The Wilderness and Wonderfulness of Women Health

This book is aimed to discuss recent progress and highlight the current challenges and controversies of Women’s Health in the 21st century that need to be addressed. Women’s health is closely related to reproductive health. It has many different aspects which can be addressed by the clinician, the public health specialist and the gender advocate, among others. The emphasis on the discussion is placed on the following issues; genetic counselling, caesarean section as opposed to normal delivery, adolescent pregnancy, assisted reproductive techniques, gynaecological cancer and ageing women. Elements of ethics and medicolegal aspects of managing women are also deliberated in this book. The general role of the Obstetrician and Gynaecologist (O&G) is to care for pregnant mothers and deliver an alive healthy baby, hence, promoting healthy population growth that would contribute to the countries’ development. A childless couple who longs to have a child, now can conceive and have a healthy baby, thanks to the advanced of assisted reproductive techniques being facilitated by the O&G specialists. Rapid developments and revolutionized in the medical field in the last century, the medical practice is at crossroads facing many ethical and legal challenges in the practice of the profession, whereby the obstetrics and gynaecology field are not spared either

Endometrial cancer in a young lady

Introduction: Endometrial cancer is the most common gynaecological cancer in developed countries and rapidly increasing together with the development of socioeconomic status and the prevalence of metabolic diseases. It is common in postmenopausal women but the incidence among young women is about 2 to 14%. Case Description: A 28-year-old single lady presented with abnormal uterine bleeding for 4 months. Her body mass index was 48.3 kg/m2 and investigations showed she had diabetes mellitus, hypertension, hyperlipidemia, mild ischemic heart disease, and obstructive sleep apnoea. Finally, she was diagnosed with endometrial cancer FIGO stage IA and treated with total abdominal hysterectomy, bilateral salpingooophorectomy, and pelvic lymph node dissection. Histopathology confirmed that it was grade 1 endometrial carcinoma, staged IA, with features of endometrial hyperplasia and atypia. Discussion: Endometrial cancer is usually diagnosed at the mean age of 68 years. Among many risk factors of endometrial cancer, components of metabolic syndrome are strongly associated with it. Young-aged endometrial carcinoma is not uncommon. According to the Asian data, among components of metabolic syndrome, obesity is a more prominent risk factor. Many studies showed metabolic syndrome caused the development of endometrial cancer by directly acting on tumour cells and regulating tumour environment. Some studies revealed that weight loss management could reduce the incidence of endometrial cancer and hyperplastic endometrium may be reversible. Therefore, many researchers conclude that early intervention of metabolic syndrome and a healthy lifestyle are important roles in the prevention and prognosis of endometrial cancer

Maternal euglycemia in gestational diabetes mellitus and intrauterine fetal death : A case report

ABSTRACT Introduction: Prevalence of diabetes in pregnancy world-wide is 1% to 28% and it is 27% in Malaysia. Since 1909, evidence showed that diabetes in pregnancy had high perinatal mortality. Case Description: A 35-year-old Gravida 2 Parity1 booked antenatal care at 9 weeks of pregnancy. Previous pregnancy was delivered by caesarean section indicated with unstable lie. Her booking antenatal investigations were normal as well as protein and sugar were absent in her urine protein. Her BMI was 21.2 Kg/m2. Ultrasound scan at 15-week pregnancy showed fetal biometry measurements consistent with gestational age. At 25 weeks of pregnancy, she was diagnosed with gestational diabetes mellitus as modified oral glucose tolerance test result showed 5.4 mmol/L and 8.5 mmol/L at fasting and 2 hours post prandial respectively. Her 7 points blood sugar monitoring results were satisfactory. At 28 weeks of pregnancy, fetal movement was lost, and intrauterine fetal death was confirmed by ultrasound scan. She was referred to Sarawak General Hospital for further management. Discussion: Maintenance of normal blood sugar level is accepted as a key modifiable factor to reduce adverse perinatal outcomes. Evidence showed that the intrauterine fetal death in diabetes in pregnancy is associated with antenatal risks high body mass index, weight gain during pregnancy and advanced maternal age. But this pregnant lady didn’t have those factors except her age. Causes of intrauterine fetal death in diabetes in pregnancy was still unclear and even in antenatal euglycemia, it would be possible

How to pass the undergraduate obstetrics and gynaecology examination

A books of questions is useful to students in many ways. It can be used to assess one's knowledge on what has been learned from textbooks, classrooms and bedside teaching. It is useful as revision tool. It also provides an avenue for an examination trial which in the case of multiple choice questions means to develop the skill to pick the right statements and not be tempte to guess answers. The answers which are given after each question serve as a quick guide to choice made. However students are reminded that this book is not textbook and cannot be treated as such. Reference given at teh end of the book indicates where students can refer to for a better understanding of the subject matter being tested

Visual Inspection of Acetic Acid (VIA) to Detect PreCancerous Cervical Cancer in Rural Areas of Sarawak

Introduction: Cervical cancer is still the leading cause of gynaecological cancer in Sarawak. Low awareness on cervical screening and logistic problems are the main reasons for delay in diagnosis, especially in rural areas. Although pap smear screening had been implemented for decades, failure to get early treatment and frequent defaulters are factors that need to be tackled for rural women. Objectives: The Sarawak Travelling Women Health Project is aimed to improve pre-cancerous cervical cancer detection in rural areas using the Visual Inspection of Acetic Acid (VIA) method. This project also helps to shorten the duration of follow up and treatment for patients with pre-cancerous lesion of cervix. Methods: Cervical screening campaigns outside Kuching areas were conducted from June until December 2018 by the Obstetrics and Gynaecology Department of Universiti Malaysia Sarawak (UNIMAS) in collaboration with Pink and Teal Empower, a Non-Government Organization. VIA was performed for all women below 50 years old. Patients with positive VIA were a colposcopy appointment and cervical biopsies are taken at the clinic. Results: During the campaign period, 83 out of 333 women were found to be VIA positive, but only 47 women turned up for the colposcopy. This high number of defaulters is mostly due to logistic reasons. Two cervical biopsies were confirmed as Cervical Intraepithelial Neoplasia (CIN) 2, 15 cases with CIN 1, one case of microglandular hyperplasia while 19 biopsies turned out to be cervicitis. The pickup rate for CIN during the outreach was about 20.4%. Conclusion: VIA is useful in low resource area with difficult access to tertiary centres as it enables faster diagnosis for CIN. However, proper training is needed to avoid false positive results and unnecessary intervention. To reduce the rate of defaulters, cervical biopsy for VIA positive women should be done in the field during the same setting

Perception of menopause among women of Sarawak, Malaysia

Background Various factors, including menopausal status, educational and social background, culture, and physical and emotional health, may influence women’s perceptions of menopause. This study documents the elements influencing attitudes towards menopause among women in Sarawak, Malaysia. Methods A face-to-face interview using a validated questionnaire was conducted with 324 Sarawakian women aged 40–65 to determine the mean age of menopause and perceptions and experiences of menopause among these women. Results The mean age ± standard deviation of the women was 51.37 ± 5.91 years. Ninety (27.8%) participants were premenopausal, 124 (38.5%) perimenopausal and 110 (33.7%) postmenopausal. The majority of these women (228; 70.4%) were local indigenous inhabitants of Sarawak. The findings show that 22.5% of the participants agreed that problems during menopause are a natural process. While 21.9% of the participants suggested that menopause should be treated medically, 32.3% argued that natural approaches for menopause symptoms are better than hormonal treatments. Seventy-five per cent of the women agreed that the absence of menses after menopause is a relief; meanwhile, 61.2% stated that menopause causes unpleasant symptoms. Notably, 51.7% were not sure whether women become less sexually attractive after menopause, and 51.1% were uncertain as to whether they feel less of a woman following menopause. Finally, 81.7% of participants were unsure if sexual activity is more enjoyable after menopause, and 71.9% were uncertain whether changes in life during menopause are more stressful. Among the different menopausal stages, the premenopausal group of women were noted to have more positive perceptions of menopause compared to the peri- and postmenopausal women. The study also observed that women with a better educational background generally had more positive perceptions of menopause. Conclusions The women’s perceptions of menopause in this study were found to correspond to those in other studies on Asian women. Women with higher levels of education and premenopausal women comparatively expressed more positive opinions regarding menopause. Lastly, most of the women noted that menopausal symptoms are unpleasant, but that the absence of menses after menopause is a relief