Clinical behaviour, pathological findings, survival and prognostic factors in young woman in comparison to menopausal women with epithelial ovarian malignancy

Objective: The purpose of this study was to evaluate the clinical behaviour, pathological findings, survival and prognostic factors in young women in comparison to menopausal women with epithelial ovarian malignancy. Methods: A retrospective analysis of 141 patients (67 for age below 40 years and 74 menopausal) treated between 1980 and 2000 was conducted. Results: Irrespective of the stage, the most common clinical presentation was abdominal distension in both young (78%) and menopausal women (66%). In young women, 52% presented at an early stage of the disease and in menopausal women this was seen in 22% (p-value <0.05). The most common histological type of carcinoma in young women was mucinous cystadenocarcinoma (36%) and in menopausal women, it was serous cystadenocarcinoma (47%) (p<0.05).The overall 5-year survival rates in each group were 54% in young women and 41% in menopausal women. The 5-year survival rate appeared to be influenced by the stage of disease and tumour debulking surgery from univariate analysis in both young and menopausal women. In the final multivariate Cox proportional hazard model analysis, the optimal tumour debulking surgery was a significant (0.25; 95% CI (0.1-0.3) p <0.01) independent prognostic factor for survival probability in both young and menopausal women Conclusion: There are limited reports in the literature comparing the outcomes of younger and menopausal women with epithelial ovarian malignancy treated by any gynaecology oncologist from a single academic institution. Our results showed that the proportion of epithelial ovarian malignancy in young women was 30% from the total identified numbers of patients treated for epithelial ovarian malignancy. Although different types of carcinoma occurred in the young and menopausal women, the stage of the disease at presentation and optimal debulking surgery are important prognostic factors to ensure better survival rate

Effect of coitus at term on length of gestation, induction of labor, and mode of delivery.

OBJECTIVE: To determine coital incidence at term and to estimate its effect on labor onset and mode of delivery. METHODS: Healthy women with uncomplicated pregnancies and established gestational age were recruited to keep a diary of coital activity from 36 weeks of gestation until birth and to answer a short questionnaire. Two hundred women with complete coital diaries were available for analysis. Outcome measures include coitus, postdate pregnancy (defined as pregnancy beyond the estimated date of confinement), gestational length of at least 41 weeks, labor induction at 41 weeks of gestation, and mode of delivery. RESULTS: Reported sexual intercourse at term was influenced by a woman's perception of coital safety, her ethnicity, and her partner's age. After multivariable logistic regression analysis controlling for the women's ethnicity, education, occupation, perception of coital safety, and partner's age, coitus at term remained independently associated with reductions in postdate pregnancy (adjusted odds ratio [AOR] 0.28, 95% confidence interval [CI] 0.13-0.58, P = .001), gestational length of at least 41 weeks (AOR 0.10, 95% CI 0.04-0.28, P < .001), and requirement for labor induction at 41 weeks of gestation (AOR 0.08, 95% CI 0.03-0.26, P < .001). At 39 weeks of gestation, 5 (95% CI 3.3-10.3) couples needed to have intercourse to avoid one woman having to undergo labor induction at 41 weeks of gestation. Coitus at term had no significant effect on operative delivery (adjusted P = .15). CONCLUSION: Reported sexual intercourse at term was associated with earlier onset of labor and reduced requirement for labor induction at 41 weeks

A six years review of placenta Accreta Spectrum Disorder in a tertiary referral Hospital

A Six Years Review of Placenta Accreta Spectrum Disorder in a Tertiary Referral Hospital Izzni Adilah Dzulkifli1, Hamizah Ismail1, Zalina Nusee1, Noraihan Mohd Nordin2 1 Department of Obstetrics and Gynaecology, International Islamic University Malaysia, Kuantan, Pahang 2Department of Obstetrics and Gynaecology, Hospital Tuanku Azizah Kuala Lumpur Introduction: Placenta Accreta Spectrum results from the rising caesarean sections, hence impacting maternal morbidity and mortality. This research is a review of women with PAS at a single tertiary center from 2015 till 2020.Materials and method: Data from medical records were collected in which women with PAS were categorized according to their primary surgical approach. SPSS version 25.0 was used for descriptive analysis. Results: There were 65 PAS cases with an overall incidence of 1 per 1000 deliveries. Four cases were excluded due to missing records. PAS affected women of age 35.8+/-4.8(36), 85% were multiparous, 96% of the women had previous caesarean delivery in whom 88% had placenta praevia. Thirty-eight had a primary caesarean hysterectomy, 23 had uterine conserving surgery. Fourteen women required delayed hysterectomy due to complications. Prenatal imaging (US/MRI) had a significant association with the intraoperative findings and histopathological confirmation of PAS (p<0.01).Adjunct procedure (internal iliac artery balloon occlusion, uterine artery embolization, uterine artery ligation) on both groups showed no significant effect on the blood loss (p=0.64).Caesarean hysterectomy were associated with higher blood loss, blood transfusions and bladder injury (p<0.05).There was no maternal death in this study. No pregnancy reported in the uterine conserved group. Conclusion: Previous caesarean delivery is the leading risk factor for PAS. Primary caesarean hysterectomy carries higher morbidity. Conservative approach is possible in selected cases through perioperative planning in an established well-equipped center. KEYWORDS: placenta accreta spectrum, caesarean hysterectomy, conservative surgery, maternal morbidit

Anemia in pregnancy in Malaysia: a cross-sectional survey

Anemia is the most prevalent nutritional deficiency during pregnancy. Except for a study conducted 10 years ago in Kelantan, Malaysia's available statistics are based on isolated small urban maternity hospital studies from the 1980s. There was therefore, a need for a large study at national level to estimate the magnitude of the problem in the country as well as to understand its epidemiology. This multi-center, cross-sectional study was conducted from February to March 2005, to assess the prevalence of anemia. Multistage stratified random sampling technique was used and 59 Ministry of Health (MOH) primary health care clinics were selected. Our final dataset consisted of 1,072 antenatal mothers from 56 clinics. The overall prevalence of anemia in this population was 35 % (SE 0.02) if the cut off level is 11 g/dL and 11 % (SE 0.03) if the cut-off level is 10 g/dL. The majority was of the mild type. The prevalence was higher in the teenage group, Indians followed by Malays and Chinese being the least, grandmultiparas, the third trimester and from urban residence. After multiple linear regression analysis, only gestational age remained significant. These findings are useful for our Maternal Health program planners and implementers to target and evaluate interventions. Work is in progress for outcomes and cost-effectiveness studies to best tackle this problem. In conclusion, the prevalence of anemia is 35% and mostly of the mild type and more prevalent in the Indian and Malays

AN AUDIT OF SINGLETON BREECH DELIVERIES IN A HOSPITAL WITH A HIGH RATE OF VAGINAL DELIVERY

The term breech trial (TBT) has brought about radical changes but it is debatable whether it provides unequivocal evidence regarding the practice of breech deliveries. There is a need to publish the data of a study that was performed before the era of the TBT in a hospital where there was a high rate of breech vaginal delivery. The objectives were to ascertain the incidence, mode of delivery and fetal outcome in singleton breech deliveries. The study design was a retrospective cohort study where 165 consecutive breech and 165 controls (cephalic) were included. Statistical analysis, used were Chi squared and Fischer’s exact test. P<0.05 is taken as the level of significance. The incidence of breech deliveries was found to be 3% and has remained fairly constant but the rate of breech vaginal delivery has fallen and the CS rates have increased. Even though more breech compared to controls were significantly sectioned, majority of the breeches {n=137 (83%)} were planned for vaginal delivery and in these patients two-thirds attained vaginal delivery. There was 1 fetal death in the CS group compared to 12 deaths in the vaginally delivered breech. However, most death in the breech delivered vaginally are unavoidable. In conclusion, there is a high rate of breech vaginal delivery in this series of patients and most perinatal deaths were not related to the mode of delivery

Undang-undang jagaan kesihatan ibu di Malaysia: hak pesakit wanita di hospital kerajaan

Pengenalan Wanita sebagai pesakit adalah satu keadaan biasa. Walau bagaimanapun, pesakit wanita daripada kategori pesakit obstetrik atau ginekologi, mereka berada dalam satu kategori lain. Ini kerana pesakit O&G akan diwadkan di wad bersalin atau bilik bersalin mengikut keperluan kesihatan serta perawatan mereka. Penjagaan dan perawatan di wad bersalin dan bilik bersalin adalah melibatkan rawatan dan penjagaan oleh sekumpulan doktor perubatan, bidan dan jururawat terlatih di dalam bidang kepakaran obstetrik dan ginekologi. Justeru, keutamaan meneliti undang-undang dan perundangan yang berkaitan perlindungan hak pesakit wanita semasa mereka mengggunakan wad bersalin dan bilik bersalin adalah asas utama dalam menentukan sama ada hak-hak tersebut wujud di dalam perkhidmatan jagaan kesihatan berkaitan wanita hamil. Penelitian terhadap peruntukan undang-undang khusus kesihatan wanita, polisi kesihatan serta garis panduan mengenai wanita hamil dibuat bagi melihat impak dan kesan undang-undang, polisi kesihatan atau garis panduan tersebut terhadap perkhidmatan jagaan kesihatan yang diberikan, termasuklah meneliti kelayakan, keupayaan serta jumlah doktor di bahagian obstetrik dan ginekologi samada ianya memenuhi keperluan di wad bersalin dan di bilik bersalin hospital kerajaan. Metodologi Metod kajian doktrinal undang-undang telah digunakan dengan mengambil pendekatan empirikal di mana temuramah dan perbincangan kumpulan fokus telah dilakukan bersama doktor pakar O&G dan pegawai perubatan dan jururawat masyarakat O&G terpilih dari Hospital Bersalin Kuala Lumpur. Keputusan Dapatan menunjukkan terdapat polisi serta garis panduan Kementerian Kesihatan Malaysia yang menggariskan tentang hak pesakit wanita semasa berada di wad bersalin dan di bilik bersalin. Tetapi, terdapat kekurangan dari aspek undang-undang dan polisi kerajaan iaitu tidak terdapat sebarang undang-undang yang khusus berkenaan hak pesakit wanita hamil ataupun dasar yang jelas tentang kesihatan wanita. Kesimpulan Penulisan ini menyimpulkan bahawa terdapat keperluan kepada satu polisi baharu bagi memperkukuhkan tadbir-urus di wad bersalin lantas meningkatkan dan memantapkan mutu jagaan kesihatan sebagai hak pesakit wanita di wad bersalin hospital kerajaan

Is Grandmultiparity A Significant Risk Factor in This New Millennium?

The aim of the study was to assess the outcomes of grandmultiparous women receiving the current obstetric care in Maternity Hospital Kuala Lumpur. Recent data regarding some of the complications are conflicting and the significance of grandmultiparity is now in question. Therefore, a retrospective cohort study of 237 grandmultiparous and 254 multiparous women were undertaken. Chi-squared and t test were used (P<0.05) where appropriate. The results revealed that grandmultiparous women tend to be Malays, age above 35, have late antenatal booking and suffered from anemia and non-proteinuric hypertension. There was no significant difference in diabetes and glucose intolerance, ante partum and post partum hemorrhage. There was a significantly lower risk of first and second-degree perineal tear, and prolonged first stage of labor. There was a significant increased in induction of labor but there was no uterine rupture and no increased in Cesarean Section. There was an increased in meconium stain liquor but there was no increased risk of fetal distress. The fetal outcome was good and there was no tendency to macrosomic infants or shoulder dystocia. With adequate care, the maternal fetal outcome of grandmutiparous women is good and comparable to the multiparous women. Anemia is still common and patient education is important to overcome this problem

Association analysis of 14 candidate gene polymorphism with depression and stress among gestational diabetes mellitus

The association of candidate genes and psychological symptoms of depression, anxiety, and stress among women with gestational diabetes mellitus (GDM) in Malaysia was determined in this study, followed by the determination of their odds of getting psychological symptoms, adjusted for socio-demographical background, maternal, and clinical characteristics. Single nucleotide polymorphisms (SNPs) recorded a significant association between SNP of EPHX2 (rs17466684) and depression symptoms (AOR = 7.854, 95% CI = 1.330–46.360) and stress symptoms (AOR = 7.664, 95% CI = 1.579–37.197). Associations were also observed between stress symptoms and SNP of OXTR (rs53576) and (AOR = 2.981, 95% CI = 1.058–8.402) and SNP of NRG1 (rs2919375) (AOR = 9.894, 95% CI = 1.159–84.427). The SNP of EPHX2 (rs17466684) gene polymorphism is associated with depression symptoms among Malaysian women with GDM. SNP of EPHX2 (rs17466684), OXTR (rs53576) and NRG1 (rs2919375) are also associated with stress symptoms

Factors associated with poor‑to‑moderate quality of life among pregnant women with gestational diabetes mellitus: a cross‑sectional study in Malaysia

Purpose: This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia. Methods: A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis. Results: A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification. Conclusion: Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL

Neonatal outcomes and its association among gestational diabetes mellitus with and without depression, anxiety and stress symptoms in Malaysia: a cross-sectional study

Objective: Prevalence of depression, anxiety and stress symptoms in gestational diabetes mellitus ranges from 10.2% to 39.9% based on previous studies in Malaysia. Presence of depression, anxiety or stress in pregnancy may increase the risk of neonatal morbidity and mortality. The aim of this study was to determine the prevalence of neonatal outcomes and its association among mothers with gestational diabetes mellitus with and without the presence of depression, anxiety and stress symptoms in Malaysia. Design: This was a cross-sectional study. Setting: Tertiary hospitals in Malaysia. Participants: Mothers with gestational diabetes mellitus (n = 418) who deliver their neonates at two major tertiary hospitals in Malaysia. Measurements: Neonatal outcomes, such as low birth weight, preterm birth, macrosomia, metabolic and electrolyte disorders, neonatal respiratory distress and congenital anomalies were determined. Findings: Prevalence of low birth weight in neonates born to mothers with gestational diabetes mellitus was 14.6%, followed by metabolic and electrolyte disorders 10.5%, preterm birth 9.1%, macrosomia 4.8%, neonatal respiratory distress 5.8% and congenital anomalies (2.4%). Among the adverse neonatal outcomes, neonatal respiratory distress was significantly associated with the presence of depression symptoms in mothers with gestational diabetes mellitus using univariate analysis (p = 0.010). After controlling for confounding factors, predictors for neonatal respiratory distress at delivery were the presence of depression symptoms in mothers with gestational diabetes mellitus (Adjusted OR = 3.87, 95% CI = 1.32-11.35), living without a husband (Adjusted OR = 9.74, 95% CI = 2.04–46.51), preterm delivery (Adjusted OR = 7.20, 95% CI = 2.23–23.30), caesarean section (Adjusted OR = 3.33, 95% CI = 1.09–10.15), being nulliparous and primiparous (Adjusted OR = 3.62, 95% CI = 1.17–11.17) and having family history of diabetes (Adjusted OR = 3.20, 95% CI = 1.11–9.21). Key conclusions: The findings of this study demonstrate the positive association of neonatal respiratory distress with the presence of depression symptoms in mothers with gestational diabetes mellitus. Implications for practice: It is therefore important to identify depression symptoms after a diagnosis of gestational diabetes mellitus in pregnant mothers is made to enable early referral and interventions