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Fulltext Performance of elderly primigravidae in Kelantan

Achanna S, Monga D

Med J Malaysia, 1995 Mar;50(1):37-41.
PMID: 7752974

The obstetric performance of 59 elderly primigravidae delivering at the University Hospital, Kelantan, between January 1, 1987 and December 12, 1988 is compared with that of 60 young primigravidae delivering during the same time period. The total number of deliveries during this period was 16,284, and the predominant ethnic group was Malays. Apart from an increased incidence of preeclampsia (23.7% vs. 13.3%), breech presentation (6.78% vs. 3.33%) and Caesarean sections (74.6% vs. 10%) among the study group, there were no other statistically significant obstetric complications. Majority of Caesarean sections were done as emergency procedures, the principal indications being poor progress of labour and foetal distress. The neonatal outcome (in terms of birthweight, gestational age and breastfeeding at discharge) was similar in the two groups. For most women in both groups this was the first marriage, though a higher proportion in the study group had an interval of more than two years between marriage and childbirth.
Transient blindness in pregnancy induced hypertension

Achanna S, Monga D, Sivagnanam

Asia Oceania J Obstet Gynaecol, 1994 Mar;20(1):49-52.
PMID: 8172527

Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject. Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.
Fulltext Is there a role for the obstetric flying squad in Peninsula Malaysia?

Monga D, Achanna S

Singapore Med J, 1999 Feb;40(2):78-80.
PMID: 10414162

The Obstetric Flying Squad (OFS) has been operating in Peninsular Malaysia for over three decades. In the light of current controversies regarding its role in modern day obstetric practice, its status in Malaysia over the last 12 years is reviewed.
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.
Fetal and maternal lactate increase during active second stage of labour

Nordström L, Achanna S, Naka K, Arulkumaran S

BJOG, 2001 Mar;108(3):263-8.
PMID: 11281466

To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour.
Reconsideration of planned vaginal breech delivery in selected cases

Achanna S, Nanda J, Paramjothi P

Med J Malaysia, 2021 05;76(3):390-394.
PMID: 34031339

INTRODUCTION: The debate surrounding the management of term breech presentation (BP) has resulted in the presence of a multitude of guidelines, reviews, and directives. The vaginal delivery of a breech baby requires sound obstetric skills since approximately 3-4% of babies at term are breech presentations. BP is the commonest of all malpresentations. However, expertise required to deliver breech babies vaginally has virtually disappeared. There is no convincing evidence that Caesarean Section (CS) is better than assisted vaginal delivery when conducted in appropriate settings, with experienced obstetricians and strict prevailing protocols. Unfortunately, planned vaginal breech delivery (VBD) is becoming an uncommon event. This has led to fewer opportunities for obstetric residents to master the skills of vaginal birth of breech presentations.
MATERIALS AND METHODS: The BP has always been a challenge for obstetricians, due to special skills required to deliver the breech safely. In addition, the immediate perinatal outcome, in terms of APGAR scores and acid-base status of the breech babies is of great concern. Thus, in 2000, in order to provide more evidence-based data, the Term Breech Trial (TBT) was published which compared the outcome of VBD with planned CS. In their 2003 Clinical Guideline, the National Institute for Health and Clinical Excellence (NICE) recommended external cephalic version (ECV) for breech presentation at 36 weeks of gestation a ns elective CS if the procedure is declined or failed. The first edition, Green-top Guidelines by the Royal College of Obstetricians and Gynaecologists (RCOG) regarding the breech delivery was first published in 1999 and revised in 2001, 2006 (Nos. 20a and 20b) and March 2017. In 2020, the Guideline Committee meeting decided on a further revision and deferred the decision for further 3 years (2023). The aim of this Guideline is to aid decision making regarding the route of delivery and choice of various techniques used during delivery. In March 2005, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) issued a formal statement concerning breech delivery at term. Through their Committee on Obstetric Practice, the American College of Obstetricians and Gynecologists (ACOG) issued a Committee Opinion paper on "Mode of term singleton breech delivery" in 2006.
RESULTS: Almost immediately, the medical community all over the world embraced the conclusions of the trial highlighting the superiority of outcomes in planned CS compared to VBD in terms of maternal, neonatal mortality and morbidity. Clinicians, in consultation with their patients, must make the final decisions regarding mode of breech delivery in the light of the updated clinical guidelines and committee opinions for a rational choice for the mode of delivery.
CONCLUSION: There is a place for planned VBD, the prerequisites are: strict case selection, operator skills and vigilant intrapartum monitoring. Provision of basic skills training by utilizing birthing pelvic models and mannikins, hands-on practice of External Cephalic Version (ECV) in clinical settings, may result in larger reduction in the risk of CS.
Case report: torsion of a gravid horn of a didelphic uterus

Achanna S, Monga D, Hassan MS

J Obstet Gynaecol Res, 1996 Apr;22(2):107-9.
PMID: 8697337

Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.
Puerperal uterine inversion: a report of four cases

Achanna S, Mohamed Z, Krishnan M

J Obstet Gynaecol Res, 2006 Jun;32(3):341-5.
PMID: 16764627

Acute puerperal uterine inversion is a life-threatening and unpredictable obstetric emergency. If overlooked, it could lead to a maternal death. Although the precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labor with premature traction of the umbilical cord and fundal pressure before placental separation. At the Ipoh General Hospital in Malaysia there were 31 394 deliveries and four acute uterine inversions occurring from 1 January 2002 to 30 June 2005. The four patients were between 25 and 36 years of age and their parities were between two and three. When manual repositioning of the uterus failed, successful correction was accomplished by the O'Sullivan's hydrostatic method. One case had to undergo subtotal hysterectomy after repositioning because of massive hemorrhage secondary to placenta accreta. Early diagnosis, immediate treatment of shock, and replacement are essential.