The early Malaysian experience of laparoscopic sterilisation with the Fallope tubal rings, as undertaken at the Obstetrical and Gynaecological Unit of the University Hospital, University of Malaya in Kuala Lumpur, Malaysia is reported in a study of 291 consecutive females that had had the procedure undertaken during the one year period, May 1975 to April 1976. Of the 291 cases, 247 women were sterilised in the "interval" period, 43 after "menstrual regulation" procedure and one after a spontaneous abortion. General anaesthesia was used in all except one case. The salient socio-demographic, contraceptive and reproductive characteristics of study cases are presented and discussed. The technical problems, the early complications and morbidity encountered in this study are presented and discussed in the light of other similar studies, and in relation to sterilisation by laparoscopic tubal electrocoagulation. The overall impression is that laparoscopic sterilisation with the Fallope tubal rings is preferred to that by tubal electrocoagulation, in view of the possible inadvertent serious electrical burns of other structures during the use of the latter procedure.
An analysis of 86 patients sterilized laparoscopically with Hulka clips is presented. We find that the method is simple, acceptable and has minimal complication. The failure rate is similar to that reported by others. However, this method could be done under local anaesthesia thus shortening the hospital stay for the patients. This method has the advantage of safety and prospects for reversal when desired.
The menstrual patterns of 281 women undergoing laparoscopic sterilization with silastic rings were studied prospectively. A significant increase in dysmenorrhea and irregular periods was seen soon after sterilization but this was transient, returning to presterilization levels by 12 months. Menorrhagia was not observed and the amount of menstrual blood loss showed a trend towards normal following sterilization. No permanent adverse effects on menstrual patterns were seen in the 1st year after sterilization. It is suggested that factors other than the sterilization procedure may be responsible for the high prevalence of menstrual dysfunction that has been reported following sterilization.
Between June 1980 and April 1986 796 cases of female sterilization were performed in a private clinic in Malaysia using Mark IVa and Mark VI Filshie clips. There was one failure. Technical failure, surgical difficulties and complications were minimal.
This retrospective study presents data from 26 women who underwent a reversal of female sterilization. The intrauterine pregnancy rate and ectopic pregnancy rate were 38.5% and 7.7% respectively. The most successful site of tubal anastomosis was isthmic-isthmic anastomosis. The importance of proper patient selection and factors that affect the success rate in attempted reversals are emphasised. The importance of microsurgical approach is highlighted.
Pulmonary hypertension in pregnancy is a rare condition but is associated with a high mortality. We report the case of a 29 year old female in early pregnancy with Protein C and S deficiency with recurrent deep venous thrombosis and pulmonary embolism and subsequent secondary pulmonary hypertension. The patient was counselled and consented for termination of pregnancy with tubal sterilization. She was administered continuous spinal anaesthesia with invasive monitoring. The successful anaesthetic management of this condition is described.
Uterine rupture is still a common problem in developing countries although even here the incidence varies from urban to rural settings. This article is a review of uterine rupture in an urban referral hospital in Malaysia. It examines aetiology, clinical presentation, complications and management of the problem. Meticulous screening of patients together with optimal antenatal and intrapartum care will markedly reduce the incidence of uterine rupture. Early diagnosis and prompt treatment will further help reduce morbidity and mortality to both mother and fetus.