Mohd Hashim Omar

Microarray profiling of secretory-phase endometrium from patients with recurrent miscarriage

The aim of the present study was to identify differentially expressed genes and their related biological pathways in the secretory phase endometrium from patients with recurrent miscarriage (RM) and fertile subjects. Endometrial samples from RM and fertile patients were analyzed using the Affymetrix GeneChip® ST Array. The bioinformatic analysis using the Partek Genomic Suite revealed 346 genes (175 up-regulated and 171 down-regulated) that were differentially expressed in the endometrium of RM patients compared to the fertile subjects (fold change ≥1.5, p<0.005). Validation step using quantitative real-time polymerase chain reaction (qPCR) confirmed a similar expression pattern of four exemplary genes: one up-regulated gene (fibroblast growth factor 9, FGF9) and three down-regulated genes: integrin β3 (ITGB3), colony stimulating factor 1 (CSF1) and matrix-metalloproteinases 19 (MMP19). The Gene Set Enrichment Analysis (GSEA) and the Pathway Studio software have found 101 signaling pathways (p<0.05) associated with the affected genes including the FGFR3 /signal transducer and activator of transcription (STAT) pathway and the CSF1R/STAT pathway. Cell adhesion, cell differentiation and angiogenesis were among biological processes indicated by this system. In conclusion, microarray technique is a useful tool to study gene expression in the secretory phase-endometrium of RM patients. The differences in endometrial gene expressions between healthy and RM subjects contribute to an increase in our knowledge on molecular mechanisms of RM development and may improve the outcome of pregnancies in high-risk women with RM.

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.

Comparison between Amnisure Placental Alpha Microglobulin-1 Rapid Immunoassay and Standard Diagnostic Methods for Detection of Rupture of Membranes

Objective. To determine the diagnostic accuracy of placental alpha microglobulin-1 assay and standard diagnostic methods for detecting rupture of membrane. Study Design. Prospective diagnostic study, between June 2011 to November 2011 at a tertiary centre. Initial evaluation included both the standard diagnostic methods for rupture of membranes and placental alpha microglobulin-1 immunoassay. The actual rupture of membranes was diagnosed on review of the medical records after delivery (absence of membrane or a positive pad chart). Main Outcome Measures. Placental alpha microglobulin-1 immunoassay and standard diagnostic methods for diagnosis of rupture of membrane. Results. A total of 211 patients were recruited. At initial presentation, 187 patients (88.6%) had ruptured membranes, while 24 patients (11.4%) had intact membranes. Placental alpha microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 95.7% (179 of 187), specificity of 100% (24 of 24), positive predictive value of 100% (179 of 179), and negative predictive value of 75.0% (24 of 32). By comparison, the conventional standard diagnostic methods had a sensitivity of 78.1% (146 of 187), specificity of 100% (24 of 24), positive predictive value of 100% (146 of 146), and negative predictive value of 36.9% (24 of 65) in diagnosing rupture of membrane. Conclusion. Placental alpha-microglobulin-1 immunoassay is a rapid and accurate method for confirming the diagnosis of rupture of membrane. It was superior to conventional standard diagnostic methods (pooling, nitrazine, and ferning), the nitrazine test alone or fern test alone.

Utero-cutaneous fistula after caesarean section secondary to red degeneration of intramural fibroid

A 33 year-old woman had an emergency caesarean section for retained second twin which was complicated by utero-cutaneous fistula due to red degeneration of intramural fibroid. The utero-cutaneous communication was demonstrated by an examination under anaesthesia using dye test. She then underwent excision of the fistula tract and myomectomy. She recovered well following the surgery. This is the first case of utero-cutaneous fistula where the communication is between the endometrial cavity and skin lesion via a necrotic intramural fibroid following caesarean section. Fistulogram might fail to demonstrate the communication. In highly suspected case, other modalities of investigations could be utilised.

Growing Teratoma Syndrome: A Rare Case Report and Review of the Literature

Growing teratoma syndrome is rare and usually it occurs in the younger aged group. The use of chemotherapy following initial surgical resection will yield the diagnosis following tumour enlargement. Complete resection is usually curative and renders better prognosis.

Heterotopic triplet pregnancy with bilateral tubal ectopic post-IVF-ICSI of two 12-cell embryos

A heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It can be as rare as 1:30,000 in spontaneous pregnancies but can be as high as 1:100 following artificial reproductive techniques (ART) [1]. Bilateral tubal ectopic pregnancy is another extremely rare clinical condition, with an estimated prevalence of 1:200,000 in spontaneous pregnancies [2]. It accounts for one in 750 to one in 1580 ectopic pregnancies [3]. Heterotopic triplets are even more uncommon, and cases with bilateral tubal ectopics and coexisting intrauterine pregnancy are limited, if not unheard of. To add to the rarity of these clinical conditions is when there is a heterotopic triplet pregnancy with bilateral tubal ectopics resulting from the transfer of only two embryos as is explained in the case of our patient. Our patient was a 37-year-old woman with unexplained secondary subfertility of 6 years (gravida 2, para 0 þ 1 miscarriage) with a confirmed intrauterine pregnancy after her first attempt of in vitro fertilization (IVF). She had controlled minimal ovarian stimulation for a total of 10 days. Four mature eggs were retrieved on Day 11, and intracytoplasmic sperm injection was performed on all the eggs. Only two embryos at the 12-cell stage were found suitable for transfer. The patient was prescribed with oral dydrogesterone 8 hourly for luteal support. The Day-10 posttransfer serum b hCG level confirmed a successful implantation, and she was scheduled for follow up. Unfortunately, she presented herself

Outcome of molar pregnancies in Malaysia: A tertiary centre experience

Gestational trophoblastic disease (GTD) is a common problem among Asian ethnics. A total of 102 women with molar pregnancies between 1 January 2005 and 31 December 2010, were analysed. The aim of the study was to determine the outcome of all molar pregnancies in our institution. The local incidence of molar pregnancy was 2.6 per 1,000 deliveries. A total of 48 women (47.1%) had complete hydatidiform mole and another 54 (52.9%) had partial mole. The mean age of the women with molar pregnancies was 32.0 ± 7.9 years. The mean gestational age at initial diagnosis was 11 weeks ± 3 days. The majority (97 women, 95.1%) had symptoms of vaginal bleeding and 18 (17.6%) women had a uterus larger than dates. A total of 48 (47.1%) women had ultrasound scan findings of ‘snow-storm’ appearance. None of the women with uncomplicated molar pregnancy had evidence of relapse following one undetectable serum β-hCG level. Four out of the 102 women (3.9%) developed persistent trophoblastic disease before attaining one undetectable serum β-hCG level. All four women required single agent methotrexate and they remained in remission. The prognosis for uncomplicated molar pregnancy is good. Establishment of a National Trophoblastic Centre is recommended to maintain optimal outcome.

Do exercises improve back pain in pregnancy

Abstract Objective To assess the efficacy of an exercise program towards reducing back pain in pregnant women. Methods In this prospective control study, 145 low risk pregnant women who scored more than 20 for functional limitation assessment were recruited. The severity of back pain was assessed using the visual analoque scale (VAS) and the functional limitation was assessed using the Oswestry disability questionnaire (ODQ). All participants were informed of back care measures and provided with Paracetamol as an adjunct analgesia. The intervention group will have a session with a trained physiotherapist. Subsequently, all participants will be required to fill in a similar questionnaire regarding pain intensity and functional limitation assessment after 6 weeks post-intervention. Results There was a significant reduction in the VAS score and improvement in functional ODQ score in the intervention group. The median usage of Paracetamol as an analgesia to control back pain in the control group was 500 mg higher than the intervention group. There was a weak association of age, parity, duration of back pain, and body mass index with functional ODQ score at 6 week following intervention. Conclusion The back pain exercise reducing program was effective in reducing back pain intensity and analgesia usage with a significant improvement in functional ability.

Dydrogesterone support following assisted reproductive technique (ART) reduces the risk of pre-eclampsia.

Abstract Background: Pre-eclampsia (PE) contributes to poor maternal morbidity and mortality. Progesterone is hypothesised to reduce the risk of PE. Aim: To determine the effect of progestogen supplementation during assisted reproductive technique (ART) in reducing the incidence of PE. Method: A retrospective comparative analysis among 1140 pregnancies between January 2006 and March 2015 conducted in a tertiary centre. A total of 570 pregnancies who conceived following ART with progesterone supplementation (study group) and an age-matched spontaneous pregnancies, without progesterone supplementation (control group, n=570) were included in the analysis. The study group received progesterone support following ART or intrauterine insemination (IUI) until 14–16 weeks’ gestation. Results: The rate of PE was significantly lower in the study group compared to control group (8.4% vs. 14.2%, p<0.05). Women supplemented with dydrogesterone only showed a lower PE incidence as compared to women received a combination of dydrogesterone and hydroxyprogesterone caproate, however, it was not statistically significant (6.9% vs. 9.9%; 6.9%; p=0.2).

Spontaneous conception following GnRHa and progestogen therapy in adenomyosis.

Abstract Adenomyosis is a common gynaecological disorder that is associated with infertility and miscarriage. We report a case of adenomyosis presented with urinary retention and infertility. The patient successfully conceived spontaneously following GnRHa followed by progestogen therapy. This treatment option might provide a synergistic effect in improving fertility and pregnancy outcome for women with adenomyosis. This modality has no potential surgical risk; it minimises the long-term side effects of GnRHa and also provides luteal support.