Prevalence of overactive bladder syndrome (OABS) among women with gynaecological problems and its risk factors in a tertiary hospital, Negeri Sembilan, Malaysia: Implication for primary healthcare providers.

OBJECTIVE: The objective of this paper was to determine the prevalence of overactive bladder syndrome (OABS) and its risk factors among patients with other gynaecological problems. METHODS: This study was conducted on women aged more than 18 years who attended the gynaecology clinic for various diagnoses other than urinary problems at a tertiary hospital in Negeri Sembilan, Malaysia, for a period of 6 months. Data on patient's profile, symptoms and risk factors for overactive bladder (OAB) were prospectively collected using a structured questionnaire adapted from ICIQ (international consultation on incontinence questionnaire). Exclusion criteria included patients with confirmed diagnosis of stress incontinence or OAB, neurological impairment, gynaecological malignancy and those with a previous history of pelvic radiation. Chi-square test and logistic regression test were used in the statistical analysis. We presented the odds ratio (OR) and 95% confidence interval for each of the OAB symptoms with p-value of 0.05. RESULTS: The prevalence of OAB among the patients (n = 573) in this study was 19.1%. History of giving births to macrosomic babies and presence of utero-vaginal prolapse (UVP) were shown to be significantly associated with OAB in the multivariate analysis. Other factors were advanced age, high parity and menopausal for more than 5 years. More than half of the patients with the symptoms of OAB did not seek treatment, as they did not think it is necessary. CONCLUSION: It is found that the prevalence of OAB is similar with many other studies conducted elsewhere. It was found to be multifactorial, but was highly significantly related with the presence of UVP, especially cystocoele and history of giving births to macrosomic babies.

The pregnancy outcome of acyanotic heart disease.

OBJECTIVE: To study the pregnancy outcome of women with acyanotic heart disease. METHOD: This is a retrospective study from a tertiary referral centre in a developing country over a period of 3 years. RESULTS: There were a total of 19,151 deliveries where 143 cases had heart disease in pregnancy, all of which were acyanotic, giving an incidence of 0.7%. Fifty-one (38.4%) of these were congenital whereas 82 (61.6%) were acquired. There was no cyanotic heart lesion during this study period. The fetal and maternal outcome of the women with heart disease (study group) was compared with the general obstetric population in the Unit (control group) using the Chi-squared test. Ninety-two percent in the study group were asymptomatic (NYHA Class I). The age distribution were no different except in the < 20 years interval where there were significantly fewer in the study group. More women with heart disease were primiparous and fewer were multiparous as compared with the controls. There was no significant difference in the rate of induction of labour (9.8% vs 11.8%). The use of epidural analgesia was significantly higher in the study group (49% vs 13%) as was the instrumental delivery rates (35.7% vs 5.7%) when compared with the controls. The caesarean section rate was no different. The mean gestation of babies born to mothers with heart disease was 38.2 weeks. Significantly fewer babies were in the 3.0-3.5 kg weight interval and more in the 2.5-3.0 kg interval. However, this did not alter the perinatal mortality rates which was not significantly different (15.3 vs 14.0 per thousand). CONCLUSION: The fetal and maternal outcome in women with acyanotic heart disease was favourable. It is advocated that the management of these cases should be multidisciplinary to optimise care for these patients.

Formation of vasculo-syncytial membranes in the human placenta.

Vasculo-syncytial membranes are localised areas of the placental villous membrane where the thickness of the barrier separating the maternal and fetal circulations is reduced to as little as 1-2 microns. Consequently, they are believed to be important sites for diffusional exchange. The morphological appearances suggest that they are caused by the obtrusion of locally dilated segments of the fetal capillaries into the trophoblast layer. This study sought quantitative evidence for the hypothesis by performing stereological analyses on vasculo-syncytial membranes at the electron microscopic level. The results confirmed that a strong relationship existed between the thickness of the capillary endothelium and that of the overlying stromal and trophoblastic tissue at these sites (r = 0.47, P < 0.001), indicating that some asymmetrical stretching or remodelling of the capillary wall was involved. Comparisons were also made between the thickness of the trophoblastic, stromal and endothelial components of the villous membrane in villi obtained from the central and from the peripheral parts of placental lobules, where vasculo-syncytial membrane formation is accentuated. The mean thickness of each component was lowest in the samples from the peripheral region, although the differences only proved to be statistically significant for the stromal layer (P = 0.01). Both sets of data lend quantitative support to the hypothesis that vasculo-syncytial membrane formation is the result of obtrusion of locally dilated segments of the fetal capillaries. The way in which this may be linked to changes in the dynamics of the fetal circulation as gestation advances is discussed.