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Fulltext Factors associated with placenta praevia in primigravidas and its pregnancy outcome

Nur Azurah AG, Wan Zainol Z, Lim PS, Shafiee MN, Kampan N, Mohsin WS, et al.

ScientificWorldJournal, 2014;2014:270120.
PMID: 25478587 DOI: 10.1155/2014/270120

To examine the factors associated with placenta praevia in primigravidas and also compare the pregnancy outcomes between primigravidas and nonprimigravidas.

Matched MeSH terms: Pregnancy Outcome*
Fulltext Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan

Kasim R, Draman N, Abdul Kadir A, Muhamad R

Education in Medicine Journal, 2016;8(4):57-68.
MyJurnal

Introduction: Pregnancy is common among women in the reproductive age and is associated with several risks. Preconception care has thus been introduced to promote health before conception and to improve pregnancy-related outcomes. The aim of this study was to determine the level of knowledge, attitudes and practices regarding preconception care among women attending antenatal care appointments. Methodology: This was a cross-sectional study conducted from April to December 2012 at Klinik Kesihatan Bachok. A self-administered questionnaire was administered to 135 respondents from 18 to 45 years of age. The questionnaire consisted of four domains, assessing socio-demographic data and knowledge, attitudes and practice of preconception care. Results: The mean (SD) knowledge, attitude and practice scores were 11.37 (3.94), 15.39 (2.12) and 10.13 (2.30), respectively. In total, 98.5% of the respondents had good attitudes, 45.2% had good practices, and 51.9% had good knowledge of preconception care. Conclusion: Women in Bachok have fair knowledge of and good attitude towards preconception care. However, they have poor preconception care practices.

Matched MeSH terms: Pregnancy Outcome
Fulltext Outcome of forceps delivery versus vacuum extraction--a review of 200 cases

Achanna S, Monga D

Singapore Med J, 1994 Dec;35(6):605-8.
PMID: 7761886

The outcome of 100 patients undergoing instrumental delivery with vacuum extractor is compared with that of 100 women delivered with the aid of obstetric forceps. Forceps deliveries were more commonly associated with maternal birth canal trauma (including episiotomy) whilst vacuum extractor carried higher odds of the neonate developing jaundice. Apart from these, there were no significant differences between these two groups in terms of maternal morbidity, neonatal trauma and morbidity and ultimate outcome (success with the type of instrument used). We conclude that with meticulous handling of the instrument and with an appropriate decision on the indication and the type of instrument used, the maternal and neonatal outcome could be equally good with the use of either instrument.

Matched MeSH terms: Pregnancy Outcome*
Fulltext A retrospective review of 25 cases of lethal fetal anomalies

Dalia, F.A., Hamizah, I., Zalina, N., Yong, S.L., Mokhtar, A.

International Medical Journal Malaysia, 2016;15(1):19-23.
MyJurnal

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.

Matched MeSH terms: Pregnancy Outcome
Fulltext Monoamniotic Twin Pregnancy; is There a Need for Frequent Fetal-Doppler Surveillance?

Suhaiza, A., Che Anuar, C.Y., Nik Zuky, N.L., Mokhtar, A.

International Medical Journal Malaysia, 2010;9(2):57-58.
MyJurnal

Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and
sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for
umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome
but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.

Matched MeSH terms: Pregnancy Outcome
A successful pregnancy outcome of homozygous familial hypercholesterolaemia patient on statin therapy

Mohd Kasim NA, Al-Khateeb A, Chua YA, Sanusi AR, Mohd Nawawi H

Malays J Pathol, 2021 Apr;43(1):87-93.
PMID: 33903311

Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disorder of lipoprotein metabolism mainly due to mutation of the low-density lipoprotein (LDL)-receptor gene (LDLR). It is a life-threatening disease that causes accelerated, multi-vessel atherosclerosis presented in early childhood. Pregnancy in HoFH may pose early coronary morbidity and mortality to both the foetus and mother. The combination of HoFH and pregnancy can be a fatal condition. While statins are very effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, they are generally contraindicated during pregnancy, thus their use during pregnancy is uncommon. On the other hand, lipid apheresis (LA) has turned into an effective treatment to control cholesterol level amid pregnancy. However, the procedure is not widely available in our region. To date, there are scarcely documented case reports of HoFH in pregnancy in which the majority of them underwent LA to keep LDL-C at a low level. We report a rare case of successful pregnancy outcome of HoFH patient treated with lipid-lowering drugs including statin without LA therapy. Apart from that, we also discussed the genetic findings of the proband and all screened family members in which to the best of our knowledge, the first study using the whole-exome sequencing technique to identify the causative gene mutations for familial hypercholesterolaemia among the Malaysian population.

Matched MeSH terms: Pregnancy Outcome
Fulltext Morbidly adherent placenta at extreme prematurity: can major haemorrhage and hysterectomy be prevented?

Shafiee, M.N., Rahana, A.R., Lim, P.S., Nor Azlin, M.I., Wan Faraliza, Z.A., Isa, M.R., et al.

Journal of Surgical Academia, 2011;1(1):56-60.
MyJurnal

Morbidly adherent placenta with spontaneous rupture of membrane at extreme prematurity poses poor pregnancy outcome. Various issues on different management modalities still remain perplexed and individual consideration is vital. Two cases of morbidly adherent placenta with symptomatic per vaginal bleeding and spontaneous rupture of membrane at severe prematurity were reviewed and discussed. We found that, active intervention by termination of pregnancy and methotrexate therapy at early gestation can prevent the need of hysterectomy following major obstetrics haemorrhage.

Matched MeSH terms: Pregnancy Outcome
Fulltext Tocotrienols and oxidative stress in ocytes and developing embryos

Yuhaniza Shafinie Kamsani, Mohd Hamim Rajikin

Journal of Clinical and Health Sciences, 2017;2:8-18.

This review summarizes the impact of tocotrienols (TCTs) as antioxidants in minimizing
oxidative stress (OS), particularly in embryos exposed to OS causing agents. OS level is
increased, for example, by nicotine, a major alkaloid content in cigarette, which is also a source
of exogenous reactive oxygen species (ROS). Increased nicotine-induced OS increases cell
stress response, which is a common trigger leading to embryonic cell death. Having more
profound anti-oxidative stress effects than its counterpart tocopherol, TCTs improve blastocyst
implantation, foetal growth, pregnancy outcome and survival of the neonates affected by
nicotine. In reversing cell developmental arrest caused by nicotine-induced OS, TCTs enhances
PDK-1 expression in the P13K/Akt pathway and permit embryonic development beyond the 4-
cell stage with the production of more morulae. At the cytoskeletal level, TCTs increase the
number of nicotine-induced apoptotic cells, through caspase 8 activation in the mitochondria.
TCTs facilitate rough endoplasmic reticulum (rER) stress-mediated apoptosis and autophagy,
resulting from nicotine-induced OS. Reduced vesicular population in TCT supplemented
oocytes on the other hand may suggest reduced secretion of apoptotic cell bodies thus probably
minimizing vesicular apoptosis during oocyte maturation. Further extensive research is
required to develop TCTs as a tool in specific therapeutic approaches to overcome the
detrimental effects of OS.

Matched MeSH terms: Pregnancy Outcome
Fulltext Tocotrienols and oxidative stress in ocytes and developing embryos

Yuhaniza Shafinie Kamsani, Mohd Hamim Rajikin

Journal of Clinical and Health Sciences, 2017;2(2):8-18.
MyJurnal

This review summarizes the impact of tocotrienols (TCTs) as antioxidants in minimizing oxidative stress (OS), particularly in embryos exposed to OS causing agents. OS level is increased, for example, by nicotine, a major alkaloid content in cigarette, which is also a source of exogenous reactive oxygen species (ROS). Increased nicotine-induced OS increases cell stress response, which is a common trigger leading to embryonic cell death. Having more profound anti-oxidative stress effects than its counterpart tocopherol, TCTs improve blastocyst implantation, foetal growth, pregnancy outcome and survival of the neonates affected by nicotine. In reversing cell developmental arrest caused by nicotine-induced OS, TCTs enhances PDK-1 expression in the P13K/Akt pathway and permit embryonic development beyond the 4-cell stage with the production of more morulae. At the cytoskeletal level, TCTs increase the number of nicotine-induced apoptotic cells, through caspase 8 activation in the mitochondria. TCTs facilitate rough endoplasmic reticulum (rER) stress-mediated apoptosis and autophagy, resulting from nicotine-induced OS. Reduced vesicular population in TCT supplemented oocytes on the other hand may suggest reduced secretion of apoptotic cell bodies thus probably minimizing vesicular apoptosis during oocyte maturation. Further extensive research is required to develop TCTs as a tool in specific therapeutic approaches to overcome the detrimental effects of OS.

Matched MeSH terms: Pregnancy Outcome
Fulltext Propolis improves pregnancy outcomes and placental oxidative stress status in streptozotocin-induced diabetic rats

Usman UZ, Bakar ABA, Mohamed M

BMC Complement Altern Med, 2018 Dec 05;18(1):324.
PMID: 30518366 DOI: 10.1186/s12906-018-2391-6

BACKGROUND: This study assessed the effects of propolis alone or combined with insulin on maternal status, pregnancy outcomes and placental oxidative stress in streptozotocin-induced diabetic rats.
METHODS: Forty female rats were randomly assigned into five groups (n = 8/group) i.e. non-DM (non-diabetes), DM (diabetes), DM + Propolis (diabetes on propolis orally); DM + Insulin (diabetes on insulin subcutaneously) and DM + Combined (diabetes on propolis and insulin) groups. Propolis and insulin were given at 300 mg/kg/day orally and 5.0 IU/kg/day subcutaneously, respectively, for 4 weeks.
RESULTS: Fasting blood glucose, conception period, implantation losses, foetal blood glucose and placental oxidative stress markers such as malonaldehyde and protein carbonyl were significantly higher while maternal weight gain, foetal body weight and total antioxidant capacity were significantly lower in DM group compared with non-DM group. These changes were significantly improved in rats treated with propolis or insulin alone with greater significant effects in rats treated with both propolis and insulin.
CONCLUSION: This study may suggest the protective effects of propolis against DM-induced impaired pregnancy outcomes and placental oxidative stress with greater effects when combined with insulin.

Matched MeSH terms: Pregnancy Outcome*
Management Options and Outcome of Cerebral Arteriovenous Malformation in Pregnancy: Case Series

Teik CK, Basri NI, Abdul Karim AK, Azrai Abu M, Ahmad MF, Abdul Ghani NA, et al.

Arch Iran Med, 2019 06 01;22(6):340-343.
PMID: 31356101

Cerebral arteriovenous malformation (AVM) is a rare entity with an estimated prevalence of 0.01-0.05% in the general population. We reviewed hospital obstetric records during 2010-2017 and reported a case series of six patients with cerebral AVM in pregnancy, of which five patients had successful pregnancy, and one maternal mortality.

Matched MeSH terms: Pregnancy Outcome
Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section

Kalok A, Zabil SA, Jamil MA, Lim PS, Shafiee MN, Kampan N, et al.

J Obstet Gynaecol, 2018 Apr;38(3):339-343.
PMID: 29017359 DOI: 10.1080/01443615.2017.1355896

This was a prospective observational study to determine the predictive factors for a successful vaginal birth after caesarean section (VBAC) and to develop a relevant antenatal scoring system. Patients with one previous caesarean section were included in this study. All data including maternal demographics, obstetric history, pregnancy progress and outcomes were collected and analysed. A total of 142 out of the 186 women (76.3%) had successful VBAC. History of previous vaginal delivery and non-recurrent indications for previous caesarean section were the significant predictive factors for a successful VBAC. Five variables for our scoring tool were selected. By using a proposed mean score of 4 out of 7, the scoring system had a sensitivity of 81.0%, specificity of 52.3% and a positive predictive value of 84.6%. VBAC antenatal scoring system was potentially a useful predictive tool in antenatal counselling. Impact statement What is already known on this subject: Planned vaginal birth after caesarean section (VBAC) is an important strategy to limit the overall caesarean section rate, which is related to maternal morbidities. However, trial of vaginal delivery does involve potential complications including scar dehiscence, postpartum haemorrhage and emergency hysterectomy. What the results of this study add: Clinical predictors of a successful VBAC include non-recurrent indications for the previous caesarean section, previous vaginal delivery, spontaneous onset of labour and birthweight less than 4kg. There were multiple screening tools developed to predict the likelihood of successful VBAC. These scoring systems involved various variables such as age, ethnicity, Bishop's score and previous caesarean indication. We had prospectively developed an antenatal scoring system based on five variables. Our result showed that patient with a score of four and above will have around 85% chance of successful VBAC. What the implications are of these findings for clinical practice and/or further research: We have also found that, estimated foetal weight based on ultrasound scan is a potential predictor for successful VBAC. This simple scoring method will be useful in-patient counselling regarding mode of delivery after one previous caesarean section. A multicentre study involving large cohort of patients is ideal to validate our scoring system.

Matched MeSH terms: Pregnancy Outcome/epidemiology*
Impact of late pregnancy haemoglobin A1c at 29-30 weeks' gestation on adverse pregnancy outcomes among women with pre-existing diabetes: a retrospective analysis

Yong SL, Ng BK, Mohd Yassin MAJ, Syed Zakaria SZ, Mohamed Ismail NA

J Obstet Gynaecol, 2018 May;38(4):461-465.
PMID: 29390907 DOI: 10.1080/01443615.2017.1372397

This study was to assess the relationship between late pregnancy haemoglobin A1C (HbA1C) at 29-30 weeks of gestation and adverse pregnancy outcomes (APOs) in 272 pregnant women with pre-existing diabetes. HbA1C ≥6.1% was associated with significantly increased risk of preterm delivery, Caesarean section, large for gestational age (LGA), neonatal respiratory distress, neonatal hypoglycaemia, and composite adverse neonatal outcome (p 5.6% (p = .039). Reduction of HbA1C cut-off from 6.1% to 5.6% improved the sensitivity but reduced the specificity for prediction of APOs. Overall, the receiver operating characteristic (ROC) curves demonstrated the moderate predictive value of late pregnancy HbA1C for APOs. In conclusion, elevated late pregnancy HbA1C levels at 29-30 gestational weeks had a negative impact on APOs in pregnant women with pre-existing diabetes. However, HbA1C cut-off levels of neither ≥6.1% nor >5.6% were ideal for predicting APOs. Impact statement What is already known on this subject: Poorly controlled diabetes is associated with adverse pregnancy outcomes (APOs). Periconceptual haemoglobin A1C (HbA1C) correlates well with the risk of foetal anomaly but is not predictive of APOs at time of delivery. New evidence suggested that late pregnancy HbA1C is predictive of APOs but the definitions of a late pregnancy gestational week and target HbA1C cutpoint remain in doubt. What the results of this study add: This study investigated the relationship between late pregnancy HbA1C levels at 29-30 weeks of gestation and the APOs among pregnant women with pre-existing diabetes. Late pregnancy HbA1C ≥ 6.1% correlated with the risk of APOs but the increased risk of pre-eclampsia only became significant at the lower cut-off of >5.6%. Reducing HbA1C cut-off from 6.1% to 5.6% improved the sensitivity but reduced the specificity for prediction of APOs. Overall, late pregnancy HbA1C had a moderate predictive value for APOs. What the implications are of these findings for clinical practice and/or further research: HbA1C cut-off levels of neither ≥6.1% nor >5.6% were ideal in predicting APOs among pregnant women with pre-existing diabetes. As HbA1C levels tend to drop in pregnancy, caution should be taken when interpreting HbA1C in pregnancy. More multi-centred studies are required to explore the respective glycaemic target for each APO and to determine the ideal timing for late pregnancy HbA1C measurement.

Matched MeSH terms: Pregnancy Outcome/epidemiology*
A retrospective study of the accuracy of sonographic chorionicity determination in twin pregnancies

Menon DK

Twin Res Hum Genet, 2005 Jun;8(3):259-61.
PMID: 15989753

The aim of this study was to determine the accuracy of sonographic chorionicity determination in the largest sample of twin pregnancies to date. We retrospectively analyzed 463 twin pregnancies delivered over a 6-year period to determine in each case what the antenatal sonographic prediction of chorionicity was, and then what the subsequent post partum pathological diagnosis of chorionicity was. Out of 436 twin pregnancies, 428 were correctly diagnosed for chorionicity as confirmed by pathology reports. Sonography as a screening tool for monochorionic twin pregnancies has a sensitivity of 100%, a specificity of 97.9% and a predictive value positive of 88.2%. Transvaginal scanning in the first trimester determined twin chorionicity with a sensitivity and a specificity of 100%. This study has confirmed in the largest sample to date that sonographic chorionicity determination is best done in the first trimester using vaginal scans, where it has 100% accuracy.

Matched MeSH terms: Pregnancy Outcome
Maternal thyroid function in women undergoing controlled ovarian hyperstimulation during in-vitro fertilization and its relation to reproductive outcome

Abdul Karim AK, Azrai Abu M, Chelliah B, Mohd Razi ZR, Omar MH, Othman H, et al.

Minerva Ginecol, 2017 Oct;69(5):431-437.
PMID: 28447444 DOI: 10.23736/S0026-4784.17.04069-2

BACKGROUND: We conducted a study to evaluate the changes in thyroid function during controlled ovarian hyperstimulation (COH) and its association with the outcome of assisted reproductive technique (ART).
METHODS: This is a prospective cohort study done in University Hospital Fertility Clinic for one year duration. A total of 88 euthyroid women who underwent COH as part of planned in-vitro fertilization (IVF) were invited to participate in this study. Serum thyroid function of each women will be monitored before stimulation (T1), day 10-13 of cycle (T2), during oocyte retrieval (T3), one week following embryo transfer (T4), and at four weeks after embryo transfer (T5). Reproductive outcome of IVF will be observed and documented.
RESULTS: Nine women had ongoing singleton pregnancy, seven suffered from miscarriage, while the rest had implantation failure. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) increased throughout stimulation, peaking at 32-36 hours after hCG administration compared to baseline (1.250 vs. 1.740 mIU/L and 13.94 vs. 15.25 pmol/L). It remains elevated until one week following embryo transfer. The increment of serum TSH exceeded the upper limit, acceptable for first trimester (<1.60 mIU/L). However, the evolution of serum TSH and fT4 did not significantly differ with pregnancy outcome.
CONCLUSIONS: In euthyroid women, thyroid function changed significantly during COH, but these changes were not different between the three reproductive outcomes. Thus, we do not suggest continuous thyroid function monitoring during COH.

Matched MeSH terms: Pregnancy Outcome*
Feasibility of successful pregnancies in women with spinal injury

Nor Azlin MI, Abd Rahman R, Abdul Karim AK, Sulaiman AS, Mahdy ZA

J Obstet Gynaecol, 2013 Aug;33(6):631-2.
PMID: 23919870 DOI: 10.3109/01443615.2013.807781
Matched MeSH terms: Pregnancy Outcome
Fulltext Maternal melanoma with placental metastasis

Shuhaila A, Rohaizak M, Phang KS, Mahdy ZA

Singapore Med J, 2008 Mar;49(3):e71-2.
PMID: 18362990

A 40-year-old woman, a grand multipara with uncertain gestation, presented with severe, prolonged diarrhoea. She was previously diagnosed to have melanoma. Examination revealed gross ascites with hepatosplenomegaly and uterus corresponding to 29 weeks gestation. An emergency caesarean section confirmed widespread metastases to the ovaries, mesentery and placenta. A viable male foetus was delivered with features of intrauterine growth restriction. The baby survived, but the mother died a week later. This case highlights the importance of thoroughly assessing placentas and babies of patients with melanoma for metastases.

Matched MeSH terms: Pregnancy Outcome
Mode of delivery and outcomes in preterm births

Sangkomkamhang U, Pattanittum P, Laopaiboon M, Lumbiganon P

J Med Assoc Thai, 2011 Apr;94(4):415-20.
PMID: 21591525

To compare maternal and neonatal outcomes by mode of delivery in preterm births.

Matched MeSH terms: Pregnancy Outcome/epidemiology*
Systemic lupus erythematosus pregnancies: the Sarawak experience and review of lupus pregnancies in Asia

Teh CL, Wong JS, Ngeh NK, Loh WL

Rheumatol Int, 2011 Sep;31(9):1153-7.
PMID: 20349069 DOI: 10.1007/s00296-010-1435-0

We performed a cross-sessional study of all systemic lupus erythematosus (SLE) pregnancies during a 4-year period (2006-2009) to describe the clinical features, maternal and foetal outcomes in our centre. There were 48 pregnancies in 44 women with SLE. Our patients have a mean age of 30.0 years (SD 6.36) and a mean disease duration of 40.67 months (SD 48.23). Our patients have complicated pregnancies: 32.7% have SLE flares, 17.3% have preeclampsia and 48.9% needed caesarean sections. There were 20.0% foetal losses and 17.8% preterm deliveries in our patients. SLE flares contributed to 60.0% of foetal losses in our patients. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable to developed countries in Asia. The low incidence of APS, the high usage of hydroxychloroquine and the high SLE remission rate in our patients prior to conceptions contributed to the good outcome.

Matched MeSH terms: Pregnancy Outcome/epidemiology
Systemic lupus erythematosus pregnancies: a case series from a tertiary, East Malaysian hospital

Teh CL, Wong JS, Ngeh NK, Loh WL

Lupus, 2009 Mar;18(3):278-82.
PMID: 19213870 DOI: 10.1177/0961203308096661

We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a two-year period (2006-2007) to describe the clinical features, maternal and foetal outcomes in our centre. There were 17 pregnancies in 16 women with SLE. Our patients have a mean age of 28.31 years (SD 5.24) and a mean disease duration of 38.62 months (SD 38.03). Our patients have complicated pregnancies: 35.3% have SLE flares, 21.1% have preeclampsia and 47.4% needed caesarean sections. There were 15.8% foetal losses and 12.5% preterm deliveries in our patients. All the foetal losses occurred in patients with severe SLE flares during pregnancies. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable with developed countries. The low incidence of antiphospholipid syndrome, the high usage of hydroxychloroquine and the high SLE remission rate in our patients before conceptions are the possible factors contributing to the good outcome.

Matched MeSH terms: Pregnancy Outcome

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