OBJECTIVE: To summarise the published research on teenage pregnancy in Malaysia, discuss the impact of the findings on clinical practice, and identify gaps in teenage pregnancy research in Malaysia.
METHODS: There were 31 articles related to teen pregnancy found after searching a database dedicated to indexing all original clinical research data published in Malaysia from year 2000 to 2014. Twenty-seven articles (including reports from the National Obstetrics Registry) were selected and reviewed on the basis of clinical relevance and future research implications. This literature review has been divided into eight sections: epidemiology, age at first marriage, adolescent fertility rate, unmarried childbearing, risk factors, maternal risks and neonatal outcome, future plan after delivery, and contraceptive use.
RESULTS: More than 19,000 births to teenage mothers were recorded each year between 2009 and 2011. Adolescent fertility rates were recorded at 6 births per 1000 women ages 15-19 years in 2013. Many of these births were from unwed pregnancies, which accounted for 1.99% of total deliveries. A majority of young mothers were willing to take care of their baby, although some of them planned to put their baby up for adoption. Risk factors for teenage pregnancy were found to be similar to those published in studies worldwide.
CONCLUSION: More research is needed to better understand the issue of teen pregnancy. For the best results, collaborative studies among nationwide hospitals and institutions should be the way forward.
INTRODUCTION: Maternal mortality and morbidity from eclampsia continues to be seen around the globe. Local Key Performance Index on recurrence of eclamptic fits did not meet targets, thus this raised the issue whether the care provided adhered to the standard management for eclampsia.
METHODS: This clinical audit was conducted to assess and improve the quality of the service being offered to patient, particularly in managing eclampsia cases. It was conducted according to the audit cycle. It begins with the development of 12 standardized criteria for eclampsia management. First audit was conducted by retrospectively reviewing eclampsia cases from year 2008 till 2012. Strategies for changes were formulated and implemented following the results of the first audit. Second audit was conducted six months after the changes.
RESULTS: The overall incidence rate of eclampsia was 9.17 per 10,000 deliveries. A first seizure occurred during the antepartum period in 52.9% of cases (n=27), intrapartum in 24% (n=11) and postpartum in 21% of cases (n=13). Suboptimal care was mainly on delay of activation of Red Alert system and no treatment for uncontrolled blood pressure. Several strategies were implemented, mainly on improving working knowledge of the staffs and reengineering hospital Red Alert system. Positive achievements observed during the second audit, shown by a reduction in the number of patients with recurrence eclamptic fits and perinatal mortality rate.
CONCLUSION: Conducting an audit is essential to evaluate local performance against the standardized criteria. Improvement can be achieved with inexpensive solutions and attainable within a short period of time.
Study site: Sultan Abdul Halim Hospital, Sungai Petani, Kedah, Malaysia
We report the first case of young woman with the p phenotype and anti-PP1P(k) antibody in the Malaysian population who was identified during a blood grouping and antibody screening procedure after her first miscarriage. Further family screening detected two other siblings who possessed the same rare phenotype and antibody. Because of difficulties in finding compatible units in the local population, the patient and her two siblings were advised to become regular blood donor. Their blood was frozen for future use. After she had two recurrent miscarriages, her third pregnancy was successfully managed using oral dydrogesterone, which was started from 10 weeks into the pregnancy. Her pregnancy was uneventful and she gave birth to a healthy term neonate.