Spontaneous rupture of uterine varicose veins: a rare cause for obstetric shock.

Spontaneous rupture of uterine surface varicose veins is rare but may result in serious complication of pregnancy, as it is associated with high perinatal and maternal mortality. We report a 24-year-old primigravida who presented with this rare condition mimicking placenta abruption, which was successfully managed. A review of reported cases was performed.

UKM Medical Graduates’ Perception of their Communication Skills during Housemanship

The art of talking to patients and their relatives does not come naturally to most of us and the ability to put oneself in the patients’ predicament is difficult particularly for the young doctors. To identify the communication abilities of the young doctors, a cross sectional study was carried out on 32 house officers who graduated from UKM in 2004 during their house jobs at different hospitals in Malaysia. A standardized questionnaire was used to collect the data. Fifty nine percent respondents claimed that they had communicated very well with patients while 69% with support staff and 88% with peers. On the other hand 38% and 41% of the respondents claimed they communicated very well with their superiors and families of patients. Only 22% of the graduates’ skills of communication in breaking bad news were very well, while 50% and 81% were very well in counselling patients and taking consent for procedures. Curriculum planners need to emphasize the importance of developing good communication skills in all aspects for the future doctors.

In vitro fertilization outcome in severe ovarian hyperstimulation syndrome: An age-matched contemporaneous control study.

Aim: Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening, iatrogenic complication of assisted reproduction and has been associated with poor in vitro fertilization outcome. The aim of the present study was to evaluate the pregnancy rate and outcome following severe OHSS, at a single center over a three-year period. Methods: The incidence of severe OHSS at the IVF Center, National University of Singapore, in Singapore, was 4% (48 cases over 1200 cycles) during the period of 1997-2000. The present retrospective study compared 48 cases of severe OHSS to 144 age-matched, contemporaneous controls without OHSS. Results: The total gonadotropin required for severe OHSS group was found to be lower than for that of controls (2664.06 ± 768.29 IU vs 3349.58 ± 2003.73 IU), although duration of stimulation was similar. The OHSS group was associated with a fivefold increase (OR 5.293, 95% CI: 2.116-13.238) in pregnancy rate compared to controls (87.5% vs 56.9%; P < 0.05). Late OHSS was more common (38/48 cases) and had a pregnancy rate of 97% per embryo transfer. There was no significant difference in the multiple pregnancy (54% vs 48%; P > 0.05) and miscarriage rates (14% vs 7.3%; P > 0.05) between the groups. Conclusion: Severe OHSS at our center were mostly late onset. The pregnancy rate was significantly higher, but multiple pregnancy and miscarriage rates were not significantly increased when compared to the age-matched contemporaneous controls. (Reprod Med Biol 2005; 4: 207-211).

Unusual form of superficial spreading microinvasive squamous cell carcinoma of uterine cervix involving the endometrium of uterus.

Microinvasive squamous cell carcinoma of the uterine cervix is a recognized entity and is defined as carcinoma with invasion of less than 5 mm penetration of the stroma and seldom metastasized. Our patient was a 70-year-old, multiparous woman who had a microinvasive, cervical, squamous cell carcinoma. The tumor had spread superficially into the entire endometrial cavity up to the fundus, totally replacing the columnar epithelium. This is an extremely rare phenomenon, with fewer than 20 cases reported so far in the literature.

Imperforate hymen: report of an unusual familial occurrence.

Imperforate hymen is an uncommon obstructive anomaly of the female reproductive tract, which usually presents with intermittent and cyclical abdominal pain. Although it is usually sporadic, four cases of familial occurrence of imperforate hymen have been reported so far. Imperforate hymen is seldom associated with complications if it is detected early. In view of the possible familial occurrence, it is important to have a high index of suspicion in women who present with imperforate hymen. A detailed menstrual history of other female family members is necessary to enable early detection.