Displaying publications 1 - 20 of 67 in total

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  1. Jegasothy R, Paranthaman S
    J Obstet Gynaecol Res, 1996 Feb;22(1):21-4.
    PMID: 8624887
    OBJECTIVES: The purposes of this study were to compare the efficacy of sublingual nifedipine with intravenous hydrallazine in the control of acute hypertension of pregnancy and to make a preliminary assessment whether sublingual nifedipine could be recommended for use by midwives faced with severe hypertension in pregnancy in a rural setting.

    METHODS: Subjects were 200 consecutive patients admitted to Kuala Tereng-ganu General Hospital, Malaysia with severe hypertension in pregnancy between August 1989 and June 1990. Admission criteria were an ongoing viable pregnancy more than 28 weeks and diastolic blood pressure (DBP) more than 120 mmHg. The patients were randomly divided into 2 groups. In group I, sublingual nifedipine 5 mg was administered and repeated after 15 minutes if DBP > 120 mmHg; and in group II hydrallazine 5 mg was intravenously injected and repeated after 15 minutes if DBP > 120 mmHg. Both groups were put on hydrallazine infusion if DBP > 120 mmHg after 30 minutes. The Chi-square test was used for analysis with significance at p < 0.05.

    RESULTS: There was no statistical difference in the efficacy of therapy for decreasing blood pressure between the 2 groups. The groups were comparable by age, parity, gestational age at presentation, birth weight of infants, incidence of postpartum haemorrhage and fetal distress. Caesarian section rates were similar. In the observational studies on nurses administering the drugs, no significant difficulties were observed.

    CONCLUSION: Sublingual nifedipine was comparable to IV hydrallazine in the treatment of acute hypertension of pregnancy. Nurses were able to administer lingual nifedipine without difficulty.

  2. Achanna S, Monga D, Hassan MS
    J Obstet Gynaecol Res, 1996 Apr;22(2):107-9.
    PMID: 8697337
    Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.
  3. Teoh T
    J Obstet Gynaecol Res, 1996 Aug;22(4):389-94.
    PMID: 8870425
    The aim is to assess the outcome of external cephalic version (ECV) for term breech in our clinical setting and the factors involved. Patients with no contraindications and who consented to ECV were recruited into this prospective study. Terbutalin infusion was used. There were 42 ECV attempts of which 21 (50%) were successful. Seventeen of the patients with successful ECV delivered vaginally and 4 had cesarean section for various indications. Only 5 of the 21 unsuccessful ECV delivered vaginally. Thirteen had elective cesarean section and 2 had emergency cesarean during trial of breech. One patient from the unsuccessful ECV group was lost to follow-up. There were 31 (74%) primipara. The birth weight of the babies was not a significant factor in the outcome of ECV. The type of breech and parity did influence the success rate. External cephalic version should be included in the routine management of our breech presentation.
  4. Raman S, Ramanujam T, Lim CT
    J Obstet Gynaecol Res, 1996 Aug;22(4):375-8.
    PMID: 8870422
    Extensive haemangioma with platelet consumption (Kasabach-Merritt syndrome) is rare. The lesion is usually a single cutaneous cavernous haemangioma similar to that found in our patient. Multiple superficial strawberry naevi were also seen all over the rest of the body. This condition was diagnosed antenatally in this patient with the use of colour Doppler. There is one recent report where the thrombocytopaenia was diagnosed by cordocentesis. Unfortunately the baby developed heart failure with intractable coagulopathy and died 2 days later.
  5. Kit LK, Janet G, Jegasothy R
    J Obstet Gynaecol Res, 1997 Feb;23(1):85-9.
    PMID: 9094824
    OBJECTIVE: To determine the incidence of postnatal depression of Malaysias women at 6 week postpartum and a survey of their sociocultural practices.

    METHODS: A hundred and fifty-four women who were 6 weeks postpartum attending the postnatal clinic between May and July 1995 at Maternal and Child Health Clinic, Seremban, Malaysia. Maternal socio-demography, depression by Edinburgh Postnatal Depression Scale (EPDS), postnatal care and practices e.g. pantang larang (prohibited behaviour and practices), diet and partnering were evaluated.

    RESULTS: Postnatal depression was 3.9%. Indians had the highest rate at 8.5% as compared to Malays (3.0%) and none in Chinese (p < 0.05). There were no demographic differences in the study groups. Average score of EPDS was 4.05 which ranged from 0 to 20. During the confinement 85.7% of women took special diet; 64.3% followed pantang larang and 78.8% had someone to look after them. The incidence of postnatal depression is low in Malaysia at 3.9%. Majority of Malaysian women still observed the traditional postnatal beliefs and practices.

  6. Geefhuysen CJ, Isa AR, Hashim M, Barnes A
    J Obstet Gynaecol Res, 1998 Feb;24(1):13-20.
    PMID: 9564100
    Measure the effectiveness of the colour coding system in Malaysia for the prediction of risk in pregnancy.
  7. Chia P, Raman S, Tham SW
    J Obstet Gynaecol Res, 1998 Aug;24(4):267-73.
    PMID: 9798356
    To study the pregnancy outcome of women with acyanotic heart disease.
  8. Cheah PL, Looi LM, Sivanesaratnam V
    J Obstet Gynaecol Res, 1999 Dec;25(6):401-6.
    PMID: 10680337
    To study the trend of different histological types of cervical carcinoma among the 3 major ethnic groups in Malaysia.
  9. Chan YK, Ng KP
    J Obstet Gynaecol Res, 2000 Apr;26(2):137-40.
    PMID: 10870307
    OBJECTIVE: A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996.

    RESULTS: From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all.

    CONCLUSIONS: Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom.

  10. Asokan S, Chew EK, Ng KY, Thanaletchimy N, Asmiati A, Kong NM
    J Obstet Gynaecol Res, 2000 Jun;26(3):199-201.
    PMID: 10932982
    Ruptured splenic artery aneurysm during pregnancy is a rare event with high maternal and fetal mortality rate. A case of ruptured splenic artery aneurysm in the post partum period is presented. The literature is reviewed on pathophysiology, clinical presentation and management of this rare and potentially fatal entity.
  11. Leong EW, Sivanesaratnam V, Oh LL, Chan YK
    J Obstet Gynaecol Res, 2000 Aug;26(4):271-5.
    PMID: 11049237
    OBJECTIVES: To prospectively study the intervention rate, duration of labour, malpositions, fetal outcome, maternal satisfaction, voiding complications and adverse events in healthy primigravidae in spontaneous labour at term following epidural analgesia.

    METHODS: A prospective randomized study involving 55 patients in the epidural group and 68 in the control pethidine--inhalational entonox group.

    RESULTS: There were significantly more obstetric interventions (instrumental deliveries) in the epidural group (p < 0.01). The total duration of labour and the duration of the second stage was prolonged in the epidural group (p < 0.01). There were more malpositions at the second stage of labour in the epidural group (p < 0.02). There were no differences in fetal outcome (Apgar scores and Special Care Nursery admissions). Patients in the epidural group were consistently happier with their method of pain relief (p < 0.01). Two patients required blood patches while another 2 patients had persistent backache post epidural analgesia.

    CONCLUSION: Epidural analgesia in primigravidae in spontaneous labour at term led to an increased instrumental delivery rate, prolonged duration of labour, greater rate of malpositions in the second stage, increased oxytocin requirements but with no difference in fetal outcomes but with happier mothers as compared to the control group.

  12. Sivanesaratnam V
    J Obstet Gynaecol Res, 2001 Feb;27(1):1-15.
    PMID: 11330724
    Fertility and gynaecological malignancies have an important relationship. A clear inverse relationship exists between family size and the incidence of ovarian and endometrial cancer. Current methods of fertility control have an influence on subsequent development of various gynaecological malignancies. A slightly increased risk of breast cancer has been reported in current users and those who had used hormonal contraceptives (OCs) within 10 years; this risk declined with time and disappeared after 10 years. Women who started OC before age 20 had a higher relative risk; the disease did not spread beyond the breast in the majority. Most studies found OC to reduce the risk of ovarian and endometrial cancer. The relative risks of squamous cell carcinoma and adenomatous carcinoma of the cervix have been reported to be 1.3 and 1.5, respectively in ever-users of OCs; however, the aetiology of cervical cancer is multifactoral. Several reports suggest the beneficial effect of tubal ligation and breast feeding in reducing the risk of ovarian cancer. Therapy of gynaecological malignancies may have an influence on subsequent fertility. Amenorrhoea developing after treatment of hydatidiform mole may be due to choriocarcinoma, recurrent mole or a normal pregnancy. Choriocarcinoma can also develop after a partial mole. The risk of fetal teratogenicity from chemotherapy is present only if conception occurs during or immediately following the treatment cycles. Fertility is not impaired following chemotherapy. Successful pregnancies have occurred in women who have had widespread GTD including cerebral metastases. In the young patient with gynaecological malignancy preservation of fertility is possible. Fertility-sparing surgery may be safe in early ovarian epithelial cancers and even in advanced germ cell tumours. Recently, the fertility-sparing surgery of radical trachelectomy and pelvic lymphadenectomy has been carried out for early invasive cervical cancer in young women. Gynaecological cancer occurring in pregnancy is uncommon; it presents the clinician with a difficult situation to manage. In most instances the cancer is treated as though the patient is not pregnant; the timing and mode of delivery needs individualization. The overall prognosis for breast cancer complicating pregnancy is poor. Survival in cervical cancers diagnosed antepartum is similar to the non-pregnant patient. Ovarian cancer in pregnancy has a good prognosis because of the early stage at diagnosis.
  13. Jegasothy R
    J Obstet Gynaecol Res, 2002 Aug;28(4):186-93.
    PMID: 12452259
    We report on a retrospective study of maternal deaths in Malaysia that occurred within 24 hours of delivery, abortion or operative termination of the pregnancy (defined as sudden deaths) in the years 1995-1996. There were 131 sudden maternal deaths (20.6% of all maternal deaths); postpartum hemorrhage, obstetric embolisms, trauma and hypertensive disorders of pregnancy were the main causes. There was a disproportionately increased risk of sudden maternal deaths in the Chinese and the 'other bumiputra' racial groups. The proportion of mothers who had no obstetric risk factors in the pregnancy that led to death was 16.8%. Fourteen mothers died in transit Twenty mothers died after a cesarean section. The findings of this review emphasize the fact that caregivers in obstetrics need to be forever vigilant. All maternity staff need to be well trained in emergency care and there needs to be quick referral to centers that can provide expertise in handling these emergencies.
  14. Chow TW, Lim BK, Vallipuram S
    J Obstet Gynaecol Res, 2002 Aug;28(4):203-10.
    PMID: 12452262
    In this review, tuberculosis of the genital tract was diagnosed retrospectively in 11 females over 15 years. The presentations of nine cases are described. Seven of the nine cases presented with ascites, vague abdominal distension, weight loss and were misdiagnosed as ovarian carcinoma. Eight women had no relevant past history. A review on clinical presentations and diagnosis of pelvic tuberculosis is presented. We conclude that although the incidence of tuberculosis is uncommon in developed countries, its prevalence appears to be increasing worldwide. Therefore, clinicians should consider tuberculosis as a differential diagnosis when encountering clinical presentations of pelvic mass and ascites.
  15. Koo V, Lynch J, Cooper S
    J Obstet Gynaecol Res, 2003 Aug;29(4):246-50.
    PMID: 12959147
    AIM: To identify whether women having emergency delivery are at increased risk of developing postnatal depression (PND).

    METHODS: This is a retrospective comparative cohort study design. Two hundred and fifty Malaysian women were part of a previous study examining the prevalence of PND in a multiracial country and the effects of postnatal rituals. All women were at least 6 weeks post-partum when asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and birth data were obtained.

    RESULTS: Data collected were divided into two groups: 55 emergency delivery and 191 non-emergency delivery. There were four missing data. There was no significant difference in the mean age, parity, gestational period, baby birthweight, 5 min baby Apgar score and EPDS scores of the two groups. However, the analysis of PND indicated that women with emergency delivery had a relative risk of 1.81 compared with women with non-emergency delivery. The comparison of the two groups using chi2 indicated a significant (chi2 = 3.94, d.f. = 1, P = 0.04) increase in the presence of PND in the emergency delivery.

    CONCLUSION: When compared with women having non-emergency delivery, women having emergency delivery had about twice the risk of developing PND. Special attention to this group appears warranted.

  16. Lim YH, Ng SP, Jamil MA
    J Obstet Gynaecol Res, 2003 Dec;29(6):399-401.
    PMID: 14641689 DOI: 10.1111/j.1341-8076.2003.00136.x
    Imperforate hymen is an uncommon obstructive anomaly of the female reproductive tract, which usually presents with intermittent and cyclical abdominal pain. Although it is usually sporadic, four cases of familial occurrence of imperforate hymen have been reported so far. Imperforate hymen is seldom associated with complications if it is detected early. In view of the possible familial occurrence, it is important to have a high index of suspicion in women who present with imperforate hymen. A detailed menstrual history of other female family members is necessary to enable early detection.
  17. Tan GC, Isa MR, Ng SP, Jamil YM
    J Obstet Gynaecol Res, 2004 Oct;30(5):363-7.
    PMID: 15327449
    Microinvasive squamous cell carcinoma of the uterine cervix is a recognized entity and is defined as carcinoma with invasion of less than 5 mm penetration of the stroma and seldom metastasized. Our patient was a 70-year-old, multiparous woman who had a microinvasive, cervical, squamous cell carcinoma. The tumor had spread superficially into the entire endometrial cavity up to the fundus, totally replacing the columnar epithelium. This is an extremely rare phenomenon, with fewer than 20 cases reported so far in the literature.
  18. Noraihan MN, Sharda P, Jammal AB
    J Obstet Gynaecol Res, 2005 Aug;31(4):302-9.
    PMID: 16018776
    To ascertain the characteristics, clinical features, and maternal fetal outcome in eclampsia in a tertiary referral center with 24 000 deliveries per year.
  19. Tan AE, Norizah WM, Rahman HA, Aziz BA, Cheah FC
    J Obstet Gynaecol Res, 2005 Aug;31(4):296-301.
    PMID: 16018775 DOI: 10.1111/j.1447-0756.2005.00291.x
    Aim: To determine the incidence of an abnormal umbilical artery resistance index (UARI) in diabetic pregnancies and the relation to fetal outcome and the development of neonatal septal hypertrophic cardiomyopathy.

    Methods: A case-control study with subjects comprising 50 randomly selected diabetic mothers and a matched control group of 50 non-diabetic pregnancies. Doppler studies of the UARI were carried out at least once per week, beginning from 36 weeks' gestation for both groups. Within 48 h post delivery, echocardiograms were carried out on the newborn infants to identify those with hypertrophic cardiomyopathy, particularly asymmetrical septal hypertrophy.

    Results: The numbers of patients with abnormal UARI were similar in both the diabetic and control groups. A higher proportion of operative deliveries for intrapartum fetal distress was seen in patients with an abnormal UARI in the diabetic group. However, the groups did not differ in the numbers of infants who were small for gestational age, who had low Apgar scores or umbilical artery acidosis, and who required admission to the special care nursery. Six infants of diabetic mothers (12%) had septal hypertrophy, but none of these were associated with abnormal antenatal UARI.

    Conclusion: Diabetic pregnancy is not associated with a significantly higher incidence of abnormal UARI on Doppler study than non-diabetic pregnancy. UARI is not a useful single indicator by which to predict subsequent fetal outcome or the development of neonatal septal hypertrophic cardiomyopathy in diabetic pregnancies.
  20. Wee YC, Tan KL, Chow TW, Yap SF, Tan JA
    J Obstet Gynaecol Res, 2005 Dec;31(6):540-6.
    PMID: 16343256 DOI: 10.1111/j.1447-0756.2005.00333.x
    AIM: Interactions between different determinants of alpha-thalassemia raises considerable problems, particularly during pregnancies where antenatal diagnosis is necessary. This study aims to determine the different types of deletional alpha-thalassemia and Hemoglobin Constant Spring (HbCS), and their frequency in Malays, Chinese and Indians in Malaysia.
    METHODS: DNA from 650 pregnant women from the Antenatal Clinic of the University of Malaya Medical Center in Kuala Lumpur, Malaysia who showed mean cell volume < or =89 fL and/or mean cell hemoglobin < or =28 pg were analyzed for the double alpha-globin gene South-East Asian deletion (--SEA), the -alpha3.7 and -alpha4.2 single alpha-globin gene deletions and HbCS.
    RESULTS: One hundred and three (15.8%) of the pregnant women were confirmed as alpha-thalassemia carriers: 25 (3.8%) were alpha-thalassemia-1 carriers with the --SEA/alphaalpha genotype, 64 (9.8%) were heterozygous for the -alpha3.7 rightward deletion (-alpha3.7/alphaalpha), four (0.6%) were heterozygous for the -alpha4.2 leftward deletion (-alpha4.2/alphaalpha), nine (1.4%) were heterozygous for HbCS (alphaCSalpha/alphaalpha) and one (0.2%) was compound heterozygous with the -alpha3.7/alphaCSalpha genotype. The double alpha-globin gene --SEA deletion was significantly higher in the Chinese (15%) compared to the Malays (2.5%) and not detected in the Indians studied. The -alpha3.7 deletion was distributed equally in the three races. HbCS and -alpha4.2 was observed only in the Malays.
    CONCLUSION: The data obtained gives a better understanding of the interactions of the different alpha-thalassemia determinants in the different ethnic groups, thus enabling more rapid and specific confirmation of alpha-thalassemia in affected pregnancies where antenatal diagnosis is necessary.
    Study site: Antenatal clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
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