Massive haemorrhage secondary to placenta percreta in the first trimester: a case report

Placenta percreta detected in the first trimester is a very rare condition. It is a known obstetric condition leading to serious maternal morbidity and mortality. High index of clinical suspicion and anticipation of placenta percreta is highly essential in early pregnancy as it is difficult to diagnose. The authors report on a patient who presented with heavy pervaginal bleeding in week 9 of pregnancy. Pelvic examination showed a 12-week sized uterus. Ultrasonography revealed a non-viable fetus. The subsequent emergency curettage performed was complicated by massive haemorrhage which required an abdominal hysterectomy performed as a life-saving procedure

Short term neonatal outcomes of singleton term breech delivery: two year experiences in a Malaysian tertiary hospital

Background: There are few neonatal complications of breech delivery including the low Apgar score, birth trauma, admission to neonatal unit and perinatal mortality. Objective: To review the short term complications and their associating factors among singleton term breech infants in relation to mode of delivery. Methodology: This is a cross-sectional study that involves 294 term singleton pregnant women with breech presentation in Hospital Serdang, Malaysia from January 1, 2014 to December 31, 2015. Data abstracted from the delivery record book and the hospital database computerised system were used to compare the short term outcomes of singleton term breech infants born via vaginal breech delivery and pre-labour or in-labour caesarean section. Results: Out of 294 cases, 25% (n=73) displayed a successful vaginal delivery, whereas the remaining 75% (n=221) have undergone caesarean delivery. It was more common in multiparous women (64.3%) and frank-typed of breech (59.9%) is more prevalence compared to others. Nulliparity was found significantly predominant in caesarean section delivery (OR 2.38, 95% CI 1.114-5.084, p= 0.005), while the complete-typed of breech was significantly lesser in caesarean section group (OR 0.47, 95% CI 0.246-0.915, p= 0.026). However, there was no significant difference discovered in adverse neonatal outcome regarding the mode of delivery. Conclusion: Pre or in- labour caesarean section and vaginal delivery in terms of singleton breech presentation contains a similar risk of adverse neonatal outcome. According to this study, the main risk factors affecting the mode of delivery are parity and type of breech presentation

Prevalence of Primary Dysmenorrhea and Factors Associated with Its Intensity Among Undergraduate Students: A Cross-Sectional Study

AbstractPrimary dysmenorrhea is a womanhood problem around the world and negatively affects quality of life. This study was designed to investigate the prevalence of primary dysmenorrhea and to determine the factors associated with its intensity. A cross-sectional study was carried out among 311 undergraduate female students aged 18 to 27 years in Isfahan University of Medical Sciences, Iran. Socio-demographic characteristics and menstrual factors were obtained through interviews with the help of a pretested questionnaire. The prevalence of primary dysmenorrhea was 89.1%. Residing at home, younger age, lower number of years of formal education for the mother, positive family history of dysmenorrhea, higher severity of bleeding, and shorter menstrual period intervals were significantly associated with the higher intensity of primary dysmenorrhea. Primary dysmenorrhea is a common health concern among young women. Being aware of the factors that are associated with its intensity makes it possible for health professionals to organize better focused programs to reduce the adverse effects of dysmenorrhea

Animal component free medium retains the stability Of hypervariable region 1 (HV1) of mitochondrial DNA of human full term amniotic fluid mesenchymal stem cells

Therapeutic potential of human amniotic fluid (hAF) cells in treating human disease is very promising. Furthermore it provides an alternative in isolating stem cells from an accessible source, where the fluid is merely discarded, thus circumventing the ethical concerns. Mesenchymal stem cell (MSC) is one of the heterogenous cell populations in the amniotic fluid (AF), however, its role and potential for stem cell therapy are yet to be discovered. One of the criteria in establishing the clinical grade of MSCs is the ability of the cells to retain their genomic stability in vitro prior to bedside applications. The microenviroment niche of the culture medium used is important to generate the safe MSCs. As mitochondria play the vital role in metabolic task such as apoptosis and cell proliferation, therefore investigating mitochondria DNA (mtDNA) is essential to mark the stability of stem cell. In this study, we aimed to detect variations of mtDNA across the passage number of cultured human amniotic fluid MSCs (hAFMSCs), cultured in animal component free (ACF) medium, specialised for human MSCs. Polymorphisms of hypervariable region 1 (HV1) in the D-loop of mtDNA were investigated in a series of cultured hAFMSCs (passage 1 and 3) from three different samples (three biological replicates) as well as in their respective fresh samples (control). Extracted DNA samples were subjected to PCR to detect the sequence variations of HV1 (nt16024-16365). The sequences were then analysed using SeqScape v2.5 by comparing the sequences with The Cambridge Reference Sequence (rCRS) for human mtDNA. The common C-to-T transition at position 16223 (C16223T) for all three samples was identified. Another common base transition was also identified for the other two samples at position 16311 (T16311C). However, one of the samples showed more variants; a C-to-T transition at position 16290 (C16290T), an A-to-G at position 16317 (A16317G) and a G-to-A at position 16319 (G16319A). All variants were identified within the sequence of around 341bp nucleotides and their polymorphisms frequency was consistent for all three samples regardless of their passage numbers when compared to control. This pattern of polymorphisms demonstrates the HV1 mtDNA integrity of hAFMSCs cultured in ACF medium, hence highly suggesting the ability of ACF medium in retaining the stability of stem cells mtDNA in vitro. The ACF medium may serve as a good medium in culturing hAFMSCs that is safe and stable for basic research in stem cell and therapeutic applications

Video observation for designers: a contextual immersion of the O&G mannequin in clinical training

The use of mannequin is essential in the training of future Obstetrics and Gynaecology (O&G) doctors as it allows them to gain crucial practical experience in conducting medical procedures before performing these procedures on live patients. Despite of the beneficial technology and design emphasised on the existing mannequin used in the O&G domain, propositions have been made by the O&G experts for a new mannequin to be designed. This proposition was therefore addressed through a co-design project. The Contextual Immersion from Mocking-Up co-design approach was used in this project as it suits the designer-clinical expert co-creation circumstances, and it also enables designers to understand the specific user context. This paper reported the process of preparing video observation for designers as a tool in understanding the context in which the O&G mannequin is used in clinical training. Eight different sessions of clinical simulation were video recorded and analysed in this study. These videos used by designers to provide insights to the respective context such as understanding the usage of relevant mannequin in training medical student. Secondly, the video showed the interaction between the expert and novice users to the mannequin. These factors helps the designers to address the related design issues

Methylmercury detection in maternal blood samples by liquid chromatography with inductively coupled plasma mass spectrometry

Methylmercury (MeHg) is one type of mercury (Hg) species known to be very toxic to humans, especially pregnant women and their fetuses. This study aims to obtain and validate the optimum condition of liquid chromatography with inductively coupled plasma mass spectrometry (LC-ICP-MS) to test MeHg concentration. To date, there is limited research that is focused on the maternal blood MeHg samples using LC-ICPMS in Malaysia. Before analysis, collected blood (500 µL) was placed into a 15 mL polypropylene test tube, followed by the addition of extractant solution [0.10% (v/v) HCl + 0.05% (m/v) L-cysteine + 0.10% (v/v) 2-mercaptoethanol] to the sample and sonicated for 15 minutes. The MeHg level was detected from the sample solution using the LC with Zorbax Eclipse XDB-C18 (4.6 x 12.5 mm, 5 µm) (Agilent Technologies) guard column and analytical column (4.6 x 150 mm, 5 µm) and was quantified by using the ICP-MS. The recovery of MeHg was in the range of 106 to 112% with RSD of less than 10%, followed by the LOD and LOQ

Beverage Intake and the Risk of Gestational Diabetes Mellitus:The SECOST

The contribution and impact of beverage intake to total nutrient and energy intake may be substantial. Given the link between lifestyle, diet, and the risk of pregnancy complications, this study investigated the association between the quantity and types of beverages with gestational diabetes mellitus (GDM) risk. The study included 452 women from the Seremban Cohort Study (SECOST). The mean energy by beverage intake was 273 ± 23.83 kcal/day (pre-pregnancy), 349 ± 69.46 kcal/day (first trimester) and 361 ± 64.24 kcal/day (second trimester). Women significantly increased intake of maternal milks and malted drinks, but significantly reduced the intake of carbonated drinks and other drinks from before until the second trimester of pregnancy. For chocolate drinks, carbonated drinks, and soy milk, women increased intake from pre-conception to the first trimester, but reduced their intake from the first to the second trimester. While higher intake of cultured-milk drinks was associated with an increased risk of GDM, higher fruit juice intake was associated with a lower risk of GDM. However, these associations were only observed for intake prior to pregnancy and during the first trimester. Further research is needed to corroborate these findings and investigate the contributions of different beverages to overall diet quality as well as adverse health outcomes during pregnancy

Sociodemographic determinants of knowledge and attitude in the primary prevention of cervical cancer among University Tunku Abdul Rahman (UTAR) students in Malaysia: preliminary study of HPV vaccination

Background: Cervical cancer is the third most common cancer affecting women around the world in which the Human Papillomavirus (HPV) is the one of the recognized causative agent affecting women health. In response to this health issue, the Malaysian government had officially implemented the HPV immunisation programme for secondary schoolchildren in 2010 at the age of 13 years old and above. The purpose of this study is to investigate the sociodemographic determinants of knowledge and attitude among students of Universiti Tunku Abdul Rahman (UTAR) towards the HPV vaccination programme. Methods: A cross-sectional study was conducted using self-administered questionnaires, recruiting 374 UTAR's students as the respondents by using convenience sampling method. Respondents were categorized as having good/poor level of knowledge and positive/negative attitude towards HPV vaccination. Results: Over half of the respondents were females (64.5%) and the majority were aged 20 years old and below (55.8%). Generally, 54.7% of the total respondents had a high level of knowledge towards HPV vaccine while 57.5% of the total respondents showed a negative attitude towards HPV vaccine. Female respondents aged 20 years old and below showed good knowledge (56.4%) and a more positive attitude (55.8%) towards HPV vaccine. Students from the Faculty of Medicine and Health Sciences (FMHS) exhibited higher knowledge (67.3%) and positive attitude (62.4%) as compared to the Faculty of Accountancy and Management (FAM) which showed only 32.7% of knowledge and 37.6% of positive attitude towards the HPV vaccination. Conclusion: The majority of UTAR students possess good knowledge regarding HPV vaccination. Nonetheless, they demonstrated a negative attitude towards HPV vaccination, depicting the necessity to impart and further intensify the sense of health awareness among all students, especially among male students. The judicious use of social media apart from the conventional mass media should be an advantage as to enhance the practice of HPV vaccination among them and thereafter minimize the health and economic burdens of cervical cancer

Early pregnancy body mass index and gestational weight gain:A mediating or moderating factor for short stature and risk of gestational diabetes mellitus?

This study examined the association between height and the risk of Gestational Diabetes Mellitus (GDM), and whether this association was mediated or moderated by early pregnancy body mass index (BMI) and gestational weight gain (GWG) that are known independent risk factors for GDM. Data of a retrospective cohort of pregnant women (N = 1,945) were extracted from antenatal clinic cards. The cut-off values of height in relation to risk of GDM were identified using receiver operating characteristic analysis and four categories of height were derived: 160cm. Mediation analysis was performed using the Preacher and Hayes bootstrapping method while the moderation effect was tested with multiple regression analysis with interaction terms. Although there was no mediation effect of BMI and GWG on the association between height and risk of GDM, both factors moderated this association with a significant association between shorter height and risk of GDM was observed in overweight / obese women (height < 150 cm: AOR = 1.41, 95% CI = 1.03-2.44; height 156-160 cm: AOR = 1.48, 95% CI = 1.03-2.14). Overweight / obese women with height < 150 cm and excessive GWG at the end of the second trimester (AOR = 2.25, 95% CI = 1.45-4.17) had significantly higher risk of GDM than those without these factors. Short stature (< 150 cm) was significantly associated with GDM risk among OW/OB women with excessive gestational weight gain at the end of second trimester. This finding underscores the importance of maintaining a healthy BMI during reproductive age and gaining weight in recommended range during pregnancy