Obstetrics & Gynaecology

A 30-years-old Taiwanese female in her second pregnancy spontaneously conceived a monochorionic twin pregnancy. A routine ultrasound at 27 weeks of gestation revealed a selective intrauterine growth restriction (sIUGR) fetus and an appropriate gestational age (AGA) fetus. The AGA fetus was found to have a fetal intra-abdominal umbilical vein (FIUV) varix. Serial ultrasounds showed no changes in the FIUV varix. 2 weeks later, the pregnancy progressed to twin-twin transfusion syndrome (TTTS). Repeated amnioreductions were required at 29 and 30 weeks gestation. The babies were delivered by caesarean section at 31 weeks due to fetal distress in the sIUGR fetus. Both fetuses survived the neonatal period with problems of prematurity. The FIUV varix disappeared a few days after delivery.

Objective: To determine the accuracy of bladder volume (BV) measurement and to identify factors that influenced the ultrasound bladder scanner (UBS) measurement of BV in postpartum women compared with transurethral catheterization. Materials, methods and results: A total of 190 paired measurements were performed on 190 women aged between 16 and 47 years. Majority of the women (36.9%) were in their first parity (range: 1-9). The mean BV was 159.46 mL [standard deviation (SD) ¼ 99.78; range: 17e593 mL] on three-dimensional (3D) UBS and 143.76 mL (SD ¼ 104.89; range: 2-588 mL) on catheterization. The mean difference between the two values was 15.70 mL (SD ¼ 69.31, p < 0.001). The Foley's catheter was clamped for a minimum of 30 minutes and a maximum of 260 minutes. The UBS measurements were highly correlated with the BV obtained by catheterization (r ¼ 0.819; p < 0.001). There was no significant difference between UBS and catheterized volume in a different volume subgroup. There were 35 cases (18.2%) with the difference in measurement of more than 25%. Twenty-five cases were associated with a catheterized volume less than 50 mL. There were a total of 33 cases with true BV of less than 50 mL, and only eight cases (24.24%) had an accurate measurement. The UBS tends to overestimate BV between 2 and 270 mL in this group. There was a significant linear relationship between the difference in measurement and body weight and duration of clamping. Conclusion: Measurement of BV in immediate postpartum period using UBS is comparable with urethral catheterization. The accuracy of measurement is affected by body weight and increasing amount of BV.

Objective: This study was conducted to assess the social-demographic characteristic and the effect of maternal fasting serum lipids between trimesters and its effect on maternal blood pressure and fetal birth weight. Materials and methods: A prospective cohort study was designed for recruiting pregnant women who were in their 1 st trimester at a primary maternal child health center (KKIA). The study involved taking fasting serum lipids (FSL), blood pressure (BP) measuring and urine albumin in every trimester. Results: Fasting serum triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and total cholesterol (TC) were significantly (p<0.05) increased as the gestational age increased. There were no significant changes in blood pressure and urine albumin throughout the pregnancy. Serum lipid did not statistically influence the birth weight (P=0.922). Meanwhile serum triglyceride level was double (4.5 mmol/L) in one patient who developed eclampsia. Conclusion: Serum lipid increase in parallel to increase in gestational age however it does not influenced the maternal blood pressure and birth weight. Further study with larger sample size is required to confirm the factors associated with PE. G y n e c o lo gy & O b s te tr ic s

Background: Cervical ripening of an unfavourable cervix can be achieved by placement of a transcervical Foley catheter. Objective: To assess the effectiveness of 750 ml traction on Foley catheter compared to no traction for labour induction. Study design: A randomized controlled trial performed on pregnant women at 37-41 week who were admitted for induction of labour with unfavourable cervix. They were randomly assigned into two groups, Foley's with 750 ml traction and and without traction. The primary outcomes were improvement in Bishop Score, number of favourable cervix following induction and the mode of delivery. The secondary outcomes were maternal pain score, neonatal outcome, and maternal infection. Results: A total of 160 women were randomized into traction group (n=80) and non-traction group (n=80). The mean change in Bishop Score was similar in both groups. Traction group had significantly (p=0.006) higher number of vaginal delivery (70%) compared to non-traction group. The rate of successful VBAC was also significantly (p= 0.001) higher in the traction group. Participants were comfortable using both methods with low pain score. There was no difference in neonatal outcomes and risk of maternal infections in both groups. Conclusion: application of traction did result in more vaginal delivery and successful VBAC without risk of maternal and neonatal infection.

The use of transobturator tape (TOT) for the treatment of stress urinary incontinence (SUI) has gained popularity since it was introduced in 2001. Only few studies have reported that TOT is superior in safety and efficacy when compared to tension free vaginal tape (TVT). This case-series study was conducted to investigate the safety and efficacy of the TOT procedure in patients at Ipoh Hospital. A cross sectional study on patients who underwent TOT procedures from Jan 2006 to Jun 2008 was conducted. Patients were followed-up 1 month, 3 month, 12 month and annually thereafter. Data were retrieved from patients" records based on the standard pre-operative assessment sheet and follow up record. Interviews were then made via telecommunication to assess the patients" progression and satisfaction using a validated questionnaire. Fiftytwo subjects (n=52) were recruited. The mean age was 54.2 ± 10.6 years with the median follow up time of 19 months. Majority of cases (n=46; 88.5%) had concomitant pelvic organ prolapse (POP), while only 2 (3.8%) had an isolated stress urinary incontinence (SUI). Pre-operatively, only 16 patients (30.8%) were diagnosed with mixed urinary incontinence (MUI) and 24 patients (46.2%) had over active bladder symptoms (OAB) which include increased frequency and urgency. The objective cure rate for SUI was 42 (80.7%), 3 (5.8%) failed while 7 (13.5%) improved. Complications were limited to minor conditions and was only observed in four patients: one case (1.9%) of acute urinary retention, three (5.7%) had prolonged indwelling catheter more than 3 days and one (1.9%) each for mesh erosion, hematoma, urinary tract infection (UTI) and wound infection. Cure rate for MUI, frequency and urgency were 37.4%, 70.8% and 54.2% respectively. De novo urgency was noted in three (n=3: 5.7%) cases while (n=3: 5.7%) required revision of the tape. Forty-nine women (n=49: 94.2%) were satisfied with the procedure. TOT procedures significantly improve OAB symptoms with high patient"s acceptance rate and no serious operative complication.

Background: The overall risk of postpartum urinary retention (PUR) is between 0.05% and 37%. Being Asian increases the risk, while other factors include epidural analgesia, prolonged first and second stage of labour and previous history of PUR. Subjects and Methods: This is a cohort study conducted at a tertiary hospital in Pahang State of Malaysia over one year duration. All postpartum women were included. The post void residual volume (PVRV) was measured after minimum 6 hours postpartum or when the subject complained of inability to pass urine. The PVRV of more than 150ml was considered as PUR. Data analysis was performed using SPSS version 20. Results: Of 1000 included women, mean age was 28.44(5.68), parity of 2.0 and 75.8% had vaginal delivery. PUR was diagnosed in 42 (4.2%) women, of whom 4 (9.5%) were diagnosed with overt and 38 (90.5%) had covert PUR. Parity and perineal tear were significantly associated with PUR. Second degree perineal tear (including episiotomy) were inde...

Synchronous tumours of gynaecological malignancies occur rarely and most of these cases are represented by synchronous ovarian and endometrial cancer. Synchronous malignancies of cervix and ovary are rare with poor prognosis. Only few cases of synchronous cancer of cervix and ovary are found in the literature as case reports. Here, we report a case of a 63 year old patient who was diagnosed with synchronous squamous cell carcinoma of cervix and high grade serous carcinoma of ovary in which her clinical presentation, investigation and intraoperative findings were atypical. Patient presented with postmenopausal bleeding and mass per abdomen. Pipelle sampling revealed squamous cell carcinoma of cervix. Examination under anaesthesia noted endocervical growth measuring 3×4 cm with endoluminal extension into the whole endometrial cavity. Computerized tomography (CT) imaging showed left ovarian mass measuring 10.0×11.7 cm. Uterine corpus involvement in this case mislead us to the initial d...

The results showed a significant (P<0.024) irregularity of oestrous cycle and reduction in relative ovarian weights of experimental animals treated by FSA extract in comparison to the control group. A reduction in the number of secondary follicles and corpora lutea was found in the treated groups as well as an increment in the number of antral follicles in all treated groups when compared with the control. Conclusion: The observation of irregular oestrous cycle, significant decrease in the number of secondary and antral follicles, and significant increase in the number of atretic follicles demonstrated the potential anti-fertility effects of fenugreek seeds on the female rats were found in this study.

The results showed a significant (P<0.024) irregularity of oestrous cycle and reduction in relative ovarian weights of experimental animals treated by FSA extract in comparison to the control group. A reduction in the number of secondary follicles and corpora lutea was found in the treated groups as well as an increment in the number of antral follicles in all treated groups when compared with the control. Conclusion: The observation of irregular oestrous cycle, significant decrease in the number of secondary and antral follicles, and significant increase in the number of atretic follicles demonstrated the potential anti-fertility effects of fenugreek seeds on the female rats were found in this study.

95% CI (1.02, 1.22)}. Interestingly, those who had dyslipidemia has 39% less risk of diabetic retinopathy {OR: 0.61, 95% CI (0.39, 0.94)}. Conclusion: Non-mydratic retinal camera use in primary care setting facilitates the detection of diabetic retinopathy early on in the disease. The presence of diabetic retinopathy is associated with chronic kidney disease, high HbA1c and dyslipidemia.

Introduction: Pelvic floor Muscle Training (PFMT) commonly used physical therapy for Female Overactive bladder (OAB) and stress urinary incontinence (SUI). However some women has difficulty to understand and comply to PFMT. Our aim is to evaluate the effectiveness of Transpelviner Magnetic Stimulation (TPMS) as a replacement for PFMT. Materials and Methods: A prospective observational study on 53 women with SUI or OAB, were assessed objectively using cough stress test, bladder diary, one hour pad test, perineometry and validated questionnaires. Then, all of them received 10 courses of individualized TPMS therapy over five weeks. Reassessments were done after five weeks and six months of initial treatment. The outcomes were measured by severity index, negative pad test, muscle power, numbers of leaking episodes, daytime frequency and nocturia, negative cough stress test and improvement in specific quality of life questionnaires (QOL) Results: Frequency of micturition in OAB showed re...

Uterine fibroid affects 0.3-2.6% of pregnant women and it is usually asymptomatic during pregnancy [1]. In about 10% of these patients will have complications such as miscarriage, fetal malpresentation, premature rupture of membranes, placenta abruptio, preterm delivery, abdominal pain due to fibroid torsion or degeneration [2]. Bleeding into the uterine fibroid is extremely rare and patient can present with acute abdomen [11]. Up to date, there were only two cases reported and both occur in postpartum period. We present a case of a pregnant woman with huge uterine fibroid with spontaneous intra-leiomyoma bleeding causing hypovolemic shock at 22 weeks of gestation. Because of failure of conservative management, we performed fibroid resection at 22 weeks of gestation with preservation of the pregnancy.

Hematological malignancy in pregnancy is a rare condition which leads to lack of prospective study and randomized control trial. Nevertheless, it has own challenge to the medical field in term of managing patient with the said condition. The dilemma is to decide among the necessities of continuation of pregnancy, the choice of diagnostic tools and chemotherapeutic drugs, and the timing of initiation treatment without disregarding the women&#39;s wish and preferences. The process often has a profound psychological burden on patients and family members. Furthermore, delays in diagnosis and intervention will adversely affect the outcomes of pregnancy and the disease itself. The effect of teratogenicity of chemotherapeutic drugs on the fetus and the progression of the disease during pregnancy are the main concern in treating this group of patients. This article will review the management and outcomes of 6 cases of hematological malignancy in pregnancy in one center (3 Hodgkin lymphoma, ...

Introduction: Uterine rupture is a rare obstetrics catastrophic especially if it occurs during early pregnancy. We experienced three cases of ruptured uterus in the second trimester that first line doctors and obstetrician could learn lessons from. Objectives: To study the presentations and outcome of uterine rupture in the second trimester. Methodology: A retrospective review of uterine rupture in Hospital Tengku Ampuan Afzan from the 1st of April 2010 to the 1st of April 2011. Data obtained from case records, histopathological and autopsy reports. Result: There were 3 cases of uterine rupture. First case, uterine rupture at 15 weeks post sexual intercourse, undiagnosed until postmortem. Second case: ruptured uterus at 24 week diagnosed at laparotomy with the indication of failed medical termination for fetal anomaly. Third case: ruptured uterus at 21 weeks following abdominal massage with initial diagnosis of acute gastroentritis. The final diagnosis was ruptured uterus secondary ...

Background: Female sexual dysfunction (FSD) following childbirth imposes significant burden to the marital institution around the world. The perineal injury may potentially be one of the main risk factors contributing to postpartum female sexual dysfunction (PPFSD). The study aimed to determine the effect of perineal injury and patients’ characteristics on PPFSD. Methodology: This cross-sectional questionnaire study was conducted in six different health clinics in the district of Kuantan from April 2019 to October 2019. Eligible women who came to the family health clinics at 6 months postpartum were recruited as study population. The participants completed their biodata and socio-demographic form and the Malay-validated Female Sexual Function Index (MVFSFI) questionnaire given. A cut-off point of 26.55 and below on MVFSFI scoring system was used as a measure of the primary outcome of sexual dysfunction. Results: Out of 240 women who delivered vaginally, 34 (14%) had intact perineum,...

Objectives: This study aims to identify knowledge, attitude, and practice of pelvic floor muscle training (PFMT) and to identify the prevalence of urinary incontinence. Materials and methods: The method used was a cross-sectional study. Self-administered knowledge, attitude, and practice questionnaires were distributed among childbearing women attending Maternal & Child Health Clinics in the East Coast region of Malaysia. Results: The findings revealed that most respondents (N = 896) had good or moderate knowledge (80.1%) and attitudes (77.3%) regarding PFMT but most of them (87.2%) still lacked practice. However, there was no association between urinary incontinence and PFMT practice. On the contrary, married women showed a higher risk of urinary incontinence. Conclusions: The practice of pelvic floor muscle training should be recommended and emphasized to childbearing women by healthcare professionals.