Oligohydramnios : A risk of adverse perinatal outcomes

Introduction: Oligohydramnios is diagnosed when amniotic fluid index is less than 5. The incidence is between 1% and 4.4%. Although there are various maternal, fetal and placental contributory factors, the cause in the majority of cases is unknown. Most oligohydramnios cases warrant obstetric intervention. Case Description: A 22-year-old, Gravida 3 Parity 1+1 lady was diagnosed to have gestational diabetes at 15 weeks of gestation, which was well controlled with diet throughout pregnancy. At 34 weeks of gestation, ultrasound examination showed oligohydramnios. Ultrasound assessment confirmed both fetal kidneys were present, and bladder was seen. End diastolic flow was present in umbilical doppler and estimated fetal weight was 2.07 kilograms. After the administration of dexamethasone for fetal lung maturity, induction of labour was started with Cook’s balloon catheter. After 5 hours, cardiotocograph showed fetal tachycardia with a non-reassuring tracing. The emergency lower segment caesarean section was performed and a baby of 2.07 kilograms was born with Apgar score 1 in 1 minute and 5 minutes. Umbilical cord blood pH of artery and vein were 7.35 and 7.338 respectively. The baby passed away the next day. Discussion: Pregnancy with oligohydramnios have a higher chance of g induction of labour which is beneficial. Pregnancies complicated with only oligohydramnios without underlying disorders may not be associated with adverse neonatal outcomes. But there is evidence that oligohydramnios cases with underlying disorders, their labours are likely to be associated with abnormal cardiotocographs, a higher rate of emergency caesarean sections and adverse neonatal outcomes

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

Sirolimus-eluting, bioabsorbable polymer-coated constant stent (Cura??) in acute ST-elevation myocardial infarction: A clinical and angiographic study (CURAMI registry)

Journal of Invasive Cardiology194182-18