Between June 1980 and April 1986 796 cases of female sterilization were performed in a private clinic in Malaysia using Mark IVa and Mark VI Filshie clips. There was one failure. Technical failure, surgical difficulties and complications were minimal.
A 23 year old Indian lady, gravida 1 para 0, with Clomid induced pregnancy was admitted to the University Hospital on 29 August 1981 with signs and symptoms of pregnancy and intraperitoneal bleed. Period ofamenorrhoea at time of admission was eight weeks. Emergency laparotomy revealed a right leaking ectopic pregnancy and an enlarged gravid uterus. Ultrasound done on the 7th post operative day confirmed concurrent intrauterine pregnancy which progressed normally to term, ending with a normal healthy baby at 39 weeks through an assisted breech delivery.
Pregnancy was associated with cardiac disease in 0.94% of pregnancies. 0.66% with rheumatic lesions and 0.25'\'0 with congenital lesions. The Malays had a higher incidence than the Chinese and Indians. Most of the cardiac pregnancies were in patients between 20-30 years of age and gravida 1 to 4. Nevertheless. still about 30% of cardiac pregnancies were in patients 30 years and over in age and 20% in patient gravida 5 and above. Rheumatic lesions predominated. involving mainly the mitral valve. of which the major lesion was mitral stenosis. PDA. ASD and VSD were the major congenital lesions. Major antepartum matemal complications included arrhythmias. heart failure, anemia and pre-eclampsia. Of the arrhythmias. atrial fibrillation and sinus tachycardia occurred most commonly. A high incidence of prophylactic forceps and vacuum deliveries
was evident. There was one matemal death. The majority of infants were bom alive and well.
Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.