Guidelines on induction of labour

This is a review version of guideline on induction of labour (IOL) following the first guideline dated January 2008. This review was based on current changes in the evidence-based clinical practice. In 1985 the World Health Organization (WHO) set the optimal rate for Caesarean Section (CS) at 10-15% of all births. A recent review showed a global CS rate around 19% and some regional rates above 30%. Malaysian public hospitals had a CS rate of 15.7% in 2006. The National Obstetrics Registry, Malaysia had reported the CS section rate in 2010 at 23%, in 2012 at 25.1% and in 2015 at 25.7% and this trend is on the rise. This rise in CS rates have caused concerns, however striving to keep the rates low should not jeopardize maternal and fetal health. It is timely to explore ways to reduce this rising trend and IOL has been proven to reduce CS rates. IOL is defined as artificial initiation of labour. This is a therapeutic option when the benefits of expeditious delivery outweigh the potential maternal and fetal risks of continuing pregnancy. IOL carries inherent benefits and risks to both mother and fetus

Antenatal iron deficiency in an urban Malaysian population

Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with socio-demographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values

Dinoprostone in first trimester miscarriages: a prospective observational study in a Malaysian Tertiary Healthcare Institution

The objective of this paper was to evaluate the outcome of medical evacuation of first trimester miscarriages using dinoprostone. A prospective observational study in a tertiary centre between 1st January and 31st December 2018 in Obstetrics and Gynaecology unit, UKM Medical Centre. Women diagnosed with incomplete and missed miscarriage (n=41) at or less than 13 weeks of gestation were recruited. Dinoprostone 3 mg was inserted into the posterior fornix, twice within 6 h apart on day-1 followed by similar protocol on day-2. Patients were reassessed clinically and sonographically upon passing out products of conception, at 48 h and day-7. Complete evacuation was defined as closed cervical os and/or endometrial thickness of less than 15 mm sonographically. Treatment failure was defined as failure to achieve complete evacuation by day-7. Overall success rate was 55.3% (n=26) being better in incomplete (n=6, 100%) as compared to missed miscarriage (n=21, 48.8%, p=0.03). Those with successful evacuation required dinosprostone at a mean of 8.4 ± 2.9 mg achieving complete miscarriage within a mean of 27.8 ± 16.6 h. Mean pain score was 5.8 ± 0.8 with mean patient satisfaction score of 8.7 ± 0.8. Mean drop in haemoglobin was 0.7 ± 0.2 g/dL. No major adverse effects were reported. Medical evacuation of miscarriage using intravaginal dinoprostone is safe and promising, with acceptable success rate and high patient satisfaction. This study supported previous studies suggesting presence of prostaglandin E2 receptors in the first trimester

To assess placental volume in first and second trimester of pregnancy in UKM Medical Centre.

This was a prospective cohort study. From May 2011 to June 2012, pregnant women were recruited via the obstetric clinic, patient admission centre and wards in UKM Medical Centre (UKMMC). An ultrasound scan was performed at 11-16 weeks and again at 18-26 weeks of gestation to check for placental volume and Uterine Artery Resistance Index (UARI) and Pulsatility Index (UAPI). The placental volume was measured by three-dimensional ultrasound using the Virtual Organ Computer-Aided Analysis (VOCAL) technique

Virtual reality assessment for obsessive compulsive disorder: a review

The use of advance computer-based technology is becoming necessary to address the growing complexity of human problems and enhance effective communication. The recent pandemic COVID-19 not only induces many morbidities and mortalities but also intensifies mental health problem worldwide. Due to the increasing benefits of virtual reality (VR) in addressing medical condition, it is believed that VR can be used as a diagnostic tool to assess numerous medical conditions and psychiatric disorders. To date, there is still scarce evidence of VR as a diagnostic tool to assess obsessive compulsive disorder (OCD). In this study, we had conducted a systematic review to investigate the use of VR as a diagnostic tool for OCD and assess its benefits and weaknesses in comparison to computer-assisted tools. Comprehensive searches of electronic databases including PubMed and Google Scholar were undertaken to discover peer review evidence of computer-based simulation tasks in detecting OCD symptoms. Twelve out of 9325 papers were screened and reviewed. Five articles reported on computerised tools and seven articles described VR tools. In comparison to computer-based tasks, VR is a promising assessment tool due to specific virtual environments and high resolutions which are able to induce anxiety symptoms. Despite numerous shortcomings, assessment can be utilised in computerised form to detect and generate a variety of psychiatry diagnoses among the general population. Although computerised assessment task and VR show promising results, the finding are uneven due to study design differences, wide variability content task use, small sample size, several methodological issue with the computerised tasks and lack of appropriate control groups. In conclusion, the choice to use computerisation or VR for OCD assessment will depend on aim, content, technical equipment and budget. More in-depth studies of these issues are required

Total nucleated cell count and CD34+ cell is reduced in preeclampsia and gestational diabetes mellitus pregnancies: viable affix criteria for cord blood banking

The aim of this study to determine the numbers of CD34+ cells and total nucleated cell (TNC) in umbilical cord blood (UCB) collected from pregnant mothers with gestational diabetes mellitus (GDM) and preeclampsia (PE), following statistical analysis of both maternal and perinatal factors which affect UCB parameters. Most of studies explored the influence of obstetric factors on the number of UCB cell collection and only a few looked at the effects on UCB haematopoietic stem cell (UCB-HSC) of common disorders complicating pregnancy. A total of 112 UCB samples (32 PE, 42 GDM and 38 non-diseased) were collected. CD34+ cell and NC count were enumerated using FACS Calibur. The TNC and CD34+ cells were significantly reduced in both PE and GDM groups as compared to the control group. The PE group shows significantly lower birth weight and higher BP which led to a lower UCB volume and CD34+ count. Gestational age shows significant correlation with nucleated cell count (NCC) and TNC. GDM group shows significantly lower systolic BP, NCC and TNC count, including low placental weight and birth weight. Conclusively, some obstetrics factors have significant influences to the numbers and quality of UCB-HSC in both PE and GDM groups, which could guide in the selection criteria for CB banking

Editorial: saving mothers and babies for the new world

First, where or what is the New World? Historically, this refers to the region of the Americas. In this context, the New World is the future of humankind, an ambiguous borderless phenomenon that is informed and built upon from lessons of its past and from stories of triumph and regrets; of innovations, experiences of the pandemic, economic successes, and failures; of those unwanted wars; and of great science. The New World we envision emphasizes the quintessential of actions to ensure human survivability, by prioritizing equitable care to mothers and babies regardless of their region. Positive outcomes for mothers and babies can only be achieved by ensuring that healthcare professionals are knowledgeable, holistic, ethical, and safe and that effective execution of ethically robust healthcare policies and guidelines for equitable perinatal healthcare is adequately supported. These aims need to be at the forefront of policies of governments across all countries in the New World despite all setbacks. With this in mind, the research topic Saving Mothers and Babies for the New World accepted 16 diverse full-length articles and collected abstracts presented at the 21st Federation of Asia Oceania Perinatal Societies (FAOPS) Congress that provided a wealth of information and science that can help carve future research and inform policies

Nutritional and socio-economic determinants of cognitive function and educational achievement of Aboriginal schoolchildren in rural Malaysia

A community-based cross-sectional study was carried out among Aboriginal schoolchildren aged 7–12 years living in remote areas in Pos Betau, Pahang, Malaysia to investigate the potential determinants influencing the cognitive function and educational achievement of these children. Cognitive function was measured by intelligence quotient (IQ), while examination scores of selected school subjects were used in assessing educational achievement. Blood samples were collected to assess serum Fe status. All children were screened for soil-transmitted helminthes. Demographic and socio-economic data were collected using pre-tested questionnaires. Almost two-thirds (67·6 %) of the subjects had poor IQ and most of them (72·6 %) had insufficient educational achievement. Output of the stepwise multiple regression model showed that poor IQ was significantly associated with low household income which contributed the most to the regression variance (r2 0·059; P = 0·020). Low maternal education was also identified as a significant predictor of low IQ scores (r2 0·042; P = 0·043). With educational achievement, Fe-deficiency anaemia (IDA) was the only variable to show significant association (r2 0·025; P = 0·015). In conclusion, the cognitive function and educational achievement of Aboriginal schoolchildren are poor and influenced by household income, maternal education and IDA. Thus, effective and integrated measures to improve the nutritional and socio-economic status of rural children would have a pronounced positive effect on their education