MyMedR

Fulltext Spontaneous twin pregnancy in premature ovarian failure

Anna Liza R, Alik RZ, Ahmad Murad Z, Ghazali I

Med J Malaysia, 2008 Aug;63(3):263-4.

PMID: 19248707 MyJurnal

Premature Ovarian Failure (POF) is associated with subfertility. Despite efforts to induce ovulation, success rates are low. We report a case of POF spontaneously conceiving twins while on hormone replacement therapy.

Matched MeSH terms: Pregnancy; Pregnancy, Multiple*

Fulltext Perioperative mortality review in relation to pregnancy-related deaths

Achanna KS, Zaleha AM, Sachchithanantham, Farouk AM

Med J Malaysia, 2006 Aug;61(3):312-9.

PMID: 17240582 MyJurnal

Pregnancy-related deaths in four published perioperative mortality review reports were analysed. The aim is to look at the quality of surgical and anaesthetic services along with the perioperative care provided. The audit identified shortfalls in the logistic and support services and recommended remedial strategies. The review was conducted by a committee consisting of practising anaesthetists, surgeons and obstetricians who analysed the questionnaires collectively. A consensus was reached to categorise the death. There were 280 pregnancy-related deaths. Post-partum haemorrhage accounted for 31.8%, followed by hypertensive disorders of pregnancy (20.0% obstetric embolism (16.1%), sepsis (10.7%) and associated medical conditions (21.4%). In brief, there were comings in preoperative, intra-operative and post-operative care in some of the cases. Increased consultant input, clinical audit, improvements in monitoring and expansion of critical care facilities were the integral issues recommended.

Matched MeSH terms: Pregnancy; Pregnancy Complications/mortality

Laparoscopic salpingectomy in tubal pregnancy: prospective randomized trial using endoloop versus electrocautery

Lim YH, Ng SP, Ng PH, Tan AE, Jamil MA

J Obstet Gynaecol Res, 2007 Dec;33(6):855-62.

PMID: 18001454

Ectopic pregnancy is conventionally managed by laparoscopic salpingectomy. Electrocautery has been used widely to secure hemostasis during salpingectomy. However, this method is associated with a risk of thermal injury to the visceral organs. Endoloop, a pre-tied suture used in laparoscopic surgery may be an alternative treatment tool and its potential use in the management of ectopic pregnancy is explored here. Our study aims to compare the effectiveness of the endoloop technique to electrocautery during laparoscopic salpingectomy for tubal pregnancy.

Matched MeSH terms: Pregnancy; Pregnancy, Tubal/surgery*

Inherited thrombophilia markers in Malaysian women with recurrent fetal loss

Ayadurai T, Ayob Y, Muniandy S, Omar SZ

Thromb. Haemost., 2007 Nov;98(5):1152-4.

PMID: 18000628

Matched MeSH terms: Pregnancy; Pregnancy Complications, Hematologic/genetics*

Fulltext Successful pregnancy in untreated limited Wegener's granulomatosis

Sahni V, Agarwal SK, Singh NP, Sikdar S, Yadav A, Wadhwa A, et al.

Med J Malaysia, 2005 Oct;60(4):492-4.

PMID: 16570714

A thirty four year old female presented with upper and lower respiratory symptoms in the third trimester of pregnancy. After the delivery of a healthy baby, the symptoms progressed to involve multiple organ systems and eventually a diagnosis of limited Wegener's Granulomatosis (Carrington-Liebow syndrome) was made. The extremely rare combination of WG and pregnancy, especially the onset of disease in late pregnancy is discussed. The successful outcome of pregnancy even without treatment of WG is the highlight of the case.

Matched MeSH terms: Pregnancy; Pregnancy Complications*

Fulltext Accelerated diabetic retinopathy in pregnancy--a real and present danger

Bastion MLC, Barkeh HJ, Muhaya M

Med J Malaysia, 2005 Oct;60(4):502-4.

PMID: 16570717

A 36 year-old Malay lady with diabetes mellitus in pregnancy and poorly controlled hypertension developed rapid progression of diabetic retinopathy from no retinopathy to florid proliferative retinopathy over three months in her right eye. She had subsequent loss of vision due to vitreous haemorrhage in the peri-partum period. She had good final visual acuity with quiescent retinopathy following pars planar vitrectomy. A similar course was avoided in the left eye by timely pan retinal photocoagulation.

Matched MeSH terms: Pregnancy; Pregnancy in Diabetics*

Total uterine artery blood volume flow rate in nulliparous women is associated with birth weight and gestational age at delivery

McKelvey A, Pateman K, Balchin I, Peebles DM, Rodeck CH, David AL

Ultrasound Obstet Gynecol, 2017 Jan;49(1):54-60.

PMID: 26990029 DOI: 10.1002/uog.15917

OBJECTIVES: To investigate the relationship between total uterine artery blood volume flow rate (TVFR) and birth weight and gestational age at delivery, and to establish normal ranges of TVFR throughout pregnancy.

METHODS: This was a prospective cohort study of 334 nulliparous women booking antenatal care at University College London Hospital between August 2008 and September 2009. Women underwent a transabdominal ultrasound examination of uterine arteries for measurement of TVFR at 12, 20 and 24 weeks' gestation. Pregnancy outcomes were recorded and linear regression was used to study the relationship between TVFR and gestational age at delivery and birth weight.

RESULTS: A total of 551 ultrasound scans were performed. There was a significant, positive correlation between TVFR at 11-13 weeks (TVFR1) and at 22-26 weeks (TVFR3) and birth weight. For every 100-mL/min increase in TVFR1 and TVFR3, there was an increase in birth weight of 45 g and 27 g, respectively. There was also a positive association between TVFR1 and gestational age at delivery, with a 1.4-day increase in gestational age for every 100-mL/min increase of TVFR1.

CONCLUSION: Ultrasound measurement of TVFR in the first trimester is significantly associated with both birth weight and gestational age at delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Matched MeSH terms: Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second

Fulltext Recurrent spontaneous pneumothorax during pregnancy managed conservatively: a case report

Mohamed Faisal AH, Hazwani A, Soo CI, Andrea Ban YL

Med J Malaysia, 2016 04;71(2):93-5.

PMID: 27326955 MyJurnal

A 36-year-old lady presented with four episodes of right sided pneumothorax during pregnancy requiring multiple chest drain insertion. It was complicated with persistent air leak despite low pressure high volume suction applied to the chest drainage. She delivered safely through spontaneous vaginal delivery with chest drainage. Further imaging by high resolution computed tomography (HRCT) scan of thorax done revealed bilateral scattered pulmonary cysts and sub pleural bullae and was later followed up with respiratory unit. She had no further episodes of pneumothorax postpartum. This case highlights the vital importance of prompt recognition and management of pneumothorax in pregnancy as the patient involved is at higher risk for acute respiratory failure leading to maternal and/or foetal mortality. It is essential for early involvement of obstetric team and to expedite the delivery for a better perinatal and maternal outcome.

Matched MeSH terms: Pregnancy; Pregnancy Complications/therapy*

Medical misadventures

Lewis K

Med J Malaysia, 2003 Mar;58 Suppl A:68-71.

PMID: 14556352

Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence.

Matched MeSH terms: Pregnancy; Pregnancy, Unwanted*

Fulltext Pregnancy in patients with renal transplants in Malaysia

Hooi LS, Rozina G, Wan Shaariah MY, Teo SM, Tan CHH, Bavanandan S, et al.

Med J Malaysia, 2003 Mar;58(1):27-36.

PMID: 14556324

There were 72 pregnancies in 46 renal transplants (RTs) between 1984 and 2001, 89% from living donors, 11% cadaveric. Mean age at RT was 26.9 +/- 4.3 years and at pregnancy 30.7 +/- 4.7 years. Mean time to pregnancy after RT was 4.5 +/- 3.1 years. 54% were unplanned. 45 (63%) resulted in surviving infants, 37% delivered by Caesarean section. 35% were premature. Mean birth weight was 2.38 +/- 0.57 kg. 64% were on cyclosporine. No patient had an acute rejection during pregnancy; 38% had pre-existing hypertension. Complications include urinary infection (13%), proteinuria (15%) and preeclampsia (15%). Mean serum creatinine before pregnancy was 112.7 +/- 32.6 umol/l, 1 year post-pregnancy it was 119.4 +/- 38.7. The mean time of follow up of mothers is 4.9 +/- 3.5 years. 10 year graft survival was 83% and patient survival 94%.

Matched MeSH terms: Pregnancy; Pregnancy Outcome/epidemiology*

Social and religious dimensions of unwanted pregnancy: an Islamic perspective

Kasule OH

Med J Malaysia, 2003 Mar;58 Suppl A:49-60.

PMID: 14556350

The concept of 'unwanted pregnancy' is a recent in human history and is associated with social stresses of modern life. The purposes of the law, maqasid al shari'at, and its principles, qawa'id a shari'at, focus on preventing 'unwanted pregnancy', protecting the rights of the fetus and infant, and mitigating the adverse effects of 'unwanted pregnancy' by social measures. 'Unwanted pregnancy' is associated with general social determinants (hedonistic life styles, sexual transgression, addiction to drugs, fear of poverty, and low female status) and specific antecedent causes (sexual crimes, egoistic greed, maternal/fetal disease, and gender discrimination). It is prevented by sexual hygiene, marriage, contraception, deterring sexual crimes, and raising the status of women. The adverse sequelae of 'unwanted pregnancy' (feticide, infanticide, or child abuse and neglect) can be prevented by defending the basic human right of the fetus and infant to life, promoting social institutions for child welfare (nuclear family, extended family, foster care, and open adoption). Closed adoption is forbidden by Law but care in a foster home is allowed and is encouraged if the nuclear and extended families are unwilling or are unable to care for children. Abortion at any stage of pregnancy is a crime against humanity. It is not a solution to the problem but is part of the problem. It will encourage more 'unwanted pregnancies'.

Matched MeSH terms: Pregnancy; Pregnancy, Unwanted/ethnology*

The legal aspects of the termination of unwanted pregnancies and the risks faced by the medical doctor: a UK perspective

Gibson C

Med J Malaysia, 2003 Mar;58 Suppl A:36-48.

PMID: 14556349

Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence.

Matched MeSH terms: Pregnancy; Pregnancy, Unwanted*

Fulltext A review on thromboprophylaxis in pregnancy

Chow TWP, Wong YM

Med J Malaysia, 2001 Dec;56(4):418-27.

PMID: 12014760

Thromboembolic disease remains an important cause of maternal mortality worldwide. The risk assessments for prevention of thromboembolism in pregnancy are controversial due to lack of large-scale randomised controlled trials. Unfractionated heparin is at present, the anticoagulant of choice during pregnancy. However, it may be superseded by low-molecular-weight heparin in the near future because of its safety and efficacy.

Matched MeSH terms: Pregnancy; Pregnancy Complications/prevention & control*

Fulltext Peritoneal trophoblastic implant

Rachagan SP, Kutty K, Govindan KS

Med J Malaysia, 1997 Sep;52(3):293-4.

PMID: 10968101

A case of persistent trophoblastic tissue on the pelvic peritoneum is presented. While most cases are secondary to conservative surgery for tubal ectopic pregnancy, primary implantation can also occur as highlighted by this case. A brief pathophysiology of the condition is presented. The importance of monitoring the serum for beta subunit human chorionic gonadotrophin (HCG) is emphasised.

Matched MeSH terms: Pregnancy; Pregnancy, Ectopic/etiology*

Fulltext Introducing routine external cephalic version for the management of the malpresenting fetus near term

Devendra K

Med J Malaysia, 2002 Dec;57(4):454-9.

PMID: 12733170

The aim of this study was to assess the efficacy and safety of external cephalic version (ECV) when its use was introduced in the routine management of breech presentation and transverse lie after 36 weeks by obstetricians with limited prior experience with the procedure. The influence of various factors on the outcome of ECV was also studied.

Matched MeSH terms: Pregnancy; Pregnancy Outcome*

Chien-Tien Hsu Memorial Lecture. Fertility and gynaecologic malignancies

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.

Matched MeSH terms: Pregnancy; Pregnancy Complications, Neoplastic*

Fulltext An initial assessment of the risk approach to antenatal management in Malaysia

Somboonsook B, Wakerman J, Hattch CT, Collison M, Barnes A, Kyi W, et al.

Med J Malaysia, 1995 Sep;50(3):212-20.

PMID: 8926897

This study was the first assessment of a nationwide risk approach system to antenatal management introduced to Malaysia in 1989. Three rapid, record-based surveys on three different study groups were conducted to determine risk factor prevalence, accuracy of risk assignment, action after risk assignment and the relationship of risk level and place of delivery. The most frequent risk factors were short birth interval, high parity and first pregnancy. Accuracy of risk assignment was highest at the lowest levels of risk and poorest at the highest levels. Women at the lowest levels of risk were more likely to be seen by a doctor than women at highest risk. These was a trend to deliver in hospital, rather than at home, as level of risk increased; but many women at high risk still delivered at home. Recommendations are made on modifications to the system prior to future evaluation.

Matched MeSH terms: Pregnancy; Pregnancy, High-Risk*

Outcome of external cephalic version: our experience

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.

Matched MeSH terms: Pregnancy; Pregnancy Outcome*

Fulltext Teronac and teratogenecity

Rachagan SP

Med J Malaysia, 1993 Jun;48(2):250.

PMID: 8350808

Matched MeSH terms: Pregnancy; Pregnancy Complications/drug therapy*

Fulltext Outcome of 80 cases of external cephalic version

Teoh TGK

Med J Malaysia, 1996 Dec;51(4):469-74.

PMID: 10968036

This is a prospective observational study of the outcome of 80 cases of external cephalic version (ECV) at term using terbutaline infusion. There were 55 primiparas and 25 multiparas. The successful ECV rate was 44% and 85% respectively. The majority (82%) of the patients with successful ECV delivered vaginally. Parity and type of breech were the two significant factors in the success of the procedure.

Matched MeSH terms: Pregnancy; Pregnancy Outcome*

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