Displaying publications 1 - 20 of 94 in total

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  1. 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.
    Matched MeSH terms: Placenta
  2. Sivarao S, Vidyadaran MK, Jammal AB, Zainab S, Goh YM, Ramesh KN
    Placenta, 2002 10 4;23(8-9):691-6.
    PMID: 12361688
    This study was conducted to determine the effect of ethnicity on maternal, placental and neonatal parameters. Maternal, placental, and the newborn parameters were corrected for gestational age. The male:female sex ratio was 1:1.03. One hundred and forty-four freshly delivered placentae from 55 Malaysian, 51 Chinese, and 38 Indian normal healthy patients were collected and standard stereological methods used to estimate the placental parameters. Pearson's correlation, Spearman's correlation and 1-way ANOVA were used to test significance of differences. Placental surface area, placental weight and placental volume of Indians were lower than Malays (P< 0.05). Placental weight correlated significantly with neonatal length (r=0.527), birthweight (r=0.665), head circumference (r=0.371) and booking weight (r=0.193) while placental volume correlated with neonatal length (r=0.588), birthweight (r=0.688), head circumference (r=0.384), parity (r=0.202) and booking weight (r=0.219) at P< 0.05. Indian babies weight and length were less than Chinese and Malay babies (P< 0.05) while booking weight of Indian mothers was less than those of Chinese mothers (P< 0.05). Even after being corrected for booking weight, placental parameters of Indian patients were still significantly less than Malays and Chinese (P< 0.05).
    Matched MeSH terms: Placenta/anatomy & histology*; Placenta/physiology
  3. Azliana AF, Zainul-Rashid MR, Chandramaya SF, Farouk WI, Nurwardah A, Wong YP, et al.
    Indian J Pathol Microbiol, 2018 1 13;60(4):515-520.
    PMID: 29323064 DOI: 10.4103/IJPM.IJPM_376_16
    INTRODUCTION: Hypertensive disorder in pregnancy (HDP) represents the most common medical complication in pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity. Vascular endothelial growth factor (VEGF) stimulates vascular endothelial cell growth, survival, and proliferation, and they are known to be expressed in human placenta. The aim of this study was to determine the VEGF expression in the placenta of hypertensive and normotensive patients.

    MATERIALS AND METHODS: This is a retrospective, cross-sectional study from January 1, 2015 to December 31, 2015. A total of 30 placentae comprised of 15 hypertensive and 15 normotensive cases were assessed. VEGF expression in placenta was assessed by immunohistochemistry, and the number of syncytial knots was counted.

    RESULTS: Our study showed an increased syncytial knot formation in the placenta of hypertensive mothers. VEGF expression was seen in syncytiotrophoblasts of 14 of the hypertensive cases (14/15, 93.3%), while only two of the normotensive cases were positive (2/15, 13.3%). There were no statistically significant differences in VEGF expression in other placenta cells, that is, cytotrophoblasts (P = 1.0), decidual cells (0.1394), maternal endothelial cells (0.5977), and fetal endothelial cells (P = 1.0).

    CONCLUSIONS: This study showed an increased number of syncytial knots is a consistent histological finding in the placenta of patient with HDP. VEGF expression was significantly increased in syncytiotrophoblasts in placenta of hypertensive group, and it could be used as a biomarker for hypertension.

    Matched MeSH terms: Placenta/pathology*
  4. Wan Adnan WF, Shamsudin F, Mohamad Zon E
    Eur J Obstet Gynecol Reprod Biol, 2021 Mar;258:467-469.
    PMID: 33483151 DOI: 10.1016/j.ejogrb.2020.12.007
    Matched MeSH terms: Placenta Accreta*
  5. Gan F, Vikneswaran V, Yu KK
    Med J Malaysia, 2021 03;76(2):273-274.
    PMID: 33742646
    A 32-year-old, gravida 2 para 0+1, was managed in Selayang Hospital, Selangor for uterine fibroids in pregnancy and placenta previa major. The lady went into preterm labour at 33 weeks, requiring emergency Caesarean section. Intraoperatively, we found a thinned-out bulge between the intramural uterine fibroids at the posterior uterine wall, which then perforated and was repaired. Persistent bleeding post operatively led to relaparotomy and hysterectomy. Histology of the uterus reported arteriovenous malformation (AVM). We postulate the possibility of these lesions coexisting with uterine fibroids. Screening for uterine AVMs in patients with fibroids may lead to early detection with option of embolization; deferring the need for hysterectomy.
    Matched MeSH terms: Placenta Previa
  6. Lim PS, Singh S, Lee A, Muhammad Yassin MA
    Arch Gynecol Obstet, 2011 Nov;284(5):1073-9.
    PMID: 21136267 DOI: 10.1007/s00404-010-1785-6
    Retained placenta is potentially life threatening due to possible complications associated with manual removal. Our aim was to determine whether umbilical vein injection of oxytocin in saline reduces the need for manual removal of placenta.
    Matched MeSH terms: Placenta, Retained/drug therapy*; Placenta, Retained/surgery*
  7. 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 placenta.

    Matched MeSH terms: Placenta, Retained/drug therapy*
  8. 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.
    Matched MeSH terms: Placenta/blood supply*
  9. Mohd Razif Mohd Idris, Fazlina Nordin, Fadilah Abd Wahid S, Zaleha Abdullah Mahdy
    Sains Malaysiana, 2018;47:2491-2499.
    The aim of this study to determine the numbers of CD34+ cells and total nucleated cell (TNC) in umbilical cord blood (UCB)
    collected from pregnant mothers with gestational diabetes mellitus (GDM) and preeclampsia (PE), following statistical
    analysis of both maternal and perinatal factors which affect UCB parameters. Most of studies explored the influence of
    obstetric factors on the number of UCB cell collection and only a few looked at the effects on UCB haematopoietic stem
    cell (UCB-HSC) of common disorders complicating pregnancy. A total of 112 UCB samples (32 PE, 42 GDM and 38 nondiseased) were collected. CD34+ cell and NC count were enumerated using FACS Calibur. The TNC and CD34+ cells were
    significantly reduced in both PE and GDM groups as compared to the control group. The PE group shows significantly
    lower birth weight and higher BP which led to a lower UCB volume and CD34+ count. Gestational age shows significant
    correlation with nucleated cell count (NCC) and TNC. GDM group shows significantly lower systolic BP, NCC and TNC count,
    including low placental weight and birth weight. Conclusively, some obstetrics factors have significant influences to the
    numbers and quality of UCB-HSC in both PE and GDM groups, which could guide in the selection criteria for CB banking.
    Matched MeSH terms: Placenta
  10. Mohamed M, Larmie ET, Singh HJ, Othman MS
    Eur J Obstet Gynecol Reprod Biol, 2007 Sep;134(1):15-9.
    PMID: 17050061
    An imbalance of vasoconstrictor and vasodilator substances in the placenta has been postulated in the pathogenesis of pregnancy-induced hypertension (PIH). There is however little information available on the kallikrein-kinin system (KKS) in women with PIH. The aim of this study therefore was to determine tissue kallikrein and kininogen levels and their distribution patterns in fetoplacental tissues from both normotensive pregnant (NTP) women and women with PIH.
    Matched MeSH terms: Placenta/metabolism*; Placenta/chemistry
  11. Hayati AR, Khong TY, Zainul R
    Malays J Pathol, 1998 Dec;20(2):99-102.
    PMID: 10879270
    144 placentas were sampled from all cases of stillbirth weighing 500 g and above seen over a period of thirteen months in the UKM Unit of the Maternity Hospital, Kuala Lumpur. Sampling was limited to 1-3 blocks per placenta for histological study. Placental abnormalities were found in 121 (85%) placentas, 78 of which had definite lesions known to contribute to foetal death while the remainder showed lesions suggestive of an underlying disease. This study supports the usefulness of limited sampling of the placenta in the face of unavailability of complete placental examination and autopsy for assessment of the cause of stillbirth.
    Matched MeSH terms: Placenta/pathology*; Placenta Diseases/pathology
  12. Ng PH, NorAzlin MI, Nasri NI
    Int J Gynaecol Obstet, 2007 Dec;99(3):251.
    PMID: 17888439
    Matched MeSH terms: Placenta Diseases/drug therapy*; Placenta Diseases/pathology
  13. Pannu D, Bharti R, Anand HP, Sharma M
    Malays J Med Sci, 2016 Sep;23(5):96-99.
    PMID: 27904431
    Term, live abdominal pregnancy secondary to rupture of a uterine rudimentary horn is a rare condition. Pregnancies conceived in the rudimentary horn of the uterus usually rupture during early gestation and present as a catastrophic event. However, rarely, after rupture of the uterine horn the foetus may continue to grow in the abdominal cavity and reach term gestation. A primigravida with a term pregnancy was referred to our centre for caesarean section with ultrasonography findings of transverse lie and placenta previa. During surgery, a live baby was extracted from the abdominal cavity, revealing a bicornuate uterus with rupture of the rudimentary horn. The early peroperative diagnosis and prompt control of the bleeding with excision of the rudimentary horn and transfusion of multiple blood products saved the patient's life. The case is presented for its rarity and to highlight the importance of a high index of suspicion in cases presenting with abnormal foetal presentation.
    Matched MeSH terms: Placenta Previa
  14. Omar NS, Mat Jin N, Mohd Zahid AZ, Abdullah B
    Am J Case Rep, 2020 Aug 10;21:e924894.
    PMID: 32776917 DOI: 10.12659/AJCR.924894
    BACKGROUND Uterine rupture is uncommon but when it happens, it can cause significant morbidity and mortality to both mother and fetus. Incidence reportedly is higher in scarred than in unscarred uteri. Most cases occur in laboring women in their third trimester with a previous history of uterine surgery, such as caesarean delivery or myomectomy. We present a case of spontaneous uterine rupture in a non-laboring uterus in the mid-trimester of pregnancy. CASE REPORT The patient presented with threatened miscarriage at 17 weeks' gestation and ultrasound findings were that raised suspicion of a morbidly adherent placenta. Her history was significant for two previous cesarean deliveries more than 5 years ago followed by two spontaneous complete miscarriages in the first trimester. The patient was managed conservatively until 20 weeks' gestation, when she presented with acute abdomen with hypotensive shock. Her hemoglobin dropped to a level such that she required blood transfusion. An emergency exploratory laparotomy was performed, which revealed a 5-cm rupture in the lower part of the anterior wall of the uterus, out of which there was extrusion of part of the placenta. Given the patient's massive bleeding, the decision was made to proceed with subtotal hysterectomy. Histopathology of the specimen confirmed the diagnosis of placenta percreta. CONCLUSIONS Identification of uterine scarring with morbidly adherent placenta is crucial because even in early pregnancy, it can lead to uterine rupture. Furthermore, failure to recognize and promptly manage uterine rupture may prove fatal.
    Matched MeSH terms: Placenta Accreta/diagnosis*; Placenta Accreta/surgery
  15. Wan Masliza WD, Bajuri MY, Hassan MR, Naim NM, Shuhaila A, Das S
    Clin Ter, 2017 10 19;168(5):e283-e289.
    PMID: 29044348 DOI: 10.7417/T.2017.2021
    BACKGROUND: The placenta is a most interesting but unfortunately often ignored and misunderstood organ. Placental abnormalities, therefore, can be an "early warning system" for fetal problems. A complete prenatal sonographic examination of the placenta is an essential component as its abnormalities can have a direct effect on fetal or maternal outcomes, obstetrical management and future fertility.

    OBJECTIVE: To determine whether any association exists between the finding of an increased thickness of placenta, abnormal placenta shape, placental calcification, placental lake and abnormal cord insertion site at 20-22 and 30-32 weeks gestation with an increased risk of uteroplacental complications or a poor pregnancy outcome.

    METHODOLOGY: A real-time ultrasound was used at the time of detail scan (at 20-22 weeks gestation) and at 30-32 weeks gestation to look for placenta appearance, fetal growth and anomaly. The main outcome measures were risk of hypertension disease in pregnancy, fetal growth restriction and poor fetal outcomes such as low Apgar score and low cord pH.

    RESULT: The majority of the participants were Malay (77.9%). Abnormal placenta found at both gestations were placental lakes and thickness, and only one case had marginal cord insertion. Approximately 6% of the cases were confirmed placenta previa. No abnormal shape or abnormal calcification found at both gestations. About 10% patient developed hypertensive disease in pregnancy, 15% of the fetus was found to have growth restriction and another 16% have low umbilical cord pH. Majority of them delivered at term (90%) and via vaginal delivery (81%). There was no significance between presence of abnormal placental lake and thickness at both gestations with the maternal and fetal outcome.

    CONCLUSION: Presence of abnormal placental thickness and lakes at 30-32 weeks scan associated with maternal hypertensive disease, fetal growth restriction and low umbilical cord pH, however these were not statistically significant.

    Matched MeSH terms: Placenta/abnormalities*; Placenta Diseases
  16. Yip MY, Dhaliwal SS, Yong HS
    Hum. Hered., 1979;29(1):5-9.
    PMID: 761922
    Four red cell enzyme systems were studied in Malaysian mothers and their newborn belonging to three racial groups, the Malays, Indians and Chinese. No significant heterogeneity was observed in the distribution of phosphoglucomutase (PGM1), adenosine deaminase (ADA), 6-phosphogluconate dehydrogenase (6PGD) and acid phosphatase (AP) phenotypes between mothers and their newborn of the three groups. Pooled mother and child acid phosphatase data show a significant heterogeneity between the Malays and Chinese, and between the Malays and Indians. This is comparable to previous studies conducted. For the placental phosphoglucomutase (PGM3) system, a significant heterogeneity was observed between the Chinese and Malays only. No significant heterogeneity was detected in the distribution of PGM1, ADA and 6PGD phenotypes among Malays, Chinese and Indians.
    Matched MeSH terms: Placenta/enzymology
  17. Faridah Hanim Zam Zam, Nazimah Idris, Tham, Seng Woh
    MyJurnal
    Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis. Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk
    singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s
    classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control. Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess. Conclusion: Certain second stage fetal heart rate
    patterns were found to be associated with neonatal acidosis.
    Matched MeSH terms: Placenta
  18. Samara TD, Liem IK, Prijanti AR, Andrijono
    Malays J Med Sci, 2019 Jan;26(1):66-72.
    PMID: 30914894 DOI: 10.21315/mjms2019.26.1.6
    Background: An imbalance between pro- and anti-angiogenic factors contributes to impaired trophoblast invasion during pregnancy, leading to failure of uterine spiral artery remodeling, blood vessel ischemia, and pre-eclampsia (PE). Anti-angiogenic semaphorin 3B (SEMA3B) and pro-angiogenic cullin 1 (CUL1) are expressed in both the placenta and maternal blood. The present study investigated correlations between serum and placental SEMA3B as well as CUL1 levels in late-onset PE.

    Methods: This cross-sectional study included 50 patients with late-onset (≥ 32 weeks gestation) PE. Maternal serum was obtained before delivery, and placentas were obtained immediately after delivery. SEMA3B and CUL1 levels were evaluated by ELISA. Results were statistically analysed by Spearman correlation test, with a P < 0.05 considered statistically significant.

    Results: While elevated serum SEMA3B levels significantly correlated with increased placental SEMA3B levels in late-onset PE (R = 0.620, P = 0.000), alteration of serum CUL1 levels did not correlate with alteration of placental CUL1.

    Conclusion: Alteration of circulating maternal SEMA3B, but not CUL1, levels can potentially be used to monitor PE progression during pregnancy.

    Matched MeSH terms: Placenta
  19. Wong YP, Tan GC, Khong TY
    Int J Mol Sci, 2023 Feb 25;24(5).
    PMID: 36901979 DOI: 10.3390/ijms24054550
    The outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global public health crisis, causing substantial concern especially to the pregnant population. Pregnant women infected with SARS-CoV-2 are at greater risk of devastating pregnancy complications such as premature delivery and stillbirth. Irrespective of the emerging reported cases of neonatal COVID-19, reassuringly, confirmatory evidence of vertical transmission is still lacking. The protective role of the placenta in limiting in utero spread of virus to the developing fetus is intriguing. The short- and long-term impact of maternal COVID-19 infection in the newborn remains an unresolved question. In this review, we explore the recent evidence of SARS-CoV-2 vertical transmission, cell-entry pathways, placental responses towards SARS-CoV-2 infection, and its potential effects on the offspring. We further discuss how the placenta serves as a defensive front against SARS-CoV-2 by exerting various cellular and molecular defense pathways. A better understanding of the placental barrier, immune defense, and modulation strategies involved in restricting transplacental transmission may provide valuable insights for future development of antiviral and immunomodulatory therapies to improve pregnancy outcomes.
    Matched MeSH terms: Placenta
  20. Wong YP, Tan GC, Omar SZ, Mustangin M, Singh Y, Salker MS, et al.
    Int J Environ Res Public Health, 2022 Aug 03;19(15).
    PMID: 35954874 DOI: 10.3390/ijerph19159517
    The association between maternal COVID-19 infection, placental histomorphology and perinatal outcomes is uncertain. The published studies on how placental structure is affected after SARS-CoV-2 virus in COVID-19-infected pregnant women are lacking. We investigated the effects of maternal SARS-CoV-2 infection on placental histomorphology and pregnancy outcomes. A retrospective cohort study on 47 pregnant women with confirmed SARS-CoV-2 infection, matched with non-infected controls, was conducted. Relevant clinicopathological data and primary birth outcomes were recorded. Histomorphology and SARS-CoV-2 immunohistochemistry analyses of placental tissues were performed. Only 1 of 47 cases showed SARS-CoV-2 immunoreactivity in the syncytiotrophoblasts. Histologically, decidual vasculopathy (n = 22/47, p = 0.004), maternal vascular thrombosis (n = 9/47, p = 0.015) and chronic histiocytic intervillositis (n = 10/47, p = 0.027) were significantly higher in the COVID-19-infected placentas when compared to the control group. Maternal vascular thrombosis was a significant feature in the active COVID-19 group. A significant lower gestational age (p < 0.001)) at delivery and a higher caesarean section rate (p = 0.007) were observed in the active SARS-CoV-2-infected cases, resulting in a significant lower fetal-placental weight ratio (p = 0.022) and poorer Apgar score (p < 0.001). Notably, active (p = 0.027), symptomatic (p = 0.039), severe-critical (p = 0.002) maternal COVID-19 infection and placental inflammation (p = 0.011) were associated with an increased risk of preterm delivery. Altered placental villous maturation and severe-critical maternal COVID-19 infection were associated with an elevated risk of poor Apgar scores at birth (p = 0.018) and maternal mortality (p = 0.023), respectively.
    Matched MeSH terms: Placenta
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