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Introduction: Pregnant women presenting with pruritus, serum bile acid (SBA) ≥10 µmol/L and/or alanine transaminase (ALT) >30 U/l is diagnostic of intrahepatic cholestasis of pregnancy (ICP). A retrospective audit was performed to look at the diagnosis, management and outcomes of ICP patients in University Malaya Medical Center (UMMC). Methods: SBA requests from Obstetrics and Gynaecology Department from 1st January 2016 to 31st December 2020 were extracted from Laboratory Information System (LIS). The medical records (preexisting medical conditions, maternal and perinatal outcomes) of ICP were obtained. Mild and severe ICP were defined based on SBA 10-40µmol/L and SBA >40 µmol/L, respectively. Results: SBA was requested for 202 pregnant women. The prevalence of ICP in our cohort was 0.18% (47 out of 26,697 deliveries). The average gestation at diagnosis was 35 weeks. Both SBA and liver enzymes were elevated in 25 (53.2%) whereas only SBA was elevated in 20 (42.6%) women. In two women, the diagnosis was made based on clinical symptoms and elevated liver enzyme alone. All with ICP had a livebirth and 31.9% were preterm. Severe ICP was noted in eight (17%) and all had cesarean section, whereas, in mild ICP, only 17 (44%) had a caesarean section. In those with normal SBA (n=149) at initial presentation, a repeat SBA was performed only in 12 (8.1%). Postpartum follow-up of ICP patients was observed in only 10 (21.2%). Conclusion: Despite being an uncommon diagnosis in our population, early diagnosis and timely delivery is important to reduce the major perinatal adverse outcomes. In women with persistent pruritus but without the biochemical evidence of ICP at the time of presentation should have repeat SBA and LFT done.

To compare Foley catheter and controlled-release dinoprostone vaginal insert on induction-to-delivery interval and maternal satisfaction in women with one previous cesarean delivery.This randomized controlled trial was conducted at the University Malaya Medical Center, Kuala Lumpur, Malaysia, from December 12, 2018, to May 28, 2019. A total of 78 term women scheduled for labor induction with one previous cesarean delivery who had ripe cervixes, singleton gestation, cephalic presentation, intact membranes, and reassuring cardiotocogram were randomized to Foley catheter or dinoprostone insert. The primary outcome was induction-to-delivery interval (in hours) and the secondary outcomes included maternal satisfaction on birth experience (assessed by 100-mm visual analog scale).Induction-to-delivery intervals were as follows: median 33.5 h (interquartile range [IQR], 26.1-36.2 h) versus 23.5 h (IQR, 12.7-34.5 h) (P = 0.004), and maternal satisfaction on birth process 100-mm visual analog scale was 80 mm (IQR, 64-88 mm) versus 82 mm (IQR, 67-88 mm) (P = 0.919) for the Foley and controlled-release dinoprostone arms, respectively. Cesarean delivery rates were 23 of 39 (59%) versus 20 of 39 (51%) (relative risk, 1.15 [95% confidence interval, 0.77-1.72]) (P = 0.496) and trial device insertion to removal time mean ± standard deviation was 20.1 ± 7.1 h versus 14.2 ± 7.3 h (P = 0.001) for Foley versus controlled-release dinoprostone, respectively.In term women after one previous cesarean delivery with unripe cervixes, controlled-release dinoprostone vaginal insert compared with Foley catheter shortens the induction-to-delivery interval but maternal satisfaction was not significantly increased.This study was registered with ISRCTN on November 30, 2018, with trial identification number: ISRCTN16957529 (https://doi.org/10.1186/ISRCTN16957529). The first participant was recruited on December 12, 2018.

Background This study aimed to determine menstrual characteristics and related morbidities among adolescent girls living in Sabah, North Borneo, the poorest state in Malaysia. Methods Data was obtained from a quantitative survey conducted in three government high schools located in Ranau, Sabah. The participants were adolescent girls who had attained menarche between the ages of 14 and 19 years. Results Based on the analysis of questionnaires completed by 757 adolescent girls, the mean age at the time of the survey was 17 ± 1.4, and the mean menarche age was 12.2 ± 1.1. Our data demonstrated that 85.7% of the participants experienced dysmenorrhea, of which at least 42% (mean pain score ± SD: 4.81 ± 0.76, 95% confidence interval (CI): 4.7, 4.9) experienced moderate dysmenorrhea and 11.3% (mean pain score ± SD: 7.86 ± 0.97, 95% CI: 7.6, 8.1) experienced severe dysmenorrhea. More than 70% of these girls complained of tiredness, headaches, and changes in appetite during menses. Conclusions The prevalence of menstrual disorders and related morbidities was high among girls residing in Sabah. Reproductive health issues in rural and socioeconomically deprived areas remain poorly addressed. The main consequences of neglecting menstrual disorders and their related morbidities are impaired future sexual reproductive health as adults. Hence, addressing adolescent reproductive health issues is crucial, especially for girls living in areas where healthcare accessibility is difficult. The information gathered from this study is can be used to strategize an effective intervention to improve adolescents' reproductive health status in rural areas.

Maternal diet during pregnancy may impact infant respiratory morbidity. The aim was to determine the association between antenatal maternal diet and respiratory morbidity of their infants during their first 6 months of life.This prospective cohort study included healthy motherinfant pairs. Maternal diet during the last trimester was determined with a validated food frequency questionnaire. Infant respiratory morbidity was solicited at 1, 3 and 6 months.Three hundred mother-baby pairs were recruited. Maternal consumption of milk and dairy products was associated with reduced respiratory symptoms at 1 month (aOR 0.29 [95% CI: 0.10, 0.86], p=0.03) and 3 months old (aOR 0.43 [95% CI: 0.20, 0.93], p=0.03), while intake of confectionery items was associated with increased unscheduled doctor visits at 3 months (aOR 2.01 [95% CI 1.33, 3.06], p=0.001) and increased nebuliser treatment at both 3 months (aOR 1.88 [95% CI 1.12, 3.17], p=0.02) and 6 months (aOR 1.64 [95% CI 1.05, 2.54], p=0.03). Finally, at 6 months, hypertensive disorders during pregnancy was associated with increased nebuliser treatment (aOR 17.3 [95% CI 1.50, 199], p=0.02) while exclusive breastfeeding was associated with reduced incidence of respiratory symptoms (OR 0.47 [95% CI 0.26, 0.83], p=0.01).Increased antenatal maternal consumption of milk and dairy products may reduce respiratory morbidity while increased consumption of confectionery items may increase respiratory morbidity in their infants during the first 6 months of life.

This study was aimed to determine the efficiency of synthetic protein-free media in spermatozoa washing, preparation and retention of the activity of washed spermatozoa over short periods in vitro. Normozoospermic semen samples (n=71) were equally apportioned and washed using synthetic protein-free medium (PFM), minimum essential medium+HSA (MEM) or commercial protein-containing medium (CPC). Washed spermatozoa were cultured in vitro using PFM, MEM or CPC media and held for 24 hrs at 4 o C, 15 o C, 22 o C or 37 o C. Spermatozoa activity was evaluated at 0 hr, 4 to 7 hrs and 24 hrs post-wash. The effects of PFM on spermatozoa motility, vitality, membrane integrity and DNA fragmentation level were not significantly different from that of MEM and CPC media at 0 hr, 4 to 7 hrs and 24 hrs post-wash in vitro. Synthetic PFM, MEM and CPC retained spermatozoa activity highest when specimen were held at 22 o C and it was significantly higher (pl0.05) than that at 37 o C after 24 hrs incubation in vitro. However, no significant changes (pg0.05) were noted in spermatozoa DNA fragmentation (SDF) levels when specimen were held at 22 o C or 37 o C at 4 to 7 hrs and also after 24 hrs post-wash in vitro in all media. The use of synthetic PFM as an alternative to the commercial protein-containing media in human spermatozoa washing and preparation procedure for an efficient and safer (Assisted Reproduction Technology) ART outcome. Spermatozoa activity can be successfully retained at room temperature post-wash over short periods; spermatozoa may lose viability rapidly if held for long hours at 37 o C in all media. DOI : http://dx.doi.org./10.17576/JSKM-2018-1601-16

The objectives of this study is to evaluate the efficacy of protein-free media in the preparation, holding and crypreservation of spermatazoa for use in ART. Normozoospermic semen samples (N=71) were used to compare the effects of media on the survival and quality of spermatozoa when washed and cultured with different media with and without added proteins at 4°C, 15°C, 22°C and 37°C for 0, 4-7 and 24h. Survival and quality of spermatozoa were assessed after freeze-thaw with synthetic cryoprotectant with and without proteins. Ethics/IRB approval was obtained (Ref. 1073.52). Spermatozoa parameters were similar in all media after washing and culture for 24h. Post-thaw survival and quality of spermatozoa was not significantly different 24h after thawing of samples frozen in all cryoprotectant medium. In conclusion synthetic protein-free culture and cryoprotectant media are equal in efficacy to protein-containing media in culture and cryopreservation of spermatozoa . Use of these synthetic media are anticipated to significantly reduce the risk, potentially associated with conventional protein-containing media, of transmission of disease and possibly harmful undeclared proteins to the patient, baby and the healtcare worker. Synthetic media also ensure consistency of quality between batches of media.

Labour induction and augmentation with Prostaglandin and Oxytocin are well established as standard practice worldwide. They are safe when used judiciously, but may be associated with maternal and neonatal morbidities. Other safer alternatives have been studied including dates consumption during late pregnancy with various outcomes. The aim of this randomised controlled trial was to investigate the effect of date fruit consumption during late pregnancy on the onset of labour and need for induction or augmentation of labour. A total of 154 nulliparous women with an uncomplicated singleton pregnancy were randomly allocated to either dates-consumer (77) or control group (77). The women in the dates-consumer group had significantly less need for augmentation of labour and longer intervention to delivery interval. There was no significant difference in the onset of spontaneous labour. Dates consumption reduces the need for labour augmentation but does not expedite the onset of labour. Impact statement • Dates fruit consumption during late pregnancy has been shown to positively affect the outcome of labour and delivery. In this study, date consumption reduced the need for labour augmentation with oxytocin but did not expedite the onset of labour. Therefore, dates consumption in late pregnancy is a safe supplement to be considered as it reduced the need for labour intervention without any adverse effect on the mother and child. This further supports the finding of earlier studies.

Objective To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery. Study design Participants were randomized to intravenous bolus injection of 100mcg carbetocin or 10IU oxytocin after cesarean delivery of the baby. The primary outcome is any additional uterotonic which may be administered by the blinded provider for perceived inadequate uterine tone with or without hemorrhage in the first 24hours after delivery. Secondary outcomes include operating time, perioperative blood loss, change in hemoglobin and hematocrit levels, blood transfusion and reoperation for postpartum hemorrhage. Results Additional uterotonic rates were 107/276 (38.8%) vs. 155/271 (57.2%) [RR 0.68 95% CI 0.57–0.81 p b 6 95% CI 3.8–9.8], mean operating time 45.9±16.0 vs. 44.5±13.1minutes p =0.26, mean blood loss 458±258 vs. 446±281ml p =0.6, severe postpartum hemorrhage (≥1000ml) rates 15/276 (5.4%) vs. 10/271 (3.7%) p =0.33 and blood transfusion rates 6/276 (2.2%) vs. 10/271 (3.7%); p =0.30 for carbetocin and oxytocin arms respectively. There was only one case of re-operation (oxytocin arm). In the cases that needed additional uterotonic 98% (257/262) was started intraoperatively and in 89% (234/262) the only additional uterotonic administered was an oxytocin infusion over 6hours. Conclusion Fewer women in the carbetocin arm needed additional uterotonics but perioperative blood loss, severe postpartum hemorrhage, blood transfusion and operating time were not different.

BackgroundAllergic conditions and respiratory tract infections (RTIs) are common causes of morbidity and mortality in childhood. The relationship between vitamin D status in pregnancy (mothers), early life (infants) and health outcomes such as allergies and RTIs in infancy is unclear. To date, studies have shown conflicting results.ObjectiveThis systematic review aims to gather and appraise existing evidence on the associations between serum vitamin D concentrations during pregnancy and at birth and the development of eczema, wheezing, and RTIs in infants.Data sourcesPubMed, MEDLINE, ProQuest, Scopus, CINAHL, Cochrane Library and Academic Search Premier databases were searched systematically using specified search terms and keywords.Study selectionArticles on the associations between serum vitamin D concentrations during pregnancy and at birth and eczema, wheezing, and RTIs among infants (1-year-old and younger) published up to 31 March 2019 were identified, screened and retrieved.ResultsFrom the initial 2678 articles screened, ten met the inclusion criteria and were included in the final analysis. There were mixed and conflicting results with regards to the relationship between maternal and cord blood vitamin D concentrations and the three health outcomes-eczema, wheezing and RTIs-in infants.ConclusionCurrent findings revealed no robust and consistent associations between vitamin D status in early life and the risk of developing eczema, wheezing and RTIs in infants. PROSPERO registration no. CRD42018093039.

Objective Feasibility of a clinical-trial comparing a low-glycaemic diet with a low-calorie healthy eating approach at achieving weight loss and reducing the risk of endometrial cancer in women with PCOS. Design A pilot Randomised-Controlled-Trial using different recruitment strategies. Setting A University Hospital in the United Kingdom. Patients Women seen at specialist gynaecology clinics over a 12 month period in one University Hospital, and women self identified through a website and posters. Interventions Potential recruits were assessed for eligibility, gave informed consent, randomised, treated and assessed as in the definitive trial. Main outcome measures Eligibility and recruitment rates, compliance with the allocated diet for 6 months and with clinical assessments, blood tests, pelvic ultrasound scans and endometrial biopsies. Results 1433 new and 2598 follow up patients were seen in 153 gynaecology clinics for over 12 months. 441 (11%) potentially eligible women were identified, 19 (0.4%) of whom met the trial entry criteria. Eleven consented to take part, of which 8 (73%) completed the study. Conclusions Planned future trials on over-weight women with PCOS should be multicentre and should incorporate primary care. This data will help other researchers plan and calculate the sample size and potential recruitment rates in future clinical trials in PCOS. The results will also be useful for inclusion in future meta-analyses.

Objective. To compare obstetric and perinatal outcome in teenage and non-teenage pregnancies. Methods. A retrospective analysis of case records of teenage pregnancies from January 2006 to December 2008. The subjects gave birth in the Department of Obstetrics and Gynaecology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia, a referral tertiary care and teaching hospital with over 5 000 deliveries annually. Pregnancy outcomes in girls aged ≤19 years were compared with those in women aged >19 years. A total of 177 teenage pregnancies were compared with 200 pregnancies in older women. Results. The prevalence of teenage pregnancies was 1.1%. Almost all the subjects were in their first pregnancies. The study showed that teenage mothers had a significant risk of delivering low-birth-weight babies. There were no differences in the risk of anaemia, severe pre-eclampsia, caesarean delivery, postpartum haemorrhage or fetal distress in labour compared with the 200 women in the older age group. Of the pregnant teenagers, 26.9% did not receive any antenatal care at all. Conclusion. The findings suggest that the long-held beliefs about the risks related to teenage pregnancy are not all justified. Early booking, adequate antenatal care and delivery by trained personnel should improve the obstetric and perinatal outcome in this age group.

The objectives of this study were: (1) to detect group B streptococcus (GBS) carriers among antenatal patients during pregnancy ( 35 to 37 weeks) in the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, and (2) to give antibiotic prophylaxis during the intrapartum period for the GBS carrier patients. The aim is to prevent early onset of GBS infection in newborn. This pilot study was carried out from 1st July 2005 to 31st August 2005. It is a prospective study involving 56 pregnant women who were seen at the antenatal clinic in the UMMC between 35 to 37 weeks gestation. High vaginal swab and low vaginal together with endoanal swab were taken for culture and sensitivity. The antibiotic prophylaxis was started early in the intrapartum period for patients with positive culture for GBS. GBS was detected in 18 patients which contributes to about 32% of the study population. The proper choice of antibiotic is important in successful disease prevention.