BackgroundEctopic pregnancy was recorded as the fourth principal cause of maternal death in Malaysia in 2019. Early diagnosis and use of methotrexate treatment proved to be safe and effective alternatives to surgical treatment. This study investigates the success rate of methotrexate treatment for ectopic pregnancy in a tertiary hospital in Malaysia. MethodsThis was a retrospective review of 73 patients with ectopic pregnancies treated with methotrexate according to a single-dose protocol from January 2009 until November 2019. The diagnosis of ectopic pregnancy was made using a combination of transvaginal scan and serial serum β-hCG levels. Their clinical and demographic data were reviewed. Serum β-hCG levels were measured at pre-and post-treatment to determine the rate of successful resolution. ResultsThe overall success rate was 87.7% (64/73 patients) with methotrexate treatment. Fifty-six patients (76.7%) were successfully treated with a single dose of methotrexate, and eight patients (11.0%) required a second dose of methotrexate. There was no relation between socio-demographic, pre-treatment β-hCG levels, ectopic mass size, and treatment efficacy. Smaller size of ectopic pregnancy (adjusted OR=29.23; 95% CI: 2.69, 317.90; P=0.006) and absence of free fluid at the pouch of Douglas (POD) (adjusted OR=27.31; 95% CI: 2.84, 262.32; P=0.004) was found to increase the likelihood of overall treatment success. Absence of fetal cardiac activities was found to increase the likelihood of first-dose methotrexate treatment success (OR=10.20; 95% CI: 1.93, 53.79; P=0.006). ConclusionsEarly diagnosis of ectopic pregnancy may reduce morbidity and mortality. In carefully selected cases, methotrexate treatment has been proven to be cost-effective and avoided risks associated with surgery and anaesthesia.

Introduction: Obstetric anal sphincter injuries (OASIS) is a term used to describe third- and fourth- degree perineal trauma during childbirth. There are a lot of risk factors associated with OASIS, however newborn’s head circumference (HC) at birth as a risk factor is understudied. The aim of this study was to determine the incidence of OASIS and establish the association between newborn’s HC at birth and OASIS among primigravidae who delivered in Hospital Raja Permaisuri Bainun (HRPB) from 2016 to 2018. Other OASIS risk factors were also analysed. Methods: This was a retrospective cross-sectional study among primigravidae who delivered in HRPB from 2016 till 2018. Systematic sampling method was used, and the total sample recruited was 538. Women who sustained OASIS were compared to women without OASIS. Simple and multiple logistic regression analysis were used to look for the association between associated risk factors and OASIS. Results: The incidence of OASIS in HRPB during the study period was 2.0%. Newborn’s HC at birth (p=0.588) was not significantly associated with OASIS, whereas birth weight (OR 1.002 95%CI 1.001-1.004 p=0.06) and instrumental delivery (OR 8.13 95%CI 1.91-34.59 p=0.05) were significant risk factors for OASIS. Conclusion: Overall incidence of OASIS in HRPB was 2.0%, which is within the normal range. Newborn’s HC was not significantly associated with the occurrence of OASIS. Birth weight and instrumental delivery were significant risk factor for OASIS. This information can be used for patient counselling and shared decision making.