Muhammad Abdul Jamil

Tocolysis in term breech external cephalic version

To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre.

Imperforate hymen: Report of an unusual familial occurrence

Imperforate hymen is an uncommon obstructive anomaly of the female reproductive tract, which usually presents with intermittent and cyclical abdominal pain. Although it is usually sporadic, four cases of familial occurrence of imperforate hymen have been reported so far. Imperforate hymen is seldom associated with complications if it is detected early. In view of the possible familial occurrence, it is important to have a high index of suspicion in women who present with imperforate hymen. A detailed menstrual history of other female family members is necessary to enable early detection.

The efficacy of etoricoxib vs mefenamic acid in the treatment of primary dysmenorrhoea: a randomised comparative trial.

Summary Dysmenorrhoea is painful menstruation that occurs in 45–72% of all women. This was a prospective randomised study of the efficacy of etoricoxib (Arcoxia®) compared with mefenamic acid (Ponstan®) in treating primary dysmenorrhoea. All single, sexually inactive women with primary dysmenorrhoea were randomised into two groups (mefenamic acid and etoricoxib) of pain relief and underwent a cross-over study. The success of treatment as evidenced by pain relief, the side-effects and complications were observed and analysed. Some 80% (20 women) had significantly better pain relief with etoricoxib, compared with only 20 per cent in the mefenamic acid group (p = 0.007). Etoricoxib has significantly fewer side-effects compared with mefenamic acid (p = 0.005) with significantly reduced menstrual blood loss (p = 0.025). In conclusion, etoricoxib is a better treatment for primary dysmenorrhoea with better pain relief, less menstrual blood loss and fewer side-effects compared with mefenamic acid.

Misoprostol (alone) in second trimester terminations of pregnancy: As effective as Gemeprost?

Summary Gemeprost (Cervagem) has been used widely compared with Misoprostol (Cytotec) alone in second trimester pregnancy termination. This prospective randomised trial was to evaluate the efficacy of intravaginal Misoprostol (alone) and Gemeprost in second trimester termination of pregnancy. A total of 54 women with 27 on each arm were involved. A total of 25 patients (92.6%) in the Misoprostol group and 22 patients (81.5%) in the Gemeprost group delivered within 48 h. The Misoprostol group delivered earlier, although average number of tablets required were similar. The side-effects were not significant between the two groups in fact, but there was more pyrexia in the Gemeprost group (p = 0.004). Misoprostol in second trimester termination of pregnancy is clinically as effective and less costly than the standard regimen of Gemeprost.

Evaluation of BV(®) Blue Test Kit for the diagnosis of bacterial vaginosis.

The aim of this study is to determine the sensitivity, specificity and the predictive value of the BV(®) Blue Test Kit in the diagnosis of bacterial vaginosis and to observe the risk factors associated with bacterial vaginosis (BV) in the study population. A prospective, cross-sectional study on 151 non-pregnant women who presented or referred to HUKM with presence of vaginal discharge, abnormal vaginal odour, pruritus vulvae of lower genital tract or incidental finding of abnormal PV discharge on pelvic examination. Samples of vaginal discharge were tested for bacterial vaginosis infection using Amsels criteria, BV(®) Blue test and Gram stain (Nugents score). Gram stain interpretation was made blinded without knowledge of other test result. Using Gram stains criteria as a gold standard, the sensitivity, specificity, positive and negative predictive value of BV(®) Blue test and each of Amsels criteria were estimated. The use of vaginal douches increased the risk of BV. The risk of BV with vaginal douching was 2.8 (95% CI 1.0-7.8) compared to never users. BV(®) Blue test showed a sensitivity of 100.0%, specificity of 98.3%, positive predictive value (PPV) of 94.4% and negative predictive value (NPV) of 100.0% compared to Gram stain (Nugents method). BV(®) Blue test had excellent agreement with Gram stain which was 98.7%. BV(®) Blue test is a simple, rapid and reliable test allowing immediate diagnosis and prompt treatment of BV in the absence of microscopy which would greatly benefit majority of women at the greatest risk of sequel of bacterial vaginosis.

Laparoscopic salpingectomy in tubal pregnancy: Prospective randomized trial using endoloop versus electrocautery

Aim:  Ectopic pregnancy is conventionally managed by laparoscopic salpingectomy. Electrocautery has been used widely to secure hemostasis during salpingectomy. However, this method is associated with a risk of thermal injury to the visceral organs. Endoloop, a pre‐tied suture used in laparoscopic surgery may be an alternative treatment tool and its potential use in the management of ectopic pregnancy is explored here. Our study aims to compare the effectiveness of the endoloop technique to electrocautery during laparoscopic salpingectomy for tubal pregnancy.

Comparative study of two insulin regimes in pregnancy complicated by diabetes mellitus.

Diabetes mellitus complicates 5% of pregnancies and attempts to normalize blood sugar concentration have been proven to be the cornerstone of treatment. The variety of insulins available and patient commitment in self-monitoring of blood sugar have revolutionized the care of these women with diabetes in pregnancy. The use of short-acting insulin (SAI) to control postprandial glucose level together with intermediate-acting insulin (IAI) to control basal glucose level is well recognized. However this requires cooperation from patients and understanding of the disease process and would affect the pregnancy if control is inadequate. By using single type insulin it is hoped that patients compliance will be improved. This trial was designed to compare the outcomes of pregnancy in using SAI versus IAI alone in pregnant diabetic patients. (excerpt)

Spontaneous rupture of uterine varicose veins: A rare cause for obstetric shock

Spontaneous rupture of uterine surface varicose veins is rare but may result in serious complication of pregnancy, as it is associated with high perinatal and maternal mortality. We report a 24‐year‐old primigravida who presented with this rare condition mimicking placenta abruption, which was successfully managed. A review of reported cases was performed.

Safety and tolerability of once or twice daily neutral protamine hagedorn insulin in fasting pregnant women with diabetes during Ramadan

Aim:  To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan.

Seropositivity of Dengue Antibodies during Pregnancy

Purpose. Malaysia a dengue endemic country with dengue infections in pregnancy on the rise. The present study was aimed at determining dengue seroprevalence (IgG or IgM) during pregnancy and its neonatal transmission in dengue seropositive women. Methods. Maternal with paired cord blood samples were tested for dengue antibodies (IgG and IgM) using an enzyme-linked immunosorbent assay (ELISA). Maternal age, parity, occupation, ethnic group, and gestational age were recorded. Data on neonatal Apgar score and admissions to the Neonatal Intensive Care Unit (NICU) were analyzed. Results. Out of 358 women recruited, about 128 (35.8%) patients were seropositive. Twelve patients (3.4%) had recent infections (IgM positive) and another 116 women (32.4%) were with past infections (IgG positive). All babies born to seropositive mothers had positive IgG paired cord blood; however, no IgM seropositivity was observed. All neonates had good Apgar scores and did not require NICU admission. Conclusion. In this study, 35.8% pregnant women were found to be dengue seropositive. However, transplacental transfer of IgG antibodies had no detrimental effect on the neonatal outcomes.