Mukhri Hamdan

BackgroundContemporary guidance for preoperative feeding allows solids up to 6 hours and clear fluids up to 2 hours before anesthesia. Clinical trial evidence to support this approach for cesarean delivery is lacking. Many medical practitioners continue to follow conservative policies of no intake from midnight to the time of surgery, especially in pregnant women.ObjectiveThis study aimed to evaluate the pragmatic approach of permitting free access to water up to the call to dispatch to the operating theater vs fasting from midnight in preoperative oral intake restriction for planned cesarean delivery under spinal anesthesia on perioperative vomiting and maternal satisfaction.Study DesignA randomized controlled trial was conducted in the obstetrical unit of the University of Malaya Medical Centre from October 2020 to May 2022. A total of 504 participants scheduled for planned cesarean delivery were randomized …

BACKGROUND: Labor pain varies significantly among pregnant women, ranging from mild to extremely distressing. Non-pharmacologic pain relief methods during vaginal birth are increasingly popular, either as a complement to pharmacologic agents or at times as the primary method of pain relief. Multiple trials have reported that manual or by-hand massage reduces labor pain. The effectiveness of full-body mechanical massage using electric massage chairs on labor pain remains unexplored.OBJECTIVE: To evaluate mechanical massage using electric massage chair on labor pain in nulliparous women.STUDY DESIGN: A randomized counterbalanced crossover trial was conducted in a university hospital in Malaysia from August 2022 to February 2023. Eligible nulliparas in labor with a minimum labor pain score of 5 (0-10 numerical rating scale) were enrolled. Participants were randomized to 30 minutes on the …

Objective To evaluate oral rehydration therapy (ORT) compared with intravenous rehydration therapy (IVT) in the early inpatient management of hyperemesis gravidarum (HG). Methods A total of 124 women hospitalized for HG from February 10, 2021 till January 6, 2023 were randomized to ORT (n = 61) or IVT (n = 63) for an initial 12 h. Inclusion criteria includes women older than 18 years, with a viable intrauterine pregnancy less than 14 weeks at their first hospitalization for HG with ketonuria of at least 2+. Primary outcomes were (1) satisfaction score with allocated intervention, (2) weight change, and (3) ketonuria change at 12 h. Secondary outcomes included vomiting frequency, nausea score, serial vital signs, hematocrit and electrolyte levels at 12 h, deviation from treatment protocol (cross‐over therapy), participant recommendation of allocated treatment to a friend, and length of hospital stay …

BackgroundThe empowerment of pregnant women is a meaningful strategy that profoundly impacts the health of women and their children. Despite a significant increase in the empowerment of pregnant women and its measurement, little attention was given to a consensus on the selection and application of assessment instruments used for pregnant women.ObjectiveTo identify the available assessment instruments for measuring the empowerment of pregnant women and to describe the appraisal content and their psychometric properties.MethodsWe searched nine bibliographic databases for original studies that focus on the measurement of empowerment in pregnant women. Arksey and O'Malley's methodology and PRISMA-ScR were selected to guide the implementation of this scoping review. The COSMIN criteria was employed to assess the methodological quality and the quality of psychometric properties …

BackgroundThe global cesarean delivery rate is high and continuing to increase. A bladder catheter is usually placed for the cesarean section as a distended bladder is assumed to be at higher risk of injury during surgery and to compromise surgical field exposure. Preliminary data suggest that self-bladder emptying (no catheter) at cesarean delivery may have advantages and be safe.ObjectiveTo evaluate self-bladder emptying to indwelling foley bladder catheterization for a planned cesarean on rate of postpartum urinary retention and maternal satisfaction.Study DesignA randomized controlled trial was conducted in a tertiary university hospital from January 10 2022 to March 22 2023. 400 participants scheduled for planned cesarean were randomized: 200 each to self-bladder emptying or indwelling foley catheter. The primary outcomes were postpartum urinary retention (overt and covert) and maternal …

BACKGROUNDVaginal examination to monitor labor progress is recommended at least every 4 hours, but it can cause pain and embarrassment to women. Trial data are limited on the best intensity for vaginal examination. Vaginal examination is not needed for oxytocin dose titration after an amniotomy has been performed and oxytocin infusion started. The Foley balloon commonly ripens the cervix without strong contractions. Amniotomy and oxytocin infusion are usually required to drive labor.OBJECTIVEThis study aimed to evaluate the first vaginal examination at 8 vs 4 hours after amniotomy-oxytocin after Foley ripening in multiparous labor induction.STUDY DESIGNA randomized controlled trial was conducted from October 2021 to September 2022 at the University Malaya Medical Center, Kuala Lumpur, Malaysia. Multiparas at term were recruited at admission for labor induction. Participants were randomized …

BACKGROUNDThe perineum is typically injured at the first vaginal birth. The application of a cold compress to the perineal repair site can reduce pain; however, the effect usually dissipates after a couple of hours. Repeated applications may be needed for sustained analgesia. However, the medium-term effect of repeated applications of cold compress on the perineal repair site on the recovery of sexual function and perineal healing is not known.OBJECTIVEThis study aimed to evaluate repeated applications of cold vs room temperature (placebo control) compress to the repaired primiparous perineum on pain upon movement.STUDY DESIGNA randomized controlled trial was conducted in a university hospital in Malaysia from May 2022 to February 2023. A total of 224 women with a repaired episiotomy or spontaneous second-degree tear sustained at normal delivery were randomized as follows: 113 to frozen gel …

Currently, many measure progesterone in ART cycles as part of cycle monitoring. Elevated or inadequate progesterone levels during ART cycle monitoring may lead to cycle cancellations or further progesterone supplementation, but practice varies. It remains controversial if measuring progesterone improves clinical outcomes. This review aims to investigate if progesterone levels at different phases of fresh and frozen ART cycles influence pregnancy outcomes, in particular, that pertaining day 3 versus day 5 embryo transfers. A systematic search of EMBASE, MEDLINE, CINAHL and PubMed identified studies between 2000 and 2022. We included studies with women undergoing fresh and frozen IVF/ICSI cycles; with extractable per woman data on pregnancy outcomes where serum progesterone measurement was performed. We excluded studies with intervention or donor cycles. The primary outcome was LBR and the secondary outcomes were OPR, CPR and MR. Eligible studies were included after the initial screen of the titles and abstracts. PICOS study protocol was used. Analysis was done using RevMan5. The study was registered with PROSPERO (registration ID CRD42022382423). 64 studies (N= 57,988 women) were included. In fresh cycles, there is no evidence that elevated progesterone (EP) impacts live birth rate (LBR) at baseline (OR 0.76, 95% CI 0.39–1.49). EP at ovulation trigger is associated with a lower LBR for D3 (P> 1.0 ng/ml, OR 0.46, 95% CI 0.38–0.55; P> 1.5 ng/ml, OR 0.68, 95% CI 0.47–0.98) but not D5 embryo transfer (P> 1.5 ng/ml, OR 0.96, 95% CI 0.81–1.14). In FET cycles, we were unable to meaningfully meta …

BackgroundLabor induction in women with one previous cesarean and unripe cervices is a high-risk process, carrying an increased risk of uterine rupture and the need for cesarean delivery. Balloon ripening is often chosen as prostaglandin use is associated with an appreciable risk of uterine rupture in vaginal birth after cesarean. Shorter placement of the balloon typically expedites delivery but that has not been evaluated in induction of labor after one previous cesarean.ObjectiveTo compare Foley balloon placement for 6 vs 12 hours in induction of labor after one previous cesarean.Study designA randomized controlled trial was conducted in a university hospital in Malaysia from January 2022 to February 2023. Eligible women with one previous cesarean admitted for induction of labor were enrolled. Participants were randomized after balloon insertion, for 6 or 12 hours of passive ripening before balloon deflation and removal to check cervical status for amniotomy. The primary outcome was the induction to delivery interval. Secondary outcomes were largely derived from the core outcome set for trials (CROWN) on induction of labor. The t-test, Mann-Whitney U test, Chi square test and Fisher exact test were used as appropriate for the data.Results126 women were randomized; 63 to each intervention. The induction to delivery interval was mean±standard 23.0±8.9 vs 26.6±7.1, mean difference-3.5 95% CI-6.4 to-0.7 hours p= 0.02 for 6 vs 12 hours placement respectively. Induction (Foley insertion) to Foley removal interval was median [interquartile range] 6.0 [6.0-6.3] vs 12.0 [12.0-12.5] hours p< 0.001, induction to amniotomy interval 14.1 [9.3-21 …

Study question Does in-vitro vitamin D treatment on fertile and infertile human sperm improves sperm motility and alter protein markers involved in capacitation and oocyte-activation. Summary answer In-vitro vitamin D treatment enhance functionality of sperm by increase intracellular calcium ion, thus increasing sperm motility and capacitation status. What is known already Many studies have been done to investigate the relationship between vitamin D and male infertility. It is known that low serum vitamin D in human contribute to male infertility. However, the effect of in-vitro vitamin D treatment on sperm remains unclear, particularly on the effect of vitamin D following ejaculation into female reproductive tract. This includes processes involved in fertilisation such as capacitation, hyperpolarization, oocyte activation and sperm-oocyte fusion. Therefore …

BACKGROUNDPlanned 6- vs 12-hour placement of the double-balloon catheter for cervical ripening in labor induction hastens delivery. The Foley catheter is low-priced and typically performs at least as well as the proprietary double-balloon devices in labor induction. Maternal satisfaction with labor induction is usually inversely related to the speed of the process.OBJECTIVEThis study aimed to compare Foley balloon placement for 6 vs 12 hours in the labor induction of multiparas with unfavorable cervixes.STUDY DESIGNA randomized controlled trial was conducted in a university hospital in Malaysia from January to October of 2022. Eligible multiparous women admitted for induction of labor for various indications were enrolled. Participant inclusion criteria were multiparity (at least 1 previous vaginal delivery of ≥24 weeks' gestation), age ≥18 years, term pregnancy >37 weeks' gestation, singleton pregnancy …

Background and Aims: Although many studies have been done to investigate the relationship between serum vitamin D and male infertility, the effect of in-vitro vitamin D treatment on sperm remains unclear, particularly the effect on sperm capacitation, hyperpolarisation, sperm-oocyte fusion and oocyte activation. This study aims to examine whether in-vitro vitamin D treatment on sperm can improve the condition of sperm parameters and further increase fertilisation and pregnancy rate. Method: Fifty men (N=50, fertile n=26; infertile men n=24, were recruited during their visit to fertility clinics for semen analysis. Each washed semen sample was aliquoted and divided into control and in-vitro vitamin D treatment groups. For in-vitro vitamin D treatment, semen samples were treated with 1nM in-vitro for 1 hour at 37°C. Intracellular calcium released, capacitation status and mitochondria membrane potential were measured after …

Background and Aims: Laparoscopy has become the access of choice even in complex abdomino-pelvic surgery cases and more abdominal access ports have been used to assist with the surgery. Systematic review done on skin closure of 5 mm laparoscopic port-site showed comparable outcome between sutured and sutureless technique. Transcutaneous suture is better than subcuticular suture in the sutured group sub-analysis. No RCT were found comparing skin closure versus non-closure technique using simple dressing only. Method: Randomised controlled trial – non superiority in Gynaecology Department, University Malaya Medical Centre in 2019. Based on power calculation, 40 subjects are needed. Each patient act as their own control – each will receive NC and TS for comparison. 40 patients (n=80) were included for final analysis. The 5 mm port site will be assigned with skin closure using NC versus …

Objectives:To validate and determine the psychometric properties of the Malay version of the endometriosis health profile-30 (EHP-30) by confirmatory factor analysis.Methods:A cross-sectional study was carried out in the main city of Malaysia at a tertiary teaching hospital between January to April 2021. A total of 218 women diagnosed with endometriosis symptoms were recruited using the universal sampling method to answer the questionnaire.Results:The revised Malay version of the EHP-30 with 28 items demonstrated that the factor loading of the 28 items had an acceptable value range between 0.60-0.90. The model fit was acceptable after the inclusion of 28 items correlated errors of the root mean square of error approximation: 0.072, 90% confidence interval:[0.065-0.080], comparative fit index (0.939), Tucker-Lewis index (0.932), and Chi-square/degrees of Freedom (2.135). The Cronbach’s alpha ranged …

Endometriosis should be diagnosed as early as possible in the continuum of care; but substantial delays of approximately 6–8 years between symptom onset and endometriosis diagnosis have been widely reported. With the purpose of improving the prompt diagnosis of endometriosis, the Asia‐Pacific Endometriosis Expert Panel (APEX) sought to address the reasons for diagnostic delays across the region, and formulate a multi‐pronged approach to overcoming these challenges. In the first instance, clinical diagnosis is preferable to surgical diagnosis, in order to facilitate earlier empirical treatment and minimize the negative sequelae of undiagnosed/untreated disease. There should be a high clinical index of suspicion in women presenting with cyclical symptoms, including those involving extrapelvic organs. Diagnostic delays in Asia‐Pacific countries are attributable to a variety of patient, physician, and …

Objective To evaluate 4‐point per day self‐monitoring of blood glucose (SMBG) every 2 weeks compared with every week. Methods A total of 104 patients with lifestyle‐controlled gestational diabetes (GDMA1) were randomized to 2‐weekly or weekly 4‐point per day (fasting on awakening and 2‐h post‐meals) SMBG. Primary outcome was the change in glycated hemoglobin (HbA1c) level from enrollment to 36 weeks of pregnancy across trial arms. The non‐inferiority margin was an HbA1c increase of 0.2%. Results The mean difference for change in HbA1c from enrollment to 36 weeks was 0.003% (95% confidence interval [CI] –0.098% to +0.093%), within the 0.2% non‐inferiority margin. The change in HbA1c level increased significantly within both trial arms—0.275% ± 0.241% (P < 0.001) in 2‐weekly arm versus 0.277% ± 0.236% (P < 0.001) in the weekly arm. Participants randomized to 2 …

Study question What is the impact of serum progesterone monitoring in fresh and frozen ART cycles on live birth rates (LBR)? Summary answer There is no evidence of benefit that monitoring progesterone impacts LBR in fresh and FET cycles. What is known already Elevated progesterone (EP) during the follicular phase is postulated to cause detrimental effects on pregnancy outcomes by prematurely advancing the endometrium and affecting endometrial receptivity. In the luteal phase, optimisation of the supplementation of progesterone is in question. However, there has not been a consensus on the timing of monitoring or a threshold level to define an optimal progesterone level that leads to improved pregnancy outcomes. Study design, size, duration A systematic search of the following electronic databases: EMBASE, MEDLINE …

Background and Aims: Many infertile couples require assisted conception and success rate depends on patient’s age. Hence, time is a huge factor. Therefore, due to postponement of fertility services and fear of COVID-19 during the pandemic, we hypothesized that these couple would experience a heightened level of stress, anxiety and depression. Method: This cross-sectional study was done in the reproductive unit, University Malaya Medical Centre, Kuala Lumpur, between July 16, 2021, and December 17, 2021. 165 patients were included in the final analysis. Couples who were planned for fertility treatment were recruited and asked to answer an anonymous electronic survey that contained depression, anxiety, and stress scales (DASS-21). Results: From univariate analysis, stress was found to be significant in 20–30-year-old, Chinese patients, degree and postgraduate degree holders, patients with …

BACKGROUNDThe adoption of Enhanced Recovery After Cesarean is increasing, but evidence supporting individual interventions having a specific benefit to Enhanced Recovery After Cesarean is lacking. A key element in Enhanced Recovery After Cesarean is early oral intake. Maternal complications are more frequent in unplanned cesarean delivery. In planned cesarean delivery, immediate full feeding enhances recovery, but the effect of unplanned cesarean delivery during labor is not known.OBJECTIVEThis study aimed to evaluate immediate oral full feeding vs on-demand oral full feeding after unplanned cesarean delivery in labor on vomiting and maternal satisfaction.STUDY DESIGNA randomized controlled trial was conducted in a university hospital. The first participant was enrolled on October 20, 2021, the last participant was enrolled on January 14, 2023, and follow-up was completed on January 16 …

ObjectiveTo identify independent predictors for vaginal delivery after induction of labor after one cesarean (IOLAC).Study designIn this retrospective cohort study, the electronic medical record of 19064 women who delivered from January 2018–September 2022 in a university hospital in Malaysia were individually searched to identify cases of IOLAC. Preselected data points on characteristics and the outcome of mode of delivery were retrieved. Bivariate analysis was performed to identify predictor characteristics for the dichotomous outcomes of vaginal delivery vs unplanned cesarean delivery. Variables with crude p < 0.05 were incorporated into a multivariable binary logistic regression analysis to identify independent predictors of vaginal delivery after IOLAC.Results819 IOLAC cases were identified. There were 465/819 (56.5 %) unplanned cesareans deliveries. Of the 14 selected characteristics, eight had p < 0.05 …

Introduction: Coronavirus disease 2019 (COVID-19) brought forth an unprecedented suspension of fertility treatment worldwide as part of a reallocation of hospital staff and resources to avoid a collapse in the healthcare system. As a nonessential service, postponement of fertility treatment due to the pandemic has impacted the mental health of infertile patients, which comprise of the Malaysian population. Objective: To establish the patient’s perspective on how the COVID-19 pandemic has affected their fertility treatment and to ascertain their psychological status. Methods: This was a cross-sectional study performed in a single academic center in Malaysia. This study was approved by the Universiti Malaya Medical Centre (UMMC) medical research ethics committee (MEC ID NO: 2021714-10376). Patients and partners who were planned for fertility treatment were approached and asked to answer an anonymous electronic survey between July 16, 2021 and …

Objective To identify independent predictors of maternal satisfaction with labor induction. Method In this prospective observational cohort study, 769 women prior to their labor induction had sleep and psychological well‐being assessed using Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scales. Women were asked about the adequacy of labor induction information provided and their involvement and time pressure felt in the decision‐making for their labor induction. Maternal characteristics, induction and intrapartum care measures, and labor and neonatal outcomes were also assessed. Prior to discharge, women rated their satisfaction with their birth experience. Results A total of 34 variables were considered for bivariate analysis, with 15 found to have P < 0.05. Following adjusted analysis, 10 independent predictors of maternal satisfaction were identified: maternal education, previous …

Background and Aims: AMH is a crucial biomarker of ovarian reserve and predictor of ovarian response to stimulation. Ovarian reserve is inversely proportional to women’s age, consequently lower AMH levels are seen in older women particularly at 40 yrs of age. A correlation between age and embryo aneuploidy was established but not with AMH level. We hypothesize that older women with good ovarian reserve produce less aneuploid embryos and produce the same blastocyst rate. Method: A retrospective study was undertaken involving 507 IVF cycles in patients aged 40 years who had ICSI with PGT-A using NGS. The cycles were categorized into three main cohorts based on the patient’s AMH level: low (< 1.1 ng/mL), moderate (>1.1 to 3.0 ng/mL) and high (> 3.0 ng/mL). Each cohort was subdivided into 3 age sub-cohorts as follow: (40 to <42), (42 to <44), and (>44). Our primary outcome was aneuploidy rate …

This scoping review describes the research-based mindfulness intervention on anxiety, distress, and depression. The search strategy retrieved articles published in English from 2014 to 2019 and were retrieved across Scopus, Web of Science, Science Direct, CINAHL, and Google Scholar. The PRISMA-Scr checklist is a tool to evaluate the quality of the articles. The selection criteria initially included all original articles in English, with 1,527 that were related to mindfulness intervention for anxiety, distress, and depression. A total of 490 full texts were retrieved, and after the abstracts were reviewed, 124 full-text articles were included for eligibility, and the final eight studies were determined. The articles were reviewed and screened for relevance to mindfulness intervention in reducing anxiety, distress, and depression among those with chronic diseases. The results have shown that mindfulness intervention reduces …

Objective 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. Methods 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). Results Induction‐to‐delivery intervals were as follows: median 33.5 h (interquartile range [IQR …

BACKGROUNDInduction of labor in women with 1 previous cesarean delivery and unripe cervices is a high-risk process, carrying an increased risk of uterine rupture and the need for cesarean delivery. Balloon ripening is often chosen as prostaglandin use is associated with an appreciable risk of uterine rupture in vaginal birth after cesarean delivery. A shorter duration of placement of the balloon typically expedites delivery; however, this has not been evaluated in induction of labor after 1 previous cesarean delivery.OBJECTIVEThis study aimed to compare Foley balloon catheter placement for 6 vs 12 hours in induction of labor after 1 previous cesarean delivery.STUDY DESIGNA randomized controlled trial was conducted in a university hospital in Malaysia from January 2022 to February 2023. Eligible women with 1 previous cesarean delivery admitted for induction of labor were enrolled. Participants were …

BackgroundA prolonged second stage of labor increases the risk of severe perineal laceration, postpartum hemorrhage, operative delivery, and poor Apgar score. The second stage is longer in nulliparas. Maternal pushing during the second stage of labor is an important contributor to the involuntary expulsive force developed by uterine contraction to deliver the fetus. Preliminary data indicate that visual biofeedback during the active second stage hastens birth.ObjectiveThis study aimed to evaluate if visual feedback focusing on the perineum reduced the length of the active second stage of labor in comparison with the control.Study DesignA randomized controlled trial was conducted in the University Malaya Medical Centre from December 2021 to August 2022. Nulliparous women about to commence the active second stage, at term, with singleton gestation, reassuring fetal status, and no contraindication for …

Background and Aims: MFSS is a state-of-the-art technology that has the ability to sort a subpopulation of sperm cells with lower DNA fragmentation index (DFI), higher motility and higher normal forms without the need for centrifugation. Methods: A randomised controlled trial that included 925 couples that were planned for ICSI with day 5/6 biopsy, PGT-A with Next Generation Sequencing (NGS) and blastocyst vitrification. The embryo transfer was planned for future cycles. The inclusion criteria for women were age (18–45), BMI (18–30), AMH level more than 1.1 ng/ml, regular menstrual cycle and normal uterine ultrasound. Whereas the inclusion criteria for men were age (18–50), fresh semen sample with count more than 10 million/ml and total motility more than 30%. Semen samples were randomly assigned with 1:1 ratio to either preparation by routine density gradient (DG) or (MFSS). The primary outcome of the …

BackgroundHyperemesis gravidarum (HG) affects about 2% of pregnancies and is at the severe end of the spectrum of nausea and vomiting of pregnancy. HG causes severe maternal distress and results in adverse pregnancy outcomes long after the condition may have dissipated. Although dietary advice is a common tool in management, trial evidence to base the advice on is lacking.MethodsA randomized trial was conducted in a university hospital from May 2019 to December 2020. 128 women at their discharge following hospitalization for HG were randomized: 64 to watermelon and 64 to control arm. Women were randomized to consume watermelon and to heed the advice leaflet or to heed the dietary advice leaflet alone. A personal weighing scale and a weighing protocol were provided to all participants to take home. Primary outcomes were bodyweight change at the end of week 1 and week 2 compared to …

Objective To evaluate immediate oxytocin and early amniotomy compared with delayed amniotomy after Foley catheter cervical ripening in multiparous women on intervention‐to‐delivery interval. Methods This randomized trial was conducted in Malaysia in 232 term multiparous women with balloon catheter–ripened cervixes (dilatation ≥3 cm), singleton fetus, cephalic presentation with intact membranes, and reassuring fetal heart rate tracing. They were randomized to immediate titrated intravenous oxytocin infusion and early amniotomy (116) or delayed amniotomy after 4 h of oxytocin (116). Primary outcome was intervention (oxytocin initiation)‐to‐delivery interval. Results Oxytocin‐to‐delivery intervals were a median of 4.99 h (interquartile range [IQR], 3.21–7.82 h) versus 6.23 h (IQR, 4.50–8.45 h) (P < 0.001) for the early versus delayed amniotomy arms, respectively. Delivery rate at 4 h and 6 h after …

BACKGROUNDCompared with a planned 12-hour placement of a double-balloon catheter, a planned 6-hour placement of a double-balloon catheter shortens the labor induction to delivery interval. The Foley catheter is low cost. Moreover, it has at least comparable effectiveness to the proprietary double-balloon labor induction devices. Of note, a 6-hour placement of a Foley balloon catheter in nulliparas has not been evaluated.OBJECTIVEThis study aimed to evaluate 6- vs 12-hour Foley balloon placement for cervical ripening in the labor induction of nulliparas.STUDY DESIGNA randomized controlled trial was conducted at the Universiti Malaya Medical Centre from January 2022 to August 2022. Nulliparas aged ≥18 years, with a term, singleton pregnancy in cephalic presentation, with intact membranes, with reassuring fetal heart rate tracing, with an unripe cervix, and without any significant contractions, were …

BackgroundPrevious studies looked into the connections between pregnancy and the Zona Pellucida (ZP) thickness and Zona Pellucida Thickness Variation (ZPTV), as well as the embryo’s radius, circumference, perimeter and global symmetry. However, no research has linked embryo implantation and pregnancy to the percentage of ZP thinning, the reduction in ooplasm volume, and the increase in perivitelline space (PVS) volume. Our objective is to correlate the percentage of ZP thinning, the percentage of ooplasm volume shrinkage and the percentage of PVS increase to the implantation. These data will be used for embryo selection as well as it can be put into a software that will assist embryo selection.Materials and methodsRetrospective study included 281 patients, all of them had 2 embryos transferred, 149 patients got pregnant with two gestation sacs and 132 patients did not get pregnant. All of the …

Background and Aims: Single embryo transfer is increasingly done in practice to avoid multiple pregnancy. Therefore, it is important to ensure the embryo with the best pregnancy outcome is selected. Although new criteria involving genomic, transcriptomic, and proteomic have been developed to predict embryo outcome, morphology of the embryo remains as the main indicator because it is easy to implement and less controversial. To study the correlation of multinucleated embryos and pregnancy outcomes Method: This is a retrospective review of a total of 411 embryos from 225 women undergoing their first IVF or ICSI cycle in University Malaya Medical Centre, Kuala Lumpur between January 2019 and October 2021. Multinucleation was defined as the presence of more than one nucleus within at least one of the blastomeres of a 2-cell embryo and a time-lapse imaging system was used to observe embryo …

BackgroundBladder overdistension in labor may lead to prolonged postpartum urinary retention. We hypothesized that nulliparas mobilizing to toilet is more likely to achieve satisfactory micturition.MethodsOne hundred sixteen (58 in each arm) term nulliparas in labor with filled bladders were randomized to mobilizing to the toilet or using bedpan to micturate. Primary outcome was satisfactory micturition defined as ultrasound derived post-void bladder volume < 150 ml. Following unsatisfactory micturition, participants crossover to the opposed intervention. Participants were catheterized if after crossover, residual bladder volume was ≥250 ml.ResultsSatisfactory micturition rates were 55/58 (95%) vs. 43/58 (74%) RR 1.28 95%CI 1.08–1.51 NNTb 4.8 95%CI 3.0–12.4 P = 0.008, failure to micturate 1/58 (2%) vs. 8/58 (14%) RR 0.13 95%CI 0.02–0.97 NNTb 8.3 95%CI 4.6–38.7 P = 0.047. After cross over following …

ObjectiveTo evaluate the effect of combined perineal massage and warm compress to the perineum (MassComp) compared to perineal massage alone during pushing in the second stage of labour in reducing perineal trauma requiring suturing in nulliparas.Study Design: A randomised trial was performed in a University hospital, Malaysia from June 2020 to May 2021. 281 term nulliparas who were about to start pushing in the second stage of labour were randomised to combined perineal massage and warm compress or perineal massage alone to the perineum. Primary outcome was suturing for perineal injury (episiotomy or tear). The Chi-square test was used to analyse categorical data, Student t test to compare means and distributions for normally distributed continuous data and Mann Whitney U test for appropriate ordinal data.ResultsData from 277 participants (140 MassComp arm, 137 perineal massage …

Purpose To evaluate Foley catheter and controlled release dinoprostone insert compared to foley catheter alone on induction to delivery interval and maternal satisfaction. Methods A randomized trial was conducted in a university hospital in Malaysia from December 2018 to May 2019. Term nulliparas with unfavorable cervix (Bishop score ≤ 5) scheduled for labor induction were randomized to Foley catheter and controlled release dinoprostone insert simultaneously or Foley catheter alone. Primary outcomes were induction to delivery interval (hours) and maternal satisfaction on birth experience (assessed by 11-point Visual Numerical Rating Scale VNRS 0–10, higher score more satisfied). Results Induction to vaginal delivery intervals was mean ± standard deviation 22.5 ± 10.4 vs. 35.1 ± 14.9 h, P =  < 0.001 but …

Methods:This is a cross-sectional study performed in a single academic center in Malaysia between July to December 2021. Patient and partner with any causes of infertility and who are planned for fertility treatment were approached and asked to answer an anonymous electronic survey.Results:165 patients were recruited to answer the survey. 66% of patients did not agree with the Ministry of Health Malaysia's recommendation to postpone fertility treatment. 97.6%, if given a choice, would want to continue with treatment. 75.8% of patients' main concern about delaying treatment would be advancing age and 11.5% cite concerns about reducing ovarian reserve if their treatment was disrupted. Patient's psychological status assessment showed findings of mild, moderate, severe and extremely severe level of psychological disorders in our patients. From multivariate logistic regression, mild level of stress was significant amongst 20-30 years old with p= 0.000 (OR 1.3 E

Conclusions: Medical treatment from different groups significantly reduces the endometrioma size, and relives painful symptoms. Limitations, reasons for caution: Despite the nature of the randomized includedstudies, the results of this study are still subjected to confounders relating to clinical and statistical heterogeneity. the studies reported the outcomes differently Wider implications of the findings: medical treatment can be given the surgery can be avoided, therefore preserve the ovarian tissue. There is limited controlled study to examine the effectiveness of the treatment for endometrioma.Trial registration number:------------------

Background Female sterilisation is the most common method of contraception worldwide and laparoscopic tubal sterilisation is increasingly considered as a day-surgery procedure. Therefore, pain following this procedure should be seriously addressed. Instillation of 200 to 300 mg of ropivacaine intraperitoneally has been proven effective in controlling pain after laparoscopic tubal ligation (LTL). However, extreme caution must be taken as potential serum toxicity has been reported with the instillation of 150 mg of intraperitoneal ropivacaine. In search of the lowest, most effective dose, this study aimed to evaluate the effectiveness of 112.5 mg of ropivacaine intraperitoneally in reducing post-operative pain after LTL. Methods This double-blind, placebo-controlled randomised trial was conducted in an ambulatory care centre in Malaysia. Sixty-two patients scheduled for LTL were recruited. Two patients were excluded from the trial because of intraoperative complications. Sixty patients were randomised to either the placebo group (intraperitoneal normal saline, n = 30) or the ropivacaine group (intraperitoneal ropivacaine, n = 30). Pain scores (using a visual analogue score), and the need for additional analgesia were assessed at 15, 60, 120, and 240 minutes post-LTL. Results We observed no significant differences in pain scores or the need for additional analgesia between the groups. Conclusion 112.5 mg of ropivacaine administered intraperitoneally is not more effective than normal saline in decreasing post-operative pain after LTL.

Introduction Multiparous labor inductions are typically successful, and the process can be rapid, starting from a ripened cervix with a predictable response to amniotomy and oxytocin infusion. Outpatient Foley catheter labor induction in multiparas with unripe cervixes is a feasible option as the mechanical process of ripening is usually without significant uterine contractions and well tolerated. Labor contractions can be initiated by amniotomy and titrated oxytocin infusion in the hospital for well‐timed births during working hours as night birth are associated with adverse events. We sought to evaluate outpatient compared with inpatient Foley catheter induction of labor in multiparas for births during working hours and maternal satisfaction. Material and methods A randomized trial was conducted in the University of Malaya Medical Center. A total of 163 term multiparas (no dropouts) with unripe cervixes (Bishop score …

Background Induction of labor (IoL) is an increasingly common obstetric procedure. Foley catheter IoL is recommended by WHO. It is associated with the lowest rate of uterine hyperstimulation syndrome and similar duration to delivery and vaginal delivery rate compared to other methods. Insertion is typically via speculum but digital insertion has been reported to be faster, better tolerated and with similar universal insertion success compared to speculum insertion in a mixed population of nulliparas and multiparas. Transcervical procedure is more challenging in nulliparas and when the cervix is unripe. We evaluated the ease and tolerability of digital compared to speculum insertion of Foley catheter for induction of labor in nulliparas with unripe cervixes. Methods A randomized trial was performed in a university hospital in Malaysia. Participants were nulliparas at term with unripe cervixes (Bishop Score ≤ 5 …

Background: Endometriosis is known to be detrimental to fertility in many ways. Evidence drawn from studies on oocyte recipient cycles suggests that the oocyte quality of women with endometriosis is compromised. Research that specifically examined the association between embryo quality and endometriosis/endometrioma are scarce and the question if endometriosis affects oocyte and/or embryo quality remain controversial. This study aims to evaluate embryo quality of women with endometriosis (EN) and without endometriosis (tubal factor [TF], unexplained infertility [UE]).Methods: Multi-centre retrospective study was performed. Treatment cycles and embryology records of women with and without endometriosis undergoing IVF was reviewed via IDEAS TM database. Number of oocytes collected per mature follicle, fertilisation rate, pregnancy rate, morphology and morphometric assessment of embryo at all stages were evaluatedResults: Total of 678 women who had IVF treatment was analysed (EN, n= 89; TF, n= 214; UE, n= 375). The mean age for each group was EN, 34.4±3.3; TF, 33.5±3.7 and 34.6±3.2 respectively. Number of mature follicles (> 14mm) on the day of trigger injection was similar (P= 0.75) between all groups. Percentage of oocytes collected per mature follicle was lower in endometriosis compared to other groups (P= 0.01; EN, 65±23; TF, 76±20; UE, 71±24). Higher percentages of embryos fail to achieve 8-cell stage in EN compared to control groups (P= 0.02; EN, 4.0±1.6 TF, 1.2±0.4; UE, 1.5±0.4. Percentages of embryos at all grades (Grade1-4) per women were similar between the comparison groups (P> 0.05 …