 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.
  12. Naim NM, Mahdy ZA, Ahmad S, Razi ZR
    Aust N Z J Obstet Gynaecol, 2007 Apr;47(2):132-6.
    PMID: 17355303 DOI: 10.1111/j.1479-828X.2007.00699.x
    OBJECTIVE: To compare the effectiveness of the Vabra aspirator and the Pipelle device as an outpatient endometrial assessment tool.
    METHOD: This was a randomised, prospective trial conducted for a period of one year.
    RESULTS: A total of 147 patients were recruited, of which 71 were in the Vabra group and 76 were in the Pipelle arm. The procedure success rate in the Pipelle group was significantly higher than the Vabra arm (98.7 vs 88.7%, P=0.02). Adequate tissue yield was also significantly more in the Pipelle arm (73.3 vs 52.4%, P=0.02). Cost-benefit analysis revealed a higher average cost per patient in the Vabra group compared to the Pipelle arm.
    CONCLUSION: This study proved that the Vabra aspirator was not as effective as the Pipelle device in obtaining endometrial tissue for histological diagnosis. Despite its higher price per unit, the Pipelle device was a more cost-effective tool for outpatient endometrial assessment.
    Study site: Medical clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia.
  13. Tan PC, Subramaniam RN, Omar SZ
    Aust N Z J Obstet Gynaecol, 2007 Feb;47(1):31-6.
    PMID: 17261097
    To compare the outcome in 1000 women at term with one lower transverse Caesarean that was suitable for a trial of labour.
  14. Tan PC, Suguna S, Vallikkannu N, Hassan J
    Aust N Z J Obstet Gynaecol, 2006 Dec;46(6):505-9.
    PMID: 17116055
    To assess the relationship of ultrasound assessment for amniotic fluid, fetal weight, cervical length, cervical funneling and clinical factors on the risk of Caesarean delivery after labour induction at term.
  15. Tan PC, Jacob R, Quek KF, Omar SZ
    Aust N Z J Obstet Gynaecol, 2006 Oct;46(5):446-50.
    PMID: 16953861
    In a retrospective analysis of 192 cases of presumed hyperemesis gravidarum, there were no biochemical markers that predicted hospital readmission. There was, however, statistically significant negative predictive value in abnormal liver function tests. This could represent acute self-limited illness with a component of hepatitis as the cause for the clinical presentation, rather than hyperemesis.
  16. Ho JJ, Thong MK, Nurani NK
    Aust N Z J Obstet Gynaecol, 2006 Feb;46(1):55-7.
    PMID: 16441696
    We studied 253 women with a pregnancy complicated by a birth defect and 506 controls to determine the frequency and type of prenatal tests and the types of defects detected antenatally. Most women had at least one ultrasound examination, but the frequency of other screening tests was low. Only 38 (15%) of defects were detected antenatally (37 by ultrasound). Birth prevalence is unlikely to be affected by pregnancy termination.
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