MyMedR

Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity

Tan PC, Vani S, Lim BK, Omar SZ

Eur J Obstet Gynecol Reprod Biol, 2010 Apr;149(2):153-8.

PMID: 20097465 DOI: 10.1016/j.ejogrb.2009.12.031

To evaluate prevalence, risk factors and clinical severity correlates of anxiety and depression caseness in hyperemesis gravidarum (HG).

Matched MeSH terms: Pregnancy

Fulltext Comparison between preloading with 10 ml/kg and 20 ml/kg of Ringer's lactate in preventing hypotension during spinal anaesthesia for caesarean section

Muzlifah KB, Choy YC

Med J Malaysia, 2009 Jun;64(2):114-7.

PMID: 20058569 MyJurnal

This prospective, randomized, study was designed to compare the effect of two different preloading volumes of Ringer's lactate for prevention of maternal hypotension induced by spinal anaesthesia for Caesarean section. Eighty ASA I or II obstetric patients were randomized to two groups. Group 1 (n = 40) received 20 ml/kg of Ringer's lactate and Group 2 (n = 40) 10 ml/kg of Ringer's lactate over 20 minutes before spinal anaesthesia. The lowest mean arterial pressure (MAP) for both groups were recorded at 15 minutes after giving spinal anaesthesia, This difference in the drop of MAP from base-line at 15 minutes (mean decrease of 12.5 mmHg from baseline), between preloading with 10 ml/kg and 20 ml/kg of Ringer's was statistically significant. Twelve patients from Group 1 required bolus doses of ephedrine and 15% of these needed additional crystalloid whereas two patients from Group 2 needed ephedrine boluses and 22% of these required additional crystalloid. The difference in frequency of requirement for treatment of hypotension was not statistically significant. There were five patients in Group 1 and six patients in Group 2 who experienced nausea and vomiting, the frequency of occurrence did not show any statistically significant difference between the two groups. In conclusion, for prevention of hypotension during spinal anaesthesia for Caesarean section, infusing 20 ml/kg or 10 ml/kg of Ringer's Lactate gave similar results and we do not recommend the use of a larger volume of crystalloid for preloading before spinal anaesthesia.

Matched MeSH terms: Pregnancy

Transabdominal fetal heart rate detection using NIR photopleythysmography: instrumentation and clinical results

Gan KB, Zahedi E, Mohd Ali MA

IEEE Trans Biomed Eng, 2009 Aug;56(8):2075-82.

PMID: 19403354 DOI: 10.1109/TBME.2009.2021578

In obstetrics, fetal heart rate (FHR) detection remains the standard for intrapartum assessment of fetal well-being. In this paper, a low-power (< 55 mW) optical technique is proposed for transabdominal FHR detection using near-infrared photoplesthysmography (PPG). A beam of IR-LED (890 nm) propagates through to the maternal abdomen and fetal tissues, resulting in a mixed signal detected by a low-noise detector situated at a distance of 4 cm. Low-noise amplification and 24-bit analog-to-digital converter resolution ensure minimum effect of quantization noise. After synchronous detection, the mixed signal is processed by an adaptive filter to extract the fetal signal, whereas the PPG from the mother's index finger is the reference input. A total of 24 datasets were acquired from six subjects at 37 +/- 2 gestational weeks. Results show a correlation coefficient of 0.96 (p-value < 0.001) between the proposed optical and ultrasound FHR, with a maximum error of 4%. Assessment of the effect of probe position on detection accuracy indicates that the probe should be close to fetal tissues, but not necessarily restricted to head or buttocks.

Matched MeSH terms: Pregnancy

Association between polymorphisms in human tumor necrosis factor-alpha (--308) and -beta (252) genes and development of gestational diabetes mellitus

Montazeri S, Nalliah S, Radhakrishnan AK

Diabetes Res Clin Pract, 2010 May;88(2):139-45.

PMID: 20189261 DOI: 10.1016/j.diabres.2010.01.028

OBJECTIVE: The aim of this study is to investigate if an association exists between single nucleotide polymorphism (SNP) in the tumor necrosis factor-alpha (TNF-alpha) and TNF-beta genes.
METHODS: The DNA was extracted and SNP in the human TNF-alpha and TNF-beta genes at positions -308 (G/A) and 252 (A/G), respectively, was analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Plasma levels of TNF-alpha in different stages of pregnancy were quantified using enzyme linked immunosorbent assay (ELISA).
RESULTS: There was no significant difference in genotype and allele frequency of SNP at position -308 (G/A) in the promoter region of the human TNF-alpha gene as well as the SNP at position 252 (A/G) in the human TNF-beta gene between the GDM and control subjects. Using the logistic regression model, it was found that the SNP in the TNF-alpha as well as TNF-beta were not associated with development of GDM. In addition, the TNF-alpha levels in the plasma of GDM and control mothers were not significantly different.
CONCLUSIONS: In the population studied, the SNP in position -308 (G/A) of the human TNF-alpha or in position 252 (A/G) of the human TNF-beta gene is not an independent risk factor or a predictor for GDM.

Matched MeSH terms: Pregnancy

Birthweight and early neonatal health: Bangladesh perspective

Ullah A, Barman A, Haque J, Khanum M, Bari I

Paediatr Perinat Epidemiol, 2009 Nov;23(6):542-7.

PMID: 19840290 DOI: 10.1111/j.1365-3016.2009.01063.x

It has been suggested that a birthweight limit of 2.5 kg should not be regarded as valid for all populations as the cut-off point of low-weight births because of demographic, genetic and environmental differences. Countries often choose alternative cut-off values for low birthweight for clinical purposes. Bangladesh also needs to choose a convenient cut-off value for low birthweight. A total of 770 live singleton full-term normal newborns were included in this study by stratified sampling; birthweight was measured using the Detecto-type baby weight machine. Newborns were followed up to the end of their first week of life. For data collection a pretested structured questionnaire and an Apgar Score estimating checklist were used. Chi-square test was applied to assess the association of different birthweight strata and neonatal health outcomes. Multiple logistic regression analyses were carried out to identify the independent effects of different levels of birthweight on early neonatal health. The neonates having birthweight < or = 2 kg had a significantly higher risk of early neonatal mortality and morbidity than the higher level birthweight group. Birth asphyxia was the commonest cause of early neonatal mortality and morbidity. Borderline birthweight (>2 to <2.5 kg) neonates experienced the same mortality and morbidity rates as the normal birthweight neonates during their early neonatal life. Birthweight < or = 2 kg may be one of the criteria for admission to a neonatal intensive care unit whereas more than 2 kg may not require admission unless otherwise necessary.

Matched MeSH terms: Pregnancy

Double neural tube defect: a case report and discussions on neural tube development

Vashu R, Liew NS

Childs Nerv Syst, 2010 May;26(5):697-701.

PMID: 20225088 DOI: 10.1007/s00381-010-1093-2

Double neural tube defect is a rare congenital problem. A case illustration and current literatures on neural tube closure theory are discussed. The available theories are summarised and compared with regard to the case report.

Matched MeSH terms: Pregnancy

Macrosomia is the only reliable predictor of shoulder dystocia in babies weighing 3.5 kg or more

Mansor A, Arumugam K, Omar SZ

Eur J Obstet Gynecol Reprod Biol, 2010 Mar;149(1):44-6.

PMID: 20042263 DOI: 10.1016/j.ejogrb.2009.12.003

To determine if shoulder dystocia can be predicted in babies born weighing 3.5 kg or more.

Matched MeSH terms: Pregnancy

Serotype distribution and antibiotic susceptibility of group B streptococci in pregnant women

Dhanoa A, Karunakaran R, Puthucheary SD

Epidemiol Infect, 2010 Jul;138(7):979-81.

PMID: 19889253 DOI: 10.1017/S0950268809991105

Group B streptococcus (GBS) is a leading cause of neonatal sepsis and is usually acquired via the woman's birth canal. GBS serotypes isolated from 200 pregnant women were determined. Serotypes V (19%) and VI (17%) were the most frequent followed by serotypes III (12%), Ia (11.5%) and IV (10%); 17% of the strains were non-typable. All isolates were susceptible to penicillin, 96% to erythromycin and 97.5% to clindamycin. The emergence of new GBS serotypes has important implications for vaccine prevention strategies.

Matched MeSH terms: Pregnancy

Prospective full-term-derived pluripotent amniotic fluid stem (AFS) cells

Ferdaos N, Nathan S, Nordin N

Med J Malaysia, 2008 Jul;63 Suppl A:75-6.

PMID: 19024991

Amniotic fluid (AF) serves as an excellent alternative source of pluripotent stem cells, as they are not bound with ethical issues and the stem cells are more primitive than adult stem (AS) cells. Hence, they have higher potential. Here we aim to isolate and characterize pluripotent stem cells from mid-term and full-term pregnant rat amniotic fluid. The results demonstrate the evidence of heterogeneous population of cells in the amniotic fluid and some of the cells morphology shows similarity with ES cells.

Matched MeSH terms: Pregnancy

Nifedipine versus terbutaline for tocolysis in external cephalic version

Mohamed Ismail NA, Ibrahim M, Mohd Naim N, Mahdy ZA, Jamil MA, Mohd Razi ZR

Int J Gynaecol Obstet, 2008 Sep;102(3):263-6.

PMID: 18554601 DOI: 10.1016/j.ijgo.2008.04.010

To study the efficacy of nifedipine compared with terbutaline as a tocolytic agent in external cephalic version (ECV).

Matched MeSH terms: Pregnancy

Fulltext Infective endocarditis in pregnancy complicated by septic embolization to the cerebellum

Tan HJ, Rabani R, Noorfaizan S

Med J Malaysia, 2007 Aug;62(3):249-50.

PMID: 18246919 MyJurnal

This report describes a pregnant lady in early trimester that was admitted with fever and left loin pain and was initially treated as presumed pyelonephritis. Subsequently she was found to have infective endocarditis with vegetation on the mitral valve. The course of her illness was complicated by acute pulmonary edema and septic embolization to the cerebellum. A decompressive craniectomy and resection of the lateral lobe of cerebellum was performed. Although the presenting features and risk factors are well described, the atypical presentations of infective endocarditis in pregnancy remain a diagnostic challenge for the treating physician. This report highlights the importance of rapid detection of endocarditis in pregnancy and the treatment of systemic complications.

Matched MeSH terms: Pregnancy

Male fetuses are associated with increased risk for cesarean delivery in Malaysian nulliparae

Viegas OA, Lee PS, Lim KJ, Ravichandran J

Medscape J Med, 2008;10(12):276.

PMID: 19242582

The association between fetal sex and outcome of pregnancy and labor has been well documented in western populations. However, no studies in Malaysia or other developing countries have examined the effect of fetal sex on such outcomes.The main objective of this study was to determine the influence of fetal sex on the outcome of labor at term in a cohort of Malaysian nulliparae.A retrospective observational study was designed using data from 4644 Malaysian nulliparae who gave birth consecutively to singleton male babies at Hospital Sultanah Aminah, Johor Bahru, after normal full-term pregnancies.The results of this study indicate that mothers giving birth to male infants have a greater risk of requiring cesarean delivery because male babies are heavier and have statistically significantly greater head circumference (P < .001). These findings concur with those obtained in western populations and suggest that the differences in outcome observed are biological, not dictated by race, ethnicity, or environmental conditions. Such information could help in the antenatal assessment of Malaysian patients and stimulate more comprehensive studies of the mechanisms involved in this sex-based difference in outcomes. Reasons for such differences are proposed.

Matched MeSH terms: Pregnancy

Intravenous salbutamol for external cephalic version

Vani S, Lau SY, Lim BK, Omar SZ, Tan PC

Int J Gynaecol Obstet, 2009 Jan;104(1):28-31.

PMID: 18922525 DOI: 10.1016/j.ijgo.2008.08.014

To evaluate the success of external cephalic version (ECV) using an adjusted bolus dose of intravenous salbutamol compared with no tocolysis.

Matched MeSH terms: Pregnancy

Kiwi Omnicup versus Malmstrom metal cup in vacuum assisted delivery: a randomized comparative trial

Ismail NA, Saharan WS, Zaleha MA, Jaafar R, Muhammad JA, Razi ZR

J Obstet Gynaecol Res, 2008 Jun;34(3):350-3.

PMID: 18686348

AIM: To compare the success, clinical outcomes, and maternal and neonatal complications between the Kiwi Omnicup and the Malmstrom metal cup in vacuum assisted delivery.

METHODS: This was a prospective randomized comparative trial. Women who required vacuum assisted vaginal delivery were randomized into the Kiwi Omnicup (KO) group and the Malmstrom metal cup (MM) group. The vacuum assisted deliveries were conducted according to hospital protocol. Details of the procedure and delivery outcomes including success and complications were analyzed.

RESULTS: One hundred and sixty-four women were recruited - 85 were assigned to vacuum assisted delivery using the KO and 79 the MM. One hundred percent delivery success was achieved with no significant differences between the two instruments in terms of maternal morbidity (P = 0.66). Six women in the MM group sustained post delivery complications in comparison to five in the KO group. Three babies were diagnosed with birth asphyxia in each group. More babies in the MM group were admitted to the Neonatal Intensive Care Unit (NICU) (10 babies versus 5 babies) and suffered complications (14 versus 12 babies), compared to the KO group, although the difference was not statistically significant. There were no intrapartum or neonatal deaths and of those admitted to the NICU, all were discharged within a week without any serious consequences.

CONCLUSION: Kiwi Omnicup is an effective alternative to the currently available Malmstrom metal cup for vacuum assisted delivery with no increase in maternal or neonatal morbidity or mortality.

Matched MeSH terms: Pregnancy

Further observations in an area with an exceptionally low prevalence of Helicobacter pylori infection

Raj SM, Lee YY, Choo KE, Noorizan AM, Zulkifli A, Radzi M, et al.

Trans R Soc Trop Med Hyg, 2008 Nov;102(11):1163-4.

PMID: 18678380 DOI: 10.1016/j.trstmh.2008.06.015

Matched MeSH terms: Pregnancy

Absorbable versus nonabsorbable sutures for subcuticular skin closure of a transverse suprapubic incision

Tan PC, Mubarak S, Omar SZ

Int J Gynaecol Obstet, 2008 Nov;103(2):179-81.

PMID: 18639876 DOI: 10.1016/j.ijgo.2008.05.023

Matched MeSH terms: Pregnancy

Effect of maternal age, birth weight and infant sex on total nucleated cell (TNC) count and volume of umbilical cord blood (UCB) collected

Choong SN, Ng YK, Kamalan A, Saraswathy S, Goh EH, Lee MJ, et al.

Med J Malaysia, 2008 Jul;63 Suppl A:55-6.

PMID: 19024981

This study evaluates the effect of maternal age, birth weight and infant sex on two main UCB parameters for use and long-term cryopreservation: TNC and volume. Data from 1000 UCB units were collected and analyzed in this study. The results indicate that TNC is correlated to infant birth weight and sex but not maternal age at delivery. Volume is only correlated to birth weight but not maternal age and infant sex.

Matched MeSH terms: Pregnancy

Fulltext GnRH agonist and GnRH antagonist in intracytoplasmic injection cycles

Rashid MR, Ong FB, Omar MH, Ng SP, Nurshaireen A, Sharifah-Teh NS, et al.

Med J Malaysia, 2008 Jun;63(2):113-7.

PMID: 18942295 MyJurnal

The long agonistic protocol for controlled ovarian hyperstimulation (COH) is effective and used most often, thus is considered the gold standard. Therefore any new regimen has to be compared in its results with those obtained with the long protocol. This report compares the efficacy of GnRH agonist and antagonist in a retrospective study of IVF/ICSI carried out in a tertiary teaching hospital from 2003 to 2006. Only the first COH cycle followed by IVF-ICSI from 200 couples (agonist = 120 and antagonist = 80) were analysed. The end points studied included the number of oocytes recovered, number of mature (MII) oocytes, fertilization, cleavage, morphology based embryo quality, pregnancy rate, quantity and cost of gonadotrophin. The average age of female subjects was 35.1 +/- 4.7 years with 50% being 35 years and above. Major infertility factors were tubal blockage, male factor and endometriosis altogether comprising 68%. GnRH agonist and antagonist cycle parameters were comparable except lesser amount of gonadotrophin was used with lower resultant costs (both p < 0.0005) in antagonistic regime. Antagonist regime produce somewhat more good quality embryos (p = 0.065), an insignificant difference. A clinical pregnancy rate per embryo transfer of 16.3% in agonist and 20.6% in antagonist regime was achieved respectively. In conclusion, GnRH antagonist protocol produced a COH response, embryonic development and pregnancy rates on par to GnRH agonist regime. Moreover GnRH antagonist protocol required a shorter stimulation period plus fewer complications. Hence GnRH antagonist regime provided means for a friendlier, convenient and cost effective protocol for patients.

Matched MeSH terms: Pregnancy

Fulltext Use of evidence-based practices in pregnancy and childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries project

SEA-ORCHID Study Group, Laopaiboon M, Lumbiganon P, McDonald SJ, Henderson-Smart DJ, Green S, et al.

PLoS One, 2008 Jul 09;3(7):e2646.

PMID: 18612381 DOI: 10.1371/journal.pone.0002646

BACKGROUND: The burden of mortality and morbidity related to pregnancy and childbirth remains concentrated in developing countries. SEA-ORCHID (South East Asia Optimising Reproductive and Child Health In Developing countries) is evaluating whether a multifaceted intervention to strengthen capacity for research synthesis, evidence-based care and knowledge implementation improves adoption of best clinical practice recommendations leading to better health for mothers and babies. In this study we assessed current practices in perinatal health care in four South East Asian countries and determined whether they were aligned with best practice recommendations.

METHODOLOGY/PRINCIPAL FINDINGS: We completed an audit of 9550 medical records of women and their 9665 infants at nine hospitals; two in each of Indonesia, Malaysia and The Philippines, and three in Thailand between January-December 2005. We compared actual clinical practices with best practice recommendations selected from the Cochrane Library and the World Health Organization Reproductive Health Library. Evidence-based components of the active management of the third stage of labour and appropriately treating eclampsia with magnesium sulphate were universally practiced in all hospitals. Appropriate antibiotic prophylaxis for caesarean section, a beneficial form of care, was practiced in less than 5% of cases in most hospitals. Use of the unnecessary practices of enema in labour ranged from 1% to 61% and rates of episiotomy for vaginal birth ranged from 31% to 95%. Other appropriate practices were commonly performed to varying degrees between countries and also between hospitals within the same country.

CONCLUSIONS/SIGNIFICANCE: Whilst some perinatal health care practices audited were consistent with best available evidence, several were not. We conclude that recording of clinical practices should be an essential step to improve quality of care. Based on these findings, the SEA-ORCHID project team has been developing and implementing interventions aimed at increasing compliance with evidence-based clinical practice recommendations to improve perinatal practice in South East Asia.

Matched MeSH terms: Pregnancy

Carbetocin versus syntometrine in prevention of post-partum hemorrhage following vaginal delivery

Nirmala K, Zainuddin AA, Ghani NA, Zulkifli S, Jamil MA

J Obstet Gynaecol Res, 2009 Feb;35(1):48-54.

PMID: 19215547 DOI: 10.1111/j.1447-0756.2008.00829.x

To compare the efficacy of a single dose of 100 microg intramuscular carbetocin to a single dose of intramuscular syntometrine (0.5 mg ergometrine and 5IU oxytocin), in preventing post-partum hemorrhage (PPH) in high risk patients following vaginal delivery.

Matched MeSH terms: Pregnancy

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