Displaying publications 1 - 20 of 32 in total

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  1. Siva Achanna K
    Med J Malaysia, 2011 Mar;66(1):1-3.
    PMID: 23765133
    Matched MeSH terms: Postpartum Hemorrhage*
  2. Achanna S, Mohamed Z, Krishnan M
    J Obstet Gynaecol Res, 2006 Jun;32(3):341-5.
    PMID: 16764627
    Acute puerperal uterine inversion is a life-threatening and unpredictable obstetric emergency. If overlooked, it could lead to a maternal death. Although the precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labor with premature traction of the umbilical cord and fundal pressure before placental separation. At the Ipoh General Hospital in Malaysia there were 31 394 deliveries and four acute uterine inversions occurring from 1 January 2002 to 30 June 2005. The four patients were between 25 and 36 years of age and their parities were between two and three. When manual repositioning of the uterus failed, successful correction was accomplished by the O'Sullivan's hydrostatic method. One case had to undergo subtotal hysterectomy after repositioning because of massive hemorrhage secondary to placenta accreta. Early diagnosis, immediate treatment of shock, and replacement are essential.
    Matched MeSH terms: Postpartum Hemorrhage/pathology; Postpartum Hemorrhage/therapy*
  3. Sinnathuray TA
    Med J Malaya, 1972 Sep;27(1):57-62.
    PMID: 4264827
    Matched MeSH terms: Postpartum Hemorrhage/epidemiology*
  4. Laffan M, Sathar J, Johnsen JM
    Haemophilia, 2021 Feb;27 Suppl 3:66-74.
    PMID: 32578345 DOI: 10.1111/hae.14050
    von Willebrand disease (VWD) is the most common inherited bleeding disorder. VWD is caused by deficiencies in von Willebrand factor (VWF), a critical adhesive haemostatic protein. This review provides an overview of VWD diagnosis and treatment, special considerations in treating women with VWD, and current genomic approaches to VWD. For diagnosis and treatment in VWD, an accurate diagnosis is critical to providing effective treatments, determining appropriate laboratory monitoring and for counselling the patient and family. Diagnosis of VWD begins with the clinical assessment for the bleeding phenotype, which is usually characterized by mucocutaneous and provoked bleeding. The diagnosis of VWD is then made by laboratory investigation. Multiple assays are used to assess VWF levels and functions. The mainstays of VWD treatment are tailored by VWD type and symptoms, and can include antifibrinolytic treatment, desmopressin and VWF replacement treatment. Women with VWD are also at risk for excessive uterine bleeding, such as with menses and childbirth. In addition to standard VWD treatments, heavy menstrual bleeding can be treated with hormones. Interdisciplinary management of childbirth and prophylaxis in the postpartum period are needed to reduce the risk of postpartum haemorrhage. Genomic approaches to VWD can inform VWD diagnosis, treatment, test assay selection, reproductive planning and family counselling. Most VWD patients have an identifiable VWF gene DNA variant. Next-generation sequencing is rapidly being adopted to provide more comprehensive VWF sequence information for patients with known or suspected VWD.
    Matched MeSH terms: Postpartum Hemorrhage*
  5. MENG LY
    Med J Malaya, 1958 Sep;13(1):74-9.
    PMID: 13589374
    Matched MeSH terms: Postpartum Hemorrhage*
  6. Upawi SN, Ahmad MF, Abu MA, Ahmad S
    Midwifery, 2022 Feb;105:103238.
    PMID: 34968819 DOI: 10.1016/j.midw.2021.103238
    OBJECTIVE: to compare the effect of amniotomy with early vs delayed oxytocin infusion on successful vaginal delivery.

    DESIGN: randomised controlled trial of nulliparous women with spontaneous labour at term.

    SETTING: labour suite of a university teaching hospital in Kuala Lumpur, Malaysia.

    PARTICIPANTS: 240 women were included (120 randomised into two arms).

    INTERVENTIONS: the randomisation sequence was generated using a computer randomisation program in two blocks: oxytocin infused early following amniotomy; and oxytocin infused 2 h after amniotomy.

    MEASUREMENTS AND FINDINGS: labour duration, mode of delivery, oxytocin dosage used, uterine hyperstimulation, postpartum haemorrhage, Apgar score and admission to the neonatal intensive care unit were recorded. No differences in vaginal delivery rate (62.9% vs 70.9%; p = 0.248) and second-stage labour were found between the early and delayed oxytocin infusion groups (21.2 ± 18.3 min vs 25.5 ± 19.9 min; p = 0.220). The mean interval from amniotomy to vaginal delivery was significantly shorter for the early group (5.8 ± 1.7 h vs 7.0 ± 1.9 h; p = 0.001), and more women in the early group delivered during/before the planned review at 4 h after amniotomy (53.6% vs 10.6%; p<0.001). Maximum oxytocin usage was lower in the early group (5.6 ± 4.4 mL/hour vs 6.8 ± 5.3 mL/hour; p = 0.104).

    KEY CONCLUSIONS: early oxytocin augmentation following amniotomy could be employed in low-risk primigravida, given that it is associated with a shorter labour duration without jeopardising maternal or neonatal outcomes.

    IMPLICATIONS FOR PRACTICE: low-risk primigravida benefit from early oxytocin infusion following amniotomy, and this can be offered as an additional practice in labour room care.

    Matched MeSH terms: Postpartum Hemorrhage*
  7. Rashid Z, Hamidah NH, Othman A, Cheong SK, Fairuz AK, Adeeb N
    J Obstet Gynaecol (Tokyo 1995), 1995 Jun;21(3):221-5.
    PMID: 8590357
    A young primigravida presented with postpartum haemorrhage with no apparent cause following a low forceps delivery. She was extremely pale with gross hepatosplenomegaly. Hysterectomy was performed following three episodes of disseminated intravascular coagulation. Investigations revealed an extremely high platelet count with poor aggregatory function. A diagnosis of primary thrombocythaemia was made.
    Matched MeSH terms: Postpartum Hemorrhage/etiology*
  8. Donnan F, Senarathna SMDKG, Ware B, Rawlins MDM, Dontham C, Chuang VTG, et al.
    Aust N Z J Obstet Gynaecol, 2020 06;60(3):344-349.
    PMID: 31512230 DOI: 10.1111/ajo.13046
    BACKGROUND: Postpartum haemorrhage (PPH) kits containing uterotonics are used on obstetric units for the timely management of PPH. Visible discolouration of ergometrine and ergometrine-oxytocin injections was observed in PPH kits stored in medical refrigerators on the obstetric unit at our hospital.

    AIM: To investigate the stability of ergometrine and ergometrine-oxytocin injections in PPH kits under simulated clinical storage conditions and to determine the potency of ampoules quarantined from PPH kits on our obstetric unit.

    MATERIAL AND METHODS: Ergometrine and ergometrine-oxytocin injection ampoules were stored exposed to and protected from light at 4°C and room temperature (25°C) for up to three months, and assayed by high-performance liquid chromatography. Stability was based on the time for the ergometrine or oxytocin concentration to fall to 90% of the original concentration (t90 ). The potency of quarantined discoloured ampoules also was determined.

    RESULTS: Ergometrine was stable at both temperatures for >6 months, when stored protected from light in simulated clinical conditions. When exposed to light, ergometrine was stable for approximately 4 days at 25°C and 10 days at 4°C. Discoloured ergometrine and ergometrine-oxytocin injection ampoules were found to be <90% of the nominal concentration.

    CONCLUSION: Stability of ergometrine in PPH kits is largely unaffected by temperature fluctuations (at 4°C and 25°C) over 6 months when protected from light. Ergometrine and ergometrine-oxytocin ampoules should be inspected prior to use and any discoloured ampoules discarded.

    Matched MeSH terms: Postpartum Hemorrhage/drug therapy*
  9. Ping WW, Sinnathuray TA
    Med J Malaya, 1970 Sep;25(1):54-7.
    PMID: 4249498
    Matched MeSH terms: Postpartum Hemorrhage/etiology
  10. LLEWELLYN-JONES D
    Med J Malaysia, 1964 Mar;18:212-4.
    PMID: 14157188
    Matched MeSH terms: Postpartum Hemorrhage*
  11. 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: Postpartum Hemorrhage/etiology; Postpartum Hemorrhage/therapy*
  12. 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 postpartum hemorrhage and transfusion when used during 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: Postpartum Hemorrhage/drug therapy; Postpartum Hemorrhage/prevention & control*
  13. Subramaniam S, Nadarajan C, Aziz ME
    Cureus, 2018 Feb 23;10(2):e2220.
    PMID: 29692958 DOI: 10.7759/cureus.2220
    Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.
    Matched MeSH terms: Postpartum Hemorrhage
  14. Thiruselvi Subramaniam, Ann Jee Tan
    MyJurnal
    Background: House-officers and medical officers are at
    the forefront during medical emergencies in the ward
    and casualty which impose cognitive, communication,
    social and system challenges and yet, training in this
    area is commonly lacking. A workshop was conducted
    using simulation to provide training on some acute
    medical emergencies like cord prolapse, post- partum
    haemorrhage with collapse, poly-trauma and acute
    exacerbation of asthma.

    Objective: To determine the effectiveness of simulation
    in developing competency in managing selected clinical
    emergencies.

    Methodology: There were 22 participants consisting
    of house-officers, junior medical officers and nursing
    clinical instructors. Only doctors were included in
    the study. Four medical emergencies were chosen viz.:
    Cord prolapse; post- partum haemorrhage with collapse;
    poly-trauma and acute exacerbation of asthma. The
    simulated sessions were conducted using high fidelity
    manikins and simulated patients. Simulated patients
    were trained and moulage was applied accordingly. The
    skills stations were on airway equipment and techniques
    of application, latest cardiac life support algorithm and
    hands on chest compression using manikins.

    Results: A 5 point Likert scale used to rate the
    sessions. The skills station had 65% (n=13) rating as
    excellent and 35% (n=7) good. The skills simulation
    was rated excellent by 75% (n=15) and good by 25%
    (n=5) of participants. Verbal feedback was that it was
    very refreshing, informative, and helpful in terms of
    improving their skills.

    Conclusion: The simulated skills training for the junior
    doctors was very well received and maybe beneficial for
    work preparedness and in the long run address patient
    safety.
    Matched MeSH terms: Postpartum Hemorrhage
  15. Hashim H, Nawawi O
    Malays J Med Sci, 2013 Mar;20(2):76-80.
    PMID: 23983582 MyJurnal
    Uterine arteriovenous malformation (AVM) is a rare condition, with fewer than 100 cases reported in the literature. Despite it being rare, it is a potentially life-threatening condition. This case report describes a 33-year-old woman who presented with secondary post-partum hemorrhage. Transabdominal ultrasound (US) of the pelvis showed increased vascularity with multidirectional flow of the uterus and a prominent vessel, located on the left lateral wall. She also had retained product of conception, which complicated the diagnosis. A uterine artery angiogram confirmed an AVM in the fundal region with an early draining vein. Embolisation of the AVM was performed successfully.
    Matched MeSH terms: Postpartum Hemorrhage
  16. Lim PS, Singh S, Lee A, Muhammad Yassin MA
    Arch Gynecol Obstet, 2011 Nov;284(5):1073-9.
    PMID: 21136267 DOI: 10.1007/s00404-010-1785-6
    Retained placenta is potentially life threatening due to possible complications associated with manual removal. Our aim was to determine whether umbilical vein injection of oxytocin in saline reduces the need for manual removal of placenta.
    Matched MeSH terms: Postpartum Hemorrhage/prevention & control
  17. Ismail NA, Saharan WS, Zaleha MA, Jaafar R, Muhammad JA, Razi ZR
    J Obstet Gynaecol Res, 2008 Jun;34(3):350-3.
    PMID: 18686348
    AIM: To compare the success, clinical outcomes, and maternal and neonatal complications between the Kiwi Omnicup and the Malmstrom metal cup in vacuum assisted delivery.

    METHODS: This was a prospective randomized comparative trial. Women who required vacuum assisted vaginal delivery were randomized into the Kiwi Omnicup (KO) group and the Malmstrom metal cup (MM) group. The vacuum assisted deliveries were conducted according to hospital protocol. Details of the procedure and delivery outcomes including success and complications were analyzed.

    RESULTS: One hundred and sixty-four women were recruited - 85 were assigned to vacuum assisted delivery using the KO and 79 the MM. One hundred percent delivery success was achieved with no significant differences between the two instruments in terms of maternal morbidity (P = 0.66). Six women in the MM group sustained post delivery complications in comparison to five in the KO group. Three babies were diagnosed with birth asphyxia in each group. More babies in the MM group were admitted to the Neonatal Intensive Care Unit (NICU) (10 babies versus 5 babies) and suffered complications (14 versus 12 babies), compared to the KO group, although the difference was not statistically significant. There were no intrapartum or neonatal deaths and of those admitted to the NICU, all were discharged within a week without any serious consequences.

    CONCLUSION: Kiwi Omnicup is an effective alternative to the currently available Malmstrom metal cup for vacuum assisted delivery with no increase in maternal or neonatal morbidity or mortality.

    Matched MeSH terms: Postpartum Hemorrhage/epidemiology
  18. Nirmala K, Zainuddin AA, Ghani NA, Zulkifli S, Jamil MA
    J Obstet Gynaecol Res, 2009 Feb;35(1):48-54.
    PMID: 19215547 DOI: 10.1111/j.1447-0756.2008.00829.x
    To compare the efficacy of a single dose of 100 microg intramuscular carbetocin to a single dose of intramuscular syntometrine (0.5 mg ergometrine and 5IU oxytocin), in preventing post-partum hemorrhage (PPH) in high risk patients following vaginal delivery.
    Matched MeSH terms: Postpartum Hemorrhage/prevention & control*
  19. Suleiman AB, Mathews A, Jegasothy R, Ali R, Kandiah N
    Bull World Health Organ, 1999;77(2):190-3.
    PMID: 10083722
    A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions.
    PIP: This is a report on the methods, findings, resulting recommendations and actions of a study on maternal mortality in Malaysia during the period 1991-94. Maternal death was defined as the death of a woman while pregnant or within 42 days following termination of pregnancy from any cause related to the pregnancy or its management but not from accidental causes. Between 1991 and 1994 there were 1066 reported maternal deaths, and the maternal mortality ratios for the successive years were respectively 44, 48, 46 and 39 per 100,000 live births. The primary causes of maternal death were postpartum hemorrhage (24%), hypertensive disorders of pregnancy (16%), obstetric pulmonary embolism (13%), and associated medical conditions (7%). Analysis of the 375 deaths from 1992 - 1993 showed that the maternal mortality ratio was 53/100,000 live births for deliveries performed at home, 36/100,000 in government hospitals, and 21/100,000 in private institutions. Shortcomings among health personnel were detected in several cases; these involved failure to diagnose, failure to appreciate the severity of a patient's condition, inadequate therapy, and inappropriate, delayed or failed adherence to protocols. The high proportion of maternal mortality associated with substandard care demonstrates that it is important to make the standard of care more widely available. Reports have been circulated to institutions and organizations providing maternal care and to medical schools. Articles and case histories have been published, and many new protocols and procedures have been developed. Furthermore, seminars have been organized and training modules have been distributed to all involved in the provision of maternity care.
    Matched MeSH terms: Postpartum Hemorrhage/mortality
  20. Rachagan SP, Sivanesaratnam V
    Eur J Obstet Gynecol Reprod Biol, 1984 Jan;16(5):321-6.
    PMID: 6608460
    Caesarean hysterectomy is a useful surgical procedure. However, the increased blood supply to the pelvis during pregnancy, distortion of the anatomy caused by the enlarged uterus, fragility of oedematous pelvic tissues and adhesions from prior caesarean sections predispose to poor haemostasis and urinary tract injuries. In this series all the cases were done as an emergency procedure and, despite the multiple obstetric complications, there was no maternal mortality and the incidence of post-operative morbidity was low.
    Matched MeSH terms: Postpartum Hemorrhage/surgery
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