Second trimester uterine rupture: lesson learned

ntroduction: Uterine rupture is a rare obstetrics catastrophic especially if it occurs during early pregnancy. We experienced three cases of ruptured uterus in the second trimester that first line doctors and obstetrician could learn lessons from. Objectives: To study the presentations and outcome of uterine rupture in the second trimester. Methodology: A retrospective review of uterine rupture in Hospital Tengku Ampuan Afzan from the 1st of April 2010 to the 1st of April 2011. Data obtained from case records, histopathological and autopsy reports. Result: There were 3 cases of uterine rupture. First case, uterine rupture at 15 weeks post sexual intercourse, undiagnosed until postmortem. Second case: ruptured uterus at 24 week diagnosed at laparotomy with the indication of failed medical termination for fetal anomaly. Third case: ruptured uterus at 21 weeks following abdominal massage with initial diagnosis of acute gastroentritis. The final diagnosis was ruptured uterus secondary to placenta percreta, related to medical induction and interstitial pregnancy respectively. Conclusion: Rupture uterus should be considered with or without any risk factors regardless of the gestational age whenever any impression of hemoperitoneum. Intensive surgical method would be needed for accurate diagnosis and immediate management even in early pregnancy is a life saving

Ameliorative effects of Aquilaria malaccensis leaves aqueous extract on reproductive toxicity induced by cyclophosphamide in male rats

Background: Cyclophosphamide (CP) is a widely used anti-neoplastic and immunosuppressive agent that is associated with adverse side effects including reproductive toxicity. Aquilaria malaccensis (AM) is a traditional medicinal plant which was reported to exhibit high anti-oxidant and free radical scavenging properties. The present study was aimed to evaluate the protective effects of AM leaves extract on sperm quality following toxic exposure to CP. Methods: Forty-eight male Sprague Dawley rats were allocated into eight groups of six rats (n = 6): control, CP only (200 mg kg−1 ), AM only (100 mg kg−1 , 300 mg kg−1 and 500 mg kg−1 ) and CP + AM (100 mg kg−1 , 300 mg kg−1 and 500 mg kg−1 ). Animals were sacrificed after 63 days of treatment and the sperm from the caudal epididymis was taken for sperm analysis. Results: The body and the reproductive organs weight, sperm count and motility did not differ between CP and other groups (P > 0.05). A significant increase (P < 0.05) in percentage of the dead and abnormal sperm were seen in the CP alone treated group compared to the control group. Co-administration of AM to the CP exposed rats significantly reduced the (P < 0.05) percentage of abnormal sperm as compared to the CP only group. Conclusion: Overall, the present results represent the potential of AM to protect against CP induced reproductive toxicity

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Prostanglandin versus oxytocin for induction of labour in prelabour rupture of membranes.

This study was conducted to compare the outcome in between prostaglandins and oxytocin as methods of induction of labour in prelabour rupture of membranes with unfavorable cervix. This is a prospective randomized double blinded study carried out from 1st July 2012 to 30th June 2013 at Hospital Sultan Ismail Johor Bahru. A total of 148 women with singleton pregnancies at ≥ 37 weeks, no prior uterine scar, vertex presentation, reactive cardiotocogram (CTG) were randomly assigned to receive immediate induction of labour either by intravenous oxytocin infusion or vaginal prostaglandin E2. The primary outcomes were maternal and neonatal outcome. Data was analyzed using SPSS version 10.0 and p value of <0.05 was considered to be statistically significant. 148 patients were included in this study, 73 patients in prostaglandins arm, and 75 patients in oxytocin arm. The mean age was 27.8+4.9 years old and the mean gestational age was 38.7+1.2 weeks. Majority of them (73%) presented with PROM of less than 24 hours. Following induction of labour, 68% of them achieved vaginal delivery. In the oxytocin group, induction of labour to vaginal delivery interval (7.6+4.7 versus 16.5+14.8, p<0.001) and leaking liquor to delivery interval (19.1+11.8 versus 32.3+22.4, p<0.001) were significantly shorter than the PGE2 group. However caesarean delivery was found 3 times more (32.0% versus 9.6%, p=0.001) in the oxytocin group. The rate of neonatal infections (31.5% versus 8.0%, p<0.001) and NICU admission (38.4% versus 21.3%, p=0.023) were significantly lesser in the oxytocin group. In conclusion, neither oxytocin nor PGE2 was preferred as a method of induction of labour in patients with PROM at term with unfavourable cervix. The management of term PROM therefore needs to be individualized to achieve the best maternal and neonatal outcomes. Expectant management remains as an alternative option

The effects of Aquilaria malaccensis leaves aqueous extract on sperm of sprague dawley rats towards early embryogenesis.

Introduction: Oxidative stress induced by excessive and unopposed levels of reactive oxygen species in male reproductive system results in impaired sperm quality, fertilization capacity and poor embryo development. Our goal is to assess the potential effects of Aquilaria malaccensis (AM) leaves, a plant with strong antioxidant property on early embryo development in vitro and embryo quality following fertilization with cyclophosphamide (CP) exposed rat sperm. Materials and Methods: Twenty four male Sprague Dawley rats were allocated into eight groups of three rats (n = 3): control, CP only (200 mg/kg), AM only (100 mg/kg, 300 mg/kg and 500 mg/kg) and CP + AM (100 mg/kg, 300 mg/kg and 500 mg/kg). Animals were sacrificed after 63 days of treatment and sperm from caudal epididymis were taken for in vitro fertilization (IVF) with oocytes from untreated female. Fertilization, embryo division and embryo morphology were examined at 8 and 48 hours post insemination and compared between groups. Statistical evaluations were performed using Chi-Square test and Fisher’s exact test and p-value<0.05 was considered significant. Results: Administration of AM leave extract at 100 mg/kg/day to normal rats and CP-exposed rats has significantly increased (p<0.05) the fertilization rate, early cleavage rate and embryo quality when compared to CP only treated group. However, other groups showed no significant differences. Conclusion: Overall, the present results indicate the potential of AM leave extract supplementation to improve the fertility and early embryo development in male rat exposed to CP by inhibiting the oxidative processes and scavenging free radicals

The effects of Aquilaria malaccencis leaves aqueous extract on sperm of sprague Dawley rats towards early embryogenesis

Introduction: Oxidative stress induced by excessive and unopposed levels of reactive oxygen species in male reproductive system results in impaired sperm quality, fertilization capacity and poor embryo development. Our goal is to assess the potential effects of Aquilaria malaccensis (AM) leaves, a plant with strong antioxidant property on early embryo development in vitro and embryo quality following fertilization with cyclophosphamide (CP) exposed rat sperm. Materials and Methods: Twenty four male Sprague Dawley rats were allocated into eight groups of three rats (n = 3): control, CP only (200 mg/kg), AM only (100 mg/kg, 300 mg/kg and 500 mg/kg) and CP + AM (100 mg/kg, 300 mg/kg and 500 mg/kg). Animals were sacrificed after 63 days of treatment and sperm from caudal epididymis were taken for in vitro fertilization (IVF) with oocytes from untreated female. Fertilization, embryo division and embryo morphology were examined at 8 and 48 hours post insemination and compared between groups. Statistical evaluations were performed using Chi-Square test and Fisher’s exact test and p-value<0.05 was considered significant. Results: Administration of AM leave extract at 100 mg/kg/day to normal rats and CP-exposed rats has significantly increased (p<0.05) the fertilization rate, early cleavage rate and embryo quality when compared to CP only treated group. However, other groups showed no significant differences. Conclusion: Overall, the present results indicate the potential of AM leave extract supplementation to improve the fertility and early embryo development in male rat exposed to CP by inhibiting the oxidative processes and scavenging free radicals