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Introduction: Red cell transfusion is expensive and not without risks. Despite the availability of transfusion guidelines, studies report a wide interhospital variation in transfusion rates. This retrospective cohort study was conducted to define the incidence of red cell transfusion in a multi-ethnic obstetric population and to evaluate current transfusion practice with regard to indications and appropriateness., Methods: All parturients who delivered a live or stillbirth in the period 2014-2015 and who received allogeneic blood transfusion during pregnancy and up to six weeks postnatally were identified. Their medical records were reviewed to extract the relevant demographic, obstetric and transfusion data. Descriptive analysis of data was performed using IBM SPSS Statistics software., Results: Out of 23,456 parturients who delivered in the study period, 760 were administered red cell transfusion, resulting in a transfusion rate of 3.2% or 32 in 1,000 maternities. A total of 1,675 red cell units were utilised in 863 transfusion episodes. Major indications for transfusion were anaemia in pregnancy (49.2%) and postpartum haemorrhage secondary to an atonic uterus. Transfusion was more frequently associated with caesarean than vaginal births (4.9% vs. 2.4%). About 14% of transfusions were initiated with pre-transfusion haemoglobin (Hb) ≥ 8.0 g/dL, whereas 37% of transfusions resulted in post-transfusion Hb > 9.0 g/dL., Conclusion: The incidence of red cell transfusion was 3.2% in a multiethnic obstetric population. Patient blood management strategies should focus on optimising antenatal anaemia, reducing blood loss during delivery and eliminating inappropriate transfusion., (Copyright: © Singapore Medical Association)

Introduction: This study aimed to assess maternal and perinatal outcomes following second stage Caesarean sections., Methods: A retrospective study was conducted in a Singapore-based tertiary referral centre from January 1, 2009 to December 31, 2009. The medical records of all the women who underwent emergency Caesarean sections in the second stage of labour were reviewed., Results: Out of 2,501 emergency Caesarean sections performed, 116 were Caesarean sections in the second stage of labour. Women with non-vertex, twins and preterm deliveries were excluded, and 110 (4.4%, 110/2,501) Caesarean sections were recruited. The majority of the Caesarean sections were determined and performed by registrars or consultants. With regard to maternal outcome, 2.7% (3/110) of patients had primary postpartum haemorrhage and 4.5% (5/110) of patients had vertical or lateral lower uterine segment tears. As for neonatal outcome, although the Apgar scores of newborns were low at birth for 8.2% (9/110) of patients, the Apgar score was > 4 at 5 minutes for all patients., Conclusion: Overall, there was no statistically significant adverse maternal or perinatal outcome.

Sacrococcygeal teratoma (SCT) is a congenital tumour that can be diagnosed by ultrasonography (USG). We present our experience with the management of two cases of SCT in our institution between 2008 and 2009. In the first case, SCT was diagnosed at 17 weeks' gestation. The patient was followed up with fortnightly USG to monitor the tumour size, foetal growth and signs of foetal hydrops. The patient delivered a baby girl by Caesarean section at 37 weeks, with good Apgar scores. The neonate underwent an uneventful resection of SCT on Day 1 of life. In the second case, SCT was diagnosed at 20 weeks during screening. In view of foetal hydrops and anaemia, the patient underwent three in utero foetal blood transfusions. A baby boy was delivered by Caesarean section at 28 weeks. There was a large friable SCT with massive haemorrhage. Despite maximal resuscitative efforts, the neonate died 30 minutes after birth.

A 28-year-old primigravida presented at 36 weeks of gestation with a one-week history of fever with myalgia. Diagnosis of dengue fever was made based on viral polymerase chain reaction. She progressed to dengue shock syndrome by day nine and subsequently recovered. She delivered a healthy male baby by the vaginal route, but within 24 hours of delivery, had an eclamptic seizure, which was controlled with intravenous magnesium sulphate. Mother and the baby were well at discharge and on the follow-up visit at three months.