ABSTRACT
Introduction: Understanding the perceptions of healthcare professionals and patients regarding gestational diabetes mellitus (GDM) is important for optimal pregnancy outcomes. This study aimed to identify the problems faced by healthcare professionals in the management of GDM and the patients' perspectives as well. Methods: Two focus groups consisting of thirteen pregnant women diagnosed with GDM at 20-28 weeks of gestation and sixteen healthcare professionals were interviewed using a semi-structured questionnaire. The subjects were recruited purposively from a public health clinic in Negeri Sembilan, Malaysia. Audio recordings were made of the interview sessions and transcribed verbatim before being assessed independently by two researchers. The NVivo 10.0 programme was used to extract key themes. Results: Five emergent themes consisting of views from both groups of subjects were identified. They were: (1) perceived patients' non-adherence to medical advice versus patients' own negligence; (2) poor appetite control versus patients' poor temptation control; (3) patients' lack of knowledge versus confusing information provided by healthcare staff; (4) patients 'giving up' versus being in a non-supportive environment; and (5) patients being in denial versus the disappointment when required to control diet. Conclusion: This study revealed conflicting perspectives between pregnant mothers with GDM and the healthcare staff in managing these patients. There is a need to promote positive communication between healthcare staff and patients for a better understanding of the needs of GDM patients.
ABSTRACT
Fulminant haemorrhage in cervical cancer leads to severe anaemia and haemodynamic instability. Palliative management includes vaginal packing as temporary measure, radiotherapy and other invasive surgical procedures. High dose emergency chemotherapy is not commonly implemented particularly when complicated with anaemia and renal impairment. We discuss three case series on the usefulness of high dose chemotherapy to combat bleeding from cervical cancer as an emergency treatment. The first case was clinically staged as operable 2A disease with severe anaemia due to bleeding from the tumour mass. The haemoglobin was corrected by blood transfusion while the bleeding was being arrested by high dose chemotherapy. The second case was inoperable with invasion to the bladder mucosa. She had frank haematuria and bleeding from the tumour with severe anaemia. A course of chemotherapy and blood transfusion controlled the bleeding and anaemia was corrected. The third case presented late with obstructive uropathy and anaemia. She required dialysis, blood transfusion and high dose emergency chemotherapy to stop the bleeding before undergoing urinary diversion after an unsuccessful ureteric stenting. High dose chemotherapy consisting cisplatin, vincristine, bleomycin and mitomycin-C has a clinical value in arresting fulminant haemorrhage in cervical cancer.
ABSTRACT
Red cell alloimmunisation is defined as the development of antibodies in response to foreign red cell antigens through transfusion or pregnancy. In pregnant women even without the history of previous blood transfusion, this is possible through previous or current pregnancy with the presence of paternal red cell antigen inherited by the fetus. This study was aimed to determine the prevalence of red cell alloimmunisation among pregnant women without previous history of blood transfusion and the association with number of pregnancy and history of obstetric complications. This was a cross-sectional study in which 150 pregnant women were randomly selected from the antenatal clinic. Ten mls of peripheral blood was obtained for antibody screening using indirect antiglobulin test besides the routine antenatal screening. In this study, the majority (37.3%) of the women were primigravidae. Red cell alloantibodies were detected in two out of 150 (1.3%) patients which were subsequently identified as anti-C and anti-D. However none of the primigravida was alloimmunised. One woman of gravida 2 (2.9%) and gravida 3 (3.6%) each were positive for alloimmunisation. One of them also had a bad obstetric history. This study showed that the prevalence of red cell alloimmunisation among pregnant women was low in this centre. Nevertheless, red cell alloantibody screening test should be made available to reduce possible complications of alloimmunisation in mothers and fetuses.