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

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

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

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

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

The role of antenatal vitamin e supplementation in the prevention of neonatal jaundice.

Objective: To determine the effect of maternal antenatal vitamin E supplementation on neonatal jaundice. Methods: A randomized double blind controlled trial assessing the role of vitamin E in the prevention of preeclampsia was conducted in a tertiary hospital over two years. From 12-16 weeks gestation until delivery, primigravida mothers with singleton pregnancies received either 100 mg daily vitamin E in the form of tocotrienol rich fraction, or placebo. The newborns were assessed for jaundice. Results: Among 262 infants, 136 were in the vitamin E group and 126 in the placebo group. The incidence of neonatal jaundice was similar: 38% (54/136) in the vitamin E group and 36% (45/126) in the placebo group (p= 0.10). Nevertheless, the vitamin E group had a tendency for lower peak serum bilirubin, although not significantly so. Conclusion: Maternal antenatal vitamin E supplementation had no effect on the incidence of neonatal jaundice

Simulation in healthcare in the realm of Education 4.0

The advent of Education 4.0, in parallel with Industrial Revolution (IR) 4.0, has translated into an evolution in healthcare education. Simultaneously, as a result of concerns in doctors’ competency and patient safety, simulation shot into center-stage in the field of healthcare education. Generally, there are five modalities in healthcare education, namely role-play (verbal), standardized patient, part-task trainer, computer or screen-based simulation, and electronic patients including virtual reality. Dissecting the nine principles of Education 4.0, this article reviews the relevance and role of the five different modalities of simulation in easing healthcare education into the mold of Education 4.0