exudates and Fetal-Death

Threatened miscarriage is a common complication of pregnancy. Despite initial viability confirmation by ultrasound scan, some of these patients had further spontaneous abortion. A highly sensitive and specific biomarker would be useful to determine the outcome of pregnancy and to prevent emotional impact to these women. A prospective 14-month cohort study was conducted in the Obstetrics and Gynaecology Department of Universiti Kebangsaan Malaysia Medical Centre to determine whether low serum levels of pregnancy-associated plasma protein A (PAPP-A) measured in early pregnancy can predict the outcome of threatened abortion. 42 pregnant women between 6 to 22 weeks of gestation with threatened abortion and 40 controls were enrolled. Serum samples were collected at presentation and PAPP-A was assayed by electrochemiluminescent immunoassay technique. Pregnancies were followed-up until 22 weeks of gestations and the outcome documented. Nine patients (11%) developed spontaneous abortion and 73 patients (89%) had successful pregnancy. The median PAPP-A level was significantly lower in patients with spontaneous abortion compared to those who had successful pregnancies in the threatened abortion group: 0.78 MoM (0.41-1.00 MoM) vs 1.00 MoM (1.00-2.0 MoM) respectively (p < 0.05). The best sensitivity of 44% and specificity of 93% were obtained at the cut of value of 0.66 MoM (95% CI, 0.561-0.773). In conclusion, low PAPP-A value in threatened abortion women is associated with pregnancy failure, although the use of PAPP-A as a one-time single marker has limited value.

Topics: Abortion, Threatened; Adult; China; Cohort Studies; Female; Fetal Death; Humans; India; Malaysia; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy-Associated Plasma Protein-A; Prospective Studies

The objective of this study was to determine the seroprevalence of cytomegalovirus (CMV) infections through antenatal screening data and the association of this virus with obstetric complications. Serum samples from 125 apparently healthy pregnant women sent for antenatal screening from various hospitals in Malaysia between January 2007 and December 2008, were examined for CMV specific IgM and IgG antibodies using an enzyme-linked immunosorbent assay method. Of the 125 pregnant women tested, anti-CMV IgG antibody was found in 105 (84%) of the cases and anti-CMV IgM in 9 cases (7.2%). Both CMV IgM and IgG were also found in another 37 women whose serum samples were sent for investigation of various obstetric complications: 17 cases of spontaneous abortions, 15 cases of fetal anomalies detected during ultrasound examination, 1 case of incomplete abortion, 3 cases with premature delivery of infant with congenital anomalies and 1 case of infertility. Our preliminary data which only represented a small study group has shown the prevalence of CMV infection among the local population and the association of CMV in obstetric complications.

Topics: Abortion, Incomplete; Congenital Abnormalities; Cytomegalovirus Infections; Female; Fetal Death; Humans; Infertility; Malaysia; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Seroepidemiologic Studies

Topics: Adult; Biomarkers; Female; Fetal Death; Humans; Malaysia; Pregnancy; Pregnancy Complications, Hematologic; Prevalence; Recurrence; Thrombophilia

The main aim of this study was to determine the causes and epidemiological aspects of paediatric death. Data was collected on 143 cases of paediatric death from a total of 2,895 autopsies performed in University Malaya Medical Centre (UMMC), Kuala Lumpur, over a five-year period from 2000 to 2004. There were 78 males and 65 females. The largest number of cases (32.9%) were stillborn. The highest proportion of cases (30.1%) were Chinese. The majority of cases of paediatric death were non-traumatic (74.8%) of which intrauterine death (IUD) was the most common (32.9%). Amongst the traumatic deaths (25.2%), accidental injury (23.8%) was observed in the majority of cases.

Topics: Accidents; Autopsy; Cause of Death; Child; Child Mortality; Child, Preschool; Cross-Sectional Studies; Female; Fetal Death; Homicide; Humans; Infant; Infant Mortality; Infant, Newborn; Malaysia; Male; Stillbirth; Suicide; Urban Population; Wounds and Injuries

Hospital University Sains Malaysia (HUSM) functions as the state referral centre and the only hospital for the state of Kelantan that can offer neonatal intensive care service. The deliveries in HUSM with grand multiparity, late booking and problems of late referrals resembles a hospital serving a semiurban rather than an urban community. A comparison between the year 1989 and 1991 showed marked improvement of perinatal mortality rate from 41.32 to 24.88, which is significantly better than the improvement achieved from 1987 to 1989 (46.0 to 41.32). This was possible due to a marked fall in the early neonatal mortality rate from 10.02 in 1989 to 5.45 in 1991 and fall in the stillbirth rate from 31.61 to 19.53.. In Malaysia, obstetricians compared 1989 and 1991 perinatal deaths at the Hospital University Sains Malaysia in Kelantan State, the state referral hospital and the only hospital in the state with a neonatal intensive care unit (NICU). There were 46.98% more deliveries in 1991 than in 1989 (7114 vs. 4840). Almost all neonatal deaths took place in the NICU. The perinatal mortality rate fell considerably from 41.32 to 24.88/1000 births, largely due to the declines in the early neonatal mortality rate (10.02-5.45) and the stillbirth rate (31.61-19.53). The rate of very low birth weight (VLBW) infants born increased 11.44% (6.82 vs. 7.5/1000 live births). Their survival rate increased only slightly (54.54-59.37%). Ventilation for VLBW infants suffering from birth asphyxia and meconium aspiration contributed greatly to improvements in survival (31.7% vs. 61.5%). A greater proportion of VLBW infants survived beyond 5 days in 1991 than in 1989 (61.4% vs. 80.2%). In 1991, sepsis was the most frequent cause of death (31.15%). Prematurity also contributed considerably to neonatal mortality. The cause of fetal death was unknown in most cases (51.08%). These findings suggest that better obstetrical management and better ventilatory management of meconium aspiration and birth asphyxia contributed largely to the marked improvement in neonatal survival.

Topics: Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Malaysia; Pregnancy

Topics: Adult; Body Height; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Malaysia; Male; Parity; Pregnancy; Retrospective Studies; Socioeconomic Factors

Some of the possible reasons why Singapore's perinatal mortality rate (PMR) is lower than that of many Western countries are examined. The PMR is lower despite the fact that Singapore's economic status is lower than that in most Western countries and the perinatal facilities are not superior. Also considered are the problems associated with perinatal health of the infants in Singapore. In Singapore in 1984 the PMR was 10.6 stillbirths and deaths within the 1st week of life per 1000 stillbirths and livebirths. This is one of the lowest PMR rates in the world. Legalized abortions comprise 50% of livebirths in Singapore. The mothers who choose legalized abortions often are young and members of the lower socioeconomic group, suggesting that if their pregnancies had come to term, many of these babies may have added to the perinatal or infant mortality rate. An assessment of the role of abortions in lowering the PMR of a country might provide some interesting data. Of the 3 major ethnic groups in Singapore -- Chinese, Malay, and Indian, the Indians have the highest proportion of low birth weight (LBW) babies. The Chinese have the least LBW babies with the Malays in between. These differences continued to be evident in 1982. In 1984, the perinatal mortality rates of the Malay and Indian children were higher than that of the Chinese, but there was no difference between that of the Indian and the Malay. In LBW babies (2500 g and less), females predominate in every birth weight category except for 1000g-1499g. After 3000g, males predominate in every birth weight category, so that males predominate as a whole. This male preponderant sex ratio changes postnatally due to a higher death rate in males right up to age 75. As the mortality rate in LBW infants is high, males also will die in greater numbers in this LBW category. An improvement in perinatal care, particularly in the intensive care area, has served to lower mortality rates among both normal birthweight and LBW babies. LBW is the major determinant of neonatal mortality, and in the Singapore context, it is necessary to study survivors with LBW and very low birth weight and to follow them to school and beyond. It is not sufficient to be satisfied with low perinatal mortality rates, as the perinatal mortality rate suggests only the tip to the iceberg, which hides considerable morbidity.

Topics: Abortion, Legal; China; Female; Fetal Death; Humans; India; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Malaysia; Pregnancy; Sex Ratio; Singapore

Out of a total of 6992 pregnancies which occurred among the 1616 Malaysian women at their various stages of reproductive cycles in 1982. 1.1% ended in stillbirths, 6.1% in spontaneous abortions, an 2.2% in induced abortions. Life cycle and family formation variables provided far sharper differentials in pregnancy wasstage as compared to the ethnic and educational variables. Pregnancy wastage rate varied from 5% at maternal age below 20, to 24% at maternal age 40-44, and from about 7.5% at the 1st 2 pregnancy orders to 13.8% at the 7th and higher orders. Intervals of 1 year or less had a wastage of 29.4%. Pregnancy outcome was strongly associated with the outcome of the preceding pregnancy. Data is based on analysis of the 1982 Survey on Health and Family Planning in Johore an Perak.

Topics: Abortion, Induced; Abortion, Spontaneous; Age Factors; Asia; Asia, Southeastern; Birth Order; Data Collection; Demography; Developing Countries; Disease; Family Characteristics; Family Planning Services; Family Relations; Fetal Death; Health; Health Surveys; Malaysia; Maternal Age; Mortality; Parents; Population; Population Characteristics; Population Dynamics; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Reproduction; Research; Sampling Studies; Statistics as Topic

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.

Topics: Adult; Birth Weight; China; Congenital Abnormalities; Delivery, Obstetric; Female; Fetal Death; Glucose Tolerance Test; Humans; India; Infant Mortality; Infant, Newborn; Malaysia; Patient Care Team; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Puerperal Disorders; Retrospective Studies; Singapore

Topics: Delivery, Obstetric; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Malaysia; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Retrospective Studies; Twins

It has been reported that studies of the genetic consequences of inbreeding should adopt a different strategy in populations having a relatively old inbreeding history and where inbreeding levels have varied over time. This contention is tested with a series of 39,495 single-birth records from Bombay, India, collected in a World Health Organization survey on congenital malformations. Our analysis reveals that: 1. the incidence of major malformations is significantly higher among the inbred offspring (1.34%) as compared to that among non-inbred ones (0,81%)--a finding at variance with a previous study in the same area; 2. the inbreeding effect on perinatal mortality (stillbirths and mortality during the first few days of life) is also found to be significant. In view of the above findings, the genetic load as disclosed by inbreeding is computed for perinatal mortality, major malformations and pooling these together. A + B, the measure of the number of lethal equivalents per gamete, is found to be at variance with other reports. Such variability can be ascribed to non-genetic factors. Supporting evidence collected from Brazil and Malaysia in the same survey is also presented.

Topics: Brazil; Congenital Abnormalities; Consanguinity; Female; Fetal Death; Genes, Lethal; Genetics, Population; Humans; India; Infant Mortality; Infant, Newborn; Malaysia; Male; Pregnancy

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Birth Weight; Blood; Diet; Female; Fetal Death; Hemoglobins; Hemolysis; Hemorrhage; Humans; Malaysia; Nutrition Disorders; Parasite Egg Count; Pregnancy; Pregnancy Complications, Hematologic; Socioeconomic Factors

Topics: Ethnicity; Female; Fetal Death; Hospitalization; Humans; Infant Mortality; Infant, Newborn; Malaysia; Pregnancy; Statistics as Topic

Topics: Adolescent; Adult; Asian People; Black or African American; Black People; Cesarean Section; Delivery, Obstetric; Extraction, Obstetrical; Female; Fetal Death; Hong Kong; Humans; Infant Mortality; Infant, Newborn; Labor Presentation; Labor, Obstetric; Malaysia; Maternal Age; Medicine, Traditional; Nigeria; Obstetric Labor Complications; Obstetrics; Pregnancy; Retrospective Studies; Scotland; Tropical Climate; White People

Topics: Aging; Birth Weight; Cesarean Section; Delivery, Obstetric; Dystocia; Eclampsia; Female; Fetal Death; Humans; Infant; Infant Mortality; Malaysia; Maternal Mortality; Nutritional Physiological Phenomena; Nutritional Sciences; Obstetric Labor Complications; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Prenatal Care; Social Conditions; Statistics as Topic