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  1. Zahar AZ
    Med J Malaysia, 2022 Jan;77(1):82-84.
    PMID: 35086998
    Induction of labour is one of the most common antepartum intervention. There are numerous methods available but the most commonly used in Malaysian public hospital is the intravaginal dinoprostone. This survey highlighted the various practices of using dinoprostone for different group of pregnant women which are unfortunately, not supported by robust clinical evidence. As such, it calls for futher studies to allow future practice standardization. Alternatively, the use of misoprostol for induction of labour, which has better data profile, should also be considered.
  2. Zahar AZ, Azny MY, Sakinah A, Gayathiri M
    Med J Malaysia, 2023 Jan;78(1):93-97.
    PMID: 36715198
    INTRODUCTION: Terbutaline has been used as a foetal resuscitation measure to improve the intrapartum foetal heart rate abnormalities and neonatal outcome for suspected foetal compromise. Unfortunately, till date, the available data are limited to draw any recommendation.

    MATERIAL AND METHODS: This was a double-blind, placebocontrolled trial conducted among women planned for emergent caesarean delivery for suspected foetal compromise where 100 were randomised to receive subcutaneous terbutaline or placebo. The primary outcomes were the neonatal acid-base status, while the 5- minute Apgar score, admission to the intensive care unit and the maternal outcomes were recorded as secondary outcomes.

    RESULTS: Data from a total of 96 women were analysed and showed a lower incidence of neonatal acidemia (4.4% vs 10.4%) and fewer neonates born with umbilical artery pH of less than 7.20 (12.5% vs 27.1%) and 7.10 (4.2% vs 6.2%) after terbutaline injection. However, the difference in the incidence of neonatal acidaemia, mean cord pH and base excess, Apgar score or admission to the intensive care unit did not differ significantly. No difference was seen in the maternal mean arterial pressure, estimated blood loss or haematocrit after the surgery between the study groups. The only significant maternal effect was tachycardia which was more common after terbutaline injection (54.2% vs 25.0 %, p=0.003).

    CONCLUSION: The study shows that acute tocolysis with subcutaneous terbutaline prior to caesarean delivery has the potential to improve the neonatal outcome in suspected intrauterine foetal compromise and should be further investigated.

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