Congenital Peritoneal Band Causing Bowel Ischaemia Post Caesarean Section: A Rare Occurrence

Congenital peritoneal band is an extremely rare condition, but may induce small bowel obstruction (SBO) at any age, predominantly in childhood and rarely in adults. We report a case of extensive bowel ischaemia following caesarean section, due to trapping of an intestinal loop between a congenital peritoneal band and the mesentery. A 42-year-old, Gravida 2 Para 1, who has no history of prior abdominal surgery or trauma, presented in spontaneous labour and underwent an uncomplicated emergency lower segment caesarean section, for fetal distress. Postoperatively, she had worsening abdominal distension and pain, followed by vomiting. Computed Tomography Scan of the abdomen showed gross fluid retention with marked small bowel dilatation and fluid filled bowel loops. An emergency exploratory laparotomy was performed which revealed a congenital band, extending between the right fimbrial end and the small bowel mesentery, looping over the small bowel, causing extensive small bowel ischemia. Postoperative course was uneventful. In conclusion, congenital peritoneal band causing small bowel obstruction, although rare, should be considered in the differential, especially for patients with virgin abdomen.

Antenatal Iron Deficiency in an Urban Malaysian Population

Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with sociodemographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values.

Early Versus Late ECV In Primigravidae With Breech Presentation: A Pilot Study

This was a pilot study comparing the success between early versus late external cephalic version (ECV) involving primigravidae with singleton breech pregnancy. They were randomised into early (34–36 weeks) and late (37-40 weeks) ECV groups. A total of 44 women were initially randomised into 22 women for each group. The overall ECV success rate was acceptable in both groups although insignificantly higher in the late ECV group (55.6% versus 46.7%, p= 0.732.) Caesarean section in the early ECV group was higher (80% versus 72.2%). Early ECV group had women with higher BMI (29.5 versus 26.8 kg/m2, p=0.107), anterior placentation (60% versus 38.9%) and extended breech presentation (55.6% versus 44.4%; p= 0.296). In conclusion, early ECV in primigravidae showed no better success rate than late ECV. Maternal obesity, anterior placentation and extended breech presentation should alert to failure risk.