Out-patient intravaginal misoprostol versus in-patient intravaginal misoprostol for the treatment of first trimester incomplete miscarriage in UKMMC: a randomised controlled trial.

A prospective randomised controlled trial was conducted at a tertiary medical center on 154 patients for the treatment of spontaneous first trimester incomplete miscarriage. The intervention group (n=77) received out-patient administration of misoprostol whereas the control group (n=77) received in-patient administration of misoprostol. The intravaginal misoprostol dosage administered was 800mcg 8 hourly to maximum of 3 doses. They were reassessed at Day 7. The primary outcome evaluated were success of evacuation, side effects, cost and patient acceptability. The secondary outcomes evaluated were mean reduction of endometrial thickness, days of passing out POC, duration of bleeding and mean reduction in hemoglobin. Assessment for treatment failure was done at day 7. Surgical evacuation was then offered

Vaginal bleeding in prepubertal girls-a case series in Malaysia

The etiology of prepubertal vaginal bleeding varies from isolated pubertal causes to malignant tumors and generates significant anxiety among girls and their caretakers. Hence, these cases require careful assessment and management. This is a report of five cases of prepubertal vaginal bleeding with various causes and were managed in a tertiary referral center in Malaysia. The first case was a 6-year-old girl who had no pubertal changes with 3 weeks’ history of bleeding. She underwent examination under anesthesia and found to have multiple vaginal polyps. Another 6-year-old girl noted to have a doughnut-shaped mass protruding from her urethral meatus. She was treated with estrogen cream and sitz baths. Another child had early breast development while pelvic ultrasound revealed a multiseptated ovarian cyst requiring a cystectomy. A 19-month-old toddler had a large intravaginal mass. She required further investigation, referral to the pediatric surgeon and oncologist for treatment of a malignant yolk sac tumor. Lastly, an 8-year-old girl was noted to have monthly vaginal spotting without any secondary sexual characteristics development. Prepubertal vaginal bleeding is abnormal thus requires prompt assessment to ascertain the cause and administer appropriate management. It is important to rule out sexual abuse and malignancy. Examination under anaesthesia and vaginoscopy is recommended when imaging modality is inconclusive. Referral to tertiary centres experienced in managing such cases ensures good outcomes. Thorough targeted history-taking and pediatric-specific gynecological examination skills are crucial to formulate accurate diagnosis and appropriate management

Diagnostic dilemma of a case of sigmoid volvulus complicating pregnancy

We report the case of a 34-year-old Malay, admitted for constipation and abdominal pain at 35 weeks of gestation. Initially, she was diagnosed to have paralytic ileus and was managed conservatively. As her condition did not improve, emergency laparotomy was performed for suspected intestinal obstruction. She delivered a baby boy weighing 2.84kg with good Apgar score through a caesarean section. Intra-operatively, she was noted to have sigmoid volvulus and sigmoidopexy was performed. Post-partum, colonoscopy and bowel decompression was performed. She recovered well and was discharged on day 5. This case illustrates the need to diagnose or suspect volvulus in pregnant woman presenting with severe constipation as early surgical intervention can reduce morbidity to both mother and fetus

Inferior vena cava filter: Is it a way out of pulmonary embolism in gynaecological cancer? - Case report

Venous thromboembolism has a strong association with pelvic malignancy, whereby a failure in recognizing this event will lead to mortality. The best intervention depends on the individual basis with the availability of supporting service. We illustrate a case of gynaecological malignancy with concurrent deep vein thrombosis undergoing staging laparotomy and debulking surgery. Inferior vena cava filter was inserted after initial thrombolytic therapy and subsequently a long term treatment. Death from massive pulmonary embolism and major bleeding was prevented and synchronous primary ovarian and endometrial cancer prognosis was reassured in this case

Normograms of ovarian volume, Uterine size and endometrial thickness in urban midlife Malaysia women

Cancers of the ovary and corpus uteri afflict 5% and 3.6% Malaysian women respectively. Ovarian cancer (OC) remained the deadliest gynaecological malignancy in perimenopausal women mainly due to the lack of symptoms until the disease had spread. Ultrasonography could provide a preliminary screening allowing the clinician to tailor subsequent management and counselling for these women. To support the basis for selective screening, a study on 517 urban disease free women aged 45 years and above, uterus-intact, non-users of HRT was undertaken. This study presented normograms of ovary, uterus and endometrium derived from entry ultrasound assessment. The sample comprised of 58.0% premenopaused and 42.0% postmenopaused women with an average age of 51.27±5.35 years old. Over two thirds were Chinese followed by Malays and Indians. The findings indicated that the average uterine size and endometrial thickness (ET) was 7.21±1.67x4.36±1.30cm and 6.36±3.73mm respectively. Premenopausal women had larger uterus compared to those postmenopaused (p70 years old. From these findings, a cut-off of <5.0mm was considered clinically acceptable in normal postmenopaused regardless of ethnicity. Nearly one fifth (18.9%) had uterine fibroids, a quarter (25%) in premenopausal women as compared to 10% postmenopaused (p<0.0005). The mean right and left ovarian volume (OV) was 5.48±7.85cm3 and 5.80±16.78cm3 respectively. There was a gradual decline in OV with age and menopause from about 7cm3 at age 45-49 years to less than 1.5cm3 at 70 years giving a clinical norm OV of <7.5cm3 and <3.5cm3 respectively in pre and postmenopausal Malaysian women. Benign ovarian cysts seen in 2.9% had a mean size of 65.14±88.22cm3. In conclusion, ET and OV normograms should be made available for the Malaysian population to facilitate screening for gynaecological malignancie

Ectopic pregnancy following levonorgesterol-only emergency contraception: the first Malaysian case report.

Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only E

Utility of pap smears and mammograms in midlife urban Malaysian women

Cancers of the breast and cervix made up 30.4% and 12% of all cancer cases in Malaysia. Thus screening for reproductive organ cancers as women approached menopause becomes exceedingly important. The study reports the baseline assessment tests of 495 disease free urban Malaysian women aged 45 years and above who volunteered in a healthy lifestyle intervention study. The sample comprised of 58.0% premenopaused and 42.0% postmenopaused women with an average age of 51.27±5.35 years old. Over two thirds were Chinese followed by Malays and Indians. Overall, abnormal Pap smears were seen in 7.6% comprising of 1.3% cervical intraepithelial neoplasia (CIN), 6.1% human papilloma virus (HPV) infection and 0.2% atypical squmous cells of undetermined significances (ASCUS). Yeast and other infections were found in 6.9% and 1.9% respectively. Comparatively, postmenopausal women had a 2.8 fold higher cancerous changes whereas premenopausal women had a higher infection rate, 11.8% vs. 4.7% respectively (p=0.024) with comparable HPV infection rates in both. This study found 1.3% had breast cancer (BC) with 3.6% requiring a biopsy while 3.4% needed regular follow up. Postmenopaused women had more abnormal mammograms (p<0.0005) of a graver nature, requiring monitoring although the rate of BC was lower than the premenopaused, 0.010 versus 0.015. The findings identified better vigorous screening for malignant carcinoma of the cervix in postmenopausal women as the incidence was higher. As for breast abnormalities, screening should begin at an earlier age, amongst pre- and postmenopausal women from 45 years old and abov