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Biomedical subjects

T G Teoh

Publications and source records attributed to T G Teoh.

18 recordsLinked to original sources
PubMed2006

A meta-analysis on the influence of inflammatory bowel disease on pregnancy.

BACKGROUND: Inflammatory bowel disease (IBD) has a typical onset during the peak reproductive years. Evidence of the risk of adverse pregnancy outcomes in IBD is important for the management of pregnancy to assist in its management. AIM: To provide a clear assessment of risk of adverse outcomes during pregnancy in women with IBD. DESIGN: The Medline literature was searched to identify studies reporting outcomes of pregnancy in patients with IBD. Random-effect meta-analysis was used to compare outcomes between women with IBD and normal controls. PATIENTS AND SETTING: A total of 3907 patients with IBD (Crohn's disease 1952 (63%), ulcerative colitis 1113 (36%)) and 320 531 controls were reported in 12 studies that satisfied the inclusion criteria. RESULTS: For women with IBD, there was a 1.87-fold increase in incidence of prematurity (<37 weeks gestation; 95% CI 1.52 to 2.31; p<0.001) compared with controls. The incidence of low birth weight (<2500 g) was over twice that of normal controls (95% CI 1.38 to 3.19; p<0.001). Women with IBD were 1.5 times more likely to undergo caesarean section (95% CI 1.26 to 1.79; p<0.001), and the risk of congenital abnormalities was found to be 2.37-fold increased (95% CI 1.47 to 3.82; p<0.001). CONCLUSION: The study has shown a higher incidence of adverse pregnancy outcomes in patients with IBD. Further studies are required to clarify which women are at higher risk, as this was not determined in the present study. This has an effect on the management of patients with IBD during pregnancy, who should be treated as a potentially high-risk group.

Birth Weight↗
PubMed2006

Obesity in pregnancy.

Overweight and obesity are common findings in women of reproductive age in the UK; as 32% of 35- to 64-year-old women are overweight and 21% obese. Obesity causes major changes in many features of maternal intermediary metabolism. Insulin resistance appears to be central to these changes and may also be involved in increased energy accumulation by the fetus. Maternal obesity is associated with many risks to the pregnancy, with increased risk of miscarriage (three-fold) and operative delivery (20.7 versus 33.8% in the obese and 47.4% in the morbidly obese group). Other risks to the mother include an increased risk of pre-eclampsia (3.9 versus 13.5% in the obese group) and thromboembolism (0.05 versus 0.12% in the obese group). There are risks to the fetus with increased perinatal mortality (1.4 per 1000 versus 5.7 per 1000 in the obese group) and macrosomia (>90th centile; 9 versus 17.5% in the obese group). Maternal obesity is associated with an increased risk of obesity in the long term. Obese woman should try to lose weight before pregnancy but probably not during pregnancy. There is no real evidence base for the management of maternal obesity but some practical suggestions are made.

Breast Feeding↗
PubMed2006

Glucose production in the human placenta.

Glucose transfer from mother to fetus by placental facilitated diffusion is the dominant mechanism by which the fetus acquires glucose. In small for gestational age pregnancies, fetal glucose concentrations tend to be lower than normal and this persists following delivery. GLUT1 is the major glucose transporter in human placenta but there is no evidence of GLUT1 deficiency as a cause of the lower fetal glucose concentration in small for gestational age pregnancy. The physiological and pathological roles of the other glucose transporters (and there are 14 currently described) are unknown. In recent years, the possibility has been raised that the placenta is itself capable of supplying glucose for fetal needs. This hypothesis derived from glucose isotope studies in normal pregnancy, where dilution of glucose isotope was demonstrated in blood samples taken from the fetal circulation during intravenous infusion of glucose isotope in the mother. Although other gluconeogenic enzymes were known to be present, the placenta was previously considered incapable of glucose secretion because it lacked functional glucose-6-phosphatase. Recent studies, however, have suggested that specific glucose-6-phosphatase may be present in placenta but it may be the product of a different gene from conventional hepatic glucose-6-phosphatase. The presence of the specific transporters necessary for glucose-6-phosphatase activity is currently being investigated. The role of placental glucose secretion in normal and growth-restricted pregnancies is an area of current study.

Amino Acid Sequence↗
PubMed2001

Uterine artery Doppler in predicting pregnancy outcome in women with antiphospholipid syndrome.

OBJECTIVE: To assess midtrimester uterine artery Doppler in the prediction of preeclampsia and small for gestational age (SGA) infants in women with primary antiphospholipid syndrome. METHODS: One hundred seventy pregnant women with histories of recurrent miscarriage in association with antiphospholipid antibodies (32 lupus anticoagulant positive, 47 IgG anticardiolipin positive, 78 IgM anticardiolipin positive, and 13 lupus anticoagulant and anticardiolipin antibodies positive) treated with low-dose aspirin and heparin were recruited prospectively. Doppler assessment of the uterine arteries (presence or absence of notches and pulsatility index) were performed at 16-18 and 22-24 weeks. The main outcome measures were the delivery of a SGA infant and the development of preeclampsia. RESULTS: There were 164 live births and six midtrimester losses. The prevalence of preeclampsia and SGA was similar at 10%. In predicting preeclampsia or SGA, uterine artery pulsatility index at either interval was of no value, and the diagnostic accuracy of the Doppler was limited to bilateral uterine artery notches at 22-24 weeks in the subgroup of women with positive lupus anticoagulant. In this subgroup, bilateral uterine artery notches at 22-24 weeks in predicting preeclampsia generated a high likelihood ratio for positive test (12.8, 95% confidence interval 2.2, 75), sensitivity (75%), specificity (94%), positive (75%) and negative (94%) predictive value. In predicting SGA, the corresponding figures were respectively 13.6 (95% confidence interval 1.9, 96), 80%, 94%, 80%, 94%. Uterine artery Doppler was of limited value in pregnancies associated with anticardiolipin antibodies in isolation. CONCLUSION: In pregnancies associated with lupus anticoagulant, uterine artery Doppler at 22-24 weeks is a useful screening test in predicting preeclampsia and SGA infants.

Abortion, Habitual↗
PubMed2001

Congenital absence of portal vein in the fetus: a case report.

Congenital absence of portal vein (CAPV) is a rare abnormality, which may be associated with other abnormalities. We report a case of prenatal diagnosis of absent portal vein confirmed on postnatal ultrasonography and computed tomography scan. The ultrasound features of CAPV include dilated intra-abdominal segment of umbilical vein, dilated inferior vena cava and the presence of hyperechogenic areas in the liver. Blood coming from the umbilical vein directly drains into the inferior vena cava. The dilated intra-abdominal segment of the umbilical vein shows high velocity pulsatile flow, resembling that of ductus venosus. These findings should prompt a careful search for the portal vein and any associated anomalies.

Adult↗
PubMed2001

Vaginal hysterectomy for the large uterus.

Vaginal hysterectomy for the large uterus is seldom performed in Malaysia. The traditional operation is abdominal hysterectomy. This is a personal series of vaginal hysterectomies for enlarged uterus of more than 12 weeks size (>280g) carried out in a private hospital between 1/1/97 to 30/9/2000. A total of 40 cases were done with the weights of the uterus ranging from 290g to 790g. The mean weight of the uterus was 434g. The average operating time was 92.1 min. The complications were minimal with 2 cases of blood transfusion for intra-operative hemorrhage, 1 case of fever and 1 case of bladder perforation. This series demonstrates feasibility and safety of the operation. The excellent recovery due to the absence of an abdominal scar should be a strong incentive for specialists to learn the skill.

Female↗
PubMed1998

Umbilical artery blood flow velocity in pregnancies complicated by systemic lupus erythematosus.

PURPOSE: We evaluated the role of umbilical artery Doppler velocimetry in the surveillance of pregnancies complicated by systemic lupus erythematosus (SLE). METHODS: We retrospectively studied 56 women with SLE whose pregnancies were managed at our perinatal center between 1988 and 1995. RESULTS: Absent or reversed end-diastolic flow velocity was detected in 6 (11%) of 56 patients. This sub-group of patients had an increased risk of pre-eclampsia, intrauterine growth restriction, cesarean section, and preterm delivery. CONCLUSIONS: A high incidence (11%) of abnormal umbilical artery waveforms was detected. This finding was associated with an increased risk of maternal and fetal complications.

Adult↗
PubMed1998

Corticotropin-releasing hormone and proopiomelanocortin-derived peptides are present in human myometrium.

CRH and POMC-derived peptides are produced at a number of intrauterine sites in both the nonpregnant and pregnant states. It is hypothesized that CRH and POMC-derived peptides may be produced locally by the uterus to modulate myometrial contractility. This study has examined the distribution of these peptides in human uterine tissue during the ovulatory cycle and pregnancy. The immunoperoxidase staining method was used to localize CRH and POMC-derived peptides: ACTH, beta-endorphin, and alphaMSH. Immunoreactive (IR-) CRH and IR-POMC-derived peptides, beta-endorphin and alphaMSH, were observed in the myometrial smooth muscle, vascular smooth muscle, endometrial glandular epithelium, and luminal epithelium of the nonpregnant uterus (n = 17). Staining for IR-CRH did not change during the cycle from the proliferative (n = 8) to the secretory phases (n = 9). Conversely, staining for IR-beta-endorphin and IR-alphaMSH was only observed during the secretory phase of the cycle (n = 9). In uterine tissue obtained from pregnant women (n = 20) IR-CRH was present in the myometrial smooth muscle, vascular smooth muscle, decidua, and glandular epithelium. IR-POMC-derived peptides were not detectable at any uterine site during pregnancy (n = 20). IR-CRH was measurable in myometrial extracts collected from pregnant women undergoing cesarean section (20.9+/-3.8 ng/g wet wt; n = 7) and from nonpregnant premenopausal women undergoing hysterectomy (7.7+/-2.1 ng/g wet wt; n = 6). IR-CRH concentrations significantly increased with pregnancy. Levels of messenger ribonucleic acid encoding for CRH were examined in nonpregnant (n = 4) and pregnant (n = 10) myometrial smooth muscle and were also significantly increased with pregnancy. This study has demonstrated that levels of CRH and POMC peptide in human uterine tissue change with pregnancy and that CRH is produced locally by myometrial smooth muscle cells. These studies are consistent with the possibility that the CRH peptide has an autocrine/paracrine activity during pregnancy and labor that may be related to the modulation of myometrial contractility.

Corticotropin-Releasing Hormone↗
PubMed1997

Effect of learning curve on the outcome of external cephalic version.

AIM: The aim of this study was to find out the effect of learning curve on the outcome of external cephalic version (ECV) at term, using tocolytics. The effect of various factors affecting the outcome of ECV was also studied in relation to the learning curve. METHODS: This is a prospective longitudinal observational study of 80 consecutive cases of ECV. They were analysed in relation to outcome, parity, type of breech, placental site and birth weight. The cases were divided consecutively into 4 groups of 20 cases each, in order to analyse the effect of learning curve. RESULTS: The learning curve for ECV is very sharp. The success rate of external cephalic version plateau after the first 20 cases from 45% to about 60%. Only parity and type of breech have a significant effect on the outcome. The success rate is lower for primipara and non-flexed breech. This negative effect is strongest in the first 20 cases and again plateaus after the first 20 cases. The high success rate of multipara and primipara flexed breech is obtained even in the first 20 cases and does not improve with further experience. CONCLUSIONS: The learning curve for ECV is sharp and plateaus after the first 20 cases. Outcome of ECV for patients with favourable factors such as multiparity and flexed breech is not affected by learning curve.

Clinical Competence↗
PubMed1996

The role of fetal karyotyping from unconventional sources.

OBJECTIVE: Our purpose was to determine whether fetal specimens, including pleural, ascitic, pericardial, facial, and cystic hygroma fluid or urine, are suitable sources for accurate chromosomal analysis. STUDY DESIGN: Thirty-nine samples of fetal fluid (pleural, n = 11; ascitic, n = 5; pericardial, n = 1; lung cyst, n = 1, facial cyst, n = 1; cystic hygroma, n = 7; and urine, n = 13) were cultured and analyzed with standard cytogenetic techniques for lymphocytes or amniotic fluid. These samples were obtained as part of the routine obstetric investigation and management. Conventional backup samples were also obtained. RESULTS: Karyotyping was successful in 34 of 39 samples. Cells were harvested from all pleural samples, three ascitic samples, and one hygroma fluid sample in 2 to 4 days from 11 urine samples, one ascitic sample, and the remaining six hygroma samples in 7 to 11 days. Five cultures were unsuccessful. Samples with high lymphocyte counts yielded results as quickly as fetal blood. CONCLUSION: The use of "alternative" samples of fetal fluids for karyotyping may be considered when amniotic fluid or fetal blood is difficult to obtain. In selected cases this approach avoids the unnecessary risk of additional invasive procedures solely to obtain a karyotype.

Ascitic Fluid↗
PubMed1996

Outcome of vaginal hysterectomy for the undescended and enlarged uterus--a preliminary report.

This is a retrospective observational study of outcome of 11 cases of vaginal hysterectomy for undescended and enlarged uterus carried in University Hospital, Kuala Lumpur. The cases included relative contraindications such as 14 weeks size fibroids, severe obesity, previous Caesarean section and nulliparity. All the eight patients agreeable for prophylactic bilateral salpingoophorectomy had their ovaries removed. Operative time ranged from 1 hr 20 min to 2 hr 15 min. All patients were sent home within 48 hours of the operation. The excellent outcome of our initial experience highlights the known advantages of vaginal hysterectomy for undescended and enlarged uterus.

Adult↗
PubMed1996

Outcome of 80 cases of external cephalic version.

This is a prospective observational study of the outcome of 80 cases of external cephalic version (ECV) at term using terbutaline infusion. There were 55 primiparas and 25 multiparas. The successful ECV rate was 44% and 85% respectively. The majority (82%) of the patients with successful ECV delivered vaginally. Parity and type of breech were the two significant factors in the success of the procedure.

Female↗
PubMed1992

Snuffles in infants--infection or autonomic dysfunction.

The presence of excess nasal mucus causing noisy nasal breathing with an obvious mucus discharge (snuffles) is a common problem in infants in the first three months of life. The presence of "snuffles" has traditionally been ascribed, unproven, to an upper respiratory tract infection despite there being no other signs of an acute infection in the majority of infants with "snuffles". To assess the possible role of impaired vasomotor control (autonomic function) in the pathogenesis of snuffles we measured the effect of a change from the supine to the upright position on resting blood pressure in 50 infants with "snuffles" and 50 healthy control infants. The mean age in both groups was 7 weeks post delivery, all infants were attending a well baby clinic for a routine examination, had no signs of an acute infection and none were on any medication (including nasal drops). A fall of greater than 10% of resting blood pressure was taken to indicate postural hypotension. Four of fifty infants in the control group compared to 22 of 50 in the snuffles group demonstrated postural hypotension (Chi square 16.84, p less than 0.001). The results suggest that in some infants "snuffles" may be associated with impaired vasomotor control.

Causality↗
PubMedDate not supplied

The management of female infertility by tubal microsurgical reconstruction: a ten year review.

The outcome of 368 consecutive tubal microsurgical operations excluding reversal of sterilizations, over a ten year period at the Rotunda Hospital, is presented. One hundred and ten conceptions resulted giving a pregnancy rate of 29.9% per procedure. The 'take home baby rate' was 24.2%, with miscarriage and ectopic pregnancy rates of 2.7% and 3% respectively.

Abortion, Spontaneous↗