Shuhaila Ahmad

The Vabra aspirator versus the Pipelle device for outpatient endometrial sampling.

Objective:  To compare the effectiveness of the Vabra aspirator and the Pipelle device as an outpatient endometrial assessment tool.

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.

Advanced abdominal pregnancy resulting from late uterine rupture.

BACKGROUND: Advanced abdominal pregnancy is rare, and one that occurs after uterine rupture with delivery of a viable fetus is exceptional. CASE: A multiparous patient was admitted at 29 weeks of gestation for conservative management of placenta previa. She complained of intermittent abdominal pain, but repeated assessment suggested that both the patient and the fetus were doing well. At 36 weeks, an abdominal pregnancy was diagnosed with radiological features suggestive of uterine rupture. Laparotomy was performed and a healthy infant was delivered. CONCLUSION: Fetal viability was achieved in this case of abdominal pregnancy secondary to uterine rupture after close maternal and fetal surveillance.

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.

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

Antenatal calcium intake in Malaysia.

To determine the adequacy of antenatal calcium intake in Malaysia, and the influencing factors.

Predictors of postpartum weight retention among urban Malaysian mothers: A prospective cohort study

BACKGROUND Women of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers. METHODS A prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices. RESULTS Average age was 29.61±4.71years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90±5.18kg. Mean postpartum weight retention was 3.12±4.76kg, 33.8% retaining ≥5kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention. CONCLUSION Women need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.

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.

P3.381 Knowledge and Attitude Towards HIV/AIDS Among Post-Secondary School Malaysian Urban Youths

Background Post secondary school, young people may continue to study or will seek work opportunities. They are exposed to a different environment which may influence their knowledge and attitude towards HIV/AIDS. The aim of this paper is to compare the knowledge and attitude of post-secondary school urban youths towards HIV/AIDS. Methods This was a cross-sectional survey using self administered questionnaire of young urban Malaysians age 18–24 years who were either enrolled in randomly selected private or public colleges and universities, or formally employed in private or public workplaces in the Klang Valley. Results Compared to the 973 students, the 615 workers who participated in this study were significantly older (22.6 + 1.5 years versus 20.4 + 1.7 years), 12.2% versus 0.8% were married, and 88.5% versus 80.1% were Muslims. Both groups had fairly good knowledge of HIV/AIDS and its prevention and did not show significant difference in their mean knowledge of HIV/AIDS. However, misconception on transmission of the disease persist when 35–40% thought sitting on toilet seats and 50% thought HIV can be transmitted through mosquito bites; and 47.5% of workers and 51.3% of students had negative attitudes towards HIV and people with HIV/AIDS. Only 48.1% of workers and 41.7% of students were sure that condom is an effective way of protecting against HIV/AIDS while both, about 20%, reported peers, and 18.0% students and 9.8% workers reported teachers/school counsellors as important sources of information on HIV/AIDS. Conclusion Knowledge and attitude of the two groups of youths did not show significant differences although working youths seems to be slightly more open about HIV/AIDS and the use of condom for prevention of STDs. Workplace or college-based health promotion for prevention of HIV/STDs should be developed and maintained since misconception remains and negative attitude is still prevalent in these post-secondary school youths.