The impact of elective surgery postponement during COVID-19 on emergency bellwether procedures in a large tertiary centre in Singapore.

The coronavirus disease 2019 (COVID-19) pandemic drove many healthcare systems worldwide to postpone elective surgery to increase healthcare capacity, manpower, and reduce infection risk to staff. The aim of this study was to assess the impact of an elective surgery postponement policy in response to the COVID-19 pandemic on surgical volumes and patient outcomes for three emergency bellwether procedures. A retrospective cohort study of patients who underwent any of the three emergency procedures [Caesarean section (CS), emergency laparotomy (EL), and open fracture (OF) fixation] between 1 January 2018 and 31 December 2021 was conducted using clinical and surgical data from electronic medical records.

Successful management of massive postpartum haemorrhage in a woman with acquired haemophilia A.

Postpartum haemorrhage (PPH) is an obstetric emergency and a leading cause of severe maternal morbidity and mortality. Timely and accurate diagnosis of the underlying cause of PPH is critical in achieving optimal care for the patient as any potential delays may result in severe morbidity and even mortality. We present a rare case of a patient presenting with PPH secondary to acquired haemophilia.

Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital.

Introduction: There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore.

Methods: A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH).

An Unusual Case of Cerebral Arteriovenous Malformation in Pregnancy.

We present a case of a woman at 31 weeks and 3 days of gestation, who developed a sudden and severe headache and loss of vision in her left eye. Magnetic resonance imaging (MRI) of the brain revealed a subarachnoid bleed secondary to a right parieto-occipital arteriovenous malformation (AVM). She was conservatively managed and subsequently transferred to our institution for multidisciplinary care.

Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit.

Introduction And Hypothesis: Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery.

A Rare Case of Watery Vaginal Discharge due to Caesarean Scar Dehiscence following Brace Suture and Balloon Tamponade for the Management of Postpartum Hemorrhage.

A woman in her early twenties with dichorionic diamniotic twins underwent emergency caesarean section (CS) for failed induction of labor for discordant growth at 37 weeks. Her CS was complicated by atonic postpartum hemorrhage (PPH) requiring uterotonics, B-lynch suture, and Bakri balloon. She presented on the 5 postoperative day (POD) with fever and wound pain and collapsed due to desaturation.

NHS hospital readiness to embrace the proposed NICE guidelines on abdominal aortic aneurysm: a public perspective.

Introduction: The National Institute for Health and Care Excellence published a draft consultation update on abdominal aortic aneurysm, which was expected to be published on 7 November 2018. This article analyses the readiness of NHS hospitals and their workforce to embrace the proposed guidelines.

Methods: The trust and individual surgeon-level anonymised data in the public domain for elective, rupture and complex abdominal aortic aneurysm cases were collected and analysed for all the acute care trusts providing these services from the Vascular Society of Great Briton and Ireland's prospective National Vascular Registry database.

Successful delayed-interval delivery in the presence of clinical chorioamnionitis in the leading twin: A report of two cases.

We present two cases of diamniotic, dichorionic twin pregnancies in which after the loss of the first foetus in the setting of clinical chorioamnionitis, both pregnancies were successfully managed by delayed-interval delivery. A fourstage protocol including aspects of management in this specific setting is proposed. We consider the importance of a selection process when managing conservatively, measures to promote latency and decisions regarding delivery of the foetuses.

Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) during pregnancy is a serious metabolic complication of diabetes with high mortality and morbidity if not detected and treated immediately. We report a case of a woman with type 1 diabetes mellitus who had poorly controlled diabetes in the first half of pregnancy and developed DKA at 29 weeks gestation. At presentation, she had a pathological fetal heart tracing but delivery was delayed for maternal stabilisation and reversal of acidosis.

Multiple pregnancy is the leading contributor to cesarean sections in in vitro fertilization pregnancies: An analysis using the Robson 10-group classification system.

Aim: In vitro fertilization (IVF) pregnancy is an important contributor to rising cesarean section (CS) rates. The profile of CS in this group is not well documented. This study sought to identify leading patient categories of the Robson 10-Group Classification System (TGCS) contributing to the high IVF CS rate.

Decision-to-delivery intervals and total duration of surgery for Caesarean sections in a tertiary general hospital.

Introduction: This study aimed to determine the decision-to-delivery intervals (DDIs), total duration of surgery and factors influencing these for Caesarean sections (CSs).

Methods: A retrospective study was conducted of all CSs performed from August 2013 to June 2014 at a single tertiary general hospital. Data collected included maternal demographics, indications for CS, category of urgency, DDI, total duration of surgery, grade of first surgeon and number of previous CSs.

A review of Caesarean section techniques and postoperative thromboprophylaxis at a tertiary hospital.

Introduction: Although Caesarean sections (CSs) are among the most commonly undertaken procedures in the world, there are wide variations in the surgical techniques used. This study aimed to: (a) review the surgical techniques used for CS by obstetricians working in a tertiary hospital in Singapore; (b) compare the techniques with those recommended in evidence-based guidelines; and (c) examine the relationship between the technique used and the level of seniority of the surgeons.

Methods: Data on 490 CSs performed in Singapore General Hospital (SGH) between 1 August 2013 and 30 June 2014 was collected from the Delivery Suite database and reviewed.

Influenza A(H1N1)pdm09 infection in pregnant and non-pregnant women hospitalized in Singapore, May - December 2009.

Objectives: The aim of this study was to compare the demographic and clinical characteristics of pregnant women and non-pregnant women of childbearing age hospitalized with laboratory-confirmed influenza A(H1N1)pdm09 infection in Singapore, and to assess whether pregnancy was a risk factor associated with the development of influenza-related complications.

Study Design: Retrospective observational study.

Methods: We retrospectively identified and collected information from available medical records of all women admitted to three tertiary hospitals between 26 May 2009 and 31 December 2009 with laboratory-confirmed influenza A(H1N1)pdm09 infection who were either pregnant or non-pregnant and of childbearing age between 15 and 50 years.

Renal and obstetric outcomes in pregnancy after kidney transplantation: Twelve-year experience in a Singapore transplant center.

Aim: Renal and obstetric outcomes in pregnancy after kidney transplantation in Singapore were last studied in 2002. A review of these outcomes in Singapore is now timely following advances in transplant and obstetric medicine. The aim was to evaluate the renal and obstetric outcomes in pregnancy after kidney transplantation in a Singapore tertiary center.

Why we do caesars: a comparison of the trends in caesarean section delivery over a decade.

Introduction: In the United Kingdom, caesarean section (CS) rates have increased from 9% of deliveries in 1980 to 21% in 2001. A similar increase in CS rates has been seen in many developed countries. This is beyond the World Health Organisation's (WHO's) recommended level of 15%.

Health promotion board-ministry of health clinical practice guidelines: treating tobacco use and dependence.

The Health Promotion Board (HPB) has updated the clinical practice guidelines on Treating Tobacco Use and Dependence to provide health professionals in Singapore with evidence-based interventions for smoking cessation. This article reproduces the introduction and executive summary of key guideline recommendations (with recommendations from the guidelines) from the HPB-MOH Clinical Practice Guidelines on Treating Tobacco Use and Dependence, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.

Spontaneous uterine rupture secondary to recurrent haematometra from cervical stenosis.

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility.

The use of anti-D immunoglobulins for rhesus prophylaxis: audit on knowledge and practices among obstetricians.

Introduction: The development of anti-D antibodies results from foetomaternal sensitisation occurring in rhesus (Rh) negative blood group women who carry an Rh-positive foetus. Despite guidelines on Rh immunoprophylaxis, isoimmunisation continues to occur, suggesting that the guidelines are not being fully applied by obstetricians. This study aims to establish the adequacy of knowledge on Rh immunoprophylaxis among obstetricians and trainees in obstetrics and gynaecology in Singapore, and their usual practice in the care of an Rh-negative mother; and hence to audit their practice in accordance with evidence-based guidelines.

Massive postpartum haemorrhage after uterus-conserving surgery in placenta percreta: the danger of the partial placenta percreta.

Placenta percreta is a rare but potentially life-threatening condition associated with high maternal mortality and morbidity rates, usually arising from severe obstetric haemorrhage. Due to rising caesarean section rates, an increase in the incidence of morbidly adherent placentas (accreta, increta and percreta) has been observed. Various treatment strategies have been employed in different centres, ranging from performing a caesarean hysterectomy at the time of delivery to leaving the placenta in situ, with or without adjuvant internal iliac and uterine arterial embolisation and/or methotrexate therapy.

Severe intrauterine hemolysis due to anti-C(w).

C(w) is a low-frequency antigen in the Rhesus blood group system. Anti-C(w) can occur naturally or develop as a result of red blood cell sensitization through transfusion or pregnancy. Clinically significant hemolytic disease of the newborn is rarely associated with anti-C(w), with no previous reported cases of hydrops fetalis or severe fetal anemia resulting in intrauterine death.

Obstetric outcomes in women with end-stage renal failure requiring renal dialysis.

Objective: To study obstetric outcomes in women with end-stage renal failure undergoing chronic renal dialysis.

Methods: A retrospective review of the database from the High-Risk Pregnancy Clinic at Singapore General Hospital, Singapore.

Results: From 1995 to 2004, 7 women treated with chronic renal dialysis had a total of 11 pregnancies.