BackgroundUniversal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population.Methods1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26–28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence.ResultsUniversal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0).ConclusionRisk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-345) contains supplementary material, which is available to authorized users.

Given the consensus that there is a causal relationship between Zika virus (ZIKV) infection in pregnancy and congenital Zika syndrome (CZS), clinicians must be prepared to manage affected patients despite the numerous gaps in current knowledge. The clinical course in pregnancy appears similar to that in non-pregnant women, although viraemia may be prolonged. ZIKV infection can be diagnosed by serum and urine reverse transcription-polymerase chain reaction, but commercially available serological tests are currently unreliable in dengue-endemic regions. Although vertical transmission can occur at any time during gestation, first-and second-trimester infections have the highest risk of developing central nervous system anomalies. Aberrant fetal growth and pregnancy loss may also occur. Serial ultrasonography should be conducted for infected cases. Without a vaccine, pregnant women should be advised to minimise mosquito bites and reduce sexual transmission risk. Overall, the absolute risk of CZS arising amid a ZIKV outbreak appears relatively low.

Objectives: The objective of the study was to evaluate the incidence of venous thromboembolism (VTE) in patients who have been admitted for adenomyosis at our institute and describe their clinical characteristics and management. Materials and Methods: A retrospective review of the medical records of all patients who were admitted to the gynecology ward between January 2015 and August 2016 was conducted, and all patients who had adenomyosis were included in this study. Clinical details that were evaluated included age, parity, body mass index, significant comorbidities, size of the uterus on physical examination, the size of the adenomyoma (if present) on pelvic ultrasonography, initial hemoglobin, and hematocrit on admission, whether blood transfusion was required, acute and long-term treatment and whether or not there were any associated VTE and treatment given. Results: Forty-one patients were included in this study. Five (12.2%) out of the 41 patients had associated VTE; all five had pulmonary embolism (PE), while two also had a concurrent left lower limb deep-vein thrombosis. Three out of the five patients had worsening menorrhagia following anticoagulation, which gonadotropin-releasing hormone analogs were effective in controlling. Four of the five patients eventually underwent a hysterectomy for long-term management of adenomyosis. Conclusion: This case series describes a few clinical cases where VTE (particularly PE) has been observed with adenomyosis, the challenges in managing these patients, and effective treatment approaches.

We present the first reported case of clear cell carcinoma associated with a midurethral tape (MUT), the possible hypotheses and the management pitfalls we encountered. We report a 58-year-old woman who presented with symptoms of urinary tract infection and acute retention of urine associated with vaginal tape exposure 10 years after placement of an inside-out transobturator tape. She subsequently had a partial transobturator tape excision and a diagnostic cystoscopy, which revealed inflammatory changes within the urethra. Postoperatively, her symptoms persisted and the vaginal epithelium healed poorly. A biopsy of the friable tissue reported clear cell carcinoma. Imaging showed a locally invasive periurethral mass and bony and lymphatic metastases. This was treated with palliative radiation therapy. She was still receiving palliative care 5 months after the initial surgery.

Objective. A retrospective study to evaluate the Thunderbeat, a new vessel sealing device in a small group of patients undergoing laparoscopic hysterectomy to test the safety and effectiveness in achieving hemostasis. Method. The Thunderbeat was used in 12 cases of total laparoscopic hysterectomy. Operative performance involving hemostasis, sealing/coagulation, cutting, dissection, and tissue manipulation was evaluated. Results. No complications were encountered intraoperatively and postoperatively. Intraoperative experience involving hemostasis, sealing/coagulation, and cutting was optimal. Tissue handling was acceptable except for fine dissection. Conclusion. The Thunderbeat is an efficient and safe alternative to standard bipolar in laparoscopic hysterectomy. Larger studies are required to evaluate the cost-effectiveness and significant reduction in operating times as compared to conventional bipolar energy.

A 38-year-old woman who had undergone three low-segment cesarean sections was admitted to the hospital in labor at 36 weeks of gestation. Antenatal ultrasonography suggested placenta accreta (Panel A), with the appearance of irregular vascular spaces (asterisk) and loss of retroplacental hypoechoic stripe (arrowheads), which suggested obliteration of the basal decidua. She underwent an emergency cesarean section, which confirmed the abnormal adherence of the placenta to the myometrium. The placenta was left in situ, and a cesarean hysterectomy was performed to decrease the risk of massive hemorrhage. Gross and histopathological examination (Panels B and C) confirmed the diagnosis of placenta increta, with trophoblastic invasion into the myometrium. There is a spectrum of abnormal placentation: placenta accreta refers to the attachment of the chorionic villi to the myometrium, placenta increta to the invasion of the chorionic villi into the myometrium, and placenta percreta to invasion through the myometrium, with or without involvement of surrounding structures. Abnormal placentation may be suspected on ultrasonography or magnetic resonance imaging but can be diagnosed definitively only on histopathological examination. The patient's postoperative course was uncomplicated. She was discharged home with her newborn on the fifth postoperative day, and both mother and child remained well at follow-up 12 months after delivery.

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