Caesarean section rates from Malaysian tertiary hospitals using Robson’s 10-group classification

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background Rising caesarean section rates is a concern worldwide. This study aimed to use Robson’s ten group classification to identify which groups of women were contributing most to the rising caesarean section rates in Malaysian tertiary hospitals and to compare between hospitals, using a common standard set of variables. Methods A 5-year (2011–2015) cross-sectional study was conducted using data from the Malaysian National Obstetrics Registry (NOR). A total of 608,747 deliveries were recorded from 11 tertiary state hospitals and 1 tertiary hospital from the Federal territory. Results During the study period, there were 141,257 Caesarean sections (23.2%). Caesarean sections in Group 1 (nulliparous term pregnancy in spontaneous labour) and Group 3 (multiparous term pregnancy in spontaneous labour) had an increasing trend from 2011 to 2015. The group that contributed most to the overall caesarean section rates was Group 5 (multiparous, singleton, cephalic≥37 weeks with previous caesarean section) and the rates remained high during the 5-year study period. Groups 6, 7 and 9 had the highest caesarean section rates but they made the smallest contribution to the overall rates. Conclusions Like many countries, the rate of caesarean section has risen over time, and the rise is driven by caesarean section in low-risk groups. There was an important hospital to hospital variation. The rise in caesarean section rates reflects a globally disturbing trend, and changes in policy and training that creates a uniform standard across hospitals should be considered.https://doi.org/10.1186/s12884-020-2760-220pubpub

Predicting Plasma Leptin With Anthropometric & Bioelectrical Impedance Analysis Measures Of Adiposity In Multiethnic Young Adult Population In Malaysia

Obesity bears multivariate causes and manifestations. Simple anthropometric and non-invasive physical markers are being proposed for easy and early detection of obesity-induced disrupted energy homeostasis and metabolic disorders. Adipose-tissuederived hormone, leptin is largely known for its role in energy homeostasis and paradoxically, higher serum leptin corresponds to higher degree of obesity. Thus, this study aims to investigate the association of plasma leptin with common physical measures of adiposity in a multiethnic, young adult Malaysian population. Methodology: Based on BMI, 185 volunteering participants were grouped as underweight, normal weight, overweight and obese. Standardized anthropometric and bio-electrical impedance assessment (BIA) measure of adiposity was done using Karada Scanner while plasma leptin was measured using a sandwich ELISA assay technique. Results: A total of 61, 45, 56 and 23 Malaysian Malays, Chinese, Indian and other minor groups, respectively were included in this study. Out of this, 28 were underweight, 100 were normal weight, 29 were overweight and 27 were obese (n=27). One-way ANOVA revealed a significant difference among all variables except height and waist-hip ratio. The multiple regression analysis predicted plasma leptin value based on age, weight, height, body age, resting metabolic rate, visceral fat, total body fat, and body mass index in both male (R2=0.54) and females (R2=0.23). The results show that weight, resting metabolic rate, visceral fat and body were reliable predictors for plasma leptin between all the groups. Conclusion: Anthropometric indices can be used as predictors of serum leptin in adults irrespective of their body weight. This observation thus emphasizes the clinical significance of simple non-invasive physical markers for detection of obesity-induced metabolic disorders

Predicting Plasma Leptin With Anthropometric & Bioelectrical Impedance Analysis Measures Of Adiposity In A Multiethnic Young Adult Population In Malaysia

Background: Obesity bears multivariate causes and manifestations. Simple anthropometric and non-invasive physical markers are being proposed for easy and early detection of obesity-induced disrupted energy homeostasis and metabolic disorders. Adipose-tissuederived hormone, leptin is largely known for its role in energy homeostasis and paradoxically, higher serum leptin corresponds to higher degree of obesity. Thus, this study aims to investigate the association of plasma leptin with common physical measures of adiposity in a multiethnic, young adult Malaysian population. Methodology: Based on BMI, 185 volunteering participants were grouped as underweight, normal weight, overweight and obese. Standardized anthropometric and bio-electrical impedance assessment (BIA) measure of adiposity was done using Karada Scanner while plasma leptin was measured using a sandwich ELISA assay technique. Results: A total of 61, 45, 56 and 23 Malaysian Malays, Chinese, Indian and other minor groups, respectively were included in this study. Out of this, 28 were underweight, 100 were normal weight, 29 were overweight and 27 were obese (n=27). One-way ANOVA revealed a significant difference among all variables except height and waist-hip ratio. The multiple regression analysis predicted plasma leptin value based on age, weight, height, body age, resting metabolic rate, visceral fat, total body fat, and body mass index in both male (R2 =0.54) and females(R2 =0.23). The results show that weight, resting metabolic rate, visceral fat and body were reliable predictors for plasma leptin between all the groups. Conclusion: Anthropometric indices can be used as predictors of serum leptin in adults irrespective of their body weight. This observation thus emphasizes the clinical significance of simple non-invasive physical markers for detection of obesity-induced metabolic disorders

An update on Gardneralla vaginalis associated bacterial vaginosis in Malaysia

Objective: To update the status of Gardnerella vaginalis (G. vaginalis) as a causative agent of bacterial vaginosis (BV) in Malaysia and to define its epidemiology, metronidazole resistance and virulence properties. Methods: It is a single-centre (Gynaecology clinic at the Hospital Kuala Lumpur, Malaysia) prospective study with laboratory-based microbiological follow up and analyses. Vaginal swabs collected from the patients suspected for BV were subjected to clinical BV diagnosis, isolation and identification of G. vaginalis, metronidazole susceptibility testing, vaginolysin and sialidase gene PCR, Piot's biotyping and amplified ribosomal DNA restriction analysis genotyping. Results: Among the 207 patients suspected for BV, G. vaginalis was isolated from 47 subjects. G. vaginalis coexisted with Trichomonas vaginalis and Candida albicans in 26 samples. Three G. vaginalis isolates were resistant to metronidazole. Biotyping revealed 1 and 7 as the common types. Amplified ribosomal DNA restriction analysis genotype II was found to be more common (n = 22; 46%) than I (n = 12; 25.53%) and III (n = 13; 27.6%). All genotype I and III isolates carried the sialidase gene, while 91.6% and 84.6% contained the vaginolysin gene. Genotype I was significantly associated with post-gynaecological surgical complications and abortions (P = 0.002). Conclusions: The existence of pathogenic G. vaginalis clones in Malaysia including drug resistant strains should not be taken lightly and needs to be monitored as these may bring more complications especially among women of child bearing age and pregnant women

‘Intracytoplasmic sperm injection (ICSI) paradox’ and ‘andrological ignorance’: AI in the era of fourth industrial revolution to navigate the blind spots

Abstract The quandary known as the Intracytoplasmic Sperm Injection (ICSI) paradox is found at the juncture of Assisted Reproductive Technology (ART) and ‘andrological ignorance’ – a term coined to denote the undervalued treatment and comprehension of male infertility. The prevalent use of ICSI as a solution for severe male infertility, despite its potential to propagate genetically defective sperm, consequently posing a threat to progeny health, illuminates this paradox. We posit that the meteoric rise in Industrial Revolution 4.0 (IR 4.0) and Artificial Intelligence (AI) technologies holds the potential for a transformative shift in addressing male infertility, specifically by mitigating the limitations engendered by ‘andrological ignorance.’ We advocate for the urgent need to transcend andrological ignorance, envisaging AI as a cornerstone in the precise diagnosis and treatment of the root causes of male infertility. This approach also incorporates the identification of potential genetic defects in descendants, the establishment of knowledge platforms dedicated to male reproductive health, and the optimization of therapeutic outcomes. Our hypothesis suggests that the assimilation of AI could streamline ICSI implementation, leading to an overall enhancement in the realm of male fertility treatments. However, it is essential to conduct further investigations to substantiate the efficacy of AI applications in a clinical setting. This article emphasizes the significance of harnessing AI technologies to optimize patient outcomes in the fast-paced domain of reproductive medicine, thereby fostering the well-being of upcoming generations

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders

© 2019 International Federation of Gynecology and ObstetricsPlacenta accreta spectrum is impacting maternal health outcomes globally and its prevalence is likely to increase. Maternal outcomes depend on identification of the condition before or during delivery and, in particular, on the differential diagnosis between its adherent and invasive forms. However, accurate estimation of its prevalence and outcome is currently problematic because of the varying use of clinical criteria to define it at birth and the lack of detailed pathologic examination in most series. Adherence to this new International Federation of Gynecology and Obstetrics (FIGO) classification should improve future systematic reviews and meta-analyses and provide more accurate epidemiologic data which are essential to develop new management strategies.info:eu-repo/semantics/publishedVersio