Approaches to adenomyomectomy

Adenomyosis is a common gynecological condition that affects women, causing menstrual disturbances, pain, and subfertility. Adenomyomectomy as an alternative to hysterectomy has been widely performed in those who have not completed childbearing or those refusing a hysterectomy for a variety of reasons. Whichever the surgical route, the challenges of adenomyomectomy include possible misdiagnosis, defining the extent of resection, technical difficulties, dealing with the associated complications, and managing the risks of uterine rupture during a subsequent pregnancy. The principles of surgery mimic those of myomectomy, but the evolution of adenomyomectomy has been relatively unexciting with a general paucity of published data to date. Laparoscopic techniques have proven feasible generally, avoiding the risks of open surgery while conferring the benefits of microsurgery. Limitations in tactile feedback and access constraints have been the main drawbacks via this route. Meticulous stitching and repair is still of paramount importance in these operations. Preoperative gonadotropin-releasing hormone agonists have proven effective in shrinking the disease and reducing blood loss during surgery, whereas the postoperative use has resulted in a dramatic reduction in symptoms. Uterine artery ligation techniques have also been shown to be useful adjuncts, although we still need to be mindful of the potential effects in those desiring fertility. Furthermore, there is still no foolproof way in predicting those at risk of uterine rupture after adenomyomectomy. Hence, a nonprescriptive approach in managing adenomyomas is advised, where proper patient selection and counseling are important

Amniocentesis increases level of anxiety in women with invasive prenatal diagnosis of Down syndrome

Backgound \ud Invasive prenatal diagnosis (PND) through amniocentesis and chorionic villus sampling (CVS) can detect Down syndrome. Pregnant women usually experience a variety of psychological responses associated with invasive PND. This study is intended to assess depression, anxiety and stress levels and the factors related to their psychological responses in pregnant women with invasive prenatal diagnosis of Down syndrome.\ud \ud Methods \ud A cross sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital, Singapore. The psychological responses of 70 women undergoing PND were assessed by Depression Anxiety Stress Scale 21 (DASS 21) questionnaire. A multiple linear regression analysis was used to analyze association between knowledge and perceived risk with psychological responses (CI 95% and significance value p<0.05).\ud \ud Results \ud More than half of the participants had normal anxiety (55.7%), stress (72.8%), depression levels (65.8%). The results revealed significantly higher level of anxiety in women with gestational age >13 weeks who had pursued amniocentesis. Women with no previous children had higher levels of depression and stress. Women who pursued amniocentesis had significantly higher anxiety scores compared to women undergoing CVS (p=0.015).\ud \ud Conclusions \ud Women’s psychological responses are associated with gestational age, type of procedure and parity. The level of anxiety increased in women who underwent amniocentesis for diagnosis of Down syndrome. Knowledge and perceived risk of having a baby with Down syndrome do not seem to have psychological effects to women

Minimally invasive surgery for gynecological cancers: Experience of one institution

Objective: Minimally invasive techniques are increasingly used in gynecological cancer surgery. Although many studies worldwide have looked at the safety and outcomes of the laparoscopic approach to gynecological cancers, there is a lack of data on this subject in our local setting. We therefore reviewed the safety and morbidity of laparoscopic techniques for gynecological cancers in Singapore's largest gynecological cancer center. Methods: We carried out a retrospective review of a prospectively maintained database of all patients from Kerdang Kerbau Women's and Children's Hospital who underwent laparoscopic staging surgery for gynecological cancers over a 5-year period from January 2008 to December 2012. We obtained information on patient demographics, the clinical–pathological features, and perioperative and follow-up details, including intraoperative and postoperative complication rates, from clinical notes and electronic records. Results: In total, 142 patients were included in the study. Ninety-eight patients underwent full staging surgery for endometrial cancer and 44 patients underwent full staging surgery for cervical cancer. One hundred and twenty-one operations were laparoscopic hysterectomies and 21 were laparoscopic radical hysterectomies. The overall conversion rate was 0.7%. The median length of the operation, the length of stay in hospital, the intraoperative complications, the lymph node yield, and the postoperative complication rates were comparable with previously published data from other institutions. At a median follow-up time of 29 months, the recurrence rates were 4.1% and 14.2% for laparoscopic hysterectomy and laparoscopic radical hysterectomy, respectively. Conclusion: Laparoscopic surgery for gynecological cancers at our institution is safe, with morbidity statistics comparable with those of other centers

Asia-Pacific consensus on physical activity and exercise in pregnancy and the postpartum period

Physical activity and exercise in pregnancy are generally beneficial and enhance the physical and mental health of women. These benefits also prevent excessive weight gain and reduce risks of obesity in pregnancy, such as gestational diabetes, hypertensive disorders, higher rates of caesarean delivery, macrosomia and stillbirth. Thus, there is a need to optimise perinatal exercise and physical activity globally. There is currently no consensus recommendation on the role of physical activity and exercise in pregnancy and the postpartum period in the Asia-Pacific region. In this paper, we present seven key consensus recommendations on physical activity and exercise in pregnancy and the postpartum period by 18 key members representing 10 countries in Asia-Pacific regions during an international workshop of the AsiaDiabetes in Pregnancy Conference in Singapore on 11–12 January 2020. Through these consensus recommendations, we hope to improve the metabolic health of pregnant women living in Asia-Pacific regions by educating the public and guiding healthcare professionals on the safety and importance of physical exercise and activity to benefit pregnant women and after childbirth

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

ANNALS ACADEMY OF MEDICINE SINGAPORE4911857-869Singapor