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Fulltext Undiagnosed Term Abdominal Pregnancy in a District-Level Hospital of a Developing Country: A Miracle Baby

Than WW, Binti Pg Baharuddin DM, Hossain Parash MT, Mra A

Cureus, 2023 Feb;15(2):e35092.
PMID: 36945266 DOI: 10.7759/cureus.35092

Term abdominal pregnancy is a sporadic ectopic pregnancy associated with high maternal and perinatal morbidity and mortality. As symptoms are non-specific and resemble those of other ectopic pregnancies, early diagnosis is the major challenge in poor health setups. A 24-year-old primigravida at 38 weeks gestation was planned to undergo a cesarean section for the transverse lie. Abdominal pregnancy was accidentally discovered during the cesarean section, and a healthy, normal baby boy was delivered. The placenta was attached to the greater omentum, so its removal required omentectomy without compromising the blood supply to the bowels. Both patient and her baby boy were discharged on the seventh day without complications. No congenital anomalies were detected in the baby. In a term abdominal pregnancy, the most significant challenges are the control of bleeding and the decision on placenta removal, followed by prompt delivery of the fetus. Therefore, along with the gynecologist, the availability of trained personnel, such as anesthetists, pediatricians, and general surgeons, is necessary for a successful management outcome.
Fulltext Vitiligo and pregnancy: How do each affect the other?

Abdelhafez MMA, Ahmed KAM, Ping Pang NT, Pg Baharuddin DM, Than WW, Kadir F, et al.

Ann Med Surg (Lond), 2021 Oct;70:102833.
PMID: 34540219 DOI: 10.1016/j.amsu.2021.102833

Vitiligo is one of the dermatomes affecting the melanocytes resulting in their destruction and subsequent patchy depigmentation of the skin. It is postulated to occur due to an autoimmune problem. Despite being a disease with limited systemic involvement and lack of mortality, it has a severe psychological impact. It may have a powerfully negative effect on a patient's quality of life. The relationship between vitiligo and pregnancy is not widely acknowledged. It may be associated with adverse pregnancy outcomes such as recurrent miscarriage, prematurity, intrauterine growth retardation and pre-eclampsia. Herein, this review describes the disease's adverse effects on pregnancy outcomes and the influence of pregnancy itself on the clinical evolution and prognosis of vitiligo.
Fulltext Obstetric challenges during COVID-19 pandemic: A narrative review

Helmy Abdelmalek Fahmy E, Yeap BT, Pg Baharuddin DM, M A Abdelhafez M, Than WW, Soe MZ, et al.

Ann Med Surg (Lond), 2021 Nov;71:102995.
PMID: 34745605 DOI: 10.1016/j.amsu.2021.102995

The severe acute respiratory coronavirus 2 (COVID-19) pandemic impacts the health of women at reproductive age in different ways, starting from pregnancy planning to post-delivery. This narrative review summarises the challenges to obstetric practice posed by the severe acute respiratory coronavirus 2 (COVID-19) pandemic. In this paper, we highlight the impacts of COVID-19 to obstetric practice globally and the efforts taken to address these challenges. Further study is critical to investigate the effects of COVID-19 on pregnancy, the outcome of COVID-19 positive pregnant women, and the safety of vaccination during pregnancy and breastfeeding.
Fulltext Bariatric surgery and its impact on fertility, pregnancy and its outcome: A narrative review

Pg Baharuddin DM, Payus AO, Abdel Malek Fahmy EH, Sawatan W, Than WW, Abdelhafez MM, et al.

Ann Med Surg (Lond), 2021 Dec;72:103038.
PMID: 34849219 DOI: 10.1016/j.amsu.2021.103038

Bariatric procedures are on the rise as a surgical treatment for morbid obesity. In reproductive age of women, bariatric surgeries will improve factors related to anovulation and lead to spontaneous fertility. Spontaneous pregnancy can happen within a year after bariatric surgery due to higher level of sex hormone binding globulin and follicular stimulating hormone and reduction in androgens level. Reduction of length of follicular phase of menstrual cycle was reported and contribute to improved ovulatory status. The major impact to pregnant women is development of small for gestational age babies due to persistent weight loss but this can be minimized by avoiding pregnancies too soon after bariatric surgery and good nutrition supplement. Risk of developing gestational diabetes mellitus and preeclampsia reduced among post bariatric surgery compared to no surgery. Another benefit observed are reduction in the risk of caesarean section and admission to neonatal intensive care unit. There are no significant changes in composition of breast milk in postpartum women without bariatric surgery and with women whom undergone surgery although more study needed to evaluate this effect. Good prenatal care, micronutrient supplement during antenatal follow up and close supervision from expert managing this pregnancy are essential component to ensure good outcome to mothers and their newborn.
Intrahepatic cholestasis of pregnancy: from an obstetrician point of view

Abdelhafez MMA, Ahmed KAM, Than WW, Baharuddin DMP, Kadir F, Jeffree S, et al.

J Obstet Gynaecol, 2022 Oct;42(7):2550-2557.
PMID: 35666947 DOI: 10.1080/01443615.2022.2081801

Intrahepatic cholestasis of pregnancy (ICP) is the commonest among the specific dermatoses of pregnancy. The disease is characterised by intense pruritus and specifically by elevated bile acid levels and owing to the rarity of data published in this context, the disease carries a great challenge in both diagnosis and management. The disease is associated with significant maternal as well as perinatal adverse effects, hence, this article aims at improving the knowledge of the women's health carers with the up-to-date and evidence-based, whenever possible, recommendations while managing patients with ICP.
A Case-Control Study on Factors Associated With Secondary Amenorrhea Among the Medical Students of Universiti Malaysia Sabah

Than WW, Hossain Parash MT, Binti Abdul Majeed N, Nyein Yin K, Pg Baharuddin DMB, Fahmy EHAM, et al.

Cureus, 2023 Oct;15(10):e47625.
PMID: 38022313 DOI: 10.7759/cureus.47625

BACKGROUND AND AIM: This study aimed to evaluate the association between body mass index (BMI), anxiety, stress, depression, hormones, and secondary amenorrhea among female medical students at Universiti Malaysia Sabah (UMS).
METHODS: In this case-control study, UMS undergraduate female medical students aged 19-25 years who did not menstruate in the last three months (with a previous history of a regular menstrual cycle) or six months (with a history of irregular menstruation) were included as cases (40 students), and students with similar criteria but no menstrual irregularities were recruited in the study as controls (40 students). The study was conducted at Polyclinic UMS from January 1, 2021, until December 31, 2022. The chi-squared test and odd ratio examined the association of the above-mentioned factors with the secondary amenorrhea. A p-value less than 0.05 was considered significant, and an odds ratio if the confidence interval did not contain one was considered significant.
RESULT: Both the groups had a similar frequency of different BMI grades. The cases exhibited significantly higher levels of depression, anxiety, and stress than the controls. Again, the cases demonstrated higher estradiol (E2), testosterone, and thyroid-stimulating hormone (TSH) levels and lower levels of luteinizing hormone (LH) than those with regular menstruation. The research also revealed that a one-unit decrease in follicle-stimulating hormone (FSH) levels corresponds to a threefold increase in the risk of experiencing secondary amenorrhea, while the risk escalates to fourfold for LH. Moreover, E2, testosterone, and TSH levels exhibited protective effects on secondary amenorrhea.
CONCLUSION: Anxiety, serum LH, and FSH were significantly associated with secondary amenorrhea. Future studies should address the diurnal variation of the hormones and consider the participants' circumstances to get a proper effect of hormonal influence and stress.
Fulltext Impetigo herpetiformis: A rare pregnancy-specific dermatosis

Abdelhafez MMA, Ahmed KAM, Mohd Daud MNB, Jeffree MS, Kadir F, Baharuddin DMP, et al.

Obstet Med, 2023 Mar;16(1):5-8.
PMID: 37139500 DOI: 10.1177/1753495X221074610

Impetigo herpetiformis (IH) is a pregnancy-specific dermatosis that is currently considered a form of generalised pustular psoriasis and mainly occurs in late pregnancy during the third trimester. IH presents as erythematous patches and pustules and might have systemic involvement. The disease may be associated with severe maternal, fetal, and neonatal complications. IH treatment is very challenging, however, various therapeutic options are available and effective for disease treatment.
Venous thromboembolism and pregnancy: A review of the literature

Abdelhafez MM, Ahmed KA, Daud MN, Eldiasty AM, Amri MF, Jeffree MS, et al.

Afr J Reprod Health, 2023 May;27(5):81-94.
PMID: 37584933 DOI: 10.29063/ajrh2023/v27i5.8

This review aims to provide the mother carers with the most recent evidence-based guidelines in the context of managing of pregnancy-associated VTE, where an extensive search through the medical journals addressing the topic including the medical database such as Pubmed, Medline, Sience direct,Embase and others using the title and key-words in order to gather the most concerned as well as the up-to-date publications concerned with the problem under research, the search resulted in recognising pregnancy as a significant risk factor for the development of VTE, both during the prenatal and postnatal periods, with an estimated increased likelihood risk of five and sixty times, respectively and concluded that venous thromboembolism (VTE) is one of the leading causes of maternal mortality hence, all pregnant women should be assessed for the risk of developing the condition as early as possible (when scheduling a booking antenatal appointment) or even in the pre-pregnancy clinic.
Menopausal hormone therapy and risk of venous thromboembolism: The story so far

Abdelhafez MMA, Ahmed KAM, Ahmed NAM, Ismail MH, Daud MNM, Eldiasty AME, et al.

Afr J Reprod Health, 2024 Mar 31;28(3):122-129.
PMID: 38583076 DOI: 10.29063/ajrh2024/v28i3.13

Menopausal hormone therapy (MHT) is known to increase the risk of venous thromboembolism (VTE), which includes deep vein thrombosis, pulmonary embolism, and less frequently cerebral vein thrombosis, but the absolute risk for a given patient is very low. After starting MHT, the risk of VTE seems to be at its highest, declining to the non-HRT user baseline level of risk after stopping. Whether estrogen-only or estrogen-progestin HRT combination is linked to a similar risk of VTE is unclear from the available evidence. The aim of this study is to evaluate the risks of developing VTE in relation to different types as well as different modes of administration of MHT through a database search including PubMed, MEDLINE, Google Scholar, Cochrane Library, and others in order to provide the women carers with the up-to-date and evidence-based guidelines and recommendations while counseling the post-menopausal women enquiring on use of hormonal therapies either to alleviate the menopausal symptoms or to prevent the long-term sequelae of estrogen deficiency.