Displaying publications 1 - 20 of 67 in total

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  1. Oncology Committee, Asia and Oceania Federation of Obstetrics and Gynecology, Tse KY, Ushijima K, Tan AL, Intasorn P, Pariyar J, et al.
    J Obstet Gynaecol Res, 2023 Apr;49(4):1230-1243.
    PMID: 36726190 DOI: 10.1111/jog.15566
    BACKGROUND: Despite the introduction of cervical cancer screening and human papillomavirus (HPV) vaccines, the utilization pattern was not standardized. The aim of this study was to elicit the current prevention care in Asia-Oceania.

    METHODS: An online questionnaire was circulated to different countries/cities in Asia-Oceania. The primary objective was to evaluate the coverage of HPV vaccination and cervical screening programs. The secondary objectives were to study the structures of these programs. Five case scenarios were set to understand how the respondents manage the abnormal screening results.

    RESULTS: Fourteen respondents from 10 countries/cities had participated. Cervical cancer ranked the first in Myanmar and Nepal. About 10%-15% did not have national vaccination or screening program. The estimated coverage rate for vaccination and screening varied from less than 1% to 70%, which the coverage ran in parallel with the incidence and mortality rates of cervical cancer. All regions approved HPV vaccines, although only four provided free or subsidized programs for nonavalent vaccine. Cervical cytology remained the most common screening tool, and 20%-30% relied heavily on visual inspection using acetic acid. The screening age groups varied in different regions. From the case scenarios, it was noted that some respondents tended to offer more frequent screening tests or colposcopy than recommended by international guidelines.

    CONCLUSION: This study revealed discrepancy in the practice of cervical cancer prevention in Asia-Oceania especially access to HPV vaccines. There is an urgent need for a global collaboration to eliminate cervical cancer by public education, reforming services, and medical training.

  2. Lim BK, Zakaria R, Hong JGS, Omar SZ, Sulaiman S, Tan PC
    J Obstet Gynaecol Res, 2022 Jan 23.
    PMID: 35068018 DOI: 10.1111/jog.15157
    AIM: To explore digital insertion in dorsal recumbent position of 16F, 22F, or 28F catheter bores on insertion failure, duration, and pain in unripe cervix labor induction.

    METHODS: A randomized trial was performed in a University hospital in Malaysia. Term women scheduled for labor induction, Bishop score ≤ 5, singleton, cephalic presentation, intact membrane, and reassuring pre-induction fetal heart rate tracing were recruited. Women with known gross fetal anomaly, allergy to latex and inability to consent or language difficulty were excluded. Participants were randomized to 16F, 22F, or 28F Foley catheter. Primary outcome was insertion failure and main secondary outcomes were insertion duration and pain (assessed by a Visual Numerical Rating Scale [VNRS] 0-10, higher score more pain). Analysis is done by analysis of variance (ANOVA), Kruskal-Wallis, and chi square test across the three arms and by t test and Mann-Whitney U test for pair wise comparisons.

    RESULTS: One hundred twenty-seven participants' data were analyzed. The insertion failure 7/43(16%) versus 4/42(10%) versus 5/42(12%), p = 0.64, insertion duration median [IQR] 2.8 [1.8-4.8] versus 2.8 [1.7-3.7] versus 2.8 [1.7-4.3] min, p = 0.68 and insertion pain VNRS mean {SD} 4.2 {2.5} versus 3.4 {2.3} versus 3.6 {2.2}, p = 0.26, insertion to delivery interval 26.0 {9.7} versus 25.6 {9.1} versus 22.8 {7.4} h, p = 0.45, and spontaneous vaginal delivery 20/43 (45%) versus 23/42(55%) versus 25/42(60%), p = 0.48 for 16F versus 22F versus 28F arms, respectively. Pairwise comparisons were not different.

    CONCLUSION: Foley catheter 16F versus 22F versus 28F resulted in similar digital insertion performance in the dorsal recumbent position for unripe cervix labor induction.

    CLINICAL TRIAL REGISTRATION: https://doi.org/10.1186/ISRCTN21224268.

  3. Tse KY, Domingo EJ, Konar H, Kumarasamy S, Pariyar J, Tjokroprawiro BA, et al.
    J Obstet Gynaecol Res, 2021 May;47(5):1643-1650.
    PMID: 33650217 DOI: 10.1111/jog.14579
    Since the outbreak of COVID-19, there have already been over 26 million people being infected and it is expected that the pandemic will not end in near future. Not only the daily activities and lifestyles of individuals have been affected, the medical practice has also been modified to cope with this emergency catastrophe. In particular, the cancer services have faced an unprecedented challenge. While the services may have been cut by the national authorities or hospitals due to shortage of manpower and resources, the medical need of cancer patients has increased. Cancer patients who are receiving active treatment may develop various kinds of complications especially immunosuppression from chemotherapy, and they and their carers will need additional protection against COVID-19. Besides, there is also evidence that cancer patients are more prone to deteriorate from COVID-19 if they contract the viral infection. Therefore, it is crucial to establish guidelines so that healthcare providers can triage their resources to take care of the most needed patients, reduce less important hospitalization and visit, and to avoid potential complications from treatment. The Asia and Oceania Federation of Obstetrics and Gynecology (AOFOG) hereby issued this opinion statement on the management of gynecological cancer patients during the COVID-19.
  4. Sachedina A, Abu Bakar M, Dunford AM, Morris A, Nur Azurah AG, Grover SR
    J Obstet Gynaecol Res, 2021 Jan;47(1):352-358.
    PMID: 33084069 DOI: 10.1111/jog.14532
    AIM: To describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions.

    METHODS: A retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain.

    RESULTS: Of 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self-reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P

  5. Zakaria ZA, Mohammad Razin NS, Abas S
    J Obstet Gynaecol Res, 2020 Nov;46(11):2442-2445.
    PMID: 32808401 DOI: 10.1111/jog.14435
    Inner myometrial laceration is a rarely encountered intrapartum uterine trauma, which usually present as post-partum hemorrhage (PPH). The diagnosis can only be confirmed by direct examination of the uterine cavity but it should be suspected in PPH with good uterine contraction. Discussed here are the characteristics and management of the reported cases including two women managed at our center.
  6. Alalaf SK, Al Tawil NG, Jawad AK, Mahmoud MB, Muhamad BQ, Abdul Rahman KH, et al.
    J Obstet Gynaecol Res, 2020 May;46(5):727-735.
    PMID: 32157797 DOI: 10.1111/jog.14232
    AIMS: This trial was conducted to determine the efficacy of umbilical vein injection of 400 versus 800 μg misoprostol to deliver retained placenta and to compare both regimens regarding the time of placental delivery and amount of vaginal blood loss.

    METHODS: A double-blind, multicenter randomized clinical trial was undertaken in four teaching hospitals in the North of Iraq and Al-Azhar University Hospital in Egypt, from March 2016 to May 2019. Group I (274 women) received 400 μg misoprostol and group II (249 women) received 800 μg misoprostol. Data regarding the time of placental separation and amount of vaginal blood loss were analyzed and proportions were compared between groups using Chi-squared test. Mean values were compared using the Student's t-test. The Mann-Whitney test was used to determine the median of vaginal blood loss.

    RESULTS: The proportion of placental separation was 84.3% among women in group I and 86.7% of women in group II. The mean time of placental separation was 18.86 ± 234.2 and 17.86 ± 213.09 min in groups I and II, respectively (P

  7. Upawi SN, Ahmad MF, Abu MA, Ahmad S
    J Obstet Gynaecol Res, 2020 Mar;46(3):479-484.
    PMID: 31958877 DOI: 10.1111/jog.14195
    AIM: This study is to evaluate whether unacceptable bleeding among the etonogestrel implant user could be better alleviated using combined oral contraceptive pills (COCP) or nonsteroidal anti-inflammation drugs (NSAID).

    METHODS: This is a prospective randomized study for evaluation of 84 etonogestrel implant (Implanon) users with prolonged or frequent bleeding. They were assigned to either receiving a COCP containing 20 mcg ethinyl estradiol/150 mg desogestrel for two continuous cycle or NSAID; mefenamic acid 500 mg TDS for 5 days, 21 days apart for two cycles. Bleeding pattern during the treatment was recorded and analyzed.

    RESULTS: A total of 32 women (76.2%) in COCP group and 15 women (35.7%) in NSAID group stop bleeding within 7 days after the initiation of treatment which was statistically significant (P 

  8. Chew BS, Ghazali R, Othman H, Ismail NAM, Othman AS, Laim NMST, et al.
    J Obstet Gynaecol Res, 2018 Oct 10.
    PMID: 30306675 DOI: 10.1111/jog.13836
    AIM: The aim of our study was to determine the endocan-1 expression in placenta of hypertensive women, and its association with maternal and fetal outcomes.

    METHODS: This was a cross-sectional study consisted of 21 pregnant women with hypertension and 23 without hypertension. The gestational age ranged from 28 to 39 weeks (hypertensive) and 32 to 40 weeks (normotensive). The paraffin embedded formalin fixed placenta tissue blocks were retrieved from the pathology archives. Endocan immunohistochemistry was performed on tissue sections of full thickness and maternal surface of the placenta. The endocan expression was determined in fetal endothelial cells, maternal endothelial cells, cytotrophoblasts, syncytiotrophoblasts and decidual cells. The differences in endocan expression in placenta between hypertensive and normotensive subjects were evaluated by Pearson chi-square test and t-test were used in the statistical analysis.

    RESULTS: The endocan expression was significantly higher in fetal endothelial cells (P

  9. Indirayani I, Kalok A, Nik Ismail NA, Shah SA, Lim PS, Mohamed Ismail NA, et al.
    J Obstet Gynaecol Res, 2018 Aug;44(8):1458-1465.
    PMID: 29845672 DOI: 10.1111/jog.13686
    AIM: Sodium pentosan polysulfate (Na-PPS) is a plant-based agent that has similar action with low-molecular-weight heparin. It inhibits factor Xa, preventing blood clot formation. To date, its use in clinical practice as thromboprophylaxis agent is still limited. In addition, the efficacy and safety profile of this agent was not robustly reported globally, especially for countries with major Muslim population. We hypothesized that Na-PPS was equally effective as the standard thromboprophylaxis. We aim to compare the efficacy and safety of Na-PPS against standard agent (fondaparinux or enoxaparin).

    METHODS: This was a randomized control, open-label trial. Women underwent major gynecological surgery were randomized to receive either subcutaneous 50 mg of Na-PPS twice daily or subcutaneous enoxaparin 40 mg once daily. Fondaparinux 2.5 mg once daily was given to Muslim women as an alternative to enoxaparin. The treatment was started 6 h postoperatively, for at least 3 days. All the patients received thromboembolic deterrent stockings. The primary efficacy outcome was venous thromboembolism up to 3 days postsurgery. The main safety outcomes were minor and major bleeding.

    RESULTS: Among 109 participants, there was no incidence of venous thromboembolism. None of the women developed major bleeding. Minor bleeding was observed in 28.3% (15/53) and 5.4% (3/56) of Na-PPS and standard thromboprophylaxis group, respectively (P = 0.001).

    CONCLUSION: Na-PPS was associated with increased risk of minor bleeding. There was insufficient data to conclude its efficacy as thromboprophylaxis. Further research is needed to evaluate Na-PPS safety as a standard thromboprophylactic agent.

  10. Voon HY, Shafie AA, Bujang MA, Suharjono HN
    J Obstet Gynaecol Res, 2018 Jan;44(1):109-116.
    PMID: 29027315 DOI: 10.1111/jog.13486
    AIM: To evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post-partum hemorrhage (PPH) during cesarean deliveries.

    METHODS: A systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period.

    RESULTS: Seven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70.

    CONCLUSION: Reduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.

  11. Krishnappa P, Kong HM, Mohamad IB, Voon K, Somanath SD
    J Obstet Gynaecol Res, 2017 May;43(5):923-928.
    PMID: 28181356 DOI: 10.1111/jog.13277
    AIM: The aim of this study was to determine the allelic frequency of single nucleotide polymorphisms (SNPs) in the human CD40 gene in cervical cancer.

    METHODS: A total of 200 cases were selected from the records of the Department of Pathology, Hospital Tuanku Jaafar, Seremban, Malaysia. The samples were collected in three separate groups: cervicitis (n = 61), cervical intraepithelial neoplasia (n = 69), and cervical carcinoma (n = 70). The patients' demographic data and the respective paraffin-embedded tissue samples from Hospital Tuanku Jaafar, Seremban were obtained upon consent. The sample tissues were submitted for DNA extraction using G-spin Total DNA Extraction Kit. DNA obtained was then submitted for nested PCR before restriction enzyme digestion.

    RESULTS: SNP rs1883832 showed higher prevalence of T alleles in the cervical carcinoma group compared to the control groups and in rs3765459, a higher prevalence of G alleles in the cervical carcinoma group was noted. The results of rs1800686 and rs4810485 were insignificant.

    CONCLUSION: The data from our study indicates a potential association between the rs1883832 and rs3765459 CD40 gene polymorphism and susceptibility to cervical cancer.

  12. Adlan AS, Chooi KY, Mat Adenan NA
    J Obstet Gynaecol Res, 2017 Apr;43(4):662-668.
    PMID: 28418209 DOI: 10.1111/jog.13269
    AIM: To evaluate the efficacy of acupressure at the Neiguan point (Pericardium [P]6) as adjuvant treatment during inpatient management of severe nausea and vomiting in pregnancy.

    METHODS: Low risk, spontaneously conceived singleton pregnancies were randomly assigned to a treatment group, who received an acupressure band placed at the Neiguan point (P6) or a placebo group who received an otherwise identical non-stimulating wristband. Participants wore the band for 12 h daily for the first three days of admission. The primary outcome measure was the severity of symptoms of nausea, vomiting and retching, recorded according to Pregnancy-Unique Quantification of Emesis and Nausea score.

    RESULTS: There was a statistically significant improvement in Pregnancy-Unique Quantification of Emesis and Nausea scores from day 1 until day 3 of admission in the treatment group compared with the placebo. Patients who received Neiguan point acupressure also showed a significant improvement in their ketonuria scores. The treatment group required a shorter hospital stay compared with the placebo. The only reported side effect of the acupressure band was redness on the wrist.

    CONCLUSIONS: The use of the acupressure band at the Neiguan point (P6) for 12 h daily for three days for inpatients with hyperemesis gravidarum significantly reduced the symptoms of nausea, vomiting and retching and ketonuria and led to a reduction in hospital stay. We recommend the use of the acupressure band at the Neiguan point (P6) as an adjunct/supplementary therapy to co-exist with the standard care of management for hyperemesis gravidarum, particularly in low-risk pregnant women.

  13. Lo TS, Jaili S, Uy-Patrimonio MC, Karim NB, Ibrahim R
    J Obstet Gynaecol Res, 2017 Mar;43(3):543-550.
    PMID: 28160508 DOI: 10.1111/jog.13234
    AIM: The aim of this study was to evaluate the management outcomes of advanced pelvic organ prolapse (POP) in nulliparous women.

    METHODS: Eight nulliparous women diagnosed with POP ≥ stage 3 between January 2005 and August 2013, according to the Pelvic Organ Quantification System (POPQ), were reviewed. Seven were managed surgically and one was managed with pessary. Primary outcome was surgical objective cure (POP-Q ≤ 1) and subjective cure, defined as negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6. Secondary outcomes were complications, symptoms' severity and quality of life according to validated questionnaires.

    RESULTS: A total of 1275 prolapse patients with POP-Q ≥ stage 3 were managed surgically, among whom seven (0.55%) were nulliparous. Each woman had at least one risk factor associated with POP. Risk factors identified were history of pelvic trauma, obesity, menopause, chronic cough, hard physical labor and constipation. Five patients underwent surgical correction (vaginal hysterectomy with sacrospinous fixation) with mesh (Perigee, n = 3; Avaulta, n = 2). Two patients had uterine preservation without mesh (hysteropexy with sacrospinous ligament fixation). One patient preferred treatment with pessary. The total cure rate (objective and subjective cure rates) was 86% after surgical reconstructive surgery.

    CONCLUSION: Management of nulliparous advanced POP poses significant challenges with regard to uterine preservation, future pregnancy and childbirth. Conservative management with pessary insertion should be offered followed by surgical correction. Reconstructive surgery with mesh may improve prolapse symptoms objectively and subjectively.

  14. Lo TS, Lin YH, Chu HC, Cortes EF, Pue LB, Tan YL, et al.
    J Obstet Gynaecol Res, 2017 Jan;43(1):173-178.
    PMID: 27762470 DOI: 10.1111/jog.13158
    AIM: By investigating the association of urodynamics and urogenital nerve growth factor (NGF) levels in vaginal mesh surgery, we may be able to associate the likelihood of postoperative lower urinary tract symptoms developing as a result of synthetic mesh implanted for pelvic floor reconstructive surgery.

    METHODS: Thirty-eight female Sprague-Dawley rats were divided into three groups: mesh, sham (no mesh), and control. Urodynamic study and NGF analysis of the urogenital tissues were done and results were compared among all groups. The urodynamic studies of the mesh and sham groups were further divided into the 4th and 10th days. A P-value 

  15. Lo TS, Huang YH, Dass AK, Karim N, Uy-Patrimonio MC
    J Obstet Gynaecol Res, 2016 Oct;42(10):1361-1368.
    PMID: 27354199 DOI: 10.1111/jog.13066
    AIM: To identify the favorable factors in rectovaginal fistula (RVF) management.

    METHODS: After Institutional Review Board approval (99-0793B), we retrospectively studied all patients diagnosed, treated and followed up with RVF at Chang Gung Memorial Hospital, Taiwan between January 1990 and December 2009. All female patients with International Classification of Diseases RVF were included. We reviewed demographic data, socioeconomic status, clinical presentation, comorbidities, method of treatment, duration of hospitalization and clinical outcome at 12 months postoperatively.

    RESULTS: A total of 397 patients were included in the study. Fifty-six patients (14.1%) had conservative treatment and 341 patients (85.9%) underwent surgical intervention. A total of 125 patients underwent simple repair while 216 patients underwent reconstruction. Three hundred and forty-four patients (86.7%) had improved outcome at 12-month follow up. Age (P = 0.003), education level (P = 0.033), ability to pay insurance (P < 0.001), and choice of treatment (P < 0.0001) were identified as significant favorable factors. An etiological factor associated with favorable outcome was RVF from obstetric complication, while that resulting from malignancy had a less favorable outcome.

    CONCLUSIONS: Age, education level and ability to pay insurance significantly affect 12-month outcome of RVF. Surgery is the preferred option, while medical treatment should be used only for small rectovaginal fistulas or for patients not suitable for surgery and anesthesia. More support and assistance should be offered to those patients with unfavorable factors, such as old age, low education level and inability to afford insurance. All RVF secondary to obstetrical injury had a 100% favorable outcome compared with those secondary to surgery or malignancy. Women with suspected RVF should receive prompt and extensive evaluation to ensure immediate effective management and prevention of further serious complications.

  16. Yong HY, Mohd Shariff Z, Koo SJ, Binti Sa'ari NS
    J Obstet Gynaecol Res, 2016 Sep;42(9):1094-101.
    PMID: 27226139 DOI: 10.1111/jog.13039
    AIM: Both inadequate and excessive weight gain during pregnancy can have immediate and long-term health risks for women and infants. This study investigated rate of gestational weight gain (GWG) and its associated factors in Malaysian pregnant women.
    METHODS: This cross-sectional study was conducted at maternal and child health clinics in Selangor and Negeri Sembilan between November 2010 and April 2012. A pre-tested questionnaire was used to obtain sociodemographic, obstetric, dietary intake and physical activity information. Current weight and height were measured using standard procedures. GWG rate was calculated as the average weekly weight gain in that particular trimester of pregnancy and further categorized according to the Institute of Medicine (IOM) recommendations.
    RESULTS: Mean GWG rate for all pre-pregnancy BMI categories in the second and third trimesters was higher than the IOM recommendations. Overweight women (adjusted OR, 4.26; 95%CI: 1.92-9.44) and women <153 cm tall (adjusted OR, 1.96; 95%CI: 1.21-3.18) tend to have inadequate GWG rate. Women with high pre-pregnancy body mass index (BMI; ≥25.0 kg/m(2) ; overweight: adjusted OR, 3.88; 95%CI: 2.12-7.09; obese: adjusted OR, 2.34; 95%CI: 1.28-4.29) and low physical activity (adjusted OR, 1.74; 95%CI: 0.77-3.97) were two-threefold more likely to have excessive GWG.
    CONCLUSION: Both inadequate and excessive GWG can have detrimental effects on the health of mothers and infants. Pre-pregnancy BMI, height and physical activity should be emphasized in prenatal care to ensure that women have adequate GWG rate.
    Study site: maternal and child health clinics (Klinik Kesihatan), Selangor and Negeri Sembilan, Malaysia
  17. Akhtari-Zavare M, Lattif LA, Juni MH, Md Said S, Ismail IZ
    J Obstet Gynaecol Res, 2015 Dec;41(12):1982-7.
    PMID: 26554636 DOI: 10.1111/jog.12819
    Abstract
    AIM:
    Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia.

    MATERIAL AND METHODS:
    A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study.

    RESULTS:
    The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03).

    CONCLUSION:
    The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women.

    KEYWORDS:
    Malaysia; breast self-examination; predictors
  18. Lo TS, Pue LB, Hung TH, Wu PY, Tan YL
    J Obstet Gynaecol Res, 2015 Jul;41(7):1099-107.
    PMID: 25808989 DOI: 10.1111/jog.12678
    To evaluate and compare the long-term outcome of sacrospinous ligament fixation (SSF) in combination with various other compartment defect native tissue repairs with hysterectomy or hysteropexy.
  19. Tumian NR, Wong M, Wong CL
    J Obstet Gynaecol Res, 2015 Jun;41(6):967-70.
    PMID: 25510540 DOI: 10.1111/jog.12648
    α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum β-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum β-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis.
  20. Fernandez AR, Husain R
    J Obstet Gynaecol Res, 2015 Feb;41(2):277-82.
    PMID: 25255906 DOI: 10.1111/jog.12511
    During preeclampsia (PE), the excessive circulation of soluble fms-like tyrosine kinase 1 (sFLT1) hinders the vasodilatory effect of vascular endothelial growth factor (VEGF). This effect has been proven in vitro in the renal artery of rats. The endothelium of the blood vessels is also said to be dysfunctional in PE. Genistein has shown the ability to antagonize the vascular contractions caused by a wide range of contractile agents. We conducted vascular reactivity studies to demonstrate the effect of: (i) sFLT1 on the vasodilatory effect of VEGF; and (ii) genistein on the vasodilatory effect of VEGF and its effects on denuded blood vessels (dysfunctional endothelium).
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