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Biomedical subjects

D Monga

Publications and source records attributed to D Monga.

12 recordsLinked to original sources
PubMed2001

Depot medroxy progesterone acetate: a poor preparatory agent for endometrial resection.

OBJECTIVE: To evaluate the efficacy of depot medroxy progesterone acetate (DMPA) as a preparatory agent for endometrial resection. STUDY DESIGN: Endometrial resection was performed on 50 women for excessive uterine bleeding. The patients were randomly divided into 2 equal groups, with the first group receiving DMPA and the second group not receiving any hormonal pre-medication. The resected tissue was sent for histopathology and all the patients were followed up regularly for a maximum period of 4 years. RESULTS: DMPA was found to increase the thickness of the endometrium, making it more fluffy and oedematous. The procedure in these patients was associated with a significantly greater fluid consumption and deficit. A power analysis showed the overall power of the study to be >90%. Forty-four percent of group 1 and 64% of group 2 patients achieved amenorrhoea or spotting. Three patients in all underwent a repeat procedure, and 1 a hysterectomy, following a dissatisfactory result. However, no statistically significant difference was found in the outcomes of the 2 groups. CONCLUSION: As a preparatory agent, DMPA, seems to have no added benefit. Larger studies are required to bring out differences in outcomes, if any.

Adult↗
PubMed1999

Is there a role for the obstetric flying squad in Peninsula Malaysia?

BACKGROUND: The Obstetric Flying Squad (OFS) has been operating in Peninsular Malaysia for over three decades. In the light of current controversies regarding its role in modern day obstetric practice, its status in Malaysia over the last 12 years is reviewed. METHOD: Statistics from three Malaysian states (Kelantan, Trengganu and Malacca) were reviewed with regard to the numbers and places of delivery as well as OFS and ambulance call out rate (per 1000 deliveries). These statistics were obtained from the annual reports of the three state hospitals. Improvement in socioeconomic development was reviewed in order to study its impact on the requirement of OFS service. RESULTS: The last decade has witnessed a marked decrease in home deliveries, a higher proportion of high risk pregnancies delivering under medical supervision and a dramatic increase in the availability of telecommunication, transport and rural medical facilities. The OFS callout rate has fallen significantly, though the principal indication for calls were due to post-partum haemorrhage and retained placenta. The average time taken to reach a patient is 47 minutes for an OFS call compared to 26 minutes for an ambulance call in Kelantan. CONCLUSIONS: Given the disadvantages of longer response time and the requirement for a skilled specialist to man the service, the OFS service can be completely replaced by the ambulance service (with training of drivers in first aid) in the general Malaysian setting. However, there may still be a limited role for the OFS in the isolated rural communities where access by land transport is extremely difficult.

Air Ambulances↗
PubMed1996

Case report: torsion of a gravid horn of a didelphic uterus.

Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.

Abdominal Pain↗
PubMed1996

Acceptability of epidural analgesia for pain relief during labour among Kelantanese women.

Three hundred and five primigravid women were interviewed at term to assess the acceptability of epidural during labour, and reasons for the decisions. Data was collected on a prestructured proforma which consisted of background information, socio-economic status, knowledge about epidural analgesia, source of information and reasons for choice. Of the 305 patients only 17.3% were willing to receive epidural analgesia. This group consisted of 56.6% non-Malay women. Those employed in professional or skilled jobs (56.6%) also readily consented for epidural. Nearly half the women willing for epidural had received college (tertiary) education (43.3%) and more than a quarter (26.4%) were over 30 years of age. The majority of those who were unwilling had no prior knowledge about the procedure, and refused either out of fear, ignorance, resistance from husbands, on religious grounds or following poor feedback from friends. In order to advocate epidural analgesia, knowledge has to be targeted to the relatively less educated, unemployed women, mainly through the media or personally in the antenatal clinic by doctors and nurses. Services have to be improved as substandard analgesia may send out wrong messages and actually do more harm than good.

Adult↗
PubMed1996

A study of knowledge and attitudes towards contraception among health care staff in Kelantan (Malaysia).

OBJECTIVE: To study the knowledge, attitudes and practices on various contraceptive methods among all government health clinic staff in the state of Kelantan. DESIGN: Questionnaire-based study. SETTING: All government health clinics in the state of Kelantan which are health facilities located outside the general hospital and seven district hospitals. SUBJECTS: All 711 nursing staff employed in government health clinics in Kelantan state (sisters, staff nurses, assistant nurses and midwives). METHOD: Pretested, prestructured proforma was sent out to all the nursing staff employed in all peripheral health centres to be completed by them and returned the same day via the medical officer in charge of that district. RESULTS: Most of the respondents were more than 30 years of age, married, multiparous and working for more than 5 years. Eighty to ninety percent practised contraception, with the majority of midwives preferring pills and the majority of staff nurses preferring condoms. Thirty to forty percent from all groups felt that folk methods are effective, and should be encouraged. Only about 50% of staff nurses are well informed on all contraceptive methods, but among assistant nurses and midwives, this figure is only 33%. A high proportion felt that the nursing curriculum deals inadequately with this subject. CONCLUSION: The first step towards achieving success in our family planning programme lies in imparting more information to this target group of health workers, by incorporating more lectures during training and sending them for courses.

Adult↗
PubMed1995

Performance of elderly primigravidae in Kelantan.

The obstetric performance of 59 elderly primigravidae delivering at the University Hospital, Kelantan, between January 1, 1987 and December 12, 1988 is compared with that of 60 young primigravidae delivering during the same time period. The total number of deliveries during this period was 16,284, and the predominant ethnic group was Malays. Apart from an increased incidence of preeclampsia (23.7% vs. 13.3%), breech presentation (6.78% vs. 3.33%) and Caesarean sections (74.6% vs. 10%) among the study group, there were no other statistically significant obstetric complications. Majority of Caesarean sections were done as emergency procedures, the principal indications being poor progress of labour and foetal distress. The neonatal outcome (in terms of birthweight, gestational age and breastfeeding at discharge) was similar in the two groups. For most women in both groups this was the first marriage, though a higher proportion in the study group had an interval of more than two years between marriage and childbirth.

Adult↗
PubMed1994

Transient blindness in pregnancy induced hypertension.

Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject. Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.

Abortion, Therapeutic↗
PubMed1994

Outcome of forceps delivery versus vacuum extraction--a review of 200 cases.

The outcome of 100 patients undergoing instrumental delivery with vacuum extractor is compared with that of 100 women delivered with the aid of obstetric forceps. Forceps deliveries were more commonly associated with maternal birth canal trauma (including episiotomy) whilst vacuum extractor carried higher odds of the neonate developing jaundice. Apart from these, there were no significant differences between these two groups in terms of maternal morbidity, neonatal trauma and morbidity and ultimate outcome (success with the type of instrument used). We conclude that with meticulous handling of the instrument and with an appropriate decision on the indication and the type of instrument used, the maternal and neonatal outcome could be equally good with the use of either instrument.

Adult↗
PubMed1992

Significance of cord problems at birth.

Cord problems at birth were prospectively studied in 12,000 singleton deliveries, of which 258 (2.15%) babies had cord abnormalities. Nearly 32% of these cases had fetal distress and 20.5% had 1 minute Apgar score less than 6. Of the various cord problems nuchal cord was noted in 79.1%, cord prolapse in 12.4% and true knots in 3.9% cases. Perinatal mortality rate with cord problems was 85.27/1000 births. Neonatal problems noted were septicemia (4.56%), aspiration syndromes (13.48%), hypoxic ischemic encephalopathy (7.30%), neonatal convulsions (2.14%) and hyperbilirubinemia (2.14%). Although mean Hb and PCV were lower in those with cord round the neck as compared to normal controls, this difference was not significant. Seven babies had Hb less than 13 g/dl with nuchal cords. Neonates born with cord around the neck or with other cord abnormalities should be carefully followed up for morbidity.

Apgar Score↗
PubMed1989

Breast feeding practices and maternal employment.

Little information exists about the relationship between maternal employment and breast feeding practices and knowledge about lactation. The study was conducted on 318 employed and 299 non-employed women prospectively. Lactational practices were significantly influenced by employment status, with 81.9% non-employed vs. only 49.7% employed going in for exclusive breast feeds in the first 3 months (p less than .001). Correspondingly, 46.8% employed women started combined breast and bottle feeds from birth (p less than .001). Within the employed group, parity and social class did not significantly alter the infant feeding practices. Employed women were better informed about feeding and weaning as compared to their non-employed counterparts (36.8% vs. 18.4% p less than .001). Women from higher social class also tended to be more aware (59.8% vs. 7.2%: p less than .001). Multiparas had an edge over primiparas with respect to knowledge about lactation (36.1% vs. 20.1% p less than .01).

Breast Feeding↗