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Background: Induction of labour (IOL) in low‐risk nulliparas at 39 weeks reduces caesarean delivery. Multiparas with ripe cervixes typically have vaginal delivery within eight hours. Delivery at night and weekend are associated with higher maternal and neonatal mortality. Aims: To evaluate IOL in full‐term multiparas with ripe cervixes to achieve delivery at normal working hours and improve maternal satisfaction. Methods: A randomised trial was performed in a tertiary hospital in Malaysia. Low‐risk multiparas with ripe cervixes (Bishop score ≥6) were recruited at 38+4–40+0 weeks, then randomised to planned labour induction at 39+0 weeks or expectant care. Primary outcomes were delivery during 'normal working hours' 09:00–17:00 hours, Monday–Friday and patient satisfaction by visual numerical rating scale. Results: For IOL (n = 80) vs expectant care (n = 80) arms respectively, primary outcomes of delivery at normal working hours was 27/80 (34%) vs 29/78 (37%), relative risk (RR) 0.9, 95% CI 0.5–1.7, P = 0.41, patient satisfaction was 8.0 ± 1.8 vs 7.8 ± 1.6, P = 0.41; presentation for spontaneous labour or rupture of membranes were 27/80 (34%) vs 70/79 (89%), RR 0.4, 95% CI 0.3–0.5, P < 0.001; and for labour induction 52/80 (65%) vs 15/79 (19%), RR 3.4, 95% CI 2.1–5.5, P < 0.001. Caesarean delivery was 8/80 (10%) vs 4/79 (5%), RR 2.0, 95% CI 0.62–6.3, P = 0.25; and mean birthweight was 3.1 ± 0.3 vs 3.3 ± 0.4 kg, P = 0.06 for IOL vs expectant care, respectively. Conclusion: Labour induction in low‐risk multiparas does not increase births during working hours or improve patient satisfaction. Antenatal clinic visits and non‐birth hospitalisation were significantly reduced. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate urine microscopy, dipstick analysis and urinary symptoms in screening for urinary tract infection (UTI) in hyperemesis gravidarum (HG). Materials and Methods: A prospective cross-sectional study was performed on women at first hospitalization for HG. A clean-catch mid-stream urine sample from each recruit was sent for microscopy (for bacteria, leucocytes and erythrocytes), dipstick analysis (for leukocyte esterase, nitrites, protein and hemoglobin) and microbiological culture. The presence of current urinary symptoms was elicited by questionnaire. UTI is defined as at least 105 colony-forming units/mL of a single uropathogen on culture. Screening test parameters were analyzed against UTI. Results: UTI was diagnosed in 15/292 subjects (5.1%). Receiver-operator characteristic curve analysis of microscopic urine leucocytes revealed area under the curve = 0.64, 95% confidence interval (CI) 0.5-0.79, P = 0.063 and erythrocytes area under the curve = 0.53, 95%CI 0.39-0.67, P = 0.67 for UTI indicating the limited screening utility of these parameters. Microscopic bacteriuria (likelihood ratio [LR] 1.1, 95%CI 0.7-1.5) and urine dipstick leukocyte esterase (LR 1.4, 95%CI 1.1-1.8), nitrites (LR 2.3, 95%CI 0.3-17.2), protein (LR 1.0, 95%CI 0.7-1.6) and hemoglobin (LR 0.8, 95%CI 0.4-1.5) were not useful screening tests for UTI in HG. Elicited symptoms were also not predictive of UTI. Conclusion: Urine microscopy, dipstick analysis and urinary symptoms were not useful in screening for UTI in HG. UTI should be established by urine culture in HG before starting antibiotic treatment. [ABSTRACT FROM AUTHOR]

Aim: The status of thrombophilia in Asian women with recurrent pregnancy loss (RPL) is obscure and poorly understood. Numerous studies suggest the non-existence or extreme rarity of the two important thrombophilia markers, factor V Leiden (FVL) and prothrombin G20210A (PTG) mutations, in patients of Asian ancestries. Thus, the consensus that thrombophilia is rare among Asians and laboratory investigations is irrelevant. We therefore investigated Malaysian women with RPL for thrombophilia abnormalities. Methods: A total of 402 patients (RPL subjects) and 160 female controls were screened for FVL, PTG and methylene tetrahydrofolate reductase mutations using polymerase chain reaction, activated protein C resistance (APC-R) using clot-based tests, protein C and antithrombin using chromogenic tests, and protein S and antiphospholipid antibodies using enzyme-linked immunosorbent assays. Results: APC-R was identified in 21.6% (87/402) of the RPL subjects. Of the 87 APC-R positive RPL subjects, 9.2% (8/87) were due to FVL, 51.7% (45/87) had protein S deficiency, 6.9% (6/87) had protein C deficiency, 6.9% (6/87) had combined protein S and protein C deficiencies, 1.1% (1/87) had antithrombin deficiency and 25.3% (22/87) had unidentifiable non-specific abnormalities. Antiphospholipid antibodies were identified in 4.2% (17/402) of the RPL subjects. FVL (2% = 8/402) and PTG (0.5% = 2/402) were identified in the Malay and Indian RPL subjects, but there were none in the Chinese subjects or the controls. Methylene tetrahydrofolate reductase was identified in 35.3% (142/402) of the RPL subjects. Conclusions: Thrombophilia was identified in more than one-quarter (26.6% = 107/402) of the RPL subjects. APC-R not caused by FVL mutation was the most common thrombophilia marker in Malaysians, whereas in Caucasians it was the APC-R due to FVL mutation. The identification of FVL and PTG mutations in Malaysian women with RPL disputes prevailing evidences suggesting its non-occurrence in patients with Asian ancestries. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the 50-g glucose challenge test (GCT) on pregnancy outcome in a multiethnic Asian population at high risk for gestational diabetes (GDM). Methods: GCT was positive if the 1-hour plasma glucose level was ≥7.2 mmol/L. GDM was diagnosed by a 75-g glucose tolerance test using WHO (1999) criteria. Of the 1368 women enrolled in the study, 892 were GCT negative, 308 were GCT false-positive, and 168 had GDM. Pregnancy outcomes were extracted from hospital records. Multivariable logistic regression analysis was performed with GCT negative women as the reference group. Results: GCT false-positive status was associated with preterm birth (adjusted odds ratio [AOR] 2.1; 95% CI, 1.2–3.7) and postpartum hemorrhage (AOR 1.7; 95% CI, 1.0–2.7). GDM was associated with labor induction (AOR 5.0; 95% CI, 3.3–7.5), cesarean delivery (AOR 2.2; 95% CI, 1.6–3.2), postpartum hemorrhage (AOR 2.1; 95% CI, 1.2–3.7), and neonatal macrosomia (AOR 2.5; 95% CI, 1.0–6.0). Conclusion: GCT false-positive women had an increased likelihood of an adverse pregnancy outcome. The role and threshold of the GCT needs re-evaluation. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the success of external cephalic version (ECV) using an adjusted bolus dose of intravenous salbutamol compared with no tocolysis. Methods: An open-label randomized study of 114 women with a term breech fetus randomized to receive either an intravenous bolus dose of 0.1 mg salbutamol with further boluses every 5 minutes, as required, before commencing ECV, or no tocolysis. Primary outcomes were successful ECV and rate of cesarean delivery. Results: Salbutamol tocolysis resulted in a higher rate of successful ECV compared with no tocolysis (70.2% [40/57] vs 36.8% [21/57]; RR 1.9, 95% CI 1.3–2.8; P <0.001). Cesarean delivery rate was lower in the salbutamol group compared with the control group (31.6% [18/57] vs 63.2% [36/57]; RR 0.5, 95% CI 0.3–0.8; P =0.001). Salbutamol dose ranged from 0.1–0.4 mg and outcome was not related to dose. Conclusion: Adjusted dose intravenous salbutamol tocolysis prior to ECV increases its success rate and reduces the cesarean delivery rate. [Copyright &y& Elsevier]

Objective: To compare oral celecoxib with oral diclofenac as pain reliever after perineal repair following normal vaginal birth. Methods: One hundred and sixty-four and 165 women, respectively, were randomised to 200 mg celecoxib or to 100 mg diclofenac orally 12 hourly for 24 h after perineal repair. A ten-point visual analog scale (VAS) for pain recorded at one, two, four, eight, 12 and 24 hours at rest and when mobilising was the primary outcome. Results: Repeated measures analysis of variance showed a larger reduction of VAS pain score at rest with celecoxib compared to diclofenac ( P = 0.044). Mean VAS pain score at rest was 2.2 versus 2.7, 2.1 versus 2.5, 1.8 versus 2.2, 1.6 versus 1.6, 1.3 versus 1.4 at one, two, four, eight, 12 and 24 hours, respectively, for celecoxib versus diclofenac. The difference in pain score when mobilising was not significant ( P = 0.75). Univariate analyses with the Student's t-test indicated significantly lower pain score at rest only at one, two and four hours with celecoxib. Randomisation to celecoxib was associated with less upper gastrointestinal symptoms reported: 38 of 163 (23.3%) versus 57 of 165 (34.5%) (relative risk 0.67 95% CI 0.48–0.96: P = 0.029) but additional analgesia for breakthrough pain was not significantly different eight of 161 (5.0%) versus 18 of 165 (10.9%) (relative risk 0.46 95% CI 0.20–1.01: P = 0.065). Conclusion: Celecoxib was associated with a slightly lower VAS pain score at rest and less upper gastrointestinal symptoms were reported when compared to diclofenac. [ABSTRACT FROM AUTHOR]

Background: The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population. Aims: To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT. Method: In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT ≥ 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria. Result: Thirty-five per cent had GCT ≥ 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was ≥ 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT ≥ 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM. Conclusions: Risk factors were not independent predictors of GDM in women with GCT ≥ 7.2 mmol/L. GCT threshold value ≥ 7.6 mmol is appropriate for the Malaysian population at high risk of GDM. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcome in 1000 women at term with one lower transverse Caesarean that was suitable for a trial of labour. Methods: One thousand consecutive women with one previous scar suitable for a trial of labour delivering in our centre from June 2002 to December 2005 were identified from the labour ward register. Data were retrieved from patients’ charts, and neonatal admissions were determined. Results: In the study, 76.8% of women underwent a trial of labour, with a 71.2% vaginal birth rate. Hospital stay was shorter with a trial of labour. The three perinatal deaths (0.4%; P = 1.0) occurred in the trial of labour group. Compared to elective repeat Caesareans, successful vaginal births after trial of labour were associated with less neonatal admission, reduced blood transfusion requirement and shorter hospital stay; emergency Caesarean deliveries after a trial of labour were associated with more neonatal admissions and operative complications. Conclusions: Trial of labour was associated with a shorter hospital stay. A successful trial of labour after one Caesarean was associated with the best outcome underscoring the importance of patient selection for a trial of labour. [ABSTRACT FROM AUTHOR]

In a retrospective analysis of 192 cases of presumed hyperemesis gravidarum, there were no biochemical markers that predicted hospital readmission. There was, however, statistically significant negative predictive value in abnormal liver function tests. This could represent acute self-limited illness with a component of hepatitis as the cause for the clinical presentation, rather than hyperemesis. [ABSTRACT FROM AUTHOR]

Objective: To compare oral celecoxib with oral diclofenac as pain reliever after perineal repair following normal vaginal birth., Methods: One hundred and sixty-four and 165 women, respectively, were randomised to 200 mg celecoxib or to 100 mg diclofenac orally 12 hourly for 24 h after perineal repair. A ten-point visual analog scale (VAS) for pain recorded at one, two, four, eight, 12 and 24 hours at rest and when mobilising was the primary outcome., Results: Repeated measures analysis of variance showed a larger reduction of VAS pain score at rest with celecoxib compared to diclofenac (P = 0.044). Mean VAS pain score at rest was 2.2 versus 2.7, 2.1 versus 2.5, 1.8 versus 2.2, 1.6 versus 1.6, 1.3 versus 1.4 at one, two, four, eight, 12 and 24 hours, respectively, for celecoxib versus diclofenac. The difference in pain score when mobilising was not significant (P = 0.75). Univariate analyses with the Student's t-test indicated significantly lower pain score at rest only at one, two and four hours with celecoxib. Randomisation to celecoxib was associated with less upper gastrointestinal symptoms reported: 38 of 163 (23.3%) versus 57 of 165 (34.5%) (relative risk 0.67 95% CI 0.48-0.96: P = 0.029) but additional analgesia for breakthrough pain was not significantly different eight of 161 (5.0%) versus 18 of 165 (10.9%) (relative risk 0.46 95% CI 0.20-1.01: P = 0.065)., Conclusion: Celecoxib was associated with a slightly lower VAS pain score at rest and less upper gastrointestinal symptoms were reported when compared to diclofenac.

Background: The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population., Aims: To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT., Method: In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT >or= 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria., Result: Thirty-five per cent had GCT >or= 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was >or= 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT >or= 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM., Conclusions: Risk factors were not independent predictors of GDM in women with GCT >or= 7.2 mmol/L. GCT threshold value >or= 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.