Ho-Yen Chueh

Chang Gung Memorial Hospital, T’ai-pei, Taipei, Taiwan

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Publications (30)59.09 Total impact

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    ABSTRACT: This study was conducted to investigate the risk factors of third- and fourth-degree lacerations following vaginal deliveries in Taiwanese women, and to offer clinical guidance for the reduction of severe perineal lacerations. A total of 1879 women who underwent vaginal deliveries assisted by midline episiotomy at a tertiary hospital were included. Obstetric risk factors were analyzed for women with and without third- and fourth-degree lacerations. Two hundred and five deliveries (10.9%) resulted in third- or fourth-degree lacerations. Parity, duration of first and second stages of labor, rate of instrument-assisted vaginal deliveries, the newborn's birth weight and head circumference, and the ratio of the newborn's birth weight to maternal body mass index were significantly different between women with and without severe perineal lacerations. Logistic regression demonstrated that nulliparity (odds ratio = 3.626, p < 0.001), duration of second stage of labor (odds ratio = 1.102, p = 0.044), instrument-assisted vaginal delivery (odds ratio = 4.102, p < 0.001), and newborn's head circumference (odds ratio = 1.323, p < 0.001) were independent risk factors of severe perineal lacerations. Instrument-assisted vaginal delivery was a common independent risk factor for severe lacerations shared between primiparous and multiparous women. With regard to severe perineal lacerations during vaginal delivery, there are multiple obstetric contributory factors despite routine episiotomy, among them, nulliparity, longer labor duration, greater newborn head circumference, and instrument-assisted vaginal delivery. The latter should only be performed after careful evaluation. Copyright © 2014. Published by Elsevier B.V.
    Taiwanese journal of obstetrics & gynecology. 12/2014; 53(4):481-5.
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    ABSTRACT: Objective A twin pregnancy consisting of a complete hydatidiform mole with a coexisting normal fetus is extremely rare with an incidence of 1/22,000 to 1/100,000. The incidence of preterm delivery is high and few pregnancies reach near term with a viable fetus. Case report A 34-year-old woman presented at 20 weeks of gestation with increased levels of serum beta human chorionic gonadotropin (beta-HCG) at 4.74 multiples of the median (310277.7 mIU/mL). Ultrasonography showed a hydatidiform mole together with a normal fetus. Fetal karyotyping revealed 46XY. The serum beta-HCG levels were followed up throughout the remainder of the pregnancy. A male infant weighting 2260 g and the molar tissue were delivered at 37 weeks of gestation. The karyotype of the molar tissue showed 46XX and the histopathological report confirmed our diagnosis. At 4 months postpartum, metastatic gestational trophoblastic disease of the lung was diagnosed in the mother by a computed tomography scan due to increased beta-HCG levels. The patient received three unsuccessful cycles of methotrexate and folinate. Another four cycles of chemotherapy consisting of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) were initiated and the beta-HCG levels returned to normal. There was no evidence of recurrence in the subsequent 5 years of regular follow up. Conclusion A pregnancy with a complete hydatidiform mole and a living cotwin can be a serious threat to the health of both the mother and the fetus. Early diagnosis depends on a combination of detecting an unusually high level of serum beta-HCG and ultrasound examination. We suggest that continuation of the pregnancy may be an acceptable option and that the pregnancy may continue until term if a normal fetal anatomy is assured and maternal complications are under control. Patients require careful postpartum follow up and any recurrent disease should be managed aggressively.
    Taiwanese Journal of Obstetrics and Gynecology. 09/2014; 53(3):397–400.
  • Taiwanese journal of obstetrics & gynecology 03/2013; 52(1):145-146.
  • Taiwanese journal of obstetrics & gynecology 09/2012; 51(3):475-480.
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    ABSTRACT: To examine obstetrician-gynecologists' knowledge, beliefs, and attitudes associated with the intention to recommend adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccination to postpartum women. A survey instrument was mailed to a total of 2686 members of the Taiwan Association of Obstetrics and Gynecology to assess provider demographic characteristics, occupational information, pertussis knowledge, and beliefs and attitudes about vaccination. The intention to recommend pertussis vaccination to postpartum women was evaluated. Trend chi-square statistics and multivariate logistic models were used to determine variables that were significantly associated with intention to recommend vaccination. Of the 676 surveys returned (25.2%), 510 participants were active in obstetric practice. A statistically significant difference was found in mean ± SD knowledge scores for pertussis disease and pertussis vaccination between obstetrician-gynecologists who intended to recommend and those who did not intend to recommend postpartum Tdap vaccination (disease: 2.99 ± 2.2 vs. 2.31 ± 1.9, respectively, p < .001; vaccination: 2.64 ± 2.2 vs. 1.36 ± 1.8, respectively, p < .001). Obstetrician-gynecologists who were in favor of postpartum Tdap vaccination were more likely to: (1) rate the change in pertussis incidence among adults as increased; (2) rate pertussis disease among newborn infants as highly severe; (3) rate pertussis as highly contagious; and (4) understand the current recommendation of important organizations for protecting infants against pertussis. Our study of obstetrician-gynecologists' attitudes and intentions concerning postpartum Tdap vaccination may be useful in guiding the design of effective perinatal Tdap immunization programs nationwide.
    Taiwanese journal of obstetrics & gynecology 06/2012; 51(2):222-8.
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    ABSTRACT: In the complex mechanism of preeclampsia, oxidative stress is an important pathogenic factor, and F₂-isoprostane is a marker of oxidative stress and lipid peroxidation. The objective of this study was to identify if the amniotic fluid (AF) levels of F₂-isoprostanes were elevated in women who later developed preeclampsia. In this study, we analyzed AF F₂-isoprostane concentrations with enzyme immunoassay (EIA), and the EIA results could be validated by quantitative mass spectrometry. The mean AF concentration of F₂-isoprostanes was significantly higher in pregnancies with subsequent development of preeclampsia (123.1 ± 57.6 pg/ml, n = 85) than in controls (73.8 ± 36.6 pg/ml, n = 85). The AF elevation of F₂-isoprostanes was even higher in the preeclampsia with intrauterine growth restriction group (138.3 ± 65.2 pg/ml, n = 39). The area under the curve of the receiver operating characteristics analysis for AF F₂-isoprostanes assay was 0.81, supporting its potential as a biomarker for preeclampsia. These results indicate that oxidative stress existed before the onset of clinical preeclampsia, further suggesting that the elevation of AF F₂-isoprostanes may be used as a guide for antioxidant supplementation to reduce the risk and/or severity of preeclampsia.
    Free Radical Biology and Medicine 05/2011; 50(9):1124-30. · 5.27 Impact Factor
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    ABSTRACT: This study examined possible relationships between homocysteine and markers used in first-trimester screening for Down syndrome. Pregnancies were categorized into 4 groups according to quartile ranking of maternal plasma homocysteine concentration. Of the 595 pregnancies, 147 were assigned to group 1 (homocysteine level 0.6-3.5 μmol/L), 156 to group 2 (homocysteine level 3.6-4.5 μmol/L), 142 to group 3 (homocysteine level 4.6-5.6 μmol/L), and 150 pregnancies to group 4 (homocysteine level 5.7-12.6 μmol/L). No significant difference in mean nuchal translucency and mean free β-human chorionic gonadotropin (free-βhCG) multiples of the median (MoM) levels were observed. However, the mean pregnancy-associated plasma protein A (PAPP-A) MoM levels were significantly decreased in inverse relationship with homocysteine level among all 4 groups (F = 31.127, P < .001). If homocysteine is assayed as part of the first-trimester maternal serum testing, it is important to adjust for homocysteine concentration when using PAPP-A serum level for calculating the risk of fetal aneuploidy.
    Reproductive sciences (Thousand Oaks, Calif.) 09/2010; 17(12):1130-4. · 2.18 Impact Factor
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    ABSTRACT: We conducted surveys to determine factors influencing women's decisions to accept or decline postpartum pertussis (Tdap) vaccination. Survey response rate among eligible individuals was 97%. Of respondents, 53% accepted and 47% declined postpartum Tdap. Women, who declined vaccination were more likely to rate maternal or infant risk of exposure to pertussis as low, report that they did not trust information about postpartum pertussis vaccination, and report being very concerned about the safety of the vaccine. Awareness about pertussis, its risk to infants, and prevention via vaccination need to be further increased among women of child-bearing age, particularly pregnant women.
    Vaccine 08/2010; 28(34):5641-7. · 3.49 Impact Factor
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    ABSTRACT: This study was designed to establish a fetal spine nomogram for age 11 through 14 weeks of gestation and to document relations among fetal spine length, distance and angle. These parameters were prospectively measured during the first trimester of singleton pregnancies, along with nuchal translucency, over a 3-year period. A total of 430 fetuses were included in the study. The regression equations among fetal spine parameters and gestational age were as follows: Spine length (mm) = 1.116 x gestational age (days) - 59.169; spine distance (mm) = 1.079 x gestational age (days) - 59.038; head-spine angle = 0.740 x gestational age (days) + 4.735; spine length:spine distance ratio = -0.002 x gestational age (days) + 1.234. Prenatal age-specific reference intervals for fetal spine biometry between 11 and 14 weeks of gestation may assist in evaluation of fetuses investigated for genetic abnormalities that can be expressed by deviation in spine length, distance, or angle.
    Ultrasound in medicine & biology 07/2010; 36(7):1060-5. · 2.46 Impact Factor
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    ABSTRACT: Up to 10% of women of reproductive age in our country are carriers of hepatitis B virus. This study examined whether maternal hepatitis B carrier status has any effect on markers used in first-trimester screening for Down syndrome. Records for 2 major Taiwanese hospitals were retrospectively examined to identify women with singleton pregnancies resulting in normal live births from June 2002 through 2008. Maternal hepatitis B data were used to define 3 groups: seronegative women, inactive carrier women, and active carrier women. Women with active or inactive carrier status were significantly older than seronegative women. The results of the study show that maternal hepatitis B carrier status does not influence first-trimester levels of maternal serum free beta-human chorionic gonadotropin (free beta-hCG) multiples of the median (MoM), pregnancy-associated plasma protein A (PAPP-A) MoM, and median fetal nuchal translucency and screening false-positive rate; therefore, correction in the risk calculation algorithm for maternal hepatitis B carrier status is not necessary.
    Reproductive sciences (Thousand Oaks, Calif.) 03/2010; 17(6):564-7. · 2.18 Impact Factor
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    ABSTRACT: To assess nuchal translucency (NT) thickness and differences in inter-twin NT thickness among naturally conceived monozygotic and dizygotic twins. Enrolled women prospectively underwent NT measurement for both twins between 11 and 14 weeks of gestational age. NT thickness and inter-twin NT difference were recorded and compared among dizygotic twins, monozygotic dichorionic twins, and monozygotic monochorionic twins. This study obtained analyzable data for 174 monozygotic twins and 107 dizygotic twins. Of the 174 monozygotic twins, 105 were monochorionic, and 69 were dichorionic. Monozygotic monochorionic twin pregnancies had a significantly higher mean fetal NT thickness (1.48 +/- 0.62 mm) than either dizygotic twin pregnancies (1.34 +/- 0.50 mm) or monozygotic dichorionic twin pregnancies (1.31 +/- 0.48 mm). Mean inter-twin NT difference was significantly lower in monozygotic dichorionic twin pregnancies (0.37 +/- 0.19 mm) than in dizygotic twin pregnancies (0.57 +/- 0.22 mm) or monochorionic twin pregnancies (0.65 +/- 0.43 mm).Irrespective of twin zygosity, NT thickness and inter-twin NT difference were larger in monochorionic twins than in dichorionic twins (1.48 +/- 0.62 mm versus 1.33 +/- 0.49 mm, and 0.65 +/- 0.43 mm versus 0.49 +/- 0.23 mm, respectively). During first-trimester ultrasonographic screening for Down syndrome, monochorionic twin pregnancies have the greatest NT thickness and monozygotic dichorionic twin pregnancies have the lowest inter-twin NT difference.
    Prenatal Diagnosis 03/2010; 30(3):247-50. · 2.68 Impact Factor
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    ABSTRACT: This study was conducted to determine the incidence of cerebral injury as detected by postnatal brain scan in monochorionic twins with selective intrauterine growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 73 monochorionic twin pregnancies divided into absence (group I, n = 46) or presence (group II, n = 27) of selective intrauterine growth restriction. Mild cerebral injury was defined as presenting one of the following abnormal cranial scan findings: intraventricular hemorrhage grade I, grade II, lenticulostiate vasculopathy and/or subependymal pseudocysts, while severe cerebral injury was defined as presenting intraventricular hemorrhage grade III, grade IV, cystic periventricular leukomalacia (PVL) grade II or higher, porencephalic cysts, and/or ventricular dilatation. The incidence of mild cerebral injury was not significantly different between these two groups (eight cases in group I and six cases in group II). Except for one case that later developed a seizure, the majority (13 out of 14) of cases with minor brain scan anomalies were only transient, without significant clinical impact. There was only one case diagnosed with a major brain scan anomaly (periventricular leukomalacia) in group II. One severe brain injury and three neonatal deaths all belonged to group II with abnormal umbilical artery Doppler in the growth restricted twin. In conclusion, the incidence of severe cerebral injury in monochorionic twin pregnancies with selective intrauterine growth restriction was low, at 3.7%.
    Twin Research and Human Genetics 02/2010; 13(1):109-14. · 1.92 Impact Factor
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    ABSTRACT: Althoughmaternally derived X pentasomy following intracytoplasmic sperm injection (ICSI) is rare, prenatal detection of a case offers insight into etiology and diagnosis. A 29-year-old gravida 1 whose pregnancy resulted from ICSI was referred for ultrasound screening at 11 weeks' gestation. Nuchal translucency thickness was 3.2 mm, and the fetal nasal bone was absent. Subsequent evaluation revealed karyotype 49,XXXXX. DNA microsatellite analysis showed the extra X chromosomes were maternal in origin. Termination of pregnancy was performed at 15 weeks. Because of the increased risk of sex chromosomal abnormalities in ICSI pregnancies, patients should be counseled prior to fertilization and standard prenatal care should include nuchal translucency measurement and any other elements necessary for indicated pregnancies to obtain a diagnosis.
    Fetal Diagnosis and Therapy 10/2008; 24(3):299-303. · 2.30 Impact Factor
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    ABSTRACT: Twin-twin transfusion syndrome is a serious obstetric complication unique to monochorionic twin gestations. Occlusion of vessel anastomoses is recommended to improve the perinatal outcome. A 36-year-old, gravida 1, woman had a monochorionic twin pregnancy which was found to be affected by twin-twin transfusion syndrome at 26 weeks' gestation. The condition was successfully treated by occlusion of placental vessel anastomoses using enbucrilate under color Doppler ultrasonographic guidance. At 35 weeks of gestation, two male infants were delivered by cesarean section. The birth weights of the babies were 2,470 and 1,750 g, and both were thriving. Targeted therapeutic ablation of vessel anastomoses involved in twin-twin transfusion syndrome using color Doppler ultrasonographic guidance is minimally invasive and may effectively obliterate interfetal transfusion, contributing to the survival of both twins.
    Taiwanese journal of obstetrics & gynecology 10/2008; 47(3):330-3.
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    ABSTRACT: Mycophenolate mofetil has been shown to have teratogenic properties in animal studies and clinical reports. We report a case of major fetal malformation likely caused by mycophenolate mofetil exposure in utero in a 36 year old patient with systemic lupus erythematosus. The diagnosis was made by ultrasonography at 22 weeks of gestation.
    American journal of obstetrics and gynecology 06/2008; 199(2):e6-8. · 3.97 Impact Factor
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    ABSTRACT: To study the effect of fast reporting by mobile phone short-message service (SMS) on anxiety levels in women undergoing prenatal biochemical screening for Down syndrome. From January 2005 to December 2006, 2782 women undergoing prenatal biochemical serum screening were randomized into fast reporting by SMS (group A) or without mobile phone reporting (group B). Anxiety levels were measured with the Spielberger State-Trait Anxiety Inventory (STAI) before prenatal screen testing, before the appointed clinic (when the SMS report had already been given to group A), and 3 days after the appointed clinic (when the full screening report had been given to groups A and B). For screen-negative women, anxiety scores did not differ between groups before prenatal screen testing and 3 days after the appointed clinic. The state-anxiety scores measured on the second occasion had declined significantly in group A. The state-anxiety scores in both groups increased over the 3-week period after being informed of positive screen results. The trait- and state-anxiety scores at all points did not differ between the two groups of screen-positive women. The provision of a routine reporting system plus additional SMS report revealed some overall benefits in reducing anxiety among women with screen-negative result.
    Prenatal Diagnosis 06/2008; 28(5):417-21. · 2.51 Impact Factor
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    ABSTRACT: To analyse parental decisions regarding pregnancies with sex chromosome abnormalities (SCA). Collected and reviewed records from our hospital for 1991-2005. Genetic counselling was provided by obstetricians or perinatologists. Among 57 fetuses with SCA were 36 non-mosaic cases (four of 36, 45,X; 12 of 36, 47,XXY; seven of 36, 47,XYY, 13 of 36, 47,XXX) and 21 mosaic cases (15 of 21, 45,X mosaicism). Only 20% of 45,X mosaic pregnancies were continued, whereas all other mosaic pregnancies (100%) were continued (P = 0.004). Of 32 SCA cases counselled by a perinatologist, 66% (21 of 32) were continued. In contrast, 36% (nine of 25) of cases counselled by a general obstetrician were continued, a barely significant difference (P = 0.048). More couples chose to continue pregnancies in recent years. Genetic counselling by well-trained specialists is valuable, and the trend towards fewer terminations at our centre suggests improved parental knowledge of pathology associated with SCA.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 05/2008; 48(2):155-9. · 1.62 Impact Factor
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    ABSTRACT: To present the application of three-dimensional (3D) ultrasonography in the early prenatal diagnosis of fetal arthrogryposis. A 26-year-old multipara had a fetus with anomalies of the limbs as shown by conventional ultrasonography at 18 weeks of gestation. A follow-up 3D ultrasonogram at the same gestational age was consistent with the diagnosis of arthrogryposis. Based on an abnormal chromosome 18p on the fetal karyotype, termination of the pregnancy was performed at 22 weeks' gestation. The outward appearance of the fetus coincided with the prenatal sonographic findings of arthrogryposis. As an advanced and sophisticated technology, 3D ultrasonography can serve as a useful technique for the early diagnosis of fetal anomalies, including arthrogryposis. The earlier the diagnosis is established, the earlier the appropriate management can be initiated, including counseling, additional work-up and timely termination of pregnancy, if indicated.
    Taiwanese journal of obstetrics & gynecology 04/2008; 47(1):75-8.
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    ABSTRACT: To document rates of recurrent group B streptococci (GBS) colonization in women with previous GBS colonization in an initial pregnancy and to assess maternal risk factors associated with recurrence. A retrospective, longitudinal study was performed in a teaching hospital on women with GBS colonization who were pregnant between 2002 and 2006 and had at least one subsequent pregnancy during the same time period. When only the index and first subsequent pregnancy were analyzed, the cohort included 251 women. The rate of recurrence was estimated for GBS colonization in the pregnancy after the index pregnancy for GBS colonization. Multivariable regression models were constructed to model recurrence of GBS colonization in a subsequent pregnancy as functions of potential predictors to estimate relative risks and confidence intervals. The rate of recurrence of GBS colonization in the pregnancy subsequent to the index pregnancy was 38.2% (95% confidence interval 33.5-42.9%). Multivariable regression models showed that the time interval between the two pregnancies and the intensity of GBS colonization from the index pregnancy were predictive of recurrent GBS colonization. More than one third of women had recurrent GBS colonization in a subsequent pregnancy. These findings should assist clinicians in counseling women with GBS colonization about their risk for recurrence, the importance of appropriate prenatal GBS screening in a subsequent pregnancy, and intrapartum antibiotic prophylaxis for unknown GBS status.
    Obstetrics and Gynecology 04/2008; 111(3):704-9. · 4.37 Impact Factor
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    ABSTRACT: To present two cases of ectopic twin pregnancy in a Cesarean section scar following IVF-embryo transfer. Case report. Tertiary referral case center. Two women who had ectopic twin pregnancy in a Cesarean section scar, in both cases following IVF and embryo transfer. Three-dimensional power Doppler ultrasound and diagnostic hysteroscopy were performed for early recognition and treatment. Prevention of pregnancy complications such as hemorrhage, uterine rupture, and preservation of fertility. Case 1: diagnosis was made in a 31-year-old woman after IVF; she was managed with laparotomy excision of the twin pregnancy. Case 2: an early such pregnancy was diagnosed in a 37-year-old woman following IVF. She was treated successfully with hysteroscopy and laparoscopic surgery. Because ectopic pregnancy in a Cesarean scar carries high risk of uterine rupture and uncontrollable hemorrhage, such a twin pregnancy presumably carries similar risks. Focused application of high-resolution ultrasound and diagnostic hysteroscopy may help lead to early recognition of ectopic twin pregnancy in a Cesarean scar and prevention of complications such as hemorrhage and uterine rupture.
    Fertility and sterility 03/2008; 90(5):2009.e19-21. · 4.30 Impact Factor