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Hyperemesis gravidarum is characterized by severe nausea and vomiting. This study aims to illustrate the efficacy of acupressure at P6 in treating nausea and vomiting in hyperemesis gravidarum. This parallel randomized controlled trial was conducted from 2016–2017 in a tertiary hospital. Hospitalized women with ≤16 weeks of gestation and moderate to severe nausea and vomiting classified using a modified PUQE score were randomly assigned in a 1:1 ratio to either apply an acupressure wristband at the P6 point three times daily or to receive regular doses of intravenous antiemetics. The primary outcome was differences in modified PUQE scores among the groups. The secondary outcomes were differences in the rate of urine ketone clearance and the frequency of requiring rescue antiemetics. Ninety women were equally randomized into two groups, with no dropout. There was a statistically significant difference in the degrees of nausea and vomiting between the groups at 8, 16, and 24 hours post-admission (p8hours= 0.001, p16hours = 0.006, and p24hours = 0.001). The requirement of antiemetics and the rate of urine ketone clearance between the two groups were also statistically significant, at p = 0.001 and p = 0.02 respectively. There were no side effects in either group. The P6 acupressure was efficacious in alleviating nausea and vomiting among hyperemesis gravidarum women. The trial was retrospectively registered on ClinicalTrials.gov (NCT05175079).

Infertility is a condition affecting women who are born with an underdeveloped or absent vagina, a birth defect known as congenital absence of the vagina. It is a rare disorder where the development of the Mullerian duct is obstructed by unidentified causes. The case is seldom reported due to the low prevalence and sparse epidemiology studies worldwide. A potential solution for the disorder is neovaginal creation with in vitro cultured vaginal mucosa. Limited studies have reported its application, but none are reproducible or specific regarding the established processes for acquiring vaginal epithelial cells from vaginal biopsies. These research gaps were adequately answered with an epidemiology study of inpatient details in Hospital Canselor Tuanku Muhriz, Malaysia, established methods and outcomes of vaginal tissue processing and isolation, and characterization of vaginal epithelial cells using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) and immunofluorescence assays. The reported evidence and speculation that the disorder arises because of a cellular transition event between epithelial and mesenchymal cells during the development of the Mullerian duct could be key in the creation of neovaginas using established culture procedures to improve surgical results and restore fertility.

Study Objective To explore the effect of the diagnosis of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome on affected Malaysian women. Design Qualitative study with a quantitative component. Setting Pediatric and adolescent gynecology unit at Universiti Kebangsaan Malaysia Medical Centre, Malaysia. Participants Twelve women with MRKH. Interventions Face-to-face interview and short questionnaire. Main Outcome Measures Thematic analysis was used to understand participants’ experiences. Results There were 7 themes identified: (1) delayed diagnoses; (2) doctors' roles and attitudes; (3) gender identity; (4) family and society's response; (5) reaction toward infertility; (6) managing sexual intimacy; and (7) coping mechanisms. Several participants consulted their physicians regarding their primary amenorrhea at an opportunistic setting. When they were referred to the gynecologists, they were dismayed at the lack of information given. The term, “MRKH” plays an important role to ease information-seeking. Participants felt that the doctors were insensitive toward them. Mental illness is a significant complication of MRKH. All participants acknowledged that infertility was the hardest part of the condition. The importance of blood lineage affects their outlook on childbearing options. Some were afraid of sexual intimacy and worried that they would not be able to satisfy their partners. Participants gained support and bonded with their counterparts in the MRKH support group. Conclusion A multidisciplinary approach including medical, psychological, and social support is essential for the management of MRKH. Adequate information and sexual education plays the utmost importance in preventing social-related complications of MRKH.

Objectives We compared cases of phenotypic female patients who presented with male karyotype and underwent prophylactic gonadectomy. Case presentation Five patients with female phenotypes presented in early adulthood with primary amenorrhoea with varying degrees of puberty. One was tall with breast development. Another was very short with clitoromegaly and multiple co-morbidities. The other three had no secondary sexual characteristics. They were examined, after which hormonal profile, karyotyping, ultrasound examination and magnetic resonance imaging were done to assess the site of gonads. Gonadectomy was performed once their 46 XY karyotype was confirmed. Results of histopathological examination of their gonads ranged from dysgenetic gonads to having testicular tissues and malignancy. Conclusion Female patients with 46 XY karyotypes require prophylactic gonadectomy performed at different timings depending on diagnosis due to the malignancy risk. Pre-operative assessment is essential to locate the gonads prior to surgery.

Infertility problems can lower the quality of life (QoL). This study aims to predict the factors associated with QoL using the Malaysian FertiQoL. This cross-sectional study was conducted at four fertility clinics in Malaysia. Sociodemographic details and FertiQoL responses were collected. A total of 395 participants were analysed using SPSS v24 with a mean (SD) age of 33.18 (4.45). Respondents were predominantly female (57.2%) and Malay ethnicity (82.5%). The core domain means score (SD) was 74.68 (14.35) and consisted of mind-body 77.56 (17.55), emotional 70.26 (18.98), relational 77.32 (17.19) and social 73.56 (15.74). Positive predictors for QoL are Islamic faith, higher income, and general well-being. Keywords: Malay FertiQoL; infertile; predictor, eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bsby e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5iSI3.2565

ObjectiveTo describe the prevalence of menstrual problems (heavy menses bleeding, dysmenorrhoea and oligomenorrhoea) and its impact towards quality of life among adolescents in Klang Valley, Malaysia.DesignCross-sectional study.SettingAdolescent girls at secondary schools in the Klang Valley, Malaysia.Population729 adolescents aged between 13 and 18 years.MethodA questionnaire survey using Menorrhagia Questionnaire and Paediatric Quality of Life-Teen Report Ages 13–18 (PedsQL).Main outcome measuresSelf reports of menstrual bleeding patterns, morbidities and effect on quality of life.ResultsThe prevalence of menstrual problems among adolescents was 63.9% in the Klang Valley. Adolescents with menstrual problems had significant lower mean total score of PedsQL (70.23±13.53 vs 76.36±14.93, p=0.001), physical health summary score (74.10±16.83 vs 79.00±15.86, pConclusionMenstrual problems among adolescents have a significant impact on their quality of life. It is probably wise to screen them at the school level, to identify those with low functional scores and to refer them for proper management at a tertiary adolescent gynaecology centre.

INTRODUCTION: Postnatal depression is a highly prevailing illness, yet underdiagnosed. Untreated, it carries a transgenerational impact, and therefore promoting awareness for it has to be of high priority. This research explored the elements of an educational tool to develop awareness for postnatal depression as preferred by stakeholders. MATERIALS AND METHOD: A descriptive qualitative approach using semi-structured face-to-face interviews were conducted, where nine participants were recruited via purposive sampling from a university hospital in Malaysia. Interviews with each participant were audio-recorded and transcribed to verbatims. Emergent themes were identified during the analysis. RESULTS: Four consistent themes regarding elements for an educational tool were derived as follows: Foundations of the tool, Illness circumstances, Support bases, and Matters of perspective. CONCLUSION: An educational video within the local setting should involve the usage of a short emotionally driven video, highlighting illness- and treatment-related content, and addressing the preference and concerns of women within the religious and cultural context. The use of edutainment as an educational tool is replicable and has a high outreach even to those who are illiterate. The findings can be used in the tailored development of an educational video on postnatal depression which will benefit local women by creating awareness and encouraging early help-seeking.

Objective To determine pregnancy outcomes in women with systemic lupus erythematosus (SLE) who were treated with hydroxychloroquine in a tertiary center. Methods A retrospective study involving pregnant women with SLE who had antenatal follow-up and delivery in between 1 January 2007 and 1 January 2017. All participants were retrospectively enrolled and categorized into two groups based on hydroxychloroquine treatment during pregnancy. Results There were 82 pregnancies included with 47 (57.3%) in the hydroxychloroquine group and 35 (42.7%) in the non-hydroxychloroquine group. Amongst hydroxychloroquine users, there were significantly more pregnancies with musculoskeletal involvement (p = 0.03), heavier mean neonatal birthweight (p = 0.02), and prolonged duration of pregnancy (p = 0.001). In non-hydroxychloroquine patients, there were significantly more recurrent miscarriages (p = 0.003), incidence of hypertension (p = 0.01) and gestational diabetes mellitus (p = 0.01) and concurrent medical illness (p = 0.005). Hydroxychloroquine use during pregnancy was protective against hypertension (p = 0.001), and the gestational age at delivery had significant effect on the neonatal birthweight (p = 0.001). However, duration of the disease had a significant negative effect on the neonatal birthweight (p = 0.016). Conclusion Hydroxychloroquine enhanced better neonatal outcomes and reduced adverse pregnancy outcomes and antenatal complications such as hypertension and diabetes.

Objective: To investigate the effects of 3-month supplementation with oral probiotics on quality of life in young women with primary dysmenorrhoea Design Randomized, double blind, placebo-controlled trial Setting A tertiary university hospital in Malaysia Population Women aged 18 to 45 years old suffering from primary dysmenorrhoea Methods: 72 patients were randomized to receive either oral sachets containing Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus lactis, Bifidobacterium bifidum, Bifidobacterium longum, and Bifidobacterium infantis 107 mg each or placebo twice daily for three months. Main outcome measures Visual Analog Score (VAS) of pain, Verbal Rating Scale (VRS) of severity, frequency of non-steroidal anti-inflammatory drugs (NSAIDs) use, and quality of life (QoL) scores derived from Short Form 12 item version 2 (SF12v2) questionnaire Results Both groups showed improvement in quality of life scores. There was a non-statistically significant lower NSAIDs use in probiotic group compared to placebo group (median 1 vs 2, p-value = 0.26). Placebo group showed better severity score (VRS) on day 2 of menses compared to probiotic group (median 0 vs 1, p-value

Intramyometrial ectopic pregnancy (IMEP) is a rare form of ectopic pregnancy. It is defined as a conceptus implanted within the myometrium and is completely surrounded by myometrium with clear separation from both the uterine cavity and tubes. IMEP possesses not only diagnostic but also therapeutic challenge. The majority of reported cases were managed by hysterectomy. Early management of unruptured IMEP using methotrexate may help to preserve fertility. We, for the first time, report a case of ruptured IMEP managed successfully using suction and curettage followed by Bakri balloon tamponade and avoiding hysterectomy. Post-procedure, the patient received two doses of intramuscular methotrexate 50 mg/m2 due to plateauing serial beta human chorionic gonadotropin (β-hCG) levels and subsequently achieved undetectable level 10 weeks post-methotrexate. She also had complete resolution of the ectopic intramyometrial mass.

Congenital peritoneal band is an extremely rare condition, but may induce small bowel obstruction (SBO) at any age, predominantly in childhood and rarely in adults. We report a case of extensive bowel ischaemia following caesarean section, due to trapping of an intestinal loop between a congenital peritoneal band and the mesentery. A 42-year-old, Gravida 2 Para 1, who has no history of prior abdominal surgery or trauma, presented in spontaneous labour and underwent an uncomplicated emergency lower segment caesarean section, for fetal distress. Postoperatively, she had worsening abdominal distension and pain, followed by vomiting. Computed Tomography Scan of the abdomen showed gross fluid retention with marked small bowel dilatation and fluid filled bowel loops. An emergency exploratory laparotomy was performed which revealed a congenital band, extending between the right fimbrial end and the small bowel mesentery, looping over the small bowel, causing extensive small bowel ischemia. Postoperative course was uneventful. In conclusion, congenital peritoneal band causing small bowel obstruction, although rare, should be considered in the differential, especially for patients with virgin abdomen.

Objective To explore the impact of congenital adrenal hyperplasia (CAH) on body image in Malaysian females with CAH and to understand the perspectives of these young women and their parents toward feminizing genitoplasty (FG). Design Multi-center cross-sectional study. Setting Two tertiary medical centers in Malaysia. Participants A total of 59 patients with CAH who were raised as females and more than 10 years old, and their parents. Methods The CAH respondents completed the validated and translated Body Image Disturbance Questionnaires (BIDQ). All CAH respondents and their parents underwent semi-structured interviews to explore their views on FG. Main Outcome Measures Body image disturbance score and perspectives on FG. Results: The 59 CAH respondents consisted of 12 children, 29 adolescents, and 18 adults. The majority were of Malay ethnicity (64.4%) with classical CAH (98.3%) and had undergone FG (n = 55, 93.2%). For the BIDQ scores, the median score (interquartile range) for general body image was 1.29 (0.71), range 1.00-3.29, whereas the genital appearance score was 1.07 (0.39), range 1.00-4.29, revealing a greater concern for general body parts over genitalia. With regards to FG, it was perceived as necessary. Infancy and early childhood were perceived as the best timing for first FG by both respondents and parents, most preferring single-stage over 2-stage surgery. Conclusions General body appearance concerns were greater than for genital appearance, with more impact on the patients’ lives. Contrary to much international opinion, feminizing surgery was perceived as necessary and appropriate by CAH respondents and their families, and should be offered in infancy or early childhood. Future qualitative studies are recommended.

Background: Pregnancy in SLE patients is closely associated with the usage of hydroxychloroquine [1]. Objectives: To determine pregnancy outcomes in women with Systemic Lupus Erythematosus who were treated with hydroxychloroquine in Universiti Kebangsaan Malaysia Medical Centre. Methods: Pregnant women with Systemic Lupus Erythematosus who had antenatal follow up and delivery in Universiti Kebangsaan Malaysia Medical Centre between 1stJanuary 2007 and 1st January 2017 were retrospectively analyzed. Data collection was done via medical case notes and laboratory investigations. Study population was categorised into two groups based on hydroxychloroquine treatment during pregnancy. Incomplete pregnancy records were excluded. Results: There were 82 completed pregnancies included with 47 (57.3%) in HCQ group and 35 (42.7%) in non HCQ group. Amongst HCQ users, there were significantly more pregnancies with musculoskeletal involvement (p=0.03), heavier mean neonatal birth weight (p=0.02) and prolonged duration of pregnancy (p=0.001). In non-HCQ users, the rate of recurrent miscarriages (p=0.003), incidence of hypertension (p=0.01) and gestational diabetes mellitus (p=0.01) and concurrent medical illness (p=0.005) were significantly more. Hydroxychloroquine use during pregnancy was protective against hypertension (p=0.001) and the gestational age at delivery had significant effect on the neonatal birth weight (p=0.001). However, duration of the disease had significant negative effect on the neonatal birth weight (p=0.016). Conclusion: HCQ enhance better neonatal outcomes and reduce adverse pregnancy outcome and antenatal complications such as hypertension and diabetes. References [1] M Leroux, C Desveaux, M Parcevaux. Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 2015. https://doi.org/10.1177/0961203315591027 Disclosure of Interests: Kyaw Min Tun: None declared, Rahana Rahman: None declared, Ixora Kamisan @ Atan: None declared, Ani Amelia Zainuddin: None declared, Ruslinda Mustafar: None declared, Mohd Shahrir Mohamed Said Paid instructor for: Eli Lilly, Speakers bureau: Eli Lilly

Trichotillomania (TTM) or hair pulling disorder is characterized by repetitive pulling of hair on the body whereas Polycystic Ovarian Syndrome (PCOS) is a metabolic-endocrine disorder, manifested by irregular menstrual cycle and clinical hyperandrogenism. Both disorders commonly occur in young females. TTM and PCOS may be related and share the same pathophysiology. We reported a case of a teenager with TTM and PCOS, which were triggered by stress. Neurobiological mechanism may explain the co-occurrences between TTM and PCOS. Further research in the neurobiology of TTM and PCOS may better explain the cooccurrences between the two disorders.

Gastrointestinal stromal tumour (GIST) is extremely rare with reported incidence of 20 per million per year. It is the most common mesenchymal tumour of the gastrointestinal tract. When it occurs at the pelvis in a female patient, it can be misleading to a gynaecological diagnosis. Non gynaecological diagnosis such as GIST must be considered in patients with pelvic mass presenting with atypical symptoms.

Bowel endometriosis is the most common extragenital manifestation of endometriosis. Clinical suspicion is of utmost importance for achieving its diagnosis. Management of this condition is, however, always challenging to the gynaecologist. We report a case of bowel endometriosis in which the patient presented with dyschezia and haematochezia prior to her menses for the past 2 years. A 44-year-old para two woman presented with worsening dysmenorrhea and dyspareunia. She also experienced dyschezia and haematochezia prior to her menses for the past 2 years. An examination revealed a fixed retroverted uterus. A computed tomography scan showed focal bowel thickening. She underwent a colonoscopy examination and biopsy that revealed stromal endometriosis. She was subsequently treated with dienogest and became asymptomatic. Diagnosis and management of this debilitating illness was revisited and discussed.

Congenital adrenal hyperplasia (CAH) is the commonest cause of ambiguous genitalia for female newborns and is one of the conditions under the umbrella term of "Disorders of Sex Development" (DSD). Management of these patients require multidisciplinary collaboration and is challenging because there are many aspects of care, such as the most appropriate timing and extent of feminizing surgery required and attention to psychosexual, psychological, and reproductive issues, which still require attention and reconsideration, even in developed nations. In developing nations, however, additional challenges prevail: poverty, lack of education, lack of easily accessible and affordable medical care, traditional beliefs on intersex, religious, and cultural issues, as well as poor community support. There is a paucity of long-term outcome studies on DSD and CAH to inform on best management to achieve optimal outcome. In a survey conducted on 16 patients with CAH and their parents in a Malaysian tertiary center, 31.3% of patients stated poor knowledge of their condition, and 37.5% did not realize that their medications were required for life. This review on the research done on quality of life (QOL) of female patients with CAH aims: to discuss factors affecting QOL of female patients with CAH, especially in the developing population; to summarize the extant literature on the quality of life outcomes of female patients with CAH; and to offer recommendations to improve QOL outcomes in clinical practice and research.

In Islam, the person with somatic sex ambiguity due to a disorder of sex development (DSD), such as 46,XX congenital adrenal hyperplasia or 46,XY androgen insensitivity, is recognized as khunsa. Two types of khunsa are distinguished: wadhih (discernible) and musykil (intractable). A recent fatwa (religious edict) in Malaysia decreed that it is permissible for male-assigned patients from these two groups to have gender reassignment surgery to female following diagnosis; however, the religious authority has yet to rule on the reassignment from female to male, if requested. The different schools of law in Islam agree on some aspects of gender-related issues like the position of khunsa in prayer congregations, but differ in their opinions on others such as property inheritance and bathing rituals. For purposes of illustration, this article includes three case reports on Muslim patients with DSD in Malaysia, focusing on issues of gender assignment: (1) a patient with 46,XX CAH, assigned as female, requesting reassignment to male; (2) a patient with 46,XX CAH, assigned female, and gender dysphoric, but undecided on the gender to be; and (3) a patient with 46,XY complete gonadal dysgenesis, raised female due to her phenotype at birth, diagnosed late, at age 18 years, and content to remain female. Gender-related issues from the perspective of Islamic jurisprudence are highlighted and discussed. To ensure holistic care, health-service providers involved in the care of Muslim patients with DSDs need to be aware of the Islamic perspectives on gender-related issues and involve expert religious authorities.

Ovarian torsion is commonly seen in young girls. Unfortunately it is often misdiagnosed because of its non-specific symptoms and lack of diagnostic modalities. This article focuses on the diagnostic challenge and also the changes in the management of ovarian torsion.We reviewed original reports on the management of ovarian torsion in young girls published from 1984 till 2014. A literature search was conducted by electronic scanning of five electronic database: MEDLINE, EMBASE, SCI, SSCI and CINAHL. In addition, relevant papers and review articles were hand-searched. The search was limited to English language and human studies. The search was conducted by combining the textwords "ovarian torsion", "adnexal torsion", "adolescents" and "oophoropexy".There are no specific symptoms that can be identified as a pathognomonic feature of ovarian torsion. Ultrasound is a useful diagnostic tool, but it is not always reliable in absence of an enlarged ovary. Laparoscopic detorsion is recognized as the mainstay of treatment regardless the condition of the ovaries. Reports have shown favorable ovarian function after detorsion. The role of oopheropexy remains controversial.Clinicians should be aware of ovarian torsion in girls presenting with abdominal pain. A timely management in this young population can help preserve their ovaries and fertility.

Amenorrhea is a common menstrual problem seen in adolescents. Amenorrhea has been shown to have a negative impact on adolescents' quality of life. In this paper we discuss the various causes and investigations of amenorrhea in adolescents and address management dilemmas for specific conditions. Specific approaches in dealing with adolescents using the HEADSS (Home, Education, Activity, Drugs, Sexual activity, Suicidal) approach are discussed.