MyMedR

Displaying all 3 publications

Abstract:

Sort:

Training and testing of integrated professional skills in management of shoulder dystocia among Malaysian Health Care Providers

Thaneemalai J, Muniswaran G, Boon Nee T, Gunasegaran PT

Med J Malaysia, 2025 Mar;80(2):206-211.
PMID: 40145164

INTRODUCTION: To evaluate if the Intensive Course in Obstetric Emergencies (ICOE) Shoulder dystocia simulation training module could improve psychomotor and cognitive skills in the management of shoulder dystocia using a Test of Integrated Professional Skills (TIPS).
MATERIALS AND METHOD: This was a prospective observational study involving Malaysian health care professionals participating in ICOE shoulder dystocia simulation, where standardized curriculum was used. Pre and post-test skills assessment were conducted to evaluate the effectiveness of the course content and delivery.
RESULTS: 609 Malaysian health care professionals attended ICOE training; 400 midwives, 128 medical officers, 55 specialist and 26 consultants. Participants were derived from 25 consecutive courses, from 2014 to 2019 and tested on predetermined skills in the management of shoulder dystocia. Their mean TIPS pre-test vs post-test score were (2.55 vs 6.77) midwives, (3.78 vs 7.25) medical officers, (5.16 vs 7.82) specialists & (3.62 vs 6.88) consultants. All four group of participants showed statistically significant improvement (51-165%) in their skills (p<0.001). The mean post test score in noting time of dystocia and call for help were significantly higher among midwives than others. All four groups statistically improved their delivery skills in McRoberts manoeuvre and directed suprapubic pressure. Pre-skills for delivery of the posterior arm was suboptimal and post skills test showed statistically significant improvement in all four groups.
CONCLUSION: ICOE shoulder dystocia simulation training module improved the psychomotor and cognitive skills in the management of delivery of shoulder dystocia.
Fulltext Intrauterine management of fetal supraventricular tachycardia (SVT) with cardiac failure

Muniswaran G, Japaraj RP, Asri Ranga AR, Cheong HK

Med J Malaysia, 2015 Dec;70(6):371-2.
PMID: 26988216 MyJurnal

Fetal arrhythmias are not uncommon in pregnancy. The diagnosis can be established on routine ultrasound scan. Fetal supraventricular tachycardia (SVT) is the most common cause of fetal tachycardia. If left undiagnosed and untreated, these fetuses may develop cardiac failure, hydrops fetalis and eventually death. We report two fetuses diagnosed antenatally to have fetal SVT. Both fetuses were in cardiac failure and were successfully treated with maternal administration of antiarrhythmic medications. Digoxin, and in severe instances, a combination with flecanaide significantly improved fetal outcomes and prevented fetal mortality. The long term prognosis of such patients are good.
Fulltext Effectiveness of selective risk based screening for gestational diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia

Muniswaran G, Soelar SA, Karalasingam SD, Bujang MA, Jeganathan R, Suharjono H

Med J Malaysia, 2017 02;72(1):46-49.
PMID: 28255139 MyJurnal

INTRODUCTION: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM.
OBJECTIVE: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia.
METHODOLOGY: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio.
RESULTS: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant.
CONCLUSION: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links