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Biomedical subjects

S Chua

Publications and source records attributed to S Chua.

89 records · Page 5Linked to original sources
PubMed1991

Induction of labour in nulliparas with poor cervical score: oxytocin or prostaglandin vaginal pessaries?

In a previous study nulliparas with poor cervical score (less than 5 out of 10) had a 43.5% Caesarean section (CS) rate of which 55% were for failed induction when labour was induced by artificial rupture of membranes and oxytocin infusion. In this study induction of labour by 2 doses of 3 mg prostaglandin E2 (PGE2) vaginal pessaries, 4 hours apart, and if necessary by artificial rupture of membranes and oxytocin infusion 24 hours later, resulted in a CS rate of 23.7% of which 38.9% were for failed induction. The latter regimen resulted in a significantly lower CS rate compared with labour induced by oxytocin infusion and rupture of membranes without the use of prostaglandins (p less than 0.001). In the prostaglandin group 53.3% were established in labour within 24 hours of inserting the pessary and in these patients the CS rate was 18.5%. In those who did not start labour and needed rupture of membranes and oxytocin infusion 24 hours after the first pessary, 34 (47.9%) had a good cervical score (greater than or equal to 6 out of 10) and 37 (52.1%) had a poor cervical score (less than or equal to 5 out of 10) at the time of amniotomy. The CS rates in these groups were 8.8% and 48.6% respectively (p less than 0.001). In nulliparas with poor cervical score induction is better performed with vaginal prostaglandin pessaries in order to reduce the high CS rate associated with artificial rupture of membranes and oxytocin infusion.

Adult↗
PubMed1991

Does prostaglandin confer significant advantage over oxytocin infusion for nulliparas with pre-labor rupture of membranes at term?

Ninety-four nulliparous women with a poor cervical score (less than 6) who had premature rupture of membranes at term were randomized by sealed envelope into two groups. One group received immediate stimulation of labor with oxytocin infusion. The second group received two prostaglandin E2 (PGE2) 3-mg pessaries 4 hours apart, followed by oxytocin infusion, if necessary. The interval between initiation of therapy to onset of labor was significantly longer in the PG group, but the length of labor was similar in both groups. The maximum dose of oxytocin needed was significantly higher in the oxytocin group. The cesarean delivery rate in the oxytocin group was 14.9%, compared with 19.1% in the PG group (not significantly different). All seven cesareans in the oxytocin group and seven of nine in the PG group were for failed stimulation of labor. Neonatal Apgar scores at 1 and 5 minutes and admission to the neonatal intensive care unit were similar in the two groups. The incidence of maternal and neonatal infection was small and was not different in the two groups. The use of PGE2 3-mg pessaries 4 hours apart, followed by oxytocin infusion if necessary, did not confer any benefit over the use of intravenous oxytocin in obstetric or neonatal outcome when both agents were started a few hours after admission.

Administration, Intravaginal↗
PubMed1990

Effectiveness of transcutaneous electric nerve stimulator for pain relief in labour.

The effectiveness of transcutaneous electric nerve stimulation (TENS) for pain relief in labour was compared to inhalation analgesia consisting of 50% nitrous oxide and 50% oxygen (ENTONOX). In the first part of the study 101 patients in early labour were allocated to using TENS (Group A) or ENTONOX (Group B) for pain relief. Our results did not show any beneficial effect on pain relief in labour with the use of TENS over ENTONOX; 18.8% of patients in Group A went through labour without any further form of analgesia as opposed to 17.0% in Group B. In the second part of the study 20 nulliparous patients having induced labour were randomly allocated to use TENS (Group C) or ENTONOX (Group D) as the first modality of pain relief. A switchover was made when labour pains were no longer tolerable. The results showed that both TENS and ENTONOX could be used in early labour up to 5-6 cm cervical dilatation till the frequency of contractions was nearly 5 in 10 min or the first 3-4 hr from the time patients first requested pain relief in labour when frequency of contractions was nearly 4 in 10 min. TENS could be used in early labour for patients who wish to be ambulant and is as effective as ENTONOX. Either modality of pain relief was not adequate for pain relief throughout labour.

Adult↗
PubMed1990

Augmentation of labor: does internal tocography result in better obstetric outcome than external tocography?

Labor was augmented in 250 patients for slow progress. These women were randomized to have uterine contractions recorded by either an external tocotransducer or an intrauterine catheter. Oxytocin was titrated to achieve an optimal frequency of contractions of six to seven every 15 minutes in each group; additional information on active contraction area profiles was available for those patients who had an intrauterine catheter. There was no statistically significant difference between the groups in the length of the post-augmentation period. The mean maximum dose of oxytocin was 11.1 mU/minute in the external tocography group and 11.0 mU/minute in the internal tocography group. Evidence of uterine hyperstimulation requiring temporary reduction of the oxytocin dose occurred in 19 and 20.2% of the patients in the external and internal tocography groups, respectively. Cesarean delivery was necessary in 12.6 and 16.9% of patients in the external and internal tocography groups, respectively, which is a nonsignificant difference. The incidence of low Apgar scores in the neonates and admission to neonatal intensive care was similar in both groups. The incidence of poor Apgar scores was not different between those who had transient hyperstimulation and those who had no hyperstimulation. In the management of augmented labor, monitoring of uterine contractions by intrauterine pressure catheters did not confer any advantage over tocography by external transducers.

Apgar Score↗
PubMed1990

Long-term hemodynamic results of percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with pliable, non-calcified valves.

Percutaneous transvenous mitral commissurotomy (PTMC) for severe, symptomatic mitral stenosis was successfully performed in 47 of 50 patients with pliable, non-calcified valves. The procedure resulted in immediate hemodynamic and sustained clinical improvements in all patients. Repeat cardiac catheterization was performed in 22 patients at a mean follow-up period of 15 months (range 12 to 29). The patients were similar to the other 25 patients in regard to gender, age, clinical and hemodynamic characteristics. There were 4 males and 18 females with a mean age of 37 years (range 20 to 61). Immediately after PTMC, there were significant increases in the mitral valve area (1.0 +/- 0.2 to 2.4 +/- .9cm2, p less than 0.001) and cardiac index (3.1 +/- 0.7 to 3.3 +/- 0.7 l/min/m2, p less than 0.05) and significant (p less than 0.001) decreases in the left atrial pressure (25.7 +/- 6.4 to 13.2 +/- 3.9 mmHg), the mitral valve gradient (15.7 +/- 5.7 to 3.9 +/- 1.4 mmHg), mean pulmonary arterial pressure (41.5 +/- 10.7 to 29.2 +/- 10.9 mmHg) and the pulmonary vascular resistance (4.2 +/ 3.4 to 3.5 +/- 2.9 Wood unit). At follow-up study, the mitral valve area (2.2 +/- 0.7 cm2) and the left atrial pressure (12.6 +/- 3.7 mmHg) remained unchanged. There were further decreases in the mean pulmonary arterial pressure (22.4 +/- 5.9 mmHg, p less than 0.05) and the pulmonary vascular resistance (2.0 +/- 1.5 Wood unit, p less than 0.05). There were significant (p less than 0.05) increases in the mitral valve gradient (6.6 +/- 2.5 mmHg) and the cardiac output (3.6 +/- 0.7 l/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Breastfeeding trends in Singapore.

About 60% of well-to-do mothers in Singapore initiate breastfeeding. This value compares favourably with the 36% recently recorded for poor mothers, but is still unacceptably low compared to the 85-95% of well-to-do mothers and 90% of poor mothers who breastfed in the 1950s and 1960s. There has been a general decline in the incidence of breastfeeding over the last 35 years. Differences between the well-to-do and poor groups were initially small. A pronounced decline in the incidence of breastfeeding among the well-to-do mothers followed; a reversal in this downward trend in well-to-do mothers over the past 10 years has narrowed, and indeed reversed, the difference between the two groups. Similar trends can be found for the duration of breastfeeding. Whilst the overall decline probably reflects increasing affluence and 'Westernization' of the population the variation between these two economic groups is probably a result of differences in education. Among the three major ethnic communities, Chinese favoured breastfeeding least and Malays favoured it most. The differences are believed to be related to cultural differences and the ability of traditional practices and beliefs among the ethnic groups to resist the modern trend towards bottlefeeding.

Breast Feeding↗
PubMed1989

Ethnic influence on uterine activity in spontaneous normal labour.

Uterine activity in spontaneous normal labour was studied in Singaporean Malay women at term with a singleton vertex presentation. Nulliparae had significantly higher uterine activity compared with their multiparous counterparts. Uterine activity in the Malay population was compared with that of a similar Chinese population. When controlled for parity, maternal height and birthweight of babies, there was no difference in uterine activity between the two groups.

Adult↗
PubMed1989

Trial of labour after previous caesarean section: obstetric outcome.

Of 305 patients with a previous lower segment Caesarean section scar admitted over a 28-month period, 207 were allowed a trial of labour. A successful trial of labour was achieved in 63.3% of patients with a recurrent indication and 73.4% with a nonrecurrent indication. Of 75 patients who received oxytocin for augmentation and 22 for induction of labour, 70.5% achieved vaginal delivery. This was similar to the vaginal delivery rate in patients who did not require augmentation in induction. Three cases of scar dehiscence occurred in patients who had oxytocin, but in whom the recommended management protocol was ignored. The events that led to these 3 dehiscences is described. Analysis of birth-weights revealed a trend towards more repeat Caesareans with increasing birth-weight beyond 2,500 g. This was especially reflected by the higher emergency Caesarean section rate in those who had a trial of labour. A trial of labour in patients with a previous Caesarean scar is safe, and can be allowed even in patients who had the previous Caesarean for cephalopelvic disproportion, although malpresentation and obvious disproportion must be excluded. Judicious use of oxytocin for a limited period of time should help in reducing the number of repeat Caesarean sections.

Birth Weight↗
PubMed1989

Malignant melanoma of the cervix.

Primary malignant melanoma of the cervix was diagnosed in a 52-year-old woman. Extended hysterectomy and partial vaginectomy were performed. A vulval recurrence was treated with wide excision and total vaginectomy. She subsequently underwent radiotherapy for metastatic lesions in the pelvis and para-aortic nodes, but succumbed to widespread metastatic disease 2 years after initial diagnosis. Diagnosis, therapy, and prognosis for malignant melanoma are discussed.

Combined Modality Therapy↗
PubMed1989

Rapid karyotyping of spontaneous abortions with trophoblastic villi.

24-hour short term culture of trophoblastic villi provided rapid and accurate karyotypes in spontaneous first trimester abortions. Good quality metaphases were obtained in 60.0% of villous cultures if these were set up within 8 hours of uterine evacuation, in contrast to the 10.3% success rate with intervals longer than 8 hours. 21% (4 of 19) of first trimester pregnancy losses were chromosomally abnormal, 3 of which were examples of autosomal trisomy; in 2 cases, the mothers were more than 37 years of age. The results of successful karyotyping reported here compare well with previous reports of long term culture of minced fetal material. Further, the risks of infected cultures, maternal contamination and pseudomosaicism are minimal with the short-term culture technique described here. Chorionic villi isolated from spontaneously aborted material are a simple and practicable source of fetal material for rapid and accurate cytogenic diagnosis in early spontaneous abortions.

Abortion, Spontaneous↗
PubMed1988

Effects of D2343, a new beta-mimetic drug, and terbutaline on spontaneous term labor.

The effects of an intravenous bolus injection of D2343 (0.75 or 1 mg) or terbutaline (0.25 mg) on spontaneous term labor were studied. The uterine activity was recorded by a transducer-tipped intrauterine catheter and calculated electronically by an uterine activity integrator module built in a conventional fetal monitor. After drug administration the uterine activity was reduced to a similar extent with D2343 and terbutaline but the contractions were abolished for a longer time with terbutaline injection (mean of 9.3-9.8 min compared with 17.0 min). Maternal blood pressure was unaffected in both groups but the increase in pulse rate was slightly higher in the D2343 groups. D2343 seems to have an effect ratio between uterine inhibitory capacity and cardiovascular side effects similar to terbutaline.

Adult↗
PubMed1987

Successful outcome of pregnancy in a subfertile patient with severe aortoarteritis (Takayasu's disease).

This report describes the successful outcome of pregnancy in a 27-yr-old subfertile Chinese nullipara with severe Takayasu's disease. Pregnancy was achieved following ovulation induction with clomiphene. Blood pressure was controlled with propranalol and fetal growth was monitored by serial ultrasound fetal anthropometry. Pregnancy was terminated at 38 weeks of pregnancy by elective caesarean section. A live female infant weighing 2420 g was delivered.

Adult↗
PubMedDate not supplied

Contrast transesophageal echocardiographic demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis.

Coronary neovascularization and fistula formation arising from the left circumflex artery demonstrated by coronary angiography is a specific sign for the presence of left atrial appendage thrombus in patients with mitral stenosis. However, the fistula drainage site in the left atrium in relation to the thrombus cannot be ascertained by the angiographic method. We performed transesophageal echocardiography simultaneously with coronary angiography in five patients with severe mitral stenosis and left atrial appendage thrombus. The angiography showed coronary neovascularization and fistula arising from the left circumflex artery in three patients. In these three patients, the transesophageal echocardiography confirmed the presence of a coronary fistula by identifying contrast exuding from the surface of the thrombus. Thus we have shown for the first time the usefulness of contrast transesophageal echocardiography in imaging the exact drainage site of coronary artery fistula from left atrial appendage thrombus.

Aged↗