No abstract

Introduction: The trend for second stage caesarean section (SSCS) has been rising, and it carries a high rate of maternal and neonatal morbidity. Aim: To determine the prevalence of caesarean section (CS) performed during the second stage of labour and identify maternal outcomes and associated risk factors in these women. Material and methods: This retrospective study was performed in the Hospital University Sains Malaysia (HUSM). Medical records of 207 women with singleton cephalic pregnancies at term who underwent a SSCS between January 1, 2010 and December 31, 2015 were reviewed, and demographic and outcome data were collected. Results and discussion: During the study period, 8,197 (19.3%) out of 42,546 babies were delivered by CS, including 257 (4.1%) SSCSs. Nearly half (49.3%) the women were nulliparous, 182 (87.9%) experienced spontaneous labour and 123 (59.4%) received oxytocin augmentation. Furthermore, 26 (12.6%) of women had post-partum haemorrhage (≥1000 mL), of whom 22 (10.6%) required blood transfusion. Only 1 (0.5%) woman was admitted to the intensive care unit postoperatively, but 163 (78.7%) had an overall hospital stay length of 3 days. Furthermore, 38 (18.4%) and 33 (15.9%) of women experienced extended uterine tear and uterine atony, respectively. Parity (P < 0.001), attempted instrumentation (P < 0.001) and baby’s weight (P < 0.004) were statistically significantly associated with total blood loss. Parity (P < 0.012) and attempted instrumentation (P < 0.001) were risk factors for extended uterine tear. Conclusions: The overall outcomes from SSCS were better compared with studies performed in other centres. Current practices must be maintained or improved to provide the best patient caree.

Introduction: Pregnant women are among those who are exempted from Ramadan fasting. Despite that, many pregnant women had chosen to fast despite understanding the risk of complications especially hypoglycaemia. In Hospital USM (HUSM), an insulin regime for pregnant women who wish to fast was designed based on expert opinion of obstetricians, but its safety and efficacy are yet to be determined. Objective: To determine the safety and efficacy of the formulated insulin regime using subcutaneous Actrapid® and Insulatard® amongst pregnant women with diabetes who fast in Ramadan. Methodology: Pregnant patients with diabetes on insulin who wish to fast during Ramadan were invited to participate in the study. The total daily dose of insulin requirement prior to Ramadan was divided 3 parts; 2/3 for iftar (sunset meal) and 1/3 for sahur (pre-dawn meal). For each timing, 2/3 of the calculated dose was given as short-acting insulin Actrapid® and remaining 1/3 as intermediate-acting insulin Insulatard®. Three patients were monitored in the ward while fasting for two days. Blood glucose checked eight times a day. Following that, eight patients were followed up during Ramadan fasting with this regime. Weekly blood sugar profile (BSP) was taken and glycaemic control evaluated. Results: All patients were able to fast without any hypoglycaemic episode, both during in-patient study and during out-patient Ramadan fasting. Mean daily blood glucose per day for in-patient monitoring was 7.3 mmol/l with the lowest being 4.56 mmol/l in the afternoon. During Ramadan fasting, average glucose level was higher (6.79 mmol/l) compared to prior to Ramadan value (5.67 mmol/l) (p> 0.05). However, improvement of glycaemic control was observed towards end of Ramadan. Conclusion: Pregnant women with diabetes treated with insulin can fast safely during Ramadan using the suggested insulin regime with improvement of glycaemic control observed at the end of Ramadan.