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Background: The rates of repeat cesarean section (CS) among women with previous CS are increasing worldwide. The predictors of a repeat CS can vary across different populations. Objective: To determine the predictors of repeat CS among women from Malaysia with one previous lower segment CS (LSCS) who underwent trial of labor (TOLAC). Materials and Methods: This retrospective cohort study included women with one previous LSCS who followed up and delivered their current pregnancy at Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia, between January 01, 2016, and December 31, 2017. Women with singleton pregnancies were included while those who had a history of classical CS, current pregnancy with preterm birth, non-cephalic pregnancy, lethal fetal anomalies, uterine rupture, and severe preeclampsia or planned for elective CS were excluded. Logistic regressions were performed. Results: The study included 388 women who underwent TOLAC and successfully gave childbirth through vaginal birth after cesarean (VBAC) (n = 194) or emergency LSCS (n = 194). Factors significantly associated with repeat CS were no history of vaginal delivery (adjusted odds ratio (aOR): 2.71; 95% confidence interval (CI): 1.60, 4.60; P < 0.001), estimated fetal weight ≥3500 grams (aOR: 4.78; 95% CI: 2.45–9.34; P < 0.001), and presence of meconium-stained liquor (aOR: 2.40; 95% CI: 1.33–4.35; P = 0.004). Conclusion: The above-mentioned predictors of a repeat CS among women from Malaysia with one previous LSCS who underwent TOLAC can be useful for clinicians in making an informed decision.

Aims: Preeclampsia is a significant disorder that poses serious risks to maternal and fetal health. This study aimed to identify the severity of preeclampsia and associated factors in a University Hospital in Malaysia. Methods: A cross-sectional study was conducted among preeclampsia patients at the Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia, between 2011 and 2016. Preeclampsia patients with chronic hypertension, hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, and eclampsia were included, whereas patients with chronic kidney disease were excluded. Preeclampsia severity was classified into mild, moderate, and severe. Results: The study included 202 patients [mean (standard deviation) maternal age: 30.49 (6.18) years]. Most patients were multigravida (134) and multipara (134). Sixty-five (32.2%) patients had a history of preeclampsia. The proportion of patients with mild preeclampsia was 35% [95% confidence interval (CI): 30%, 40%], moderate preeclampsia was 30% (95% CI: 25%, 35%), and severe preeclampsia was 35% (95% CI: 30%, 40%). High levels of uric acid [adjusted odds ratio (OR): 1.05, 95% CI: 1.02, 1.07, p=0.001], chronic hypertension (adjusted OR: 2.36, 95% CI: 1.28, 4.33, p=0.006), and gestational diabetes mellitus (adjusted OR: 0.53, 95% CI: 0.30, 0.96, p=0.035) were the factors associated with the severity of preeclampsia. Conclusions: Higher levels of uric acid, chronic hypertension, and gestational diabetes mellitus were significantly associated with the severity of preeclampsia among patients in the USM. [ABSTRACT FROM AUTHOR]

Preeclampsia patients have frequently been found to experience hyperuricaemia and this may result in poor outcomes compared to those with normal uric acid levels. This study aimed to determine the relationship of hyperuricaemia in pre-eclampsia patients with foetal and maternal outcomes. This prospective cohort study involved 79 patients in a tertiary centre from year 2016 to 2018. Blood samples were taken antenatally and at the 6th week, post-delivery for renal function including serum uric acid level. Our findings indicate that there was a higher incidence of poor maternal and foetal outcomes in the hyperuricaemia group than the normal uric acid group. Serum uric acid has been shown to be a significant predictor for low birth weight and premature delivery in preeclampsia patients. It was also found that there was a significant negative correlation between uric acid level and antenatal creatinine clearance (rs = −0.338, p =.002). The assessment of the serum uric acid level seems to be important to ensure better outcomes in patients with preeclampsia. What is already known on this subject? Preeclampsia is a serious pregnancy-related complication and remains as one of the most important cause of maternal and foetal morbidity and mortality, affecting 2–8% in all pregnancy. Many studies have established the association between hyperuricaemia and preeclampsia. Besides, numerous studies have found that hyperuricaemia contributed to adverse maternal and foetal outcomes. What the results of this study add? There was a significant increase in adverse foetal and maternal outcomes in the hyperuricaemia group compared to the normal uric acid group. This study revealed that serum uric acid remains a significant predictor for low birth weight and premature delivery in preeclampsia patients. Whatthe implicationsareof these findings for clinical practice and/or further research? Hyperuricaemia does not merely become an indicator for the severity of disease in preeclampsia patients but also indicates adverse foetal outcomes. Large population-based studies are required to establish the absolute maternal and foetal outcomes in patients with hyperuricaemia. Besides, further studies are recommended on long-term implication of hyperuricaemia which is not limited to only during antenatal period. [ABSTRACT FROM AUTHOR]

Purpose: To determine the cutoff point of cystatin C for the detection of renal impairment in hypertensive pregnancies. Methods: A cross-sectional study was conducted in an antenatal clinic and ward at Hospital Universiti Sains Malaysia, Kelantan, Malaysia from January 2009 until January 2010. Sixty four pregnant patients beginning at 2nd trimester, aged of 16 to 55 years and hypertensive, including gestational hypertension, chronic hypertension with superimposed preeclampsia, preeclampsia and unclassified hypertension, were included in the study. Consenting patients were required to provide 5 ml of blood and 24-h urine. Serum and reagent, N Latex cystatin C, were equilibrated at room temperature and measured by particle-enhanced nephelometric immunoassay (PENIA) using a BN II Dade Behring Nephelometer System Results: The mean age of the patients was 37.06 ±4.32 (range: 24 to 46 years). A majority (64.1 %) of the patients were in the second trimester of pregnancy and delivered in the gestational period of 38 - 40 weeks (54.7 %). The number of patients in chronic kidney disease (CKD) stages I, II, III, IV and V were 25 (39.1 %), 18 (28.1 %), 18 (28.1 %), 2 (3.1 %) and 1 (1.6 %), respectively. The mean systolic blood pressure was 149.59 ± 18.79 mm Hg, and diastolic blood pressure 91.53 ± 10.33 mm Hg. The cutoff point in detecting renal impairment using cystatin C was > 0.74 with 84.6 % sensitivity and 86.7 % specificity for second trimester and > 0.81 with sensitivity of 76.9 % and specificity of 60.0 % in detecting renal impairment for third trimester Conclusion: The cutoff point in detecting renal impairment for second trimester is better than for third trimester since it maximizes the value of sensitivity and specificity. [ABSTRACT FROM AUTHOR]