Displaying all 13 publications

  1. Teo KP, Jacob SCM, Lim SH
    Med J Malaysia, 1997 Dec;52(4):325-30.
    PMID: 10968108
    We reviewed all documented cases of septicaemia following caesarean deliveries in Kandang Kerbau Hospital between 1st January 1993 to 31st December 1995. There were 22 cases of septicaemia among 8201 caesarean births, and hence the incidence is 2.7:1000. There were 45,412 deliveries, and the overall caesarean section rate was 18.1%. Among the 22 documented cases of septicaemia which came under this study, the most common clinical conditions found were endomyometritis (7 cases), urinary tract infection (6 cases), and wound infection (3 cases). One of the three cases with wound infection also had pneumonia. There was one patient who had mild transient myocarditis. We could not determine with certainty any site of infection in five patients. The most common bloodstream bacterial isolates was Staphylococcus aureus (16), while the uncommon ones were Acinetobacter baumanii (2), Escherichia coli (1), Klebsiella sp. (1), Staphylococcus epidermidis (1), Streptococcus Group F (1), Peptostreptococcus species and Veillonella species (1). There was no mortality and prompt, vigorous treatment had led to uneventful recovery in all the cases.
    Matched MeSH terms: Cesarean Section/adverse effects*
  2. Basri NI
    BMJ Case Rep, 2024 Apr 08;17(4).
    PMID: 38589245 DOI: 10.1136/bcr-2024-259938
    Listeriosis is a rare foodborne infection caused by Listeria monocytogenes It has been reported to be commonly found among the obstetric population, immunocompromised group and elderly, presumably due to the lower immunity status in these populations. Presentation in pregnancy is usually non-specific like fever, diarrhoea, respiratory tract symptoms and preterm rupture of membrane. These make the diagnosis challenging and may delay the correct management. We present a case of a female in her early 40s, gravida 4 para 0+3 at 27 weeks who presented with fever. She later developed preterm rupture of membrane 24 hours after admission. The leaking of liquor later changed from clear to meconium stained raising the suspicion of listeria chorioamnionitis, necessitating an emergency preterm delivery via caesarean section. The newborn acquired listeria infection and required ventilation support. He subsequently was discharged from neonatal unit after nearly 3 months of life.
    Matched MeSH terms: Cesarean Section/adverse effects
  3. Karanth KL, Sathish N
    Med J Malaysia, 2010 Sep;65(3):204-8.
    PMID: 21939169
    Caesarean section is a common operation and the best postoperative outcomes are desired. Surgical techniques have been devised or modified to reduce operative and post operative discomfort. Many studies have evaluated or compared the Joel-Cohen abdominal incision with Pfannenstiel incision and found the former to be superior for various reasons such as less postoperative febrile morbidity, less analgesia requirements, shorter operating time, less intra operative blood loss and adhesion formation, reduction in hospital stay and wound infection in the group undergoing Caesarean section by this technique. This study is to find whether better postoperative outcomes of the Joel-Cohen incision group can be justified by the explanations of fundamentals of the basic sciences. Literature was reviewed for randomized clinical trials and review articles comparing the different kinds of abdominal incisions for Caesarean section. The study revealed that the Joel-Cohen method was beneficial. The fundamentals of basic sciences were studied to try to find an explanation to the enumerated advantages of the Joel-Cohen procedure; attributing to the differences in the techniques used.
    Matched MeSH terms: Cesarean Section/adverse effects*
  4. Japaraj RP, Raman S
    Med J Malaysia, 2003 Oct;58(4):604-7.
    PMID: 15190639
    Massive postpartum haemorrhage after Cesarean section for placenta previa is a common occurrence. The bleeding is usually from the placental bed at the lower uterine segment. Uterine tamponade has a role in the management of such patients especially when fertility is desired. We describe here a case of massive postpartum haemorrhage, which was managed, with the use of a Sengstaken-Blakemore tube. This allowed us to avoid a hysterectomy for a young primiparous patient.
    Matched MeSH terms: Cesarean Section/adverse effects
  5. Tan PC, Rohani E, Lim M, Win ST, Omar SZ
    BJOG, 2020 09;127(10):1250-1258.
    PMID: 32202035 DOI: 10.1111/1471-0528.16228
    OBJECTIVE: To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure.

    DESIGN: Randomised trial.

    SETTING: University Hospital, Malaysia: April 2016-October 2016.

    POPULATION: 331 women delivered by caesarean section.

    METHOD: Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal).

    MAIN OUTCOME MEASURES: Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge.

    RESULTS: The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1-2.1; P = 0.45) and patient satisfaction with wound management was 7 [5-8] versus 7 [5-8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound-exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound-dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre-randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups.

    CONCLUSION: The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken.

    TWEETABLE ABSTRACT: An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.

    Matched MeSH terms: Cesarean Section/adverse effects
  6. Ting Tai Y, Mohd Noor N
    J R Coll Physicians Edinb, 2022 Jun;52(2):120-123.
    PMID: 36147001 DOI: 10.1177/14782715221103668
    Fulminant type 1 diabetes mellitus (FT1DM) is recognised as a novel subtype of type 1 diabetes mellitus characterised by the abrupt onset of insulin-deficient hyperglycaemia and ketoacidosis. Fulminant type 1 diabetes mellitus is known to be associated with pregnancy and had been associated with high fetal mortality. We report a case of a gestational diabetes mellitus (GDM) mother complicated with FT1DM immediately post-delivery. A 29-year-old Malay lady who was diagnosed with GDM at 19 weeks of pregnancy, underwent emergency lower segment caesarean section (EMLSCS) due to fetal distress at 36 weeks of gestation; 18 h post-EMLSCS, she developed abrupt onset Diabetic ketoacidosis (DKA) (blood glucose 33.5 mmol/L, pH 6.99, bicarbonate 3.6 mmol/L, ketone 4.4 mmol/L and HbA1c 6.1%). She received standard DKA treatment and discharged well. Her plasma C-peptide level 3 weeks later showed that she has no insulin reserve (C-peptide <33 pmol/L, fasting blood glucose (FBS) 28 mmol/L). Her pancreatic autoantibodies were negative. This case highlights that FT1DM not only can occur in pregnancy with normal glucose tolerance but can also complicate mother with GDM.
    Matched MeSH terms: Cesarean Section/adverse effects
  7. Tan PC, Subramaniam RN, Omar SZ
    Singapore Med J, 2008 Mar;49(3):188-92.
    PMID: 18362998
    Caesarean delivery rates are still increasing, and reliable predictors of adverse outcomes at a subsequent trial of scar are important as they guide decision-making on the best mode of delivery. We aimed to evaluate whether there are any predictors for caesarean delivery and neonatal admission, following trial of labour after one lower transverse caesarean section.
    Matched MeSH terms: Cesarean Section/adverse effects*
  8. Nor AM, Jagdeesh K, Mohd FAS, Kamraul AK, Yusmadi A, Noraslawati R, et al.
    Med J Malaysia, 2023 Nov;78(6):756-762.
    PMID: 38031217
    INTRODUCTION: The study aims to evaluate and report on the clinical characteristics, incidence, risk factors and associated complications of emergency and planned peripartum hysterectomy in a single training and research tertiary health care centre in Malaysia.

    MATERIALS AND METHODS: We conducted a 6-year retrospective cross-sectional study from the 1st January 2016 until 31st December 2021. Clinical, demographic characteristics, perioperative parameters, operative indications, blood loss, maternal/neonatal outcomes and complications were analysed. Patients were subdivided, analysed and studied in two subgroups- emergency hysterectomy (EH) and planned hysterectomy (PH).

    RESULTS: There were 65 cases of peripartum hysterectomy out of total 100,567 deliveries, with a prevalence rate of 0.06%. Overall, the majority of patients were multiparous (96.9%), having previous caesarean scar (73.8%) or diagnosed with placenta praevia (75.4%). More than half of the total patients (61.5%) have both previous caesarean scar and concomitant placenta praevia. EH was carried out in 39(60%) patients while 26(40%) patients underwent PH. The only indication for surgery in the PH group (100%) was abnormal placentation while the most common indication for surgery in the EH group (53.8%) was postpartum haemorrhage related to abnormal placentation. Patients who underwent EH were more likely to have massive blood loss (p=0.001), require ICU admissions (p=0.001), have DIVC cycles transfused (mean [SD] regime: 1.35 [0.95] vs 0.54 [0.99]; p=0.002), have lower postoperative haemoglobin level (mean [standard deviation, SD] haemoglobin: 9.23g/l [SD1.8] vs. 10.8 g/l [SD1.86]; p=0.001) and have higher difference between pre/post operative haemoglobin level (mean [SD] haemoglobin difference: 1.78g/l [SD6.34] vs 0.32g/l [SD1.7]; p=0.008) compared to patients with PH. Red blood cell transfusion, operating time, length of stay, weight of babies and Apgar score between two groups showed no significant differences. A significant reduction of blood loss between the first and the second half duration of the study (mean [SD] blood loss: 6978 ml [SD 4999.45] vs. 4100ml [SD2569.48]; p=0.004) was also observed. In the emergency group, 'non-placental cause' EH required significantly more red blood cell transfusion than 'placental cause' (p<0.05) while in the PH group, no significant difference was observed between the occlusive internal iliac artery 'balloon' and 'no balloon' subgroup in terms of operating time, total blood loss or blood transfusion. Overall complications showed more cases of post operative fever and relaparotomy in the EH group (18.4% vs. 7.6%) while urinary tract injuries including injuries to bladder and ureter occurred only in the PH group (9.4% vs. 0%).

    CONCLUSION: The majority of peripartum hysterectomy cases are due to placenta accreta spectrum disorders. Planned peripartum hysterectomies have a lower morbidity rate compared to emergency hysterectomies. Therefore, early identification of placenta accreta spectrum disorders and timely planning for elective procedures are crucial to minimise the need for emergency surgery.

    Matched MeSH terms: Cesarean Section/adverse effects
  9. Salari N, Kazeminia M, Shohaimi S, Nankali AA, Mohammadi M
    Reprod Biol Endocrinol, 2020 Nov 09;18(1):108.
    PMID: 33168010 DOI: 10.1186/s12958-020-00666-0
    BACKGROUND: Previous caesarean scar pregnancy is one type of ectopic pregnancy in myometrium and fibrous tissue of previous caesarean scar. One of the therapeutic methods of this type of ectopic pregnancy is treatment with methotrexate. Given various findings on the treatment of caesarean scar pregnancy with methotrexate and lack of global report in this regard, we aimed to achieve a global report on the treatment of CSP with methotrexate through related literature review and analysis of the results of the studies, to enable more precise planning to reduce complications of CSP.

    METHOD: This review study extracted information through searching national and international databases of SID،, Embase, ScienceDirect, ، Scopus, ، PubMed, Web of Science (ISI) between 2003 and January 2020. To perform the meta-analysis, random-effects model and heterogeneity of the studies with I2 index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2.

    RESULTS: In total, 26 articles with a sample size of 600 individuals were enrolled in the meta-analysis. According to the results of the study, the mean level of β-hCG was 28,744.98 ± 4425.1 mIU/ml before the intervention and was 23,836.78 ± 4533.1 mIU/ml after the intervention. The mean intraoperative blood loss (ml) was 4.8 ± 3.76 ml, mean hospital stay (days) was 11.7 ± 1.2 days, mean time for serum-hCG normalization (days) was 41.6 ± 3.2 days, success was 90.7% (95% CI: 86.7-93.5%), and complication was 9% (95% CI: 6.3-12.8%).

    CONCLUSION: The results of the current study show methotrexate significantly reduces β-hCG levels and can be effective in treating caesarean scar pregnancy and its complications.

    Matched MeSH terms: Cesarean Section/adverse effects
  10. Voon HY, Suharjono HN, Shafie AA, Bujang MA
    Taiwan J Obstet Gynecol, 2018 Jun;57(3):332-339.
    PMID: 29880160 DOI: 10.1016/j.tjog.2018.04.002
    OBJECTIVE: Postpartum hemorrhage remains the leading cause of maternal mortality in developing countries and a significant proportion of these cases are attributable to uterine atony. In contrast to the advances made in the treatment of postpartum hemorrhage, there has been few novel prophylactic agents. This study was undertaken to analyze the effectiveness of carbetocin compared to oxytocin for the prevention of postpartum hemorrhage, in the context of cesarean deliveries.

    MATERIALS AND METHODS: Major electronic databases were searched for randomized-controlled trials comparing carbetocin with oxytocin. Only trials involving cesarean deliveries were included. Non-randomized trials, non-cesarean deliveries, studies which did not directly compare carbetocin to oxytocin and studies which did not analyze the intended outcomes were excluded. Outcomes analysed were postpartum hemorrhage, additional use of uterotonic and transfusion requirement.

    RESULTS: Seven studies involving 2012 patients were included in the meta-analysis. There was a significant reduction in the rates of postpartum hemorrhage (RR 0.79; 95% CI 0.66 to 0.94; p = 0.009), use of additional uterotonics (RR 0.57; 95% CI 0.49 to 0.65; p cesarean deliveries. However, despite the potential benefits illustrated in this meta-analysis, the disparity between the cost of carbetocin and oxytocin suggests that locoregional cost-effectiveness analysis should be performed before any decision is made to adopt it for routine prophylaxis.

    Matched MeSH terms: Cesarean Section/adverse effects
  11. Nathan AM, de Bruyne J, Khalid F, Arumugam K
    Asian Pac J Allergy Immunol, 2012 Sep;30(3):204-8.
    PMID: 23156850
    Birth cohort studies in some countries have shown a link between caesarean section and asthma.
    Matched MeSH terms: Cesarean Section/adverse effects
  12. Achanna S, Monga D, Hassan MS
    J Obstet Gynaecol Res, 1996 Apr;22(2):107-9.
    PMID: 8697337
    Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.
    Matched MeSH terms: Cesarean Section/adverse effects
  13. Ravindran J
    Med J Malaysia, 1994 Mar;49(1):53-61.
    PMID: 8057992
    Obstetric pulmonary embolism forms the most serious vascular problem during pregnancy. The following report is a retrospective study into maternal deaths in Malaysian mothers probably due to obstetrical pulmonary embolism. Obstetric pulmonary embolism can be divided into amniotic fluid embolism and obstetric blood clot embolism. There were 37 maternal deaths attributable to this cause -9.9 per cent of all maternal deaths to blood clot embolism and 6.7 per cent to amniotic fluid embolism. Most cases were diagnosed clinically because a postmortem examination was not done. Eleven cases of embolism were associated with Caesarean delivery. The typical profile of a Malaysian mother dying from obstetrical pulmonary embolism is that of a Malay mother in the "non-risk" parities of one to four and usually aged between 31-35 years. In the management of these patients, there should be an urgency in diagnosis and improvement in diagnostic procedures. Health staff at all levels should be trained to pick up patients who present with features of deep vein thrombosis.
    Matched MeSH terms: Cesarean Section/adverse effects
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