Kuldip Singh

A comparative study using two dose regimens (200 μg or 400 μg) of vaginal misoprostol for pre‐operative cervical dilatation in first trimester nulliparae

Objective To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre‐operative cervical dilatation.

Vaginal misoprostol for pre‐abortion cervical priming: is there an optimal evacuation time interval?

Objective To determine the optimal evacuation time interval in the use of vaginal misoprostol for cervical priming before first trimester termination of pregnancy.

A comparison between intravenous iron polymaltose complex (Ferrum Hausmann) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy.

Abstract: Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases. Over 90% of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake. The two main modalities of treating iron deficiency anaemia are oral or parenteral iron. Ferrous Hausmann® (iron dextrin) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion. This study compares the efficacy of Ferrum Hausmann® with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy. Our study shows that treatment with intravenous Ferrum Hausmann® (iron dextrin) resulted in a significantly better level and rate of increase of haemoglobin (p<0.001). Serum ferritin, which is the best indicator of iron stores, was significantly higher (p<0.001) in the intravenous group. Other indices of iron status such as serum iron, serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron. The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently, completely and at a faster rate than oral iron therapy, thus providing the fuel for stimulation of full erythopoiesis compared to oral iron. There were also no reports of any adverse reactions with intravenous iron dextrin, whereas there were a considerable proportion of women on oral iron therapy who reported side effects. In conclusion, intravenous iron therapy with Ferrous Hausmann® (iron dextrin) is a suitable, effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy.

The influence of abortion legislation on maternal mortality.

Worldwide some 20 million unsafe abortions take place each year and account for approximately 13% of all maternal mortality and serious complications associated with it, such as sepsis, hemorrhage and trauma. Only a quarter of all women in the world do not have any access to legal abortion, whereas 40% have a legal right to decide for themselves. This liberalization of abortion legislation has seen a tremendous drop in abortion‐related maternal mortality. Death from unsafe abortions are almost unknown in countries where abortion is available on request. Reduction of the need for induced abortion through the provision of good family planning services should be an integral part of healthcare. Consistent use of contraception greatly reduces the need for abortion, but it cannot completely eliminate this need. Thus, it is essential that safe medical abortion services should be made available to all women in the world in cases of contraceptive failure.

A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks

Objective To study the efficacy of repeated doses of vaginal misoprostol over 9 hours in a day care setting for terminating pregnancies up to eight weeks of gestation.

Abortion Trends in Singapore: A 25-Year Review

STUDY OBJECTIVE Abortion legislation in Singapore has gone through dramatic changes in the past 25 years. In this paper, we studied the effect of abortion legislation on abortion trends in Singapore. SETTING AND PARTICIPANTS The Ministry of Health, Singapore, collects data on all abortions performed in Singapore. These data have been analyzed and are presented in this paper. RESULTS The liberalization of abortion legislation resulted in a dramatic increase in the number of abortions performed beginning in 1974. The rate peaked at 23,512 abortions in 1985, and in fact, 35% of all pregnancies were terminated in 1985. The introduction of mandatory abortion counseling in 1986 resulted in a decline in the number of abortions to 16,476 in 1993 with only 24.6% of pregnancies being terminated. The teenage abortion rate was 0.2 per 1000 female teenagers under 20 years of age in 1970. With the liberalization of abortions, the rate reached a peak of 13.7 per 1000 female teenagers in 1985. In 1993, the teenage abortion rate was 9.5%. The proportion of nulliparous women seeking abortion has increased phenomenally from 0.5% in 1976 to 40.6% in 1993. Close to 95% of the women seeking abortions in 1993 did so for social reasons, 3.7% for medical reasons, and 2.0% for failed contraception (Table 3). CONCLUSION Mandatory abortion counseling and a change in the government policy which now encourages Singaporeans to have more children if they can afford it, have resulted in a decrease in the number of abortions being performed. The problems of teenage abortions, nulliparous abortions, and repeated abortions need to be further addressed.

Intravenous iron polymaltose complex for treatment of iron deficiency anaemia in pregnancy resistant to oral iron therapy

To the Editor: Anaemia in pregnancy is a common problem in both developed and developing countries. In over 90% of cases anaemia is due to red cell iron de®ciency associated with depleted stores and de®cient intake (1, 2). While the majority of women with iron de®ciency anaemia can be treated with oral iron, there remain a group who are resistant to oral therapy. We present two patients with iron de®ciency anaemia in pregnancy who were initially treated with oral iron. Compliance was ruled out as a cause of therapy failure for the ®rst, as she was an in-patient throughout the period of treatment. The second patient was given multiple blood transfusions for her ®rst three pregnancies as she did not respond to oral iron. Both responded well to intravenous iron polymaltose complex given as a total dose infusion (TDI), with evidence of repletion of iron stores.

A comparison of the clinical performance, contraceptive efficacy, reversibility and acceptability of Norplant implants and Ortho Gynae T380 intrauterine copper contraceptive device

In this comparative study, the five-year continuity rate of 53.7% in the Norplant implants group was comparable to that of 52.7% in the copper IUD group. The difference was not statistically significant. Only one accidental pregnancy occurred during the five years of copper IUD use.Desire for future pregnancy was the main reason for removal in the Norplant implants group (35.9%) while expulsion of the IUD (13.2%) was the main reason for removal of the copper IUD. Menstrual disturbance was not a major side-effect in either group.The post-removal conception rates of 78.6% in the Norplant implants group and 75.0% in the copper IUD were good and comparable.Both the Norplant implants and copper IUD are acceptable and effective contraceptive methods in Singapore.

Acceptability of Norplant®-2 rods as a method of family planning

The Norplant-2 rod system consists of two silastic rods in which levonogestrel has been incorporated with the polymer. The continuation rate at the end of five year was 62%. No accidental pregnancies occurred throughout the five years of use. The post-removal conception rate in women desiring pregnancy was 70.8% at the end of two years. The majority of acceptors were happy with the rods and 86.8% expressed the desire to have another set of implants inserted following removal of the first set. The study shows the Norplant-2 rod system to be a well accepted method of family planning.

Profiles of women presenting for abortions in Singapore: focus on teenage abortions and late abortions

OBJECTIVE Teenage abortions predispose women to adverse pregnancy outcomes in subsequent pregnancies such as anemia, stillbirths, preterm deliveries and low birth weight babies. We aim to profile the women presenting for abortions in our institution and determine risk factors for late presentation for abortions. STUDY DESIGN In this retrospective cohort study, all women who underwent an abortion at the National University Hospital, Singapore, from 2005 to 2009 were recruited. Data was obtained from a prepared questionnaire during the mandatory pre-abortion counseling sessions. Profiles of women aged <20 years were compared with those ≥ 20 years old using Chi-square test if the assumptions for Chi-square test were met; otherwise, Fishers exact test was carried out. Logistic regression was used to investigate the risk factors for second trimester termination of pregnancy. RESULTS 2109 women presented for induced abortions, of which 1998 had single abortion throughout the course of the study. The mean age of women with single abortion was 29.1 years (sd 7). In the group of women with single abortion, 182 (9.1%) were teenage abortions. In contrast to women ≥ 20 years of age, pregnant teenagers were more likely not to have used any contraception (51.1% vs. 25.2%) and more likely to present late for abortions (39.6% vs. 15.9%). Other risk factors for late presentation for abortions include Malay ethnicity, singlehood, nulliparity and lack of prior usage of contraception. CONCLUSION Teenagers are more likely to have no prior contraceptive usage and to present late for abortions. Lack of proper sexual education and awareness of contraceptive measures may have a major contributory factor to such a trend in teenage abortions. Recommendations have been made in order to curb this societal problem.