Objective To compare oral nifedipine with intravenous labetalol in their rapidity to control hypertensive emergencies of pregnancy.Design A double-blind randomised trial.Setting A university hospital in Malaysia.Population Pregnant women with severe gestational hypertension ‡160/110 mmHg who required immediate treatment.Methods Patients were randomised to receive nifedipine (10 mg tablet, orally, up to five doses) and intravenous placebo saline injection or intravenous labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) and a placebo tablet every 15 minutes until the target blood pressure of £150/100 mmHg was achieved. Crossover treatment was effected if the initial treatment regimen was unsuccessful.Main outcome measure The time taken to achieve a blood pressure of £150/100 mmHg.Results The median time taken to achieve target blood pressure was 30 minutes (interquartile range, IQR 22.5-67.5 minutes) versus 45 minutes (IQR 30-60 minutes) for nifedipine and labetalol, respectively (P = 0.59). Repeated measures analysis of variance indicated that in the first hour both systolic (F = 87.6, P < 0.001) and diastolic (F = 55.8, P < 0.001) blood pressure significantly decreased, but there was no difference between the nifedipine and labetalol groups for both systolic (F = 0.12, P = 0.74) and diastolic (F = 0.92, P = 0.34) blood pressure trends over time. Crossover treatment was required in 20% of women from each group.Conclusions Oral nifedipine and intravenous labetalol regimens are similarly effective in the acute control of severe hypertension in pregnancy.

Objective To evaluate immediate compared with on-demand full maternal oral feeding after caesarean delivery Study design A randomised trial.Setting Obstetric unit of a university hospital in Kuala Lumpur, Malaysia.Population Women admitted for a planned caesarean under spinal anaesthesia.Methods Participants were randomised to a sandwich meal served immediately on return to the ward or on-demand.Main outcome measures Primary outcomes were patient satisfaction VAS (visual analog scale of 100 mm) on the feeding regimen and vomiting at 24 hours.Results 453 women were initially enrolled, 395 were randomised and available for analysis. Median (full range) patient satisfaction VAS scores were 82 (15-100) versus 84 (0-100) mm, P = 0.88 and vomiting rates were 1/197 (0.5%) versus 2/198 (1.0%), P > 0.99 for immediate compared with on-demand feeding, respectively. The immediate versus on-demand arms first ate at a median of 105 (35-210) versus 165 (45-385) minutes, P < 0.001, had second meal at 5.3 (1.2-15.5) versus 5.8 (2.2-29.7), P < 0.001, flatus passage at 9.5 (3.1-29.0) versus 10.3 (2.8-24.6), P = 0.023 hours post-caesarean and opiate analgesia use was 10/ 197 (5.1%) versus 23/198 (11.6%), P = 0.028, RR 0.4 (95% CI 0.2-0.9), NNTb 16 (95% CI 8-89). The median visual numerical rating scale (0-10 scale) for nausea and bloating at 8, 16 and 24 hours was similarly scored at zero in both arms. Other outcomes were similar.Conclusion Immediate full feeding has some advantage over on-demand feeding. Both regimens are tolerated well. Patients probably should be fed as soon as practicable after a caesarean.

Objective To evaluate the effect of suggesting coitus as a safe and effective means to expedite labour on pregnancy duration and requirement for labour induction.Design A randomised trial.Setting Antenatal clinic in a university hospital in Malaysia.Population Women from 35 weeks of gestation with an uncomplicated singleton pregnancy.Methods The advise-coitus arm was counselled that coitus at term is a safe, natural and effective means to initiate labour and to avoid labour induction. The control arm was told coitus was safe. Both arms were asked to record coital activity.Main outcome measures Pregnancy duration and labour induction.Results The intervention to delivery interval (mean ± SD) was 3.2 ± 1.4 versus 3.3 ± 1.3 weeks (P = 0.417), with a gestational age at delivery of 39.4 ± 1.2 versus 39.5 ± 1.2 weeks (P = 0.112), and with labour induction rates of 126/574 (22.0%) versus 120/576 (20.8%) (P = 0.666) for the advise-coitus and control arms, respectively, with no statistical difference between the groups. Coitus prior to delivery was more often reported in the advise-coitus arm compared with the control arm: 481/574 (85.3%) versus 458/576 (79.9%) (RR 1.5, 95% CI 1.1-2.0, P = 0.019). Also, the median (interquartile range) reported number of coital acts of 3 (2-5) versus 2 (1-4) (P = 0.006) was higher for the advise-coitus arm. Other pregnancy and neonatal outcomes did not differ between the groups.

Background:Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors' experience with UAE at the University Malaya Medical Centre.Method:Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patient-controlled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI.Results:Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up.Conclusion:Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients ended up with total abdominal hysterectomy. These results suggest that UAE is an appealing alternative to hysterectomy or myomectomy for many women with symptomatic fibroids.

Background: Preterm birth (PTB) is the largest cause of neonatal mortality and morbidity in the world. Ethnicity disparity in the occurrence of PTB has been associated with the cytokine function. In this study, we aimed at examining cytokine levels in women with spontaneous preterm and term births. Method: Women with spontaneous preterm birth (SPTB) between 24 and 31 weeks (n = 40) and women with spontaneous term birth between 37 and 41 weeks (n = 40) admitted to the University of Malaya Medical Centre from 2011 to 2013 were involved in this study. Plasma proteins were determined for 35 cytokines using ProcartaPlex™ immunoassay. Protein levels were compared between women with SPTB and women with term birth. Result: Six specific cytokines were significantly high among women with SPTB. This includes TNFA (odds ratio (OR) 3.4, 95% confidence interval (CI) 2.0-6.0, p = 0.001), MCP-3 (OR 2.5, 95% CI 1.29-4.67, p = 0.007), IL16 (OR 2.4, 95% CI 1.34-4.30, p = 0.003), IL17A (OR 2.3, 95% CI 1.28-4.06, p = 0.005), IFNG (OR 3.8, 95% CI 2.0-8.0, p = 0.001), and farctalkine (OR 2.1, 95% CI 1.17-4.22, p = 0.031), respectively. Conclusion: This study identifies high levels of specific cytokines in women with PTB. These inflammatory biomarkers may play an important role in the mechanisms that result in uterine contraction and PTB.