Displaying publications 1 - 20 of 27 in total

  1. Tan GN, Tan PC, Hong JGS, Kartik B, Omar SZ
    BMJ Open, 2021 05 13;11(5):e046528.
    PMID: 33986063 DOI: 10.1136/bmjopen-2020-046528
    OBJECTIVE: To evaluate four foods in women with hyperemesis gravidarum (HG) on their agreeability and tolerability.

    DESIGN: Prospective, randomised, within-subject cross-over trial.

    SETTING: Single-centre, tertiary, university hospital in Malaysia.

    PARTICIPANTS: 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks' gestation were recruited and analysed. Women unable to consume food due to extreme symptoms, known taste or swallowing disorder were excluded.

    INTERVENTIONS: Each participant chewed and swallowed a small piece of apple, watermelon, cream cracker and white bread in random order and was observed for 10 min after each tasting followed by a 2 min washout for mouth rinsing and data collection.

    OUTCOME MEASURES: Primary outcome was food agreeability scored after 10 min using an 11-point 0-10 Visual Numerical Rating Scale (VNRS). Nausea was scored at baseline (prior to tasting) and 2 and 10 min using an 11-point VNRS. Intolerant responses of gagging, heaving and vomiting were recorded.

    RESULTS: On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses. The intolerant (gagged, heaved or vomited) response rates within the 10 min study period were apple 3/72 (4%), watermelon 7/72 (10%), crackers 8/72 (11%) and white bread 12/72 (17%): χ2 test for trend p=0.02.

    CONCLUSION: Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. White bread consistently performed worst.

    Matched MeSH terms: Hyperemesis Gravidarum*
  2. Tan PC, Vani S, Lim BK, Omar SZ
    Eur J Obstet Gynecol Reprod Biol, 2010 Apr;149(2):153-8.
    PMID: 20097465 DOI: 10.1016/j.ejogrb.2009.12.031
    To evaluate prevalence, risk factors and clinical severity correlates of anxiety and depression caseness in hyperemesis gravidarum (HG).
    Matched MeSH terms: Hyperemesis Gravidarum/etiology; Hyperemesis Gravidarum/epidemiology*; Hyperemesis Gravidarum/psychology
  3. Tan PC, Jacob R, Quek KF, Omar SZ
    J Obstet Gynaecol Res, 2007 Aug;33(4):457-64.
    PMID: 17688612
    To determine pregnancy outcome in hyperemesis gravidarum and the effect of metabolic, biochemical, hematological and clinical indicators of disease severity on outcome.
    Matched MeSH terms: Hyperemesis Gravidarum/blood; Hyperemesis Gravidarum/pathology*; Hyperemesis Gravidarum/urine
  4. Tan PC, Tan NC, Omar SZ
    Clin Chem Lab Med, 2009;47(2):165-71.
    PMID: 19191722 DOI: 10.1515/CCLM.2009.041
    Serum human chorionic gonadotropin (hCG) and estradiol levels are higher in women with hyperemesis gravidarum (HG) than in unaffected pregnant controls. We postulated that higher levels of these hormones may be associated with clinically more severe HG. The aim of this study was to evaluate the effect of maternal hCG and estradiol levels on the severity of HG.
    Matched MeSH terms: Hyperemesis Gravidarum/blood*; Hyperemesis Gravidarum/diagnosis; Hyperemesis Gravidarum/pathology*
  5. Tan PC, Norazilah MJ, Omar SZ
    Obstet Gynecol, 2013 Feb;121(2 Pt 1):291-298.
    PMID: 23232754 DOI: 10.1097/AOG.0b013e31827c5e99
    OBJECTIVE: To compare 5% dextrose-0.9% saline against 0.9% saline solution in the intravenous rehydration of hyperemesis gravidarum.

    METHODS: Women at their first hospitalization for hyperemesis gravidarum were enrolled on admission to the ward and randomly assigned to receive either 5% dextrose-0.9% saline or 0.9% saline by intravenous infusion at a rate 125 mL/h over 24 hours in a double-blind trial. All participants also received thiamine and an antiemetic intravenously. Oral intake was allowed as tolerated. Primary outcomes were resolution of ketonuria and well-being (by 10-point visual numerical rating scale) at 24 hours. Nausea visual numerical rating scale scores were obtained every 8 hours for 24 hours.

    RESULTS: Persistent ketonuria rates after the 24-hour study period were 10 of 101 (9.9%) compared with 11 of 101 (10.9%) (P>.99; relative risk 0.9, 95% confidence interval 0.4-2.2) and median (interquartile range) well-being scores at 24 hours were 9 (8-10) compared with 9 (8-9.5) (P=.73) in the 5% dextrose-0.9% saline and 0.9% saline arms, respectively. Repeated measures analysis of variance of the nausea visual numerical rating scale score as assessed every 8 hours during the 24-hour study period showed a significant difference in favor of the 5% dextrose-0.9% saline arm (P=.046) with the superiority apparent at 8 and 16 hours, but the advantage had dissipated by 24 hours. Secondary outcomes of vomiting, resolution of hyponatremia, hypochloremia and hypokalemia, length of hospitalization, duration of intravenous antiemetic, and rehydration were not different.

    CONCLUSIONS: Intravenous rehydration with 5% dextrose-0.9% saline or 0.9% saline solution in women hospitalized for hyperemesis gravidarum produced similar outcomes.

    CLINICAL TRIAL REGISTRATION: ISRCTN Register, www.controlled-trials.com/isrctn, ISRCTN65014409.


    Matched MeSH terms: Hyperemesis Gravidarum/therapy*
  6. MUN CT
    Med J Malaysia, 1964 Jun;18:223-5.
    PMID: 14199437
    Matched MeSH terms: Hyperemesis Gravidarum*
  7. Tan PC, Norazilah MJ, Omar SZ
    Obstet Gynecol, 2013 Jun;121(6):1360.
    PMID: 23812475 DOI: 10.1097/AOG.0b013e31829395ef
    Matched MeSH terms: Hyperemesis Gravidarum/therapy*
  8. Tan PC, Abdussyukur SA, Lim BK, Win ST, Omar SZ
    BJOG, 2020 10;127(11):1430-1437.
    PMID: 32356413 DOI: 10.1111/1471-0528.16290
    OBJECTIVE: To evaluate fasting for 12 hours compared with expedited oral feeding in hospitalised women with hyperemesis gravidarum (HG).

    DESIGN: Randomised trial.

    SETTING: University Hospital, Malaysia: April 2016-April 2017.

    POPULATION: One hundred and sixty women hospitalised for HG.

    METHOD: Women were randomised upon admission to fasting for 12 hours or expedited oral feeding. Standard HG care was instituted.

    MAIN OUTCOME MEASURE: Primary outcome was satisfaction score with overall treatment at 24 hours (0-10 Visual Numerical Rating Scale VNRS), vomiting episodes within 24 hours and nausea VNRS score at enrolment, and at 8, 16 and 24 hours.

    RESULTS: Satisfaction score, median (interquartile range) 8 (5-9) versus 8 (7-9) (P = 0.08) and 24-hour vomiting episodes were 1 (0-4) versus 1 (0-5) (P = 0.24) for 12-hour fasting versus expedited feeding, respectively. Repeated measures analysis of variance of nausea scores over 24 hours showed no difference (P = 0.11) between trial arms. Participants randomised to 12-hour fasting compared with expedited feeding were less likely to prefer their feeding regimen in future hospitalisation (41% versus 65%, P = 0.001), to recommend to a friend (65% versus 84%, P = 0.01; RR 0.8, 95% CI 0.6-0.9) and to adhere to protocol (85% versus 95%, P = 0.04; RR 0.9, 95% CI 0.8-1.0). Symptoms profile, ketonuria status at 24 hours and length of hospital stay were not different.

    CONCLUSION: Advisory of 12-hour fasting compared with immediate oral feeding resulted in a non-significant difference in satisfaction score but adherence to protocol and fidelity to and recommendation of immediate oral feeding to a friend were lower. The 24-hour nausea scores and vomiting episodes were similar.

    TWEETABLE ABSTRACT: Women hospitalised for hyperemesis gravidarum could feed as soon, as much and as often as can be tolerated compared with initial fasting.

    Matched MeSH terms: Hyperemesis Gravidarum/therapy*
  9. Tan PC, Jacob R, Quek KF, Omar SZ
    Aust N Z J Obstet Gynaecol, 2006 Oct;46(5):446-50.
    PMID: 16953861
    In a retrospective analysis of 192 cases of presumed hyperemesis gravidarum, there were no biochemical markers that predicted hospital readmission. There was, however, statistically significant negative predictive value in abnormal liver function tests. This could represent acute self-limited illness with a component of hepatitis as the cause for the clinical presentation, rather than hyperemesis.
    Matched MeSH terms: Hyperemesis Gravidarum/blood; Hyperemesis Gravidarum/classification*; Hyperemesis Gravidarum/epidemiology
  10. Tan PC, Jacob R, Quek KF, Omar SZ
    BJOG, 2006 Jun;113(6):733-7.
    PMID: 16709219
    The association between female fetal sex and hyperemesis gravidarum is well established in European and North American populations. The association between female fetuses and severity of hyperemesis remains uncertain. A retrospective study based on case notes review of 166 Asian women hospitalised for hyperemesis was performed. Female fetuses were significantly associated with hyperemesis in our population (P= 0.004, OR 1.6, 95% CI 1.2-2.2) as well as associated with severe ketonuria and high urea. When both severe ketonuria and high urea were present at initial hospital admission for hyperemesis, 83% (95% CI 66-93) of the fetuses were female.
    Matched MeSH terms: Hyperemesis Gravidarum/etiology*; Hyperemesis Gravidarum/urine
  11. Tan PC, Zaidi SN, Azmi N, Omar SZ, Khong SY
    PLoS One, 2014;9(3):e92036.
    PMID: 24637791 DOI: 10.1371/journal.pone.0092036
    To evaluate the temporal and case-controlled correlations of anxiety, depression and stress with hyperemesis gravidarum.
    Matched MeSH terms: Hyperemesis Gravidarum/complications*; Hyperemesis Gravidarum/psychology*
  12. Tan PC, Omar SZ
    Curr. Opin. Obstet. Gynecol., 2011 Apr;23(2):87-93.
    PMID: 21297474 DOI: 10.1097/GCO.0b013e328342d208
    Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years.
    Matched MeSH terms: Hyperemesis Gravidarum/diagnosis; Hyperemesis Gravidarum/therapy*
  13. Tan PC, Kartik B, Thanendran P, Zakaria R, Win ST, Omar SZ
    Sci Rep, 2020 03 10;10(1):4445.
    PMID: 32157169 DOI: 10.1038/s41598-020-61114-y
    A case-controlled study was performed to evaluate taste and smell impairment, nausea or vomiting (NV) response to taste and smell and toleration to food texture, item and cooking method in hyperemesis gravidarum patients (HG) compared to gestation-matched controls from a university hospital and primary care clinic in Malaysia. Taste strips (4 base tastes), sniff sticks (16 selected smells) and a food-related questionnaire were used. 124 participants were recruited. Taste impairment was found in 13%(8/62) vs. 0%(0/62) P = 0.003 and the median for correct smell identification was 5[4-6] vs. 9[7-9] P 
    Matched MeSH terms: Hyperemesis Gravidarum/complications*; Hyperemesis Gravidarum/physiopathology*
  14. Tan PC, Jacob R, Quek KF, Omar SZ
    Int J Gynaecol Obstet, 2006 Jun;93(3):246-7.
    PMID: 16682037
    Matched MeSH terms: Hyperemesis Gravidarum/pathology*; Hyperemesis Gravidarum/physiopathology*; Hyperemesis Gravidarum/ultrasonography
  15. Tan JYL, Loh KC, Yeo GSH, Chee YC
    BJOG, 2002 Jun;109(6):683-8.
    PMID: 12118648
    OBJECTIVE: To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum.
    DESIGN: Prospective observational study.
    SETTING: Hospital inpatient gynaecological ward.
    POPULATION: Women admitted with hyperemesis gravidarum and found to have hyperthyroidism.
    METHODS: Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation.
    MAIN OUTCOME MEASURES: Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes).
    RESULTS: Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of > 5% of their pre-pregnancy weight was lower compared with those of women who did not (P = 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile.
    CONCLUSIONS: In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.
    Matched MeSH terms: Hyperemesis Gravidarum/complications*; Hyperemesis Gravidarum/ethnology; Hyperemesis Gravidarum/metabolism
  16. Mun-Wei L, Gayathri G, Kwang Hwee G, Ruban K, Suresh Kumar V, Shatriah I
    Cureus, 2018 Jun 12;10(6):e2793.
    PMID: 30112269 DOI: 10.7759/cureus.2793
    Wernicke's encephalopathy following severe hyperemesis gravidarum is an uncommon clinical entity. We describe a rare manifestation of optic discs swelling in a pregnant woman that has caused a diagnostic dilemma. With high index of suspicion of clinical manifestations and radiological evidences, a clinical diagnosis of Wernicke's encephalopathy was made. Intravenous thiamine therapy was instituted, and prompt improvement of clinical signs was observed. The association of optic discs swelling and Wernicke's encephalopathy after hyperemesis gravidarum is discussed.
    Matched MeSH terms: Hyperemesis Gravidarum
  17. Tan PC, Khine PP, Vallikkannu N, Omar SZ
    Obstet Gynecol, 2010 May;115(5):975-981.
    PMID: 20410771 DOI: 10.1097/AOG.0b013e3181d99290
    OBJECTIVE: To compare the effects of promethazine with those of metoclopramide for hyperemesis gravidarum.

    METHODS: Women at their first hospitalization for hyperemesis gravidarum were approached when intravenous antiemetic therapy was needed. They were randomly assigned to receive 25 mg promethazine or 10 mg metoclopramide every 8 hours for 24 hours in a double-blind study. Primary outcomes were vomiting episodes by diary and well-being visual numerical rating scale score (10-point scale) in the 24-hour main study period. Participants also filled out an adverse-effects questionnaire at 24 hours and a nausea visual numerical rating scale score at recruitment and at 8, 16, and 24 hours.

    RESULTS: A total of 73 and 76 women, randomized to metoclopramide and promethazine, respectively, were analyzed. Median vomiting episodes were one (range 0-26) compared with two (range 0-26) (P=.81), and well-being visual numerical rating scale scores were 8 (range 1-10) compared with 7 (range 2-10) (P=.24) for metoclopramide and promethazine, respectively. Repeat-measures analysis of variance of the nausea visual numerical rating scale scores showed no significant difference between study drugs (F score=0.842, P=.47). Reported drowsiness (58.6% compared with 83.6%, P=.001, number needed to treat to benefit [NNTb] 5), dizziness (34.3% compared with 71.2%, Pgravidarum. The adverse effects profile was better with metoclopramide.

    Matched MeSH terms: Hyperemesis Gravidarum/drug therapy*
  18. Beevi Z, Low WY, Hassan J
    Am J Clin Hypn, 2015 Oct;58(2):215-23.
    PMID: 26264544 DOI: 10.1080/00029157.2015.1013186
    Ptyalism gravidarum, or sialorrhea, is the excessive secretion of saliva during pregnancy. Treatment of ptyalism gravidarum is often challenging due to its unknown etiologies. This article discusses a case of ptyalism gravidarum with concomitant hyperemesis in which the condition was successfully treated with hypnosis. A 28-year-old woman presented with ptyalism 2 months into her pregnancy and hyperemesis 3 months into pregnancy with associated vomiting that occurred following every meal. Hypnosis was administered at week 16 of pregnancy to eliminate ptyalism and hyperemesis, to prepare for childbirth, and to increase overall psychological well-being. Ptyalism resolved by week 36, concurrent with the final hypnosis session.
    Matched MeSH terms: Hyperemesis Gravidarum/therapy*
  19. Subramaniam R, Soh EB, Dhillon HK, Abidin HZ
    Aust N Z J Obstet Gynaecol, 1998 Aug;38(3):339-41.
    PMID: 9761170
    Matched MeSH terms: Hyperemesis Gravidarum/therapy*
  20. Tan PC, King AS, Omar SZ
    J Obstet Gynaecol Res, 2012 Jan;38(1):145-53.
    PMID: 21955280 DOI: 10.1111/j.1447-0756.2011.01652.x
    AIM: The aim of this study was to evaluate urine microscopy, dipstick analysis and urinary symptoms in screening for urinary tract infection (UTI) in hyperemesis gravidarum (HG).
    MATERIALS AND METHODS:   A prospective cross-sectional study was performed on women at first hospitalization for HG. A clean-catch mid-stream urine sample from each recruit was sent for microscopy (for bacteria, leucocytes and erythrocytes), dipstick analysis (for leukocyte esterase, nitrites, protein and hemoglobin) and microbiological culture. The presence of current urinary symptoms was elicited by questionnaire. UTI is defined as at least 10(5) colony-forming units/mL of a single uropathogen on culture. Screening test parameters were analyzed against UTI.
    RESULTS: UTI was diagnosed in 15/292 subjects (5.1%). Receiver-operator characteristic curve analysis of microscopic urine leucocytes revealed area under the curve=0.64, 95% confidence interval (CI) 0.5-0.79, P=0.063 and erythrocytes area under the curve=0.53, 95%CI 0.39-0.67, P=0.67 for UTI indicating the limited screening utility of these parameters. Microscopic bacteriuria (likelihood ratio [LR] 1.1, 95%CI 0.7-1.5) and urine dipstick leukocyte esterase (LR 1.4, 95%CI 1.1-1.8), nitrites (LR 2.3, 95%CI 0.3-17.2), protein (LR 1.0, 95%CI 0.7-1.6) and hemoglobin (LR 0.8, 95%CI 0.4-1.5) were not useful screening tests for UTI in HG. Elicited symptoms were also not predictive of UTI.
    CONCLUSION: Urine microscopy, dipstick analysis and urinary symptoms were not useful in screening for UTI in HG. UTI should be established by urine culture in HG before starting antibiotic treatment.
    Matched MeSH terms: Hyperemesis Gravidarum/complications*; Hyperemesis Gravidarum/urine
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