Extrapelvic endometriosis is fairly rare and may occur in numerous sites throughout the body. Unnecessary investigation may be performed before the diagnosis could be made. Here we present two cases where endometriotic nodules occurred on a caesarean section scar and in the vagina. Further management is discussed in the report.
This study examines the effect of a low glycaemic index (LGI) intervention to improve dietary intake among women with Gestational Diabetes Mellitus (GDM). Women with GDM were randomised to receive either a low GI intervention (LGI; n = 20) or standard nutrition therapy (SNT; n = 20) for a 4-week period. Food Frequency Questionnaire (FFQ) and Three-Day Diet Record assessed the dietary intake and food choices. Dietary intake and food choices of the participants were comparable at baseline. At the end of the study, energy, protein, fat and carbohydrate were reduced in both groups (p < 0.05). In the LGI group, fibre and calcium intake was higher compared with SNT group. More participants in
the LGI group consumed rice from the low GI varieties, the whole grain breads and the low GI biscuits (p<0.05) compared with participants in the SNT group. The diet GI reduced significantly in the LGI group (50 ± 9 units) compared with the SNT group (57 ± 6) (p < 0.05). Findings showed low GI dietary intervention improved the dietary intake of women with GDM.
Keywords: Carbohydrate, dietary intake, Gestational Diabetes Mellitus, low glycaemic index
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Placenta previa is a condition when the placental tissue extends over the internal cervical os. It is associated with
maternal and fetal morbidity and mortality. With intrauterine death, the mode of delivery will be more difficult to
decide. Here, we report a case of 30 years old G3P2 with placenta previa major diagnosed with intrauterine death at
29 weeks gestation who was managed conservatively and delivered vaginally with minimal complication. A good
patient selection and thorough counseling, patient with placenta previa major and intrauterine death still can be safely
delivered vaginally.
Pregnancy induced hypertension (PIH) is commonly encountered in hypertensive disease in pregnancy (HDP) and important cause of feto-maternal morbidity and mortality. Abnormal changes of placenta development in PIH leads to abnormal elevation of second trimester maternal hCG level. Thus, it may have a role in prediction of PIH. The objective of this study was to evaluate the ability of serum hCG levels during early second trimester to predict PIH and obstetric outcome at later gestation. We conducted a cohort study which comprised 34 pregnant women varying from 14–20 weeks of gestation with serum hCG level taken at points of recruitment. Serum hCG was measured by a chemiluminescent immunoassay. Three (8.8%) pregnant women developed late onset PIH while the remainder were normotensive. The diagnostic performance of second trimester hCG in predicting PIH as assessed by receiver operator characteristic curve was poor (AUC = 0.398). Multiple of median (MoM) were used to improve the hCG performance and MoM of >2 MoM were considered as elevated hCG level. All pregnancies with PIH had 0.655). There was no significant association of hCG level and pregnancy outcome. In conclusion, estimation of second trimester hCG is a poor predictive marker for PIH. These findings are limited by the less number of hypertensive cases
This was a pilot study comparing the success between early versus late external cephalic version (ECV) involving primigravidae with singleton breech pregnancy. They were randomised into early (34–36 weeks) and late (37-40 weeks) ECV groups. A total of 44 women were initially randomised into 22 women for each group. The overall ECV success rate was acceptable in both groups although insignificantly higher in the late ECV group (55.6% versus 46.7%, p= 0.732.) Caesarean
section in the early ECV group was higher (80% versus 72.2%). Early ECV group had women with higher BMI (29.5 versus 26.8 kg/m2, p=0.107), anterior placentation (60% versus 38.9%) and extended breech presentation (55.6% versus 44.4%; p= 0.296). In conclusion, early ECV in primigravidae showed no better success rate than late ECV. Maternal obesity, anterior placentation and extended breech presentation should alert to failure risk.
Placenta praevia is a known obstetric condition that causes complications to mother and fetus. This study was done to evaluate the knowledge of placenta praevia amongst the obstetric patients. A cross sectional study was carried out in Hospital Ipoh, Perak among 323 antenatal and postnatal patients. Socio-demographic parameters (ie age, race, parity, occupation, educational level) and history of placenta praevia were studied in relation to level of knowledge and attitude towards placenta praevia. Twenty (6.2%) from 323 women had current or past history of placenta praevia. Three had history of placenta praevia while 17 had current placenta praevia with prevalence of 5.3%. The mean score of knowledge achieved by patients was 11.8 which indicated overall poor knowledge. Occupation, level of education and history of placenta praevia were found to have a relationship with level of knowledge regarding placenta praevia in all obstetric patients. There was a significant relationship between attitude of patients with current and history of placenta praevia to level of knowledge regarding placenta praevia. (p=0.037,
Morbidly adherent placenta with spontaneous rupture of membrane at extreme prematurity poses poor pregnancy outcome. Various issues on different management modalities still remain perplexed and individual consideration is vital. Two cases of morbidly adherent placenta with symptomatic per vaginal bleeding and spontaneous rupture of membrane at severe prematurity were reviewed and discussed. We found that, active intervention by termination of pregnancy and methotrexate therapy at early gestation can prevent the need of hysterectomy following major obstetrics haemorrhage.