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ABSTRACT: Abstract Objectives: To determine the relationship between advanced maternal age (≥35 years) and incidence of postpartum hemorrhage (PPH) in singleton pregnancies managed over a 10-year period. Methods: Retrospective cohort study comparing demographics, risk factors, complications, infant outcome, and incidence of PPH between parturients aged ≥35 and <35 years at delivery. Results: Parturients aged ≥35 years (12,686/64,886 or 19.6%) had significantly increased obstetric risk factors, complications, caesarean delivery, large-for-gestational age infants, and incidence of PPH, but no difference in the attributed cause of PPH such as uterine atony, retained placenta, genital lacerations, except for multiple factors. Multivariate analysis indicated that aging was actually associated with decreased PPH, the risk decreasing progressively from those aged 25-29 years to those aged ≥40 years compared with the 20-24 years group. Conclusions: Advanced maternal age only served as a surrogate factor for PPH due to the associated increased risk factors, obstetric complications and interventions.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2013; · 1.36 Impact Factor
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ABSTRACT: OBJECTIVE: To assess the incidence of macrosomia and the influence of birth weight on shoulder dystocia risk among a cohort of Chinese women. METHODS: A retrospective analysis was conducted of 80953 singleton deliveries recorded at the Prince of Wales Hospital, Hong Kong, between 1995 and 2009. The incidences of macrosomia (birth weight ≥4000g) and shoulder dystocia were assessed by birth weight; risk factors for shoulder dystocia were examined by multiple logistic regression analysis. RESULTS: The incidence of macrosomia was 3.4%. The overall incidence of shoulder dystocia was 0.3%; however, the incidence rose with increasing birth weight. The odds ratio (OR) for a birth weight of 4000-4199g was 22.40, while the OR for a birth weight of 4200g or above was 76.10. Other independent risk factors for shoulder dystocia included instrumental delivery (OR 12.11), short stature (OR 2.16), maternal diabetes mellitus (OR 1.78), and obesity (OR 1.58). CONCLUSION: Although the overall incidences of macrosomia and shoulder dystocia were low, the risk of shoulder dystocia was strongly linked to increasing birth weight. International guidelines for elective cesarean delivery in suspected cases of macrosomia may not, therefore, apply to Chinese women.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 01/2013; · 1.41 Impact Factor
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ABSTRACT: To determine the obstetric outcome in teenage women managed in the recent decade with easily accessible health care provision.
In a retrospective cohort study, maternal demographics, underlying medical conditions, obstetric complications, preterm birth, type of labor, mode of delivery, and perinatal mortality were compared between 1505 women aged ≤ 19 years (study group) with 10,320 women aged 20-24 years (comparison group), who were carrying singleton pregnancies beyond 24 weeks of gestation and managed in our hospital between January 1998 and June 2008.
The study and comparison groups accounted for 2.2% and 15.1% respectively of the total deliveries. Despite comparable health status and rates of other obstetric complications, teenage women was associated with birth <34 weeks (aOR 2.45, 95% CI 1.67-3.60), birth at 34-36 weeks (aOR 2.13, 95% CI 1.71-2.65), and reduced instrumental vaginal (aOR 0.62, 95% CI 0.50-0.77) and caesarean (aOR 0.79, 95% CI 0.64-0.97) delivery, without increase in perinatal mortality.
Teenage women had increased preterm birth, despite improved health care provision, nutrition, and similar incidence of other obstetric complications, but the obstetric and perinatal outcome remained favorable.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2012; 25(8):1358-62. · 1.36 Impact Factor
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ABSTRACT: This study was conducted to determine whether carrying a singleton male fetus increases the risk of preterm birth (PTB) in Chinese women.
A retrospective cohort study was conducted on women with singleton pregnancies and delivered in our hospital. Maternal characteristics, pregnancy outcome, and incidence of PTB, were compared between women carrying a male versus a female fetus. The independent effect of a male fetus on PTB was examined with multiple logistic regression analysis adjusting for the other confounding factors identified.
There were significant differences in maternal and infant characteristics between women with a male versus a female fetus. Despite similar or lower incidences of complications and labor induction, women with a male fetus had increased birth <37 weeks (7.0% versus 6.2%, p<?0.001) and birth at 34?36 weeks (5.15% versus 4.4%, p<0.001), but not for birth <34 weeks (2.0% versus 1.8%, p=?0.163). Regression analysis confirmed the association between male fetus with birth at 34-36 weeks (aOR 1.11, 95% CI 1.10?1.33) and spontaneous preterm labor (aOR 1.09, 95% CI 1.00-1.19).
The results confirmed that carrying a male fetus is an independent risk factor for spontaneous preterm labor and PTB at 34?36 weeks gestation in southern Chinese women.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2011; 24(12):1440-3. · 1.36 Impact Factor
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ABSTRACT: The rates of preterm birth in Chinese women and the potential effects of differing environments are poorly understood.
To determine the rate of preterm birth in Chinese women in China, Hong Kong and Western Australia.
The rates of preterm birth were obtained from records of 26,611 pregnancies in Jiangsu Province in mainland China, 48,976 pregnancies in Hong Kong and 185,798 pregnancies in Western Australia.
Preterm birth rates increased from 2.6 and 2.9% in urban and rural Jiangsu Province, respectively, and 2.5% in China-born women in Western Australia who required an interpreter; to 4.9% in China-born women in Western Australia who did not require an interpreter; to 5.6% in non-resident Chinese women in Hong Kong; and 7.6% for women resident in Hong Kong. Within Western Australia, the rate of preterm birth was significantly less in women who were born in China and declared themselves to be Chinese (4.4%) than Caucasians (7.8%), other women who declared themselves to be 'Asian' (8.7%) and women of Aboriginal heritage (14.5%).
The rate of preterm birth in China is relatively low but appears to differ in Chinese women in other environments. Differences between traditional Chinese and contemporary Western lifestyles, possibly including smoking and sexual practices, may contribute to the different rates of preterm birth. Further research in this area may provide avenues for the prevention of preterm birth and also help to prevent a possible rise in this complication of pregnancy as Chinese society continues on the path of economic and social reform.
Australian and New Zealand Journal of Obstetrics and Gynaecology 06/2011; 51(5):426-31. · 1.24 Impact Factor
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ABSTRACT: To investigate whether three-dimensional (3D) technology offers any advantage over two-dimensional (2D) ultrasound in fetal biometric measurement training.
Ten midwives with no hands-on experience in ultrasound were randomized to receive training on 2D or 3D ultrasound fetal biometry assessment. Midwives were taught how to obtain fetal biometric measurements (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL)) by a trainer. Subsequently, each midwife measured the parameters on another 10 fetuses. The same set of measurements was repeated by the trainer. The percentage deviation between the midwives' and the trainer's measurements was determined and compared between training groups. Time required for completion was recorded. Frozen images were reviewed by another sonographer to assess the image quality using a standardized scoring system.
The median time for the complete set of measurements was significantly shorter in the 2D than in 3D group (13.4 min versus 17.8 min, P = 0.03). The mean percentage deviations did not reach statistical significance between the two groups except for FL (3.83% in 2D group versus 2.23% in 3D group (P = 0.046)). There were no significant differences in the quality scores.
This study showed that the only demonstrable advantage of 3D ultrasound was a slightly more accurate measurement of FL, at the expense of a significantly longer time required.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 01/2011; 24(9):1173-5. · 1.36 Impact Factor
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ABSTRACT: Nausea and vomiting in pregnancy (NVP) is the most common pregnancy complication affecting women during the first trimester of pregnancy. The cause of NVP remains unknown and factors associated with the occurrence of NVP are contradictory. There is currently little information on its effects of NVP in general and specifically in the Chinese population.
To assess the prevalence of NVP with different degree of severity and identify their relationship with health-related quality of life (HRQoL) and to determine its association with the sociodemographic and obstetric factors.
In a prospective cross-sectional study, 396 women who attended the antenatal clinic between 10 and 14 weeks of gestation were invited to complete a structured questionnaire covering maternal characteristics, severity of NVP and their HRQoL. The status of NVP and HRQoL was measured by the frequency of symptoms and the Medical Outcomes Study Short-Form-36 (SF-36) respectively. Logistic regression analysis was performed to delineate the factors associated with NVP.
The prevalence of NVP was 90.9%. Almost all domains and dimensions of SF-36 were affected by the presence of NVP and its severity. Factors associated with the presence and severity of NVP were non-smoking, younger age and history of NVP in previous pregnancy.
The various degrees of severity of NVP significantly impair both physical and mental HRQoL in Hong Kong Chinese women. Awareness and care should be given to women with symptoms of nausea or retching alone, as well as vomiting.
Australian and New Zealand Journal of Obstetrics and Gynaecology 12/2010; 50(6):512-8. · 1.24 Impact Factor
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ABSTRACT: Maternal rubella status was compared between local residents with non-residents who delivered in our hospital during 1998-2008. Among the 60,822 women, non-immunity was more common in the non-residents (19.9% versus 8.1%, P<0.001). Significant difference and positive correlation with age and parity were found for both groups, but a significant inverse correlation with year-of-birth was found only in the residents. Regression analysis confirmed that birth after 1970 was associated with reduced odds of non-immunity, which indicated that the rubella vaccination programme, introduced since 1978, has succeeded in reducing the incidence of non-immunity to <5% in the youngest generation.
Vaccine 03/2010; 28(10):2227-30. · 3.77 Impact Factor
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ABSTRACT: To re-examine the prevalence of group B Streptococcus colonisation in our antenatal population, and identify demographic factors associated with carriage.
Prospective observational study.
A tertiary obstetrics unit in Hong Kong.
A total of 1002 pregnant women were recruited at the booking clinic in a tertiary obstetrics unit in Hong Kong. High and low vaginal swabs and rectal swabs were taken for group B Streptococcus culture. Demographic data and delivery outcomes of the recruits were analysed.
The prevalence of group B Streptococcus colonisation in our antenatal population was 10.4%. The majority of carriers were identified by low vaginal swabs (78%), while high vaginal swabs and rectal swabs only identified 31% and 30% of the carriers, respectively. Professional women yielded a higher carrier rate than housewives (21% vs 10%, P=0.03). There was no increase in preterm delivery rate in group B Streptococcus carriers.
We noted a dramatic increase in the prevalence of group B Streptococcus colonisation in the Hong Kong pregnant population at their booking visit. Professional women had a higher colonisation rate compared to other groups.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2009; 15(6):414-9.
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ABSTRACT: To determine the background, qualifications, and certification status of specialists currently performing first trimester screening in Hong Kong, the extent of their participation (and the laboratories they use) in quality assurance programmes, and their willingness to provide follow-up data for auditing purposes.
Questionnaire survey.
Hong Kong.
A survey was mailed to all registered Hong Kong specialist obstetricians. Results were reported using descriptive statistics.
The response rate was 32% (106/331). Overall, 73% offered universal screening to all pregnant women. The majority (72%) most commonly performed first trimester screening for their patients. Sixty-six (62%) of the respondents performed nuchal translucency scanning; only 30 (45%) were accredited by a recognised body to perform such scans. Only 33% of the relevant laboratories used by specialists participated in external quality assurance programmes specific to Down's syndrome screening undertaken by a third party organisation.
According to our data, first trimester screening has become one of the most common screening strategies for Down's syndrome in Hong Kong, but there is a need to assess the quality of such prenatal screening for aneuploidy to ensure its efficacy.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2009; 15(6):447-51.
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ABSTRACT: While the prevalence of young female smokers is rising among the Hong Kong Chinese population, data on their smoking pattern during pregnancy are limited.
To investigate the smoking habit of Hong Kong Chinese women and their partners during pregnancy.
Postal questionnaires were sent to 479 couples to explore their smoking patterns during pregnancy at one to two years after the index delivery.
Questionnaires were completed by 247 subjects. Among 117 women who were ever-smokers, 26% had stopped smoking before the index pregnancy, while 60% stopped and 14% reduced smoking during the pregnancy. Most women stopped smoking in the first trimester (93%) and prior to the first antenatal visit (79%). Those who used to smoke fewer cigarettes before pregnancy were more likely to stop smoking during pregnancy but women with a history of recreational drug use were more likely to continue smoking during pregnancy. The post-partum smoking relapse rate was 59% in women who had stopped smoking before or during their pregnancy. Only 2.6% of the partners who were ever-smokers stopped smoking before the pregnancy while smoking habits remained unchanged in 52%.
Approximately one-fifth of an unselected sample of Hong Kong mothers had a history of smoking prior to pregnancy. Pregnancy is an opportune time to implement smoking intervention programs for female smokers and their partners with an emphasis on the maintenance of post-partum smoking abstinence.
Australian and New Zealand Journal of Obstetrics and Gynaecology 07/2008; 48(3):280-5. · 1.24 Impact Factor
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ABSTRACT: To determine any relationship between ambient temperatures adjusted for humidity at conception and the occurrence of pre-eclampsia.
The subjects were singleton primiparae delivered in a Teaching Hospital between 1995 and 2002. We studied the odds of developing pre-eclampsia across months and investigated the association between the pre-eclamptic rates based on the months of conception and the mean monthly heat index.
A total of 245 (1.6%) women were diagnosed pre-eclampsia and eclampsia during the study period. There was a significant association between the seasons of conception and rate of pre-eclampsia (logistic regression Wald chi(2) = 9.2, p = 0.03). Conceptions during summer had a higher risk of pre-eclampsia than those during autumn (2.3 vs. 1.6%, OR 1.7, 95% CI 1.2-2.5). Women who conceived in June had the highest risk of developing pre-eclampsia (OR 2.8, 95% CI 1.5-5.2) while women who conceived in October had the lowest after adjusting for age. A 2-month time lag was observed between the peak pre-eclamptic rate in women who conceived in June and the peak heat index in August.
Singleton primiparous women who conceived in summer and had a longer exposure to higher ambient temperature were at a greater risk of pre-eclampsia.
Gynecologic and Obstetric Investigation 02/2008; 66(1):22-6. · 1.28 Impact Factor
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ABSTRACT: The true risk of chronic villus sampling (CVS) is poorly defined. The objective of this study was to review the clinical outcome of transabdominal CVS performed in a university teaching unit, with an emphasis on the complication rate.
A comprehensive audit database was maintained for 1,351 pregnant women, including 17 sets of twin pregnancies, who had a CVS. Details and outcome of all CVSs made in the unit between May 1996 and May 2004 were reviewed. All CVSs were performed by one of 5 operators using the identical techniques.
All procedures were performed transabdominally. A total of 1,355 CVSs were performed because there were 4 dichorionic twin pregnancies which required 2 punctures. The mean gestation at CVS was (11.8 +/- 0.7) weeks, and 97.3% of the procedures were performed between 11 and 13 completed weeks. The majority (96.2%) required only 1 puncture to achieve correct needle placement. The procedure failed to obtain an adequate sample in 4 subjects (0.30%). A total of 1,351 chromosomal studies were requested and there was 1 case (0.07%) of culture failure. The results of chromosomal studies were available within 14 days in 36.7% of the cases and within 21 days in 94.0%. Overall, 77 chromosomal abnormalities (5.7%) and 5 cases of thalassemia major were detected. Pregnancy outcome was unknown in only 13 singleton subjects (0.96%). In the remaining 1,355 fetuses, there were 76 pregnancy terminations (5.56%), 10 fetal losses with obvious obstetric causes (0.73%), and 21 potentially procedure-related fetal losses (1.54%). In the last group, the majority had one or more co-existing obstetric complications. The background fetal loss rate for pregnancies at similar gestational age in the unit was about 0.8%. Therefore, the procedure-related fetal loss rate was estimated to be at the maximum of 0.74%.
In experienced hands, first trimester transabdominal CVS is an accurate and safe invasive prenatal diagnostic procedure. It should be one of the treatment options available to pregnant women who require prenatal genetic diagnosis.
Chinese medical journal 11/2005; 118(20):1675-81. · 0.86 Impact Factor
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ABSTRACT: This study was performed to investigate the impact of hypertensive disorders of pregnancy at term on neonatal birth weight. All singleton live births delivered between 37 and 42 weeks of gestation complicated by hypertensive disorders over a 7-year period (n = 362) was compared to 34 783 uncomplicated singleton deliveries in the same period. The individualized gestation-related optimal weight (GROW) was calculated for each individual case adjusted for the effects of maternal booking weight, height, parity, gestation at delivery, and fetal sex. Small-for-gestational-age (SGA) was defined as a birth weight less than the 10th percentile of the GROW. The incidence of SGA babies was significantly higher in subjects with preeclampsia and eclampsia than in control subjects (24.6 versus 11.3%; odds ratio = 2.55; 95% CI: 1.84, 3.55). Preeclampsia significantly reduced fetal birth weight by 130 g or 4.3%. Those with eclampsia on average had a neonatal birth weight 349 g or 11.0% below that of the GROW. In contrast, there was no significant difference in the incidence of SGA babies or degree of deviation from GROW between those with or without gestational hypertension.
Acta Obstetricia Et Gynecologica Scandinavica 10/2005; 84(9):875-7. · 1.77 Impact Factor
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ABSTRACT: There has thus far been no empirical research on the occurrence of antenatal psychiatric morbidity in Chinese population. Epidemiological studies in western societies generally show that depressive episodes occur in 10-20% of pregnant women. Longitudinal studies have demonstrated that antenatal depression is one of the most powerful predictors of postnatal depression. There is also a growing literature that shows that antenatal psychological distress can adversely affect maternal and foetal well being.
At 38 weeks of pregnancy, 238 consecutive women were invited to return for psychiatric assessment. The participants were interviewed using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID-NP).
Seventy women (29%) declined to participate, and another 11 (5%) defaulted the SCID interview. Among the 157 women interviewed, the 1-month prevalence of antenatal depression was 4.4%. The 1-month prevalence of all psychiatric diagnoses was 6.4%. The prevalence of antenatal depression and all psychiatric diagnoses for the entire pregnancy was 6.4% and 8.3%, respectively.
About a third of eligible subjects did not participate in the study.
A significant proportion of Chinese women suffer from psychiatric morbidity during pregnancy. Depressive disorders are by far the commonest morbidity in the study population. Given the scope of the morbidity and the potential impact on obstetric and neonatal outcomes, early screening and treatment are warranted.
Journal of Affective Disorders 11/2004; 82(1):93-9. · 3.52 Impact Factor
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ABSTRACT: Maternal rubella status was compared between local residents with non-residents who delivered in our hospital during 1998–2008. Among the 60,822 women, non-immunity was more common in the non-residents (19.9% versus 8.1%, P < 0.001). Significant difference and positive correlation with age and parity were found for both groups, but a significant inverse correlation with year-of-birth was found only in the residents. Regression analysis confirmed that birth after 1970 was associated with reduced odds of non-immunity, which indicated that the rubella vaccination programme, introduced since 1978, has succeeded in reducing the incidence of non-immunity to <5% in the youngest generation.
Vaccine.
