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ABSTRACT: BACKGROUND: The data in the literature suggests that Methimazole (MMI)/Carbimazole (CMZ) embryopathy is rare. This study examined the incidence of CMZ embryopathy in the Hong Kong Chinese population and the factors associated with its development. METHODS: Of the 145 pregnant women with hyperthyroidism managed from 2008 to 2010, 29 (20%) had taken CMZ during pregnancy. The presence and details of birth defects, the dosage of CMZ, and the period of exposure during pregnancy were examined in these 29 pregnancies. All cases of CMZ embryopathy in the English literature were reviewed in the same way. RESULTS: Of the 27 babies (93.1%) with known outcome, 3 had aplasia cutis and 1 had an omphalocele in addition, and 1 affected baby had a sibling with aplasia cutis and patent vitellointestinal duct. The incidence of CMZ embryopathy in our study group is 11.1%. Amongst the 21 cases of CMZ embryopathy in the literature, 85% were exposed to a CMZ dosage of ≥20 mg/day, and the minimum duration of exposure being 7 weeks from last menstrual period. The most common abnormality is ectodermal anomaly (62%), followed by oro-nasal anomaly (48%), facial dysmorphism (38%), gastrointestinal anomaly (33%) and abdominal wall defect (19%). There was no relationship between the type of abnormality and the dosage or duration of exposure to CMZ. CONCLUSIONS: The incidence of CMZ embryopathy in our study group is 11.1%. Critical factors for its development are exposure to a CMZ dosage of ≥20 mg/day before 7 weeks of gestation. Genetic susceptibility may also play a role. Birth Defects Research (Part A), 2013. © 2013 Wiley Periodicals, Inc.
Birth Defects Research Part A Clinical and Molecular Teratology 03/2013; · 2.27 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: The averaged incidences of nonsyndromal/isolated cleft lip (CL), cleft palate (CP), and cleft lip with cleft palate (CLCP) by each month-of-conception, and managed in our hospital in from 2002 to 2009 were correlated with the reported levels of sunshine, ultraviolet radiation, and ambient nitrogen oxides (nitrogen oxide, nitrogen monoxide, and nitrogen dioxide), sulfur dioxide, and ozone, at the month of, and then at 4 and 8 weeks after, conception. There were 25, 12, and 22 cases each of CL, CP, and CLCP, respectively, totaling 59 cases (1.21 of 1000 births). On regression analysis, sunshine correlated inversely with the isolated CL at (P = .009) 4 weeks (P = .005) and 8 weeks (P = .008) postconception, and with CP (P = .009) and CLCP (P < .001) at 8 weeks postconception, while NOx correlated inversely with CL (P = .018) and NO with CLCP (P = .031), at 8 weeks postconception. Our results suggested that the interaction between sunshine and nitrogen oxides with other factors results in the reported seasonal variation in the incidence of isolated oral-facial clefts.
Reproductive sciences (Thousand Oaks, Calif.) 12/2012; · 2.31 Impact Factor
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ABSTRACT: Fetal distress is an emergency condition requiring rapid caesarean delivery. Hence, it has been recommended that the decision-to-delivery interval should be within 30 mins. Many previous studies have failed to show any improved outcome with short decision-to-delivery interval. The reasons are (1) most of these studies were of small scale and retrospective with limitation in design; (2) the indications for caesarean deliveries recruited in these studies were not specific for life-threatening fetal distress; (3) selection bias as clinicians tended to deliver worse cases more quickly than less severe cases; (4) correlation was analysed between adverse fetal outcome and decision to delivery interval, but ignored the bradycardia-to-delivery interval, which reflected the actual duration of fetal hypoxia. Latest studies indeed have shown that bradycardia-to-delivery interval correlated significantly with arterial pH and base excess in life-threatening fetal conditions. The longer the bradycardia-to-delivery, the poorer the arterial blood gases parameters and neonatal outcomes. This result supports that every obstetric unit should have the capability to accomplish emergency caesarean section in 30 mins of decision for fetal safety. The Royal College of Obstetrics and Gynaecology has standardised the classification of the urgency of caesarean delivery, which helps to identify those life-threatening fetal conditions that will be benefited from rapid delivery. Training in teamwork and communication, availability of anaesthetists, and operation theatre are the main factors to achieve a quick caesarean delivery.
Best practice & research. Clinical obstetrics & gynaecology 10/2012; · 1.87 Impact Factor
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ABSTRACT: Objective: To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency. Methods: The pregnancy outcome of 20 women carrying singleton pregnancy referred for suspected cervical insufficiency and chose Arabin cerclage pessary for treatment from 2009-2011 were reviewed. Pregnancy outcome were analysed according to presence of risk factors, amniotic fluid sludge, cervical length and gestation at pessary insertion. Results: At presentation, mean cervical length was 1.17 cm (range 0-2.33 cm), mean gestation at pessary insertion and delivery was 20.6 (12.9-26.1) weeks and 32.1 (14.7-40.1) weeks, respectively, and mean prolongation of pregnancy was 11.5 (0.5-25.2) weeks. Overall, 5 (25%) had fetal loss between 14.7-23.1 weeks, while 3 (15%) and 12 (60%) delivered before and after 34 weeks gestation, respectively with no perinatal mortality. Compared with women with cervical length <1.5 cm, all those with cervical length ≥1.5 cm had pregnancy prolonged for ≥49 days (100 vs. 54% p = 0.032) and 86% delivered beyond 34 weeks (86 vs. 46% p = 0.085). Conclusions: Arabin cerclage pessary appears to be optimal for treating women at high risk of cervical insufficiency with a cervical length of 1.5-2.5 cm, while it is an acceptable option for high risk women with cervical length <1.5 cm.
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 08/2012; · 1.36 Impact Factor
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ABSTRACT: Objective To determine the effectiveness of cerclage pessary in the prevention of preterm birth in asymptomatic Chinese women with a short cervix at 20 to 24 weeks.Methods Low-risk women carrying singleton pregnancies were screened with transvaginal ultrasound, and those with a cervical length <25 mm at 20 to 24 weeks were recruited into a randomized controlled trial, comparing the prophylactic use of cerclage pessary with expectant management. The analysis was by intent-to-treat. The primary outcome measure was preterm delivery before 34 weeks.Results Among 4438 screened women, 203 women (4.6%) met the inclusion criteria and 108 (58%) consented for the study. A total of 53 and 55 women were allocated to pessary and control groups, respectively. There was no difference in background demographics, including the mean cervical length (19.6 mm versus 20.5 mm) and the mean gestational age at randomization (both 21.9 weeks). Delivery before 34 weeks occurred in 9.4% and 5.5% (p = 0.46) in the pessary and the control groups, respectively. No differences in major side effects were noted between the groups.Conclusion In our population, <5% had a cervical length of less than 25 mm at 20 to 24 weeks' gestation. The prophylactic use of cerclage pessary did not reduce the rate of preterm delivery before 34 weeks.
American Journal of Perinatology 08/2012; · 1.32 Impact Factor
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ABSTRACT: Objective: To elucidate the effect of hepatitis B virus (HBV) infection on breastfeeding uptake in Chinese mothers in an endemic region. Patients and Methods: A retrospective cohort study on 63 885 consecutive pregnant delivered between January 1997 and June 2008, were extracted from computerized database to examine the relationship between breastfeeding uptake and maternal HBV status, adjusted for demographic factors. Results: A total of 6593 (10.3%) women were hepatitis B surface antigen (HBsAg)-positive, with an annual prevalence of around 10%. In the study period, 29 869 (46.8%) practised breastfeeding, and its prevalence ranged from 35.4 to 54.8% with an increasing trend throughout the years (p < 0.001). HBsAg-positive mothers had a significantly lower rate of breastfeeding (39.2 vs. 47.6% p < 0.001). Multiparas had higher incidence of HBV infection (10.9 vs. 9.8%, p < 0.001) and lower breastfeeding rate (42.2% versus 51.0%, p < 0.001) when compared with primiparas. Among those factors, maternal HBV infection had the strongest negative association with breastfeeding (adjusted odd ratio (aOR) = 0.726, 95% confidence interval (CI): 0.689-0.765). Conclusions: Our results suggested maternal HBV infection was one of the factors for the persistently low breastfeeding rate in Hong Kong over the past decades. To promote breastfeeding, it is necessary to generate definitive data on its safety regarding to mother-to-child transmission (MTCT) of HBV in order to allay the fear and anxiety in HBsAg-positive mothers.
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 06/2012; 25(11):2390-4. · 1.36 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: The present study was to examine the effects of skin pressures by compression legwear (CL) with different pressure levels
on multiple physiological indices and the physical-mechanical stimuli of CLs on psychological comfort perceptions following
prolonged standing and sitting period in women. Heart rate (HR), blood pressures (BP), core temperature at deep ear canal
(T
ear canal), and skin temperatures on the breast (T
breast), arm (T
arm), thigh (T
thigh), and lower leg (T
lowerleg) regions were measured by using a Polar S810i heart rate monitor, Dynapulse 5000A ambulatory BP monitor, and thermistor sensors
based on the Ramanathan method, in twelve healthy female subjects wearing CLs with four kinds of different pressure levels
during designed 4-hour wear trials under a controlled environment chamber. No significant differences and variation in HR
and systolic blood pressure (SBP) were found among different pressures applied. While HR significantly decreased with time,
and constant skin pressures exerted by the CLs appeared to have reduced the activation of sympathetic nervous system, resulting
in lower HR compared with that of the control condition. The application of CLs increased core temperatures (T
ear canal) and skin temperatures (T
breast, T
arm, T
thigh, and T
lowerleg) with elevation of pressure levels, but with increasing wearing time, the core and skin temperatures gradually decreased.
Decrease in skin heat dissipation might have been responsible for the changes in T
ear canal and skin temperatures. CLs with light and mild pressure levels decreased the leg fatigue feeling and maintained a comfortable
wearing sensation after wearing for 180 min. The application of CLs did not impose an unacceptable stress on the subjects.
Wearing of CLs should be safe in leg health care and treatment of venous disorders. CLs with light and mild pressures enhanced
wearing comfort, which would be more suitable for subjects whose work required sitting and standing for prolonged periods.
KeywordsCompression-Legwear-Body temperature-Heart rate-Blood pressure
Fibers and Polymers 04/2012; 11(1):128-135. · 0.84 Impact Factor
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Prenatal Diagnosis 04/2012; 32(5):491-3. · 2.11 Impact Factor
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ABSTRACT: Hepatitis B infection is a major global health problem. Vertical transmission is the commonest route of spreading hepatitis B virus (HBV) in many endemic areas. In order to control such transmission in Hong Kong, neonatal immunization programme was implemented for more than two decades. A declining prevalence of HBV infection was expected. However, the prevalence remained unabated at around 10% in recent studies. We suspect that one of the explanations of this persistent high prevalence is deficient knowledge on infection with the HBV and its prevention. Our paper gives an overview of the knowledge on HBV infection among Chinese population in both high and low endemic areas and discusses the potential factors that influenced the knowledge on as well as the implication of the sources of information for HBV infection, which was not addressed in previous studies.
Hepatitis research and treatment 01/2012; 2012:317451.
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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: Thalassaemia is the most common monogenetic disease worldwide. Antenatal screening is effective and simple, and accurate genetic prenatal diagnosis can be achieved in early gestation. Less invasive methods are feasible with ultrasound fetal assessment for alpha-thalassaemia, analysis of circulating fetal nucleic acid in maternal plasma, and pre-implantation genetic diagnosis. Women with thalassaemia major and intermedia are at risk of various maternal complications, such as cardiac failure, alloimmunisation, viral infection, thrombosis, endocrine and bone disturbances. Therefore, it is prudent to adhere to a standard management plan in this group of pregnant women. Close monitoring of the maternal and fetal condition during pregnancy is essential, and various treatments, such as blood transfusion or postpartum prophylaxis for thromboembolism, may be indicated. After birth, resumption of iron chelation and bisphosphonates treatment is needed, and counselling on breast feeding and contraception should be given.
Best practice & research. Clinical obstetrics & gynaecology 11/2011; 26(1):37-51. · 1.87 Impact Factor
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ABSTRACT: Abstract Objective: To determine if seasonal variation in the incidence of oral-facial clefts exists in the Hong Kong Chinese population. Methods: Cases of non-syndromal oral-facial clefts identified from the Prenatal Diagnostic Clinic database from 2002-2009, and total births from our departmental statistics during this period, were used to calculate the averaged month-of-conception incidence for overall cases and individual categories of clefts, including cleft lip (CL), cleft palate (CP), cleft lip with/without cleft palate (CL+/-CP), and cleft lip with cleft palate (CLP). Results: There were 59 eligible cases (1.21/1000 births), including 25 CL, 12 CP and 22 CLP cases. The peak incidence was in February (1.96/1000 births) and the lowest in September (0.67/1000 births). There was significant inverse correlation with the months from winter (December) to autumn (November) for all categories except for CP. When analysed by seasons, significant inverse correlation from winter to autumn was observed for all categories, and significant differences in incidence was demonstrated for CL+/-CP and CL. Conclusions: The seasonality in the incidence of oral-facial clefts found in this study suggested that environmental factors are probably involved, which would have accounted for the reported seasonal variations and geographical and racial differences in the incidence in the literature.
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 10/2011; · 1.36 Impact Factor
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ABSTRACT: Hepatitis B virus (HBV) infection is highly endemic in many Asian countries.
We examined whether prior contraceptive methods and sexual behavioral factors impact maternal HBV carriage in an obstetric population.
For this study, pregnant women were considered to be representative of the sexually active and fertile female population. Contraceptive methods used prior to the index pregnancy were examined in 1283 pregnant Chinese women attending an antenatal clinic using a self-administered questionnaire, and correlated with the maternal HBV status determined using routine antenatal screening.
In our study, 111 (8.7%) women were infected with HBV and there was no difference in the incidence of male condom usage between HBV-positive (88.3%) and HBV-negative (83.5%) women. No contraceptive method was associated with a reduced incidence of maternal HBV carriage, except for coitus interruptus. In multivariate analysis, only multiparity (adjusted odds ratio [aOR], 1.62) and more than 1 sexual partner (aOR, 1.57) were independent factors associated with maternal HBV carriage.
Contraceptive use played only a minimal role in preventing sexual transmission of HBV infection within the sexually active female population in an endemic area.
Hepatitis Monthly 10/2011; 11(10):829-34. · 2.19 Impact Factor
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ABSTRACT: To compare seroprevalence (serum IgG titre) with self-reported history of varicella zoster virus (VZV) infection among pregnant women in Hong Kong.
Pregnant women undergoing first trimester Down screening over a 3-months period were recruited for the study.
Positive immunity was found in 477 (95.4%) of the 500 recruited women, and those with positive, negative, or uncertain history of infection had similarly high seroprevalence (96.4, 90.5, 95.9% respectively). The mean age of infection from self-recalled history was 8.61 (SD 4.69) years, and only 3% recalled infection after age 18. Insufficient knowledge on the disease and vaccination was demonstrated.
Despite the absence of a routine vaccination programme, VZV immunity was high among pregnant women, the majority being infected during childhood and infection above age 18 was very rare. Hence, universal antenatal screening or vaccination for all women in the reproductive age would not be cost-effective in Hong Kong.
Vaccine 09/2011; 29(46):8186-8. · 3.77 Impact Factor
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ABSTRACT: To assess the knowledge on commercial cord blood banking (CCBB) among pregnant women.
Cross-sectional survey. Setting. Antenatal clinics of two major public maternity units in Hong Kong.
Pregnant women.
Self-administered questionnaire.
The survey explored knowledge about the use of self-stored umbilical cord blood (UCB) stem cells and attitude towards CCBB.
Of the 2,000 women recruited, 1 866 (93.3%) completed the questionnaire. The majority (78.2%) had no idea that there was the chance of using self-stored stem cells. Moreover, most of the respondents were unclear about which diseases other than leukemia are amenable to treatment with UCB stem cells in general. Only 20.3% of women knew that stem cells are available from the Red Cross in case their children need hematopoietic cell transplantation.
The results of this study revealed inadequate knowledge on UCB stem cell banking and its applications among most of our pregnant women. The government and clinicians should combine efforts to provide accurate information on utilization of UCB stem cells during antenatal care.
Acta Obstetricia Et Gynecologica Scandinavica 05/2011; 90(9):1005-9. · 1.77 Impact Factor
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ABSTRACT: To elucidate the significance of isolated absent or hypoplastic nasal bone in the second trimester ultrasound scan.
All cases of absent or hypoplastic nasal bone (length < 5th percentile) encountered during 2007-2009 were retrieved from database and all the ultrasound findings including structural abnormalities and soft markers for Down syndrome and fetal karyotype were reviewed. The cases were categorized into a study group with isolated absent or hypoplastic nasal bone and a comparison group with additional ultrasound findings. The incidence of Down syndrome confirmed by karyotyping was compared between the two groups.
Among 14 fetuses with absent or hypoplastic nasal bone identified, six (42.9%) had Down syndrome and eight (57.1%) were normal. All (100%) of the six fetuses with isolated absent or hypoplastic nasal bone (Study Group) had normal karyotype, while six (75%) of the other eight fetuses with additional ultrasound findings (Comparison Group) had Down syndrome (p = 0.010).
The use of isolated absent or hypoplastic nasal bone in the second trimester ultrasound scan for Down syndrome screening may not be effective. Amniocentesis, however, is indicated for fetuses with structural abnormality or additional soft marker which should be carefully searched by an experienced ultrasonographer.
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 04/2011; 24(4):555-8. · 1.36 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
