Nor Azlin Mohamed Ismail

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.

Kiwi Omnicup versus Malmstrom metal cup in vacuum assisted delivery: a randomized comparative trial.

Aim:  To compare the success, clinical outcomes, and maternal and neonatal complications between the Kiwi Omnicup and the Malmstrom metal cup in vacuum assisted delivery.

GESTATIONAL DIABETES MELLITUS IN PRIMIGRAVIDAE: A MILD DISEASE

This prospective observational study was done to analyse the prevalence of gestational diabetes mellitus (GDM) among primigravidae and its outcome. All healthy primigravidae with singleton pregnancies were offered universal glucose tolerance testing between 16 and 28 weeks gestation. GDM and non GDM groups were managed according to hospital protocol. The antenatal features and pregnancy outcomes were analysed. Out of 616 primigravidae, 113 (18.34%) were GDM with slightly older (27.9 +/- 4.2 versus 26.32 +/- 3.3, p < 0.001) age. The mean fasting and two hours postprandial blood glucose in both groups were 4.99 +/- 1.08 mmol/l, 8.86 +/- 1.41 mmol/l(GDM) and 4.36 +/- 0.43 mmol/l, 5.71 +/- 1.11 mmol/l (Non GDM), respectively. Maternal family history of diabetes mellitus, weight exceeding 80 Kg, polyhydramnios (2.65% versus 0.2%, p = 0.028) and neonatal hyperbilirubinaemia (9.73% versus 2.98%, p = 0.01) occurred significantly more frequent in the GDM group compared to normal. There was no significant difference in other pregnancy outcomes and complications between the two groups. In conclusion GDM in primigravidae was detected at a relatively young age with more frequent maternal family history of DM, weight exceeding 80 Kg, polyhydromnions and neonatal hyperbilirubinaemia. The degree of disease was mild and treatment led to no significant complication.

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)

Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective.

Abstract This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia.

Nifedipine versus terbutaline for tocolysis in external cephalic version

To study the efficacy of nifedipine compared with terbutaline as a tocolytic agent in external cephalic version (ECV).

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.

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.

Association of transient hyperthyroidism and severity of hyperemesis gravidarum

Abstract Background Transient non-immune hyperthyroidism in early pregnancy is hyperthyroidism diagnosed for the first time in early pregnancy, without evidence of thyroid autoimmunity or clinical findings of Grave’s disease and resolved spontaneously as the pregnancy progressed. Hyperemesis gravidarum (HG) is the commonest cause with 66%–73% of women with severe HG were found to have elevated thyroid function. Materials and methods We conducted a cross sectional study to determine the prevalence of transient hyperthyroidism in patients with hyperemesis gravidarum and its relation to the severity of nausea and vomiting. Severity of nausea and vomiting in pregnancy was assessed using the modified pregnancy-unique quantification of emesis (PUQE) scoring system. Each patient had urine and blood investigations which also included a full blood count and thyroid and renal function tests. Patients with abnormal thyroid function were retested at 20 weeks of gestation. The patients’ demographic data, electrolyte levels, thyroid function and their respective PUQE score were analyzed. Results The prevalence of transient hyperthyroidism in women with hyperemesis gravidarum was 4.8%. Although there was a significant association between the severity of the PUQE score and hypokalemia (p = 0.001), there was no significant association with transient hyperthyroidism in early pregnancy (p = 0.072). Free T4 and TSH values of all women with transient hyperthyroidism were normalized by 20 weeks of gestation. Conclusion Transient hyperthyroidism in pregnancy is not significantly associated with the severity of the PUQE score. Women with transient hyperthyroidism in pregnancy are normally clinically euthyroid, hence a routine thyroid function test is unnecessary unless they exhibit clinical signs or symptoms of hyperthyroidism.

Pulmonary hypertension complicating systemic sclerosis: A successful pregnancy outcome

Systemic sclerosis is rare during pregnancy. However, delay in child bearing among the women has resulted in an increase in the number of cases (Chakravarty 2010). The ordeal in pregnancy varies with stable disease in 50% of patients, deterioration in 30% and improvement in 20% (Ismail et al. 2013). Clinically, the systemic form is progressive fibrosis (in association with anti-Scl-70 antibodies) involving Raynaud’s phenomenon and multiple organs i.e. oesophagus (80%), lungs (45%), heart (40%) and kidney (35%). This case report describes an uneventful pregnancy outcome of systemic sclerosis in pregnancy complicated by pulmonary hypertension (PH) and vocal cord involvement.