ABSTRACT
Background: Urinary incontinence (UI) demonstrates major prevalence in women of different population groups. Reduced quality of life (QOL) is observed due to incontinence problems. Urogenital Distress Inventory (UDI-6) and Incontinence Impact Quality of Life (IIQ-7) are useful disease-specific questionnaires evaluating the impact of urinary incontinence on the QOL of women which is accepted internationally. Objective: This study aims to translate and validate UDI-6 and IIQ-7 in Malay language. Methods: A cross sectional study, which recruited 100 participants from two urogynecology clinics. Both questionnaires were initially translated from English to Bahasa Malaysia followed by back translation and final correction done by the professional translators. The participants were requested to maintain a urinary record of the upcoming week for three days that assisted in quantifying the severity of symptoms. None of the subjects were assigned any treatment during the study period. Validity and reliability of the translated questionnaires were determined by checking the internal consistency and also by doing test-retest. Results: The internal consistency levels of the UDI-6 and IIQ-7 Bahasa Malaysia questionnaires were 0.73 and 0.90 respectively with good test-retest (0.86 and 0.95). Incontinence episodes were strongly associated with obstructive, irritative, and stress symptoms. The factor of day time voiding had strong correlation with obstructive and irritative symptoms. Conclusion: UDI-6 and IIQ-7 did not measure similar outcomes; however, both questionnaires have their strengths in clinical settings. Analysis has also revealed that the Malaysian versions of both questionnaires had appropriate test-retest validity and reliability. Thus, it can be said that both of the questionnaires had great importance for screening patients with urinary incontinence in Malaysia.
ABSTRACT
Uterine rupture is a rare life-threatening complication. It mainly occurs in the third trimester of pregnancy and is rarely seen during the first or second trimesters. Our centre experienced three important cases of uterine rupture. First case: spontaneous uterine rupture at 14 weeks of pregnancy, which was diagnosed at autopsy. It was misled by the ultrasound finding of an intrauterine pregnancy, and searching for other non-gynaecological causes delayed the urgent obstetric surgical management. Second case: ruptured uterus at 24 weeks following medical termination due to foetal anomaly. It was diagnosed only at laparotomy indicated for failed medical termination and chorioamnionitis. Third case: uterine rupture at 21 weeks of pregnancy in a patient with gastroenterology symptoms. In these reports, we have discussed the various risk factors, presentations, course of events and difficulties in diagnosing uterine rupture. The study concludes that the clinical presentation of uterine ruptures varies. It occurs regardless of gestational age. Ultrasound findings of intrauterine pregnancy with free fluid do not exclude uterine rupture or ectopic pregnancy. Searching for non-gynaecological causes in such clinical presentations might delay crucial surgical intervention, which leads to unnecessary morbidity, mortality or loss of obstetrics function.