Zaleha Abdullah Mahdy

Risk factors associated with subaponeurotic haemorrhage in full‐term infants exposed to vacuum extraction

Objectives  To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction.

Risk factor screening for abnormal glucose tolerance in pregnancy

Objectives: To assess the prevalence and association of frequently used screening risk factors for gestational diabetes mellitus (GDM) and to compare the validity and cost of universal screening with risk factor screening. Method: A cross‐sectional survey of 768 pregnant women at ≥24 weeks’ gestation who were attending the antenatal clinic at the Hospital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were determined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2‐h post‐prandial blood sugar level of ≥7.8 mmol/l. Results: A total of 191 pregnant mothers (24.9%) had GDM. The most commonly identified screening factors were positive family history of diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vaginal discharge and pruritis vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8%) had at least one risk factor. All screening risk factors, except past history of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Risk factor screening gave a sensitivity of 72.2% and a specificity of 35.0%. Universal screening would cost RM 12.06 while traditional risk factor screening would cost RM 11.15 per identified case and will have missed 53 of the 191 cases. Conclusions: Risk factor screening scored poorly in predicting GDM. Cost analysis of universal compared with traditional risk factor screening showed a negligible difference. Thus universal screening appears to be the most reliable method of diagnosing GDM.

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.

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.

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.

Effects of preeclampsia on the yield of hematopoietic stem cells obtained from umbilical cord blood at delivery.

Aim:  To compare the numbers of cord blood CD34+ hematopoietic stem cells (HSC) between preeclampsia (PE) and control (non‐PE) subjects and to determine the factors that may influence this observation.

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.

Nifedipine maintenance tocolysis and perinatal outcome: an individual participant data meta-analysis

Preterm birth is the leading cause of neonatal mortality and morbidity in developed countries. Whether continued tocolysis after 48 hours of rescue tocolysis improves neonatal outcome is unproven.

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.

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).