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  1. Kaur H, Narayanan L, Yachendra VSG, Bhaskaran B
    Med J Malaysia, 2025 Jan;80(Suppl 1):37-43.
    PMID: 39773941
    INTRODUCTION: Pregnancy induces physiological changes, including alterations in cardiovascular dynamics, predisposing pregnant women to supine hypotension syndrome (SHS) during lower-segment cesarean section (LSCS) under spinal anesthesia. Various methods, including manual displacement of the uterus and use of wedges or cushions, have been proposed to prevent SHS, but their effectiveness remains variable. This study aimed to compare the efficacy of a novel 3D-printed uterine displacement device with that of a traditional wedge in preventing SHS during LSCS after spinal anesthesia.

    METHODOLOGY: This prospective, randomized, controlled trial enrolled pregnant females undergoing LSCS after spinal anesthesia. The participants were randomized into two groups: a novel 3D device group and a traditional wedge group. Primary outcome measures included the incidence of SHS, while secondary outcomes included maternal hemodynamic parameters, fetal outcomes, feasibility, ease of use, and the safety profile of the devices.

    RESULTS: Baseline characteristics were well balanced between the two groups. Although some differences in maternal hemodynamic parameters were noted, the incidence of SHS was significantly lower in the novel 3D device group than that in the traditional wedge group. Fetal outcomes did not differ significantly between the groups. The novel 3D device demonstrated high compatibility with various patient anatomies and was easy to integrate into routine practice. The adverse event profiles were similar between the groups.

    CONCLUSION: This study highlights the potential of a novel 3D-printed uterine displacement device for preventing SHS during LSCS, thereby improving maternal and fetal outcomes. Future research should further validate these findings and explore the long-term implications of the maternal and neonatal outcomes.

    Matched MeSH terms: Hypotension, Orthostatic/etiology
  2. Hamzaid NA, Tean LT, Davis GM, Suhaimi A, Hasnan N
    Spinal Cord, 2015 May;53(5):375-9.
    PMID: 25366533 DOI: 10.1038/sc.2014.187
    STUDY DESIGN: Prospective study of two cases.

    OBJECTIVES: To describe the effects of electrical stimulation (ES) therapy in the 4-week management of two sub-acute spinal cord-injured (SCI) individuals (C7 American Spinal Injury Association Impairment Scale (AIS) B and T9 AIS (B)).

    SETTING: University Malaya Medical Centre, Kuala Lumpur, Malaysia.

    METHODS: A diagnostic tilt-table test was conducted to confirm the presence of orthostatic hypotension (OH) based on the current clinical definitions. Following initial assessment, subjects underwent 4 weeks of ES therapy 4 times weekly for 1 h per day. Post-tests tilt table challenge, both with and without ES on their rectus abdominis, quadriceps, hamstrings and gastrocnemius muscles, was conducted at the end of the study (week 5). Subjects' blood pressures (BP) and heart rates (HR) were recorded every minute during pre-test and post-tests. Orthostatic symptoms, as well as the maximum tolerance time that the subjects could withstand head up tilt at 60°, were recorded.

    RESULTS: Subject A improved his orthostatic symptoms, but did not recover from clinically defined OH based on the 20-min duration requirement. With concurrent ES therapy, 60° head up tilt BP was 89/62 mm Hg compared with baseline BP of 115/71 mm Hg. Subject B fully recovered from OH demonstrated by BP of 105/71 mm Hg during the 60° head up tilt compared with baseline BP of 124/77 mm Hg. Both patients demonstrated longer tolerance time during head up tilt with concomitant ES (subject A: pre-test 4 min, post-test without ES 6 min, post-test with ES 12 min; subject B: pre-test 4 min, post-test without ES 28 min, post-test with ES 60 min).

    CONCLUSIONS: Weekly ES therapy had positive effect on OH management in sub-acute SCI individuals.

    Matched MeSH terms: Hypotension, Orthostatic/etiology*
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