MyMedR

Fulltext The prevalence of HIV positive antenatal mothers in a routine screening programme in two states

Japaraj RP, Sivalingam N

Med J Malaysia, 2001 Jun;56(2):180-5.

This is a retrospective study of the prevalence of Human Immunodeficiency Virus (HIV) positive mothers in two states in Malaysia i.e., Perak and Negeri Sembilan since the introduction of the HIV screening programme in antenatal mothers. The study period was from 1/9/97 to 1/9/99. A total of 29 HIV positive antenatal mothers were detected (21 from Perak and 8 from Negeri Sembilan) throughout the study period. Out of the 21 HIV positive mothers from Perak, 8 (38%) were foreign nationals whereas only 1 (12%) out of the 8 from Negeri Sembilan was a foreign national. The main risk factor identified in both the groups was multiple sexual partners. The vertical transmission rates for the patients from Perak were 14.2% and 37.5% in Negeri Sembilan. There was no significant short-term adverse obstetric outcome.

Fulltext Sengstaken-Blakemore tube to control massive postpartum haemorrhage

Japaraj RP, Raman S

Med J Malaysia, 2003 Oct;58(4):604-7.

PMID: 15190639

Massive postpartum haemorrhage after Cesarean section for placenta previa is a common occurrence. The bleeding is usually from the placental bed at the lower uterine segment. Uterine tamponade has a role in the management of such patients especially when fertility is desired. We describe here a case of massive postpartum haemorrhage, which was managed, with the use of a Sengstaken-Blakemore tube. This allowed us to avoid a hysterectomy for a young primiparous patient.

Fulltext Complete hydatidiform mole and surviving coexistent twin--a case report

Japaraj RP, Sivalingam N

Singapore Med J, 2000 Mar;41(3):126-8.

PMID: 11063197

Hydatidiform mole with a coexistent fetus is a rare occurrence with an incidence of I per 22,000-100,000 pregnancies. It is associated with persistent gestational trophoblastic tumour. Hence an early and correct diagnosis is imperative to plan subsequent management of such patients. We report a case of a primigravida who presented with vaginal bleeding at early second trimester. Expectant management was carried out for her pregnancy which finally ended in an abortion. The pathology, clinical findings and current management of this rare entity is discussed.

Antenatal diagnosis of placenta previa accreta in patients with previous cesarean scar

Japaraj RP, Mimin TS, Mukudan K

J Obstet Gynaecol Res, 2007 Aug;33(4):431-7.

PMID: 17688608

To determine the accuracy of transabdominal and transvaginal gray-scale and color Doppler in diagnosing placenta previa accreta in patients with previous cesarean sections.

Fulltext Intrauterine management of fetal supraventricular tachycardia (SVT) with cardiac failure

Muniswaran G, Japaraj RP, Asri Ranga AR, Cheong HK

Med J Malaysia, 2015 Dec;70(6):371-2.

PMID: 26988216 MyJurnal

Fetal arrhythmias are not uncommon in pregnancy. The diagnosis can be established on routine ultrasound scan. Fetal supraventricular tachycardia (SVT) is the most common cause of fetal tachycardia. If left undiagnosed and untreated, these fetuses may develop cardiac failure, hydrops fetalis and eventually death. We report two fetuses diagnosed antenatally to have fetal SVT. Both fetuses were in cardiac failure and were successfully treated with maternal administration of antiarrhythmic medications. Digoxin, and in severe instances, a combination with flecanaide significantly improved fetal outcomes and prevented fetal mortality. The long term prognosis of such patients are good.

Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh Hospital

Nalliah S, Loh KY, Japaraj RP, Mukudan K

J Matern Fetal Neonatal Med, 2009 Feb;22(2):129-36.

PMID: 19197787 DOI: 10.1080/14767050802509520

The 'Term Breech Trial' (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.

Fulltext Influence of a targeted educational intervention on evidence-based practice in two Malaysian maternity units: the SEA ORCHID project in Malaysia

Ho JJ, Japaraj RP, Anuar CY, Van Rostenberghe HA, Chang AS, Sivasangari S

Med J Malaysia, 2011 Oct;66(4):288-95.

PMID: 22299544 MyJurnal

We conducted a before and after study to determine whether an educational intervention to build capacity in the understanding and implementation of evidence could result in improved outcomes for mothers and babies in obstetric and neonatal units of two Malaysian hospitals. Twelve practices and thirteen associated outcomes were selected based on clear evidence from the Cochrane Library. There were significant improvements in most practices with little change in outcomes. In the short term a targeted intervention to build capacity in the understanding and implementation of evidence results in an improved process of care without adverse outcomes.

Fulltext Influence of training in the use and generation of evidence on episiotomy practice and perineal trauma

Ho JJ, Pattanittum P, Japaraj RP, Turner T, Swadpanich U, Crowther CA, et al.

Int J Gynaecol Obstet, 2010 Oct;111(1):13-8.

PMID: 20598690 DOI: 10.1016/j.ijgo.2010.04.035

OBJECTIVE: To examine episiotomy practices before and after a multi-component intervention designed to support the use and generation of research evidence in maternal and neonatal health care.

METHODS: Set in 9 centers across 4 Southeast Asian countries, a retrospective survey was performed for 12 recommended pregnancy/childbirth practices and 13 outcomes of women in each center before and after intervention. Qualitative interviews were conducted to assess staff awareness and experience in evidence-based practice.

RESULTS: There were significant decreases in the rate of episiotomy, from 64.1% to 60.1% (risk difference [RD] -4.0; 95% confidence interval [CI], -5.8 to -2.2) for all women and from 92.2% to 80.7% (RD -11.5; 95% CI, -13.4 to -9.6) for nulliparous women. Severe trauma decreased from 3.9% to 1.9% (RD -2.0; 95% CI, -2.7 to -1.4) for all women and from 6.7% to 3.0% (RD -3.7; 95% CI, -4.9 to -2.5) for nulliparous women. The frequency of intact perineum increased from 12.4% to 15.6% (RD 3.2; 95% CI, 1.9-4.6) for all women and from 1.7% to 8.0% (RD 6.3; 95% CI, 5.0-7.5) for nulliparous women.

CONCLUSION: An intervention based on understanding and using the best available evidence can result in significant improvements in care and health outcomes.

Risk factors for depression and anxiety among pregnant women in Hospital Tuanku Bainun, Ipoh, Malaysia

Fadzil A, Balakrishnan K, Razali R, Sidi H, Malapan T, Japaraj RP, et al.

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:7-13.

PMID: 23857831 DOI: 10.1111/appy.12036

Anxiety and depression are prevalent during pregnancy. Estimates of the prevalence of anxiety and depression during pregnancy vary according to the criteria used, variable methodologies and population characteristics.

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