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ABSTRACT: To assess the impact of intimate partner violence (IPV) against pregnant women on subsequent perpetration of child abuse and neglect (CAN) by parents; and to test the mediation effect of recent IPV on the link between IPV during pregnancy and subsequent CAN.
This study was a longitudinal follow-up of a population-based study on pregnancy IPV conducted in antenatal clinics in 7 public hospitals in Hong Kong in 2005. Of all participants in the 2005 study, we recruited 487 women (with 184 having reported pregnancy IPV in the 2005 study) with newborn babies for a follow-up telephone interview in 2008. Participants responded to the Abuse Assessment Screen (AAS), the Parent-Child Conflict Tactics Scale, and some questions assessing demographic information.
The most common form of physical violence was corporal punishment, with a prevalence rate of 75.1% in the preceding year and 75.4% over their lifetime. Physical maltreatment was less likely to be reported, accounting for 4.7% in the preceding year and 4.9% over their lifetime. The preceding-year and lifetime prevalence rates of neglect were 11.3% and 11.5%, respectively. Findings from logistic regression analyses showed that IPV experienced by participants during pregnancy was associated with greater odds of both lifetime (aOR=1.74) and preceding-year child physical maltreatment (aOR=1.78). Results of the regression analyses also provided supportive evidence for the mediation effect of recent IPV victimization on the relationship between IPV during pregnancy and recent CAN against children.
IPV against women during pregnancy predicted subsequent CAN on newborns in Chinese populations. This underscores the importance of screening pregnant women for IPV in order to prevent CAN at an early stage. Home visitations are suggested to break the cycle of violence within a nuclear family.
Child abuse & neglect 05/2012; 36(4):275-84. · 2.34 Impact Factor
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ABSTRACT: We report an unusual case in which sonographic diagnosis of face presentation was made by translabial ultrasound examination during the first stage of labor. In a multigravida, induction of labor was performed at 39 weeks' gestation for suspected small-for-gestational age. The diagnosis of face presentation was confirmed by the use of intrapartum translabial ultrasound examination. In face presentation, the orbits and nasal bridge are shown in the center of the presenting part at the mid-sagittal plane. Emergency cesarean delivery was performed for labor dystocia. Here we discuss the merits and limitations of transabdominal, transvaginal and translabial ultrasound examinations in assisting clinical diagnosis of non-vertex malpresentation. We propose the use of intrapartum translabial scan in documentation, counseling and education in case of unusual non-vertex malpresentation.
Journal of Obstetrics and Gynaecology Research 09/2011; 37(12):1868-71. · 0.94 Impact Factor
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ABSTRACT: The present study discusses if pregnancy is a risk factor for intimate partner violence using a large, representative sample containing detailed information on partner violence including physical and sexual abuse as well as perpetrator-related risk factors. Data from a representative sample of 2,225 men were analyzed. The self-reported prevalence of men's violence against their female partners was computed and compared in terms of demographic, behavioral, and relationship characteristics. The preceding-year prevalence of physical assault, sexual violence, and "any violence or injury" among the group whose partners were pregnant was 11.9%, 9.1%, and 18.8%, respectively. This is significantly higher than the nonpregnant group. Pregnancy was significantly associated with increased odds of violence, including physical assault, sexual violence, and "any violence or injury" (ORs = 2.42, 2.42, and 2.60, respectively). Having controlled for relationship characteristics including social desirability, social support, in-law conflict, dominance, and jealousy of male perpetrators, pregnancy was significantly associated with "any violence or injury." Demographic and behavioral variables accounted for pregnant women's significantly higher odds of having been abused in the year preceding the data collection. This study provides preliminary findings on the association between pregnancy and partner violence. Our findings underscore the need to screen for violence among pregnant women in clinical health care settings as well as in communities. Perpetrator-related risk factors should be included in the assessment of risk for partner violence against pregnant women. For the prevention of intimate partner violence, family-based intervention is needed to work with victims as well as perpetrators.
Journal of Interpersonal Violence 05/2011; 26(7):1478-500. · 1.64 Impact Factor
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ABSTRACT: Before April 2006, women with singleton pregnancy and advanced maternal age (AMA, 35 years and older) were offered either direct invasive tests or a variety of screening tests for Down syndrome (DS) with routine anomaly scan at 18-20 weeks. After April 2006, to reduce procedure-related fetal loss, invasive test was performed only for positive screening result or the presence of major fetal anomaly on ultrasound. We reviewed our 2-year experience after the policy change.
Two-year data after policy change were compared to the 1-year historic control before policy change.
A total of 2257 eligible women were counselled in the 2 years after policy change. The uptake of screening was 96.7%. The overall detection rate for DS was 90% (18/20) at a false positive rate of 10.9%. The number of invasive tests performed to diagnose one case of DS was reduced 7-fold from 97 to 13.
The number of direct invasive tests was markedly reduced. With effective DS screening policy, it is possible to do away with direct invasive testing for the majority of women with AMA.
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 11/2009; 23(8):914-9. · 1.36 Impact Factor
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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 09/2009; 23(7):747-9. · 1.36 Impact Factor
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International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 08/2009; 107(1):62-3. · 1.41 Impact Factor
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ABSTRACT: This study examines risk factors of intimate partner violence against women in a cohort of Chinese women drawn from a large representative sample in Hong Kong. Data from a cross-section of 1,870 women are analyzed. Prevalence rates of women's self-reports of violence by their intimate partners and conflict with in-laws are computed and compared in terms of demographic and socioeconomic characteristics. The results show that in-law conflict was the characteristic most significantly associated with women's reports of violent victimization. This suggests that in-law conflict should be included in the screening and assessment of risk for intimate partner violence.
Violence Against Women 10/2008; 14(11):1295-312. · 1.33 Impact Factor
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International Journal of Gynecology & Obstetrics 09/2008; 102(2):176-8. · 2.05 Impact Factor
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ABSTRACT: This study examines correlates of in-law conflict with intimate partner violence (IPV) against pregnant women in a cohort of Chinese pregnant women who visited antenatal clinics in Hong Kong. This was a territory-wide, cross-sectional study of 3,245 pregnant women recruited from seven hospitals in Hong Kong. Participants were invited to complete the Chinese Abuse Assessment Screen and a demographic questionnaire. About 9% of the pregnant women reported having been abused by their partners in the preceding year. In-law conflict was the characteristic most significantly associated with preceding-year abuse against pregnant women, after controlling for covariates. Findings underscore the need to obtain information on in-law conflict as a risk factor for IPV. In-law conflict should be included in the assessment of risk for IPV. For the prevention of IPV, family-based intervention is needed to work with victims as well as in-laws.
Journal of Interpersonal Violence 04/2008; 24(1):97-110. · 1.64 Impact Factor
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ABSTRACT: The purpose of the study was to shed light on the potentially differing dynamics of violence against separated and divorced women by their ex-husbands and violence against married women by their current husbands. Using a nationally representative sample of 7,369 heterosexual women from Cycle 13 of Statistics Canada's General Social Survey, available risk markers were examined in the context of a nested ecological framework. Separated women reported nine times the prevalence of violence and divorced women reported about four times the prevalence of violence compared with married women. The strongest predictors of violence against married women, namely, patriarchal domination, sexual jealousy, and possessiveness, were not significant predictors of violence against separated and divorced women. This suggested that post-separation violence is a complex phenomenon the dynamics of which can be affected by much more than domination and ownership.
Journal of Interpersonal Violence 02/2008; 23(1):117-35. · 1.64 Impact Factor
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ABSTRACT: This retrospective cohort study was performed to examine the relationship between maternal hepatitis B virus infection, as indicated by the surface antigen status, with the development of gestational diabetes mellitus in a normal-risk Chinese obstetric population.
Maternal demographics, risk factors, and pregnancy outcome of 13,683 singleton pregnancies delivering in 1998-2001 were analysed according to maternal hepatitis B surface antigen status, which was routinely screened. Multiple logistic regression analysis was performed to examine the role of hepatitis B infection in the development of gestational diabetes mellitus.
The 1138 women (8.3%) with hepatitis B infection had lower mean weight and body mass index, similar prevalence of chronic medical diseases and smokers, but increased prevalence of gestational diabetes mellitus, which remained significant (odds ratio 1.24, 95% confidence interval 1.01-1.51) after adjustment for confounding variables. However, there was no difference in pregnancy outcome.
Our results confirmed the independent association between hepatitis B infection with gestational diabetes mellitus. The magnitude of chronic hepatitis B infection in the developing world and certain ethnic groups could have contributed to the high prevalence of gestational and possibly type 2 diabetes in these populations. Further studies on the long-term implications of our finding are warranted.
Journal of Hepatology 08/2007; 47(1):46-50. · 9.26 Impact Factor
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ABSTRACT: To assess the usefulness of amniotic fluid index (AFI) in the assessment of postdate pregnancies.
A prospective, observational study was carried out on the AFI of 118 well-dated postdate pregnancies at 41 weeks within 2 days of delivery. The AFI quartile distribution was determined and correlated with the risk of thick meconium-stained liquor (MSL), intervention for fetal distress and admission to the special care baby unit (SCBU).
The median AFI was 8 cm, with a range from 1-33 cm. There was a significant inverse correlation between the occurrence of thick MSL, intervention for fetal distress and SCBU admission. Logistic regression analysis, upon adjusting for possible confounding factors, showed that only AFI in the 2 lower quartiles combined (< or = 8 cm) had a significant association with the risk of thick MSL (adjusted OR 11.0, 95th CI 2.43-49.8) but not admission to the SCBU. AFI in the lowest quartile (< or = 5 cm) had a significant association with the risk of intervention for fetal distress only (adjusted OR 7.95, 95th CI 1.67-37.7).
Although AFI may be used to predict the occurrence of thick MSL and the need for intervention for fetal distress in postdate pregnancies, its role on its own is limited.
The Journal of reproductive medicine 06/2006; 51(6):484-8. · 0.87 Impact Factor
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Diabetes Care 05/2006; 29(4):948-9. · 8.09 Impact Factor
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European Journal of Obstetrics & Gynecology and Reproductive Biology 05/2006; 125(2):269-71. · 1.97 Impact Factor
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Obesity research 12/2004; 12(11):1903-4; author reply 1904-5. · 4.95 Impact Factor
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Prenatal Diagnosis 12/2004; 24(11):926-8. · 2.11 Impact Factor
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ABSTRACT: Reliable methods are available for rapid aneuploidy detection (RAD) for the prenatal diagnosis of trisomies 21, 18 and 13. This study examines the potential advantages and limitations of using RAD as a replacement rather than as an adjunct to traditional karyotyping.
One thousand five hundred and eighty-nine consecutive pregnancies referred for cytogenetic assessment were offered RAD (FISH or QF-PCR) as an adjunct to traditional karyotyping. The results of these two processes were compared, and the effects of three policies for cytogenetic evaluation were determined: RAD alone, a combination of RAD for all and traditional karyotyping for cases with ultrasound anomalies or a policy of RAD and traditional karyotyping in all cases.
RAD was uninformative because of maternal-cell contamination in 37 (2.3%) cases compared to 4 (0.3%) cases of culture failure in traditional karyotyping. RAD and traditional karyotyping results were concordant in 1526 of 1548 (98.6%) cases. All non-mosaic cases of trisomies 21, 18 and 13 and cases of triploidy were correctly identified by RAD, and there were no false-positive diagnoses. The gold standard of a traditional karyotype in each case would have detected all chromosomal abnormalities. A policy of RAD alone would have identified 60 of 73 (82%) clinically important chromosomal abnormalities. The addition of a full karyotype for cases with evidence of ultrasound abnormalities would have improved detection to 95%.
A policy offering RAD to all patients, but restricting traditional karyotyping to cases with ultrasound anomalies, would reduce the number of traditional karyotypes requested by 70%, but maintain a 95% detection rate for all clinically important chromosomal abnormalities. Further studies are required to determine whether similar results could be obtained in district general hospital units and to determine whether this approach would be acceptable to health professionals and patients.
Prenatal Diagnosis 11/2004; 24(10):790-5. · 2.11 Impact Factor
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ABSTRACT: The aim of this study is to explore the relationship between high cord blood thyroid-stimulating hormone (TSH) level and in-utero stress to the fetus in gestational diabetes mellitus (GDM). Cord blood TSH results were analyzed in 1,578 euthyroid infants from singleton pregnancies with GDM: 103 with elevated TSH (>16 mIU/l) and 1,475 with normal TSH. Maternal characteristics, pregnancy outcome and perinatal complications were compared between the two groups. Multiple logistic regression was used to study the association between high cord blood TSH level and various perinatal complications which reflect in-utero stress in GDM after adjusting for the confounding effects of parity, instrumental delivery, cesarean section and baby gender. High cord blood TSH level was found to be associated with the 1-min Apgar score <7 (OR 3.31, 95% CI 1.78-6.16), birth trauma (OR 3.44, 95% CI 1.11-10.69), neonatal jaundice requiring treatment (OR 2.08, 95% CI 1.30-3.32), neonatal sepsis (OR 2.34, 95% CI 1.24-4.42), respiratory complications (OR 3.45, 95% CI 1.37-8.70), neurological complications (OR 8.01, 95% CI 1.91-33.60) and overall perinatal morbidity (OR 2.41, 95% CI 1.58-3.67). Cord blood TSH level seems to be a better and independent indicator of the in-utero stress to the fetus in GDM when compared to the commonly used sugar profile result and HbA1c level.
Neuroendocrinology 02/2004; 80(2):124-8. · 2.38 Impact Factor
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ABSTRACT: Triplet fetofetal transfusion is an extremely rare complication with high perinatal mortality. Its rarity does not allow any prospective randomized study on various interventional methods to be conducted.
We report one case of triplet fetofetal transfusion syndrome with survival of all three fetuses. Two were donor fetuses, and one was the recipient fetus. Serial amnioreductions were performed at 22, 24, and 26 weeks' gestation to relieve symptomatic polyhydramnios. Premature rupture of membranes occurred at 27 weeks and cesarean delivery was performed. All three babies were discharged home by 4 months of age, and all had normal neurological development when assessed at 6 months of age.
The option of serial amnioreduction, with the anticipation and preparation for delivery at around 28 weeks, should be seriously considered when triplet fetofetal transfusion syndrome is encountered.
Obstetrics and Gynecology 06/2003; 101(5 Pt 2):1107-10. · 4.73 Impact Factor
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ABSTRACT: To determine whether amnio-polymerase chain reaction (amnio-PCR) can replace conventional cytogenetic study for confirming the karyotype of fetuses in women with positive biochemical screening for fetal Down syndrome. To check the accuracy of this technique in our laboratory, we first compared the amnio-PCR results with those of conventional cytogenetic study in 235 patients referred from June 1999 to December 2001 for prenatal diagnosis in a referral center in Hong Kong. We then reviewed the results of 1526 amniotic fluid cultures performed for positive fetal Down syndrome screening between January 1997 and December 2001 and classified them as detectable or not detectable by amnio-PCR, using the assumption that we had replaced conventional cytogenetic study with amnio-PCR. The 235 amnio-PCR results were all informative, without a false-positive or false-negative result. Of the 1526 cases with positive fetal Down syndrome screening and no ultrasound abnormalities, only two cases of sex chromosome abnormalities and two cases of marker chromosomes would have been missed if conventional cytogenetic study had been replaced by amnio-PCR.Amnio-PCR can be an alternative to conventional cytogenetic study for women with positive biochemical screening for fetal Down syndrome and no demonstrable fetal structural abnormality.
Obstetrics and Gynecology 06/2003; 101(5 Pt 1):856-61. · 4.73 Impact Factor
