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Kajdy A, Sys D, Pokropek A, Shaw SW, Chang T, Calda P, Acharya G, Ben‐Zion M, Biron‐Shental T, Borowski D, Czuba B, Etchegaray A, Feduniw S, Garcia‐Mandujano R, Santacruz MG, Gil MM, Hassan S, Kwiatkowski S, Martin‐Arias A, Martinez‐Portilla RJ, Prefumo F, Rabijewski M, Salomon LJ, Tiller H, Verlohren S, Voon HY, Yanque‐Robles OF, Yong SL, Poon LC. Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study. Int J Gynaecol Obstet 2022; 160:167-186. [PMID: 35932096 PMCID: PMC9538861 DOI: 10.1002/ijgo.14388] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies. METHODS A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). RESULT Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances. CONCLUSIONS According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.
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Affiliation(s)
- Anna Kajdy
- Department of Reproductive HealthCenter of Postgraduate Medical EducationWarsawPoland
| | - Dorota Sys
- Department of Reproductive HealthCenter of Postgraduate Medical EducationWarsawPoland
| | - Artur Pokropek
- Institute of Philosophy and Sociology of the Polish Academy of SciencesWarsawPoland
| | - Steven W. Shaw
- Department of ObstetricsChang Gung Memorial HospitalTaipeiTaiwan
| | | | - Pavel Calda
- Fetal Medicine CenterFirst Medical Faculty of the Charles University and General Teaching HospitalPragueCzech Republic
| | - Ganesh Acharya
- Division of Obstetrics and GynecologyDepartment of Clinical Science, Intervention and Technology (CLINTEC), Karolinska InstitutetStockholmSweden,Women's Health and Perinatology Research Group Institute of Clinical Medicine Faculty of Health Sciences UiT‐The Arctic University of NorwayTromsøNorway
| | - Maya Ben‐Zion
- Women's Health and Perinatology Research Group Institute of Clinical Medicine Faculty of Health Sciences UiT‐The Arctic University of NorwayTromsøNorway,Meir Medical CenterTel Aviv UniversityIsrael
| | - Tal Biron‐Shental
- Women's Health and Perinatology Research Group Institute of Clinical Medicine Faculty of Health Sciences UiT‐The Arctic University of NorwayTromsøNorway,Meir Medical CenterTel Aviv UniversityIsrael
| | - Dariusz Borowski
- Nicolaus Copernicus University in ToruńCollegium Medicum in Bydgoszcz, The Faculty of Health Sciences, Department of Perinatology, Gynacology and Gynecologic OncologyToruńPoland
| | - Bartosz Czuba
- Chair and Department of Gynecology and ObstetricsFaculty of Health Sciences in Katowice, Medical University of SilesiaPoland
| | | | - Stepan Feduniw
- Department of Reproductive HealthCenter of Postgraduate Medical EducationWarsawPoland
| | | | | | - Maria M. Gil
- Hospital Universitario de TorrejónSchool of Medicine. Universidad Francisco de VitoriaMadridSpain
| | - Sonia Hassan
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMichiganUSA,Office of Women's HealthIntegrative Biosciences Center, Wayne State UniversityDetroitMichiganUSA,Department of PhysiologyWayne State University School of MedicineDetroitMichiganUSA
| | | | - Arancha Martin‐Arias
- Hospital Universitario de TorrejónSchool of Medicine. Universidad Francisco de VitoriaMadridSpain
| | | | - Federico Prefumo
- Department of Clinical and Experimental SciencesUniversity of BresciaItaly
| | - Michał Rabijewski
- Department of Reproductive HealthCenter of Postgraduate Medical EducationWarsawPoland
| | - Laurent J. Salomon
- Médecine et Chirurgie FoetalesMaternité—Hôpital Universitaire Necker‐Enfants Malades, Assistance Publique—Hôpitaux de Paris (AP‐HP), Université de ParisFrance
| | - Heidi Tiller
- Women's Health and Perinatology Research GroupInstitute of Clinical medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North NorwayTromsøNorway
| | - Stefan Verlohren
- Department of ObstetricsMedical School – Charité – University Medicine BerlinGermany
| | - Hian Yan Voon
- Maternal Fetal Medicine SpecialistSarawak General HospitalKuchingMalaysia
| | | | - Soon Leong Yong
- Department of Obstetrics & GynaecologyHospital Tengku Ampuan AfzanKuantanMalaysia
| | - Liona C. Poon
- Department of Obstetrics and Gynaecology Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong SAR
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Voon HY, Sinthamoney E, Hamdan M, Vinodhini B, Nagandla K, Aznal SSS, Daud S. Progestogens in the management of miscarriage and preterm birth. Med J Malaysia 2022; 77:512-518. [PMID: 35902945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Miscarriage affects up to 20% of pregnant women, resulting in substantial psychological repercussions in addition to inherent problems from bleeding and infection. Preterm births constitute about 7-12% of all births but are over represented in terms of perinatal morbidity and mortality. Despite existing trials examining the use of progestogens in both these conditions, there is a dearth of guidelines for the practicing clinician. A systematic review of the literature was performed by an expert panel formed by the Obstetrical & Gynaecological Society of Malaysia from the inception of the databases searched up to February 2020, without language restrictions. The level of evidence and recommendations was determined by the panel and peer-reviewed by local and international experts. The use of progestogens is recommended in women with threatened miscarriages who have experienced previous miscarriage as luteal phase support in women undergoing assisted reproduction and in women with short cervix of <25mm in the midtrimester. In addition, it can be considered in women with recurrent miscarriage, where no other cause is identified. This article reviews the existing evidence including the guideline above and is intended to aid primary care doctors and obstetricians in their prescribing practices when managing these common conditions.
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Affiliation(s)
- H Y Voon
- Sarawak General Hospital, Department of Obstetrics & Gynaecology, Kuching, Malaysia.
| | - E Sinthamoney
- Sunfert International Fertility Centre, Kuala Lumpur, Malaysia
| | - M Hamdan
- University Malaya, Department of Obstetrics & Gynaecology, Kuala Lumpur, Malaysia
| | - B Vinodhini
- Sri Kota Specialist Medical Centre, Klang, Selangor, Malaysia
| | - K Nagandla
- International Medical University, School of Medicine, Seremban, Malaysia
| | - S S S Aznal
- International Medical University, School of Medicine, Seremban, Malaysia
| | - S Daud
- Universiti Teknologi MARA, Faculty of Medicine, Department of Obstetrics & Gynaecology, Sungai Buloh Campus, Selangor, Malaysia
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Voon HY, Pow JY, Tan LN, Suharjono HN, Teo WS. Antibiotic prophylaxis in ragged placental membranes: a prospective, multicentre, randomized trial. BMC Pregnancy Childbirth 2019; 19:240. [PMID: 31296180 PMCID: PMC6624936 DOI: 10.1186/s12884-019-2373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ragged placental membranes is a distinct entity from retained placenta and not uncommonly reported in midwifery texts. Although the incidence of postpartum endometritis is merely 1-5% after vaginal births, it remains the most common source of puerperal sepsis, contributing up to 15% of maternal mortality in low income countries. Geographically-remote centres in Malaysia prophylactically administer antibiotics for women with ragged placental membranes after vaginal birth, extrapolating evidence from retained placenta. We sought to clarify the rationale in continuing such practices. METHODS This was an open-label, prospective, multicentre, randomized trial. Three hospitals where the current protocol was to administer prophylactic amoxycillin-clavulanic acid served as the sites of recruitment. Women who delivered vaginally beyond 24+ 0 weeks of gestation with ragged membranes were invited to participate in the trial and randomized into prophylaxis or expectant management with medical advice by blocks of 10, at a 1:1 ratio. A medication adherence diary was provided and patients followed up at 2 weeks and 6 weeks postpartum. RESULTS A total of 6569 women gave birth vaginally in three centres during the trial period, of which 10.9% had ragged membranes. The incidence of endometritis was not significantly raised in women with or without prophylaxis (0.90% vs 0.29%; p = 0.60). All cases of endometritis presented within the first 2 weeks and preventive use of antibiotics did not ameliorate the severity of endometritis since rates of ICU admission, surgical evacuation and transfusion were comparable. CONCLUSION Preventive use of antibiotics after vaginal delivery in women with ragged placental membranes did not result in a reduction of endometritis. Educating women on the signs and symptoms of endometritis would suffice. Based on the reported incidence of ragged membranes, a change in practice would result in 1500 less prescriptions of antibiotics per annum in these three centres. TRIAL REGISTRATION NCT03459599 (Retrospectively registered on 9 March 2018).
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Affiliation(s)
- Hian Yan Voon
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Hospital Road, 93586, Kuching, Sarawak, Malaysia. .,Department of Obstetrics and Gynaecology, Sri Aman Hospital, Hospital Road, 95000, Sri Aman, Sarawak, Malaysia. .,Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia.
| | - Jun Yan Pow
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Hospital Road, 93586, Kuching, Sarawak, Malaysia
| | - Lee Na Tan
- Department of Obstetrics and Gynaecology, Bintulu Hospital, Nyabau Road, 97000, Bintulu, Sarawak, Malaysia
| | - Haris Njoo Suharjono
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Hospital Road, 93586, Kuching, Sarawak, Malaysia.,Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300, Kota Samarahan, Sarawak, Malaysia
| | - Wan Sim Teo
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Hospital Road, 93586, Kuching, Sarawak, Malaysia
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Tan YL, Voon HY, Ngeh N. Ryzophagia secondary to PCOS -related menorrhagia. Med J Malaysia 2018; 73:170-171. [PMID: 29962501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report the peculiar case of a patient who consumed raw rice daily and had iron-deficiency anaemia secondary to menorrhagia with underlying polycystic ovarian syndrome. A 32-year-old lady of Asian descent presented with symptoms of fatigue, lethargy and prolonged, irregular periods for the last two months. There was noticeable increase in body weight, male pattern alopecia and facial acne. In addition, she experienced sudden, unexplained predilection towards consumption of raw rice (up to 300- 400g/day). The patient was treated with oral iron and cyclical progestin. After three weeks, her haemoglobin improved and her ryzophagia subsided. Gynaecologists should be vigilant of pica, which can occur outside of the context of pregnancy and also poses potential health risks including tooth attrition, electrolyte imbalance, intestinal obstruction and poisoning.
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Affiliation(s)
- Y L Tan
- Kuching Specialist Hospital, Department of Obstetrics & Gynaecology, KPJ Healthcare, Kuching, Sarawak, Malaysia.
| | - H Y Voon
- Sarawak General Hospital, Department of Obstetrics & Gynaecology, Kuching, Sarawak, Malaysia
| | - N Ngeh
- Borneo Medical Center, Department of Obstetrics & Gynaecology, Kuching, Sarawak, Malaysia
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Voon HY, Chai MC, Hii LY, Amin R, Suharjono HN. Postpartum thromboprophylaxis in a multireligious cohort: a retrospective review of indications and uptake. J OBSTET GYNAECOL 2018; 38:493-497. [PMID: 29433369 DOI: 10.1080/01443615.2017.1389867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Strategies to prevent mortality from obstetric venous thromboembolism begin with identification, risk stratification and subsequently, implementation of prophylactic measures. We sought to identify the burden of pharmacologic thromboprophylaxis in postpartum women, including the main clinical indications and its uptake in a multireligious population, with Islam as the official religion. A total of 2514 deliveries between 1st January to 31st December 2016, across three centres in Malaysia were reviewed retrospectively from hospital-based registries. 770 (30.62%) patients fulfilled the criteria for thromboprophylaxis based on the revised 2015 criteria proposed by the Royal College of Obstetricians and Gynaecologists. A combination of age, parity, BMI, caesarean section and preterm births were the main indications. One out of the five patients who delivered vaginally required thromboprophylaxis. In our setting with a sizable Muslim population, low molecular weight heparin was the thromboprophylaxis of choice in more than two-third of the patients. The information obtained from this study allows better local resource planning. Impact statement What is already known on this subject: Risk factors for venous thromboembolism in pregnancy and puerperium are largely drawn from registries due to the rarity of the index event. Up to 7% of women require antenatal thromboprophylaxis based on the criteria proposed by the Royal College of Obstetrician and Gynaecologists in 2009. What do the results of this study add: Using the RCOG guideline revised in 2015, a significant proportion of women delivering vaginally would require postnatal thromboprophylaxis based on age, parity and BMI. When either age or parity, both with relatively low odds ratio for thrombosis were omitted, a substantial proportion of women would not achieve the threshold for prophylaxis. Despite a sizable Muslim population in the country, the uptake of low molecular weight heparin was relatively high. What are the implications of these findings for clinical practice and/or future research: Cost-benefit studies should consider the adjusted odds ratio of individual indications on a VTE event. While uptake and acceptability is high, prospective studies on medication adherence is equally pertinent.
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Affiliation(s)
- Hian Yan Voon
- a Departments of Obstetrics & Gynaecology , Sarawak General Hospital , Kuching , Malaysia
| | | | | | - Rafaie Amin
- a Departments of Obstetrics & Gynaecology , Sarawak General Hospital , Kuching , Malaysia
| | - Haris Njoo Suharjono
- a Departments of Obstetrics & Gynaecology , Sarawak General Hospital , Kuching , Malaysia
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Voon HY, Shafie AA, Bujang MA, Suharjono HN. Cost effectiveness analysis of carbetocin during cesarean section in a high volume maternity unit. J Obstet Gynaecol Res 2018; 44:109-116. [PMID: 29027315 PMCID: PMC5813149 DOI: 10.1111/jog.13486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/22/2017] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the cost effectiveness of carbetocin compared to oxytocin when used as prophylaxis against post-partum hemorrhage (PPH) during cesarean deliveries. METHODS A systematic review of the literature was performed to identify randomized controlled trials that compared the use of carbetocin to oxytocin in the context of cesarean deliveries. Cost effectiveness analysis was then performed using secondary data from the perspective of a maternity unit within the Malaysian Ministry of Health, over a 24 h time period. RESULTS Seven randomized controlled trials with over 2000 patients comparing carbetocin with oxytocin during cesarean section were identified. The use of carbetocin in our center, which has an average of 3000 cesarean deliveries annually, would have prevented 108 episodes of PPH, 104 episodes of transfusion and reduced the need for additional uterotonics in 455 patients. The incremental cost effectiveness ratio of carbetocin for averting an episode of PPH was US$278.70. CONCLUSION Reduction in retreatment, staffing requirements, transfusion and potential medication errors mitigates the higher index cost of carbetocin. From a pharmacoeconomic perspective, in the context of cesarean section, carbetocin was cost effective as prophylaxis against PPH. Ultimately, the relative value placed on the outcomes above and the individual unit's resources would influence the choice of uterotonic.
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Affiliation(s)
- Hian Yan Voon
- Department of Obstetrics and GynecologySri Aman HospitalSarawakMalaysia
| | - Asrul A. Shafie
- School of Pharmaceutical SciencesUniversity of Science MalaysiaPenangMalaysia
| | | | - Haris N. Suharjono
- Department of Obstetrics and GynecologySarawak General HospitalKuchingMalaysia
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Tan LN, Mariappa G, Voon HY, Suharjono H. Septic miscarriage with toxic shock syndrome and disseminated intravascular coagulation (DIC): The role of surgery, recombinant activated factor VII and intravenous immunoglobulin (IVIG). Med J Malaysia 2017; 72:380-381. [PMID: 29308782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Severe sepsis with multi-organ failure is associated with a high mortality rate. This case report highlights the challenges and modalities available in the management of a lady with refractory shock and disseminated intravascular coagulation (DIC) due to toxic shock syndrome (TSS) from genital tract sepsis. Early surgical intervention to remove the source of infection, the use of recombinant activated factor VII to treat intractable disseminated intravascular coagulation and intravenous immunoglobulin to neutralise the circulating exotoxins, have been employed and shown to drastically improve outcomes.
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Affiliation(s)
- L N Tan
- Bintulu Hospital, Department of Obstetrics and Gynaecology, Sarawak, Malaysia.
| | - G Mariappa
- Bintulu Hospital, Department of Obstetrics and Gynaecology, Sarawak, Malaysia
| | - H Y Voon
- Sarawak General Hospital, Department of Obstet-rics and Gynaecology, Sarawak, Malaysia
| | - H Suharjono
- Sarawak General Hospital, Department of Obstet-rics and Gynaecology, Sarawak, Malaysia
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Voon HY, Leong MS, Li CW, Bujang A, Suharjono H. Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study. Med J Malaysia 2017; 72:259-263. [PMID: 29197879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies. METHODS Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone. RESULTS The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours. CONCLUSION In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.
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Affiliation(s)
- H Y Voon
- Sarawak General Hospital, Department of Obstetrics & Gynaecology, Sarawak, Malaysia.
| | - M S Leong
- Sarawak General Hospital, Department of Obstetrics & Gynaecology, Sarawak, Malaysia
| | - C W Li
- Sarawak General Hospital, Department of Obstetrics & Gynaecology, Sarawak, Malaysia
| | - A Bujang
- Sarawak General Hospital, Clinical Research Centre, Sarawak, Malaysia
| | - H Suharjono
- Sarawak General Hospital, Department of Obstetrics & Gynaecology, Sarawak, Malaysia
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Voon HY, Amin R, Kok JL, Tan KS. Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma. Fetal Diagn Ther 2017; 43:77-80. [DOI: 10.1159/000479105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022]
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Tan YL, Suharjono H, Lau NLJ, Voon HY. Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta: A 36-month review. Med J Malaysia 2016; 71:111-116. [PMID: 27495883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The contemporary obstetrician is increasingly put to the test by rising numbers of pregnancies with morbidly adherent placenta. This study illustrates our experience with prophylactic bilateral internal iliac artery occlusion as part of its management. METHODS Between January 2011 to January 2014, 13 consecutive patients received the intervention prior to scheduled caesarean delivery for placenta accreta. All cases were diagnosed by ultrasonography, color Doppler imaging and supplemented with MRI where necessary. The Wanda balloon(TM) catheter (Boston Scientific, Natick, MA, U.S.A) were placed in the proximal segment of the internal iliac arteries preceding surgery. This was followed by a midline laparotomy and classical caesarean section, avoiding the placenta. Both internal iliac balloons were inflated just before the delivery of fetus and deflated once haemostasis was secured. Primary outcomes measured were perioperative blood loss, blood transfusion requirement and the need for ICU admission. RESULTS The mean and median intraoperative blood loss were 1076mls±707 and 800mls (300-2500) respectively while mean perioperative blood loss was 1261mls±946. Just over half of the patients in our series required blood and/or blood products transfusion. Two patients (15.4%) required ICU admission. CONCLUSION Our study suggests that preoperative prophylactic balloon occlusion of bilateral internal iliac arteries reduces both blood loss and transfusion requirement in patients with placenta accreta, scheduled to undergo elective caesarean hysterectomy. It is an adjunct to be considered in the management of a modern day obstetric problem, although the authors are cautious about generalizing its benefit without larger, randomized trials.
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Affiliation(s)
- Y L Tan
- KPJ Kuching Specialist Centre, Kuching, Sarawak, Malaysia,.
| | - H Suharjono
- Sarawak General Hospital, Department of Obstetrics & Gynecology, 93586 Kuching, Sarawak, Malaysia
| | - N L J Lau
- Sarawak General Hospital, Department of Obstetrics & Gynecology, 93586 Kuching, Sarawak, Malaysia
| | - H Y Voon
- Sarawak General Hospital, Department of Obstetrics & Gynecology, 93586 Kuching, Sarawak, Malaysia
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Voon HY, Wong ATY, Ting ML, Suharjono H. Cervical Ripening Balloon for Induction of Labour in High Risk Pregnancies. Med J Malaysia 2015; 70:224-227. [PMID: 26358018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Cervical Ripening Balloon (CRB) is a novel mechanical method for induction of labour (IOL), reducing the risks of hyperstimulation associated with pharmacological methods. However, there remains a paucity of literature on its application in high risk mothers, who have an elevated risk of uterine rupture, namely those with previous scars and grandmultiparity. METHODOLOGY A retrospective study on IOL using the CRB in women with previous caesarean section or grandmultiparity between January 2014 and March 2015. All cases were identified from the Sarawak General Hospital CRB request registry. Individual admission notes were traced and data extracted using a standardised proforma. RESULTS The overall success rate of vaginal delivery after IOL was 50%, although this increases to about two-thirds when sub analysis was performed in women with previous tested scars and the unscarred, grandmultiparous woman. There was a significant change in Bishop score prior to insertion and after removal of the CRB. The Bishop score increased by a score of 3.2 (95% CI 2.8-3.6), which was statistically significant (p<0.01) and occurred across both subgroups, not limited to the grandmultipara. There were no cases of hyperstimulation but one case of intrapartum fever and scar dehiscence each (1.4%). Notably, there were two cases of change in lie/presentation after CRB insertion. CONCLUSION CRB adds to the obstetricians' armamentarium and appears to provide a reasonable alternative for the IOL in women at high risk of uterine rupture. Rates of hyperstimulation, maternal infection and scar dehiscence are low and hence appeals to the user.
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Affiliation(s)
- H Y Voon
- Sarawak General Hospital, Jalan Hospital 93586 Kuching, Sarawak, Malaysia.
| | - A T Y Wong
- Sarawak General Hospital, Jalan Hospital 93586 Kuching, Sarawak, Malaysia
| | - M L Ting
- Sarawak General Hospital, Jalan Hospital 93586 Kuching, Sarawak, Malaysia
| | - H Suharjono
- Sarawak General Hospital, Jalan Hospital 93586 Kuching, Sarawak, Malaysia
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