A dilemma in management of intrauterine death in mother with major placenta previa

Placenta previa is a condition when the placental tissue extends over the internal cervical os. It is associated with maternal and fetal morbidity and mortality. With intrauterine death, the mode of delivery will be more difficult to decide. Here, we report a case of 30 years old G3P2 with placenta previa major diagnosed with intrauterine death at 29 weeks gestation who was managed conservatively and delivered vaginally with minimal complication. A good patient selection and thorough counseling, patient with placenta previa major and intrauterine death still can be safely delivered vaginally

Role of first trimester ultrasound scan as a predictor of monochorionic diamniotic complications

Introduction: Monochorionic twin pregnancies come with substantially higher complications compared to their dichorionic counterparts, which include intrauterine fetal death, fetal loss prior to 24 weeks, selective intrauterine growth restriction and twin-to-twin transfusion syndrome (TTTS). Objectives: This work aims to examine the inter-twin discrepancy in nuchal translucency thickness (NT), crown-rump length (CRL), fetal heart rate (FHR) and ductus venosus Doppler (DV), as predictors of complications in monochorionic diamnotic twins (MCDA). Methods: This is a retrospective study that involves 118 MCDA pregnancies followed-up in a tertiary centre, from January, 2011 to June, 2016. NT was measured at 11 to 13+6 weeks’ gestation in 23 MCDA pregnancies. Regression analysis was employed to determine the significance of the association between inter-twin discrepancy in NT, CRL, FHR and DV Doppler with intrauterine death of both fetuses and monochorionic (MC) complications such as TTTS, selective intrauterine growth restriction (sIUGR) and twin anemia and polycythemia sequence (TAPs). Results: Multiparous mothers (53.8%) aged between 19 and 35 years (89.9%) contributed to the majority of MCDA twin pregnancies. Among a total of 118 MCDA pregnancies, 16.8% (n=20) developed complications. About 3.4% (n=4) of them had TTTS, and 10.9% (n=13) had sIUGR, while only 0.9% (n=1) developed TAPs and intrauterine fetal death (IUFD) of both fetuses each. A significant prediction of MC complications and intrauterine death was provided by discordant NT of 35% or more (p= 0.021) with a relative risk of 4.0 (95% CI 1.2312.99), a sensitivity of 57.1% and a specificity of 88.2%. Otherwise, there exist no significant associations between discrepancy in CRL, FHR and DV Doppler and MC complications. Conclusions: Inter twin discordance in NT of 35% or more was reported in about 25% of MCDA twins in this group, with the risk of developing MC complications and intrauterine death of over 40%. Among other parameters, it is the early predictors of hemodynamic imbalance between both twins that significantly contribute to a more reliable screening tool for MCDA pregnancies with high specificity

An observational study of serum vitamin D levels in pregnancy complicated with spontaneous preterm birth.

This observational study was conducted in the Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre. The eligible women were grouped into 3 arms after assessment of antenatal history, vitamin D level and bacterial vaginosis status. Women who continued their pregnancy till term were allocated as the control arm, whereas the preterm arm was further divided into pregnancies continued until term and those who delivered prematurely. The pregnancy and the neonatal outcomes were measured

Low methylation of matrix metalloproteinase 1 (MMP1) is associated with preterm labour in Malaysian mothers

Preterm births comprise 10.6% of livebirths worldwide and account for 35% of deaths among newborn babies. Understanding DNA methylation may offer basic knowledge in the understanding of pathogenesis of preterm labour. The study was undertaken to determine DNA methylation of matrix metalloproteinase 1 (MMP1) promoter in term and preterm labour using methylation-specific polymerase chain reaction (MSP). Thirty maternal venous blood samples (n=15 each) of term and preterm labour was subjected to bisulfite treatment prior to MSP. This result was then validated using DNA sequencing. Evaluation of the sequencing results by CpG islands analysis was performed using the ClustalW and SPSS software. Primers for MMP1 were located between -1226 and -1378 upstream from the transcription start site (TSS) that consisted five CpG islands. Preterm labour group had significantly lower methylated CpG islands with 39 out of total 75 (52%) compared to the term labour that has 49 out of 75 methylated CpG islands (65.33%) (t=0.694, p<0.05). Methylation occurred in 4 out of 5 methylated CpG islands in the MMP1 promoter where it only involved 2 preterm samples (13.33%) and 7 term samples (46.47%). This data suggested there were significant lower percentage of methylated MMP1 in preterm labour. Higher percentage of methylated MMP1 as observed in the term labour, will probably reduce the expression of MMP1, thus maintaining fibrillar collagen strength on the amniotic membrane and subsequently maintain the pregnancy till term. In conclusion, preterm labour has higher percentage of methylated CpG compared with term labour in MMP1 gene

Disengagement of impacted fetal head during caesarean section in advanced labour using C-snorkel device versus the conventional method: a randomised control trial.

This pilot study was a randomized control trial conducted in the labour ward and operating theatre of Pusat Perubatan UKM, between May 2013 to September 2013. The trial included 34 women whom were in advance labour during caesarean section. The C-snorkel device was used to disengage an impacted fetal head during caesarean section. Maternal outcomes evaluated were blood loss, blood transfusion, duration of surgery, incidence of extended tears and post operative infection. The fetal outcomes evaluated were APGAR score at 1 and 5 minutes, umbilical cord pH, trauma to the fetus during delivery and admission to the neonatal intensive care unit

Usage of mobile applications in diabetes management: a review

Peer-reviewed articles on the usage of mobile applications in the management of diabetes were reviewed. Studies using mobile device applications for diabetes interventions published between January 2007 and March 2013 were included in this review. Studies related to the developmental processes of the mobile applications were excluded. The characteristics of these studies and the outcomes of the methods used in the management of diabetes were gathered. We retrieved a total of 372 articles from ACM Digital library, PubMed and Proquest Medical Library. After applying the inclusion and exclusion criteria, 8 articles were eligible for further review. Most of the studies included in this review showed the effectiveness of mobile applications in diabetes management. Their major contribution comes from feedback functions of the systems that assist participants in the self-monitoring of their blood glucose and dietary intake. However, the majority of the studies showed the limited use of the mobile phone as a tool to input information into systems which would in turn convey a reminder message to the patient. In conclusion, with its features of portability and convenience, mobile application used in the management of diabetes has the potential to improve glycaemic control, resulting in significant clinical and financial benefits

Current dietetic practices in the management of gestational diabetes mellitus: a survey of Malaysian dietitians

The role of the dietitian in the management of Gestational Diabetes Mellitus (GDM) is highly recognised. However, consensuses on dietetic approaches for the management of GDM in Malaysia are scarce. This study aimed to examine the current dietetic practices in the management of GDM and to compare nutrient recommendations provided by dietitians to those of several established international guidelines. A survey was conducted among dietitians who were working in government affiliated hospitals across Malaysia. Of 148 questionnaires posted to dietitians, a total of 101 were returned representing an overall response rate of 68%. The majority of the dietitians (80%) reported that they see women with GDM in their daily practices with more than half (53%) having counselled 5 to 9 women per day during the previous 3 months. Flexible carbohydrate exchanges (82%) was the most common recommendation on carbohydrate intake followed by advice regarding small frequent meals spread over the day (62%) and portion control by using the plate method (54%). Only 11% dietitians incorporated the use of the glycaemic index as a measure of carbohydrate intake into their intervention. While recommendations regarding protein intake were consistent with established guidelines, the amount of carbohydrate recommended by the dietitians was higher than that in established guidelines. Although consistency was seen in key components of nutrition intervention, there were differences in the delivery of nutrient recommendations particularly in regard to dietary carbohydrate intake indicating a need for consensus on dietetic practice guidelines for the management of GDM

Anti N-Methyl-D-Aspartate Receptor encephalitis with ovarian teratoma: a dilemma in diagnosis

We report a rare case of altered mental status in a young patient with immature ovarian teratoma. A 22-year-old woman presented with seizures, hallucination, amnesia and orofacial dyskinesia. Examination and investigation revealed an ovarian massand asalphing-oophorectomy was performed. The histopathological examination result showed an immature teratoma grade 2 with thepresence of immature primitive glial tissue. Her CSF N-Methyl-D-Aspartic acid receptor (Anti-NMDAR) antibodytest was positive. N-Methyl-D-Aspartic acid receptor antibody associated limbic encephalitis is an autoimmune antibody-mediated neuropsychiatric disorder. Resection of the tumour and immunotherapy resulted in full recovery

Case control study of anxiety and depression among patients with miscarriage compared to those with successful pregnancy

Miscarriage is one of the most common complications in pregnancy. There is emerging evidence that psychological impact following miscarriage is not unusual. Understanding the magnitude of psychological morbidity is important in the management of miscarriage. The main objective of this study was to compare the mean Hospital Anxiety and Depression Scale (HADS) score between women with miscarriage and women with successful pregnancy and to determine the socio-demographic factor and clinical characteristic that are associated with anxiety and depression. A descriptive case control study was conducted in a teaching hospital, over a period of 12-months (from October 2014 till September 2015). A total of 65 women were recruited with 32 women as the study group (miscarriage) and another 33 women as the control group (women with successful pregnancy). Mean HADS-anxiety score was higher in the study group compared to control group although it was not statistically significant (6.53 ± 3.427 vs 5.73 ± 2.875, p=0.309). Mean HADS-depression score was higher in the control group (4.34 ± 2.695 vs 4.45 ± 3.073, p=0.878). Women with maternal age more than 35 years and history of previous miscarriage had a higher tendency of anxiety and depression with higher mean HADS score. There was no association between other socio-demographic data and clinical characteristic with risk of anxiety and depression. As conclusion, there was no significant difference in women with miscarriage as compared to those with successful pregnancies, although older women with history of miscarriage had a preponderance to both disorders

Comparing efficacy of octyl-cyanoacrylate dermabond adhesive glue versus vicryl 3/0 suture for closure of caesarean section skin incision in UKMMC- a prospective randomised controlled trial.

This is a prospective randomised controlled trial conducted at a tertiary hospital on 82 women who underwent caesarean section. The study group, 41 women underwent dermabond skin closure whereas the control group, 41 women had subcuticular vicryl skin closure. Anaesthesia, prophylactic antibiotic, operative technique and post-operative oral analgesia was standardised between both groups. Outcomes that were measured at day 2 before discharge and at postoperative day 10-14 were pain score using VAS, duration and total analgesic dose (after day 2), time taken for skin closure and adverse events between both groups in particular inflammation, surgical site infection and allergic reaction (itching)