Abdul Kadir Abdul Karim

Case report of ruptured non-communicating right rudimentary horn pregnancy: an acute emergency.

Ruptured pregnancy in the rudimentary horn of women who have had a vaginal delivery is rare and unpredictable. However, when undiagnosed, this condition could lead to maternal morbidity and mortality. We report a pregnancy at 19 weeks gestation presented with acute abdomen and hypovolemic shock. She was initially thought to have an intrauterine pregnancy with the provisional diagnosis of a ruptured uterus. Intraoperatively, a ruptured non-communicating right rudimentary horn with ex utero pregnancy was discovered.

Cesarean scar pregnancy: What can we offer?

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where implantation of the gestational sac occurs at the previous scar with the surrounding myometrium [1]. The incidence reported by Seow et al [2] was extremely low (approximately 1 in 2000), which is consistent with the prevalence of 1:1800 reported by Jurkovic et al [3]. The precise mechanism is still not clear and poorly understood. Implantation of the conceptus into the myometrium through a microscopic tract or scar defect had been suggested [4]. Catastrophic and life-threatening complications such as uterine rupture and massive hemorrhage could occur in case of misdiagnosis. Therefore, prompt and early diagnosis is essential to facilitate early intervention. This is a case of CSP successfully treated with local injection of methotrexate (MTX) and hypertonic dextrose solution. Subsequent vaginal bleeding after the termination of CSP was effectively controlled by tranexamic acid followed by gonadotropin releasing hormone analog (GnRHa). This approach resulted in avoidance of surgical intervention. A 30-year-old gravida 3 para 2 woman in the 9th week of amenorrhea who had two previous cesarean sections (CSs), was referred for an incidental finding of CSP during her first antenatal visit. She was asymptomatic, and the result of her physical examination was unremarkable. An ultrasound scan noted a gestational sac embedded at the previous CS scar. The pregnancy was considered viable with a crown rump length of 25.8 mm. The uterine cavity was empty with no free fluid seen in the pouch of Douglas (Figs. 1e3). Her serum beta human chorionic globulin

Feasibility of successful pregnancies in women with spinal injury

is up to 10 – 12 h. One study at an emergency department in San Francisco has given the incidence of seizures secondary to amphetamine usage at 25% (Alldredge et al. 1989). Th e seizure pattern is distinct, with seizures that are generally brief and, in contrast to eclampsia, lack a clonic phase aft er the initial ictal event (Hanson et al. 1999). Clearly it is possible that ingestion of the drug the previous evening resulted in side-eff ects such as diarrhoea, vomiting, nausea and eventually seizure activity the following morning. Follow-up was essential for this woman, in order to advise her with regard to the risks of continued amphetamine use, including mood disorders and the possibility of myocardial infarction and stroke. Her general practitioner was also alerted, but no safeguarding issues were identifi ed for her children following further investigation.

The World Health Organization (WHO) versus the International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria of gestational diabetes mellitus (GDM) and their associated maternal and neonatal outcomes

Abstract Background Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. The aim of this study was to compare the prevalence of GDM using the World Health Organization (WHO) criteria and the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in our population. We further compared the incidence of adverse maternal and neonatal outcomes in women diagnosed with GDM using these criteria and determined whether the IADPSG criteria is suitable in our population. Methods This randomized controlled trial was conducted at our antenatal clinic involving 520 patients from 1st February 2015 until 30th September 2017. They were randomized into the WHO and the IADPSG groups. All eligible women underwent a standard oral glucose tolerance test with 75 g glucose, their fasting and 2 h post prandial glucose levels were taken. The primary outcome was the prevalence of GDM. The secondary outcomes were the incidence of primary cesarean section, gestational hypertension or preeclampsia, preterm delivery <37 weeks, fetal macrosomia, neonatal hypoglycemia and shoulder dystocia or birth injury. Results The prevalence of GDM in both groups were similar (37.9% vs. 38.6%). GDM women in the WHO group had a significantly higher incidence of gestational hypertension or preeclampsia (p = 0.004) and neonatal hypoglycemia (p = 0.042). In contrast, GDM women in the IADPSG group had a significantly higher incidence of fetal macrosomia (p = 0.027) and cesarean section (p = 0.012). Conclusion The IADPSG diagnostic criteria for GDM may not be suitable for use in our population as it resulted in women being diagnosed later and being undertreated, thus leading to adverse maternal and neonatal outcomes.

Reviewing the role of progesterone therapy in endometriosis

Abstract Endometriosis is a benign, chronic inflammatory condition characterized by the presence and growth of endometrial implants outside the uterine cavity. The cause of endometriosis is multifactorial. It is due to the diversity of hypothesis and plausibility of hormonal alterations which could play a major role. Evidence has shown that progesterone resistance is a key factor for endometriosis sufferers. Medical therapy can avoid surgical intervention, which may lead to a reduced in ovarian reserve, and its effects of earlier menopause and reduced fecundity. Progesterone receptor isoform has provided new insight as the potential treatment. Progestin, anti-progestin and selective progesterone receptor modulators usage, which target these receptors, could avoid hypo-estrogenic side effects, which can be debilitating. Numerous types of these medications have been used on and off labeled to treat endometriosis with varying success. This review aims to consolidate series of clinical trials using progestins in endometriosis.

Maternal thyroid function in women undergoing controlled ovarian hyperstimulation during in-vitro fertilization and its relation to reproductive outcome

BACKGROUND We conducted a study to evaluate the changes in thyroid function during controlled ovarian hyperstimulation (COH) and its association with the outcome of assisted reproductive technique (ART). METHODS This is a prospective cohort study done in University Hospital Fertility Clinic for one year duration. A total of 88 euthyroid women who underwent COH as part of planned in-vitro fertilization (IVF) were invited to participate in this study. Serum thyroid function of each women will be monitored before stimulation (T1), day 10-13 of cycle (T2), during oocyte retrieval (T3), one week following embryo transfer (T4), and at four weeks after embryo transfer (T5). Reproductive outcome of IVF will be observed and documented. RESULTS Nine women had ongoing singleton pregnancy, seven suffered from miscarriage, while the rest had implantation failure. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) increased throughout stimulation, peaking at 32-36 hours after hCG administration compared to baseline (1.250 vs. 1.740 mIU/L and 13.94 vs. 15.25 pmol/L). It remains elevated until one week following embryo transfer. The increment of serum TSH exceeded the upper limit, acceptable for first trimester (<1.60 mIU/L). However, the evolution of serum TSH and fT4 did not significantly differ with pregnancy outcome. CONCLUSIONS In euthyroid women, thyroid function changed significantly during COH, but these changes were not different between the three reproductive outcomes. Thus, we do not suggest continuous thyroid function monitoring during COH.

Back pain in pregnancy among office workers: risk factors and its impact on quality of life

Abstract Background Back pain is a common presenting complaint during pregnancy and it is often being considered as part of the pregnancy process. The purpose of the study is to investigate the prevalence of back pain in pregnancy, risk factors and its impact on the quality of life in pregnant women. Materials and methods Three hundred and fifty-eight pregnant women who attended the antenatal clinic in Universiti Kebangsaan Malaysia (UKM) Medical Centre were recruited in this cross-sectional study from October 2011 until April 2012. The back pain was further classified into lumbar pain and posterior pelvic pain. The severity of back pain was assessed using visual analoque scale (VAS) and the functional limitation was assessed using the Oswestry Disability Questionnaire (ODQ). Result The prevalence of back pain in pregnancy was 84.6%. Occupation and previous history of back pain were associated with back pain in pregnancy. In terms of functional limitation disability, total ODQ score was statistically significant correlate with severity of pain (VAS score). Personal care, sitting, standing, sex life and social life were significantly affected. Conclusion The risk factors for back pain in pregnancy were type of occupation and history of back pain. The higher VAS score, the more ODQ will be affected. Personal care, sitting, standing, sex life and social life were significantly affected.

Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

Acupressure only as pain relief for patient with multiple drug allergies undergoing oocyte retrieval

In vitro fertilization (IVF) is associated with significant stress, which can affect the general wellbeing of the couple as well as the outcome of treatment. Oocyte retrieval (OR) is the fundamental step in the IVF/intracytoplasmic sperm injection (ICSI) cycle. Transvaginal ultrasound-guided OR (TVOR) is the most common method used in assisted reproductive technology (ART). However, even though TVOR is a short and minimally invasive procedure, it is stressful and undoubtedly painful [1]. Such pain is due to the passage of a double-bore needle through the vaginal wall and ovarian capsule followed by mechanical stimulation within the ovary during the procedure.

Use of hydroxyprogesterone caproate to prevent preterm labour in uterine didelphys: a case report.

Abstract Congenital uterine anomalies have been associated with poor reproductive outcome, which include recurrent miscarriage, abruptio placenta, intra-uterine growth restriction and preterm delivery. Here, we report a case: 36 years old, G3P2, known case of uterine didelphys, with history of preterm birth, who successfully carried her pregnancy till term with weekly intramuscular injection of 250 mg hydroxyprogesterone caproate (®Proluton Depot, Zuellig Pharma).