W L Lau

Kwong Wah Hospital, Hong Kong, Hong Kong

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Publications (33)69.14 Total impact


  • No preview · Article · Dec 2015 · Journal of Maternal-Fetal and Neonatal Medicine
  • Lucia LK Chan · T W Leung · T K Lo · W L Lau · W C Leung
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    ABSTRACT: To review and compare pregnancy outcomes of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage. Case series with internal comparison. A regional obstetric unit in Hong Kong. Women undergoing cervical cerclage at Kwong Wah Hospital between 1 January 2001 and 31 December 2011. Cervical cerclage. Pregnancy outcomes including miscarriage, gestational age at delivery, birth weight, and duration of pregnancy prolongation. Overall, 47 patients were included. Nine (19.1%) pregnancies resulted in miscarriage. The median gestational age at delivery was 35.7 weeks. Among the 23 patients who had history-indicated cerclage, only four (17.4%) had three or more previous second-trimester miscarriages or preterm deliveries. Among the 15 patients who had ultrasound-indicated cerclage, preoperative cervical length of ≤1.5 cm was associated with shorter prolongation of pregnancy, compared with that of >1.5 cm (median, 12.1 vs 18.4 weeks; P=0.009). Among the nine women who had rescue cerclage, those who underwent the procedure before 20 weeks of gestation delivered earlier than those underwent cerclage later (median, 22.5 vs 34.1 weeks; P=0.048). Patients eligible for the Royal College of Obstetricians and Gynaecologists-recommended history-indicated cerclage remain few. The majority of patients may benefit from serial ultrasound monitoring of cervical length with or without ultrasound-indicated cerclage.
    No preview · Article · Jul 2015 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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    ABSTRACT: To determine any change in adverse neonatal/maternal outcomes after increasing the rate of vaginal twin delivery by comparing vaginal twin delivery and caesarean delivery with our previous cohort study. In a retrospective cohort study, all twins booked at a Hong Kong regional obstetrics unit were evaluated during a 3-year period from 1 April 2009 to 31 March 2012. Out of the 269 sets of twins who eventually delivered in our unit, 68 (25.3%) of them were delivered vaginally, compared to 15.8% in our previous cohort study (p = 0.02). For those who were suitable for vaginal delivery, significantly more women attempted vaginal delivery: 93/133 (69.9%) versus 47/100 (47%) (p = 0.0005). The success rate for vaginal delivery and rate of requiring caesarean delivery for the 2nd twin were similar between these two periods. There were significantly more 2nd twins with cord blood pH < 7.2 when both twins were delivered by vaginal delivery. Otherwise, there was no significant difference between other neonatal/maternal morbidities. With proper counseling, significantly more women who were suitable for vaginal twin delivery would opt to do so. There was no significant increase in neonatal/maternal morbidities despite the increased rate of vaginal twin delivery.
    No preview · Article · Apr 2015 · 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
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    ABSTRACT: Objective: To determine any change in adverse neonatal/maternal outcomes after increasing the rate of vaginal twin delivery by comparing vaginal twin delivery and caesarean delivery with our previous cohort study. Methods: In a retrospective cohort study, all twins booked at a Hong Kong regional obstetrics unit were evaluated during a 3-year period from 1 April 2009 to 31 March 2012. Results: Out of the 269 sets of twins who eventually delivered in our unit, 68 (25.3%) of them were delivered vaginally, compared to 15.8% in our previous cohort study (p = 0.02). For those who were suitable for vaginal delivery, significantly more women attempted vaginal delivery: 93/133 (69.9%) versus 47/100 (47%) (p = 0.0005). The success rate for vaginal delivery and rate of requiring caesarean delivery for the 2nd twin were similar between these two periods. There were significantly more 2nd twins with cord blood pH < 7.2 when both twins were delivered by vaginal delivery. Otherwise, there was no significant difference between other neonatal/maternal morbidities. Conclusion: With proper counseling, significantly more women who were suitable for vaginal twin delivery would opt to do so. There was no significant increase in neonatal/maternal morbidities despite the increased rate of vaginal twin delivery.
    No preview · Article · Apr 2015
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    ABSTRACT: Abstract Objective: To assess whether angle of progression (AOP) and head-perineum distance (HPD) measured by intrapartum transperineal ultrasound (ITU) correlate with clinical fetal head station (station); and whether AOP versus HPD varies during uterine contraction and relaxation. In a subset of primipaorus women, whether these ITU parameters correlate with time to normal spontaneous delivery (TD). Methods: We evaluated prospectively 100 primiparous and multiparous women at term in active labor. Transabdominal and transperineal ultrasound (sagittal and transverse plane) were used to measure fetal head position, and ITU parameters respectively. Digitally palpated station and cervical dilatation were also noted. The results were compared using regression and correlation coefficients. Results: Station was moderately correlated with AOP (r= 0.579), and HPD (r= -0.497). AOP was highly correlated with HPD during uterine contraction (r= -0.703) and relaxation (r= -0.647). In the subgroup of primiparous women, natural log of TD has the highest correlation with HPD and AOP during uterine contraction (r=0.742), making prediction of TD similar to that using cervical dilatation. Conclusion: ITU parameters were moderately correlated with station. There was constant high correlation between AOP and HPD. Prediction of TD in primiparous women using ITU parameters was similar to that using cervical dilatation.
    No preview · Article · Aug 2014 · Journal of Maternal-Fetal and Neonatal Medicine
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    ABSTRACT: A rebound increase in vaginal delivery for twins was observed in a regional obstetric unit in Hong Kong, reinforced by the results of a recent multicenter randomized controlled trial.
    Preview · Article · Jul 2014 · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
  • W K Yung · Winnie Hui · Y T Chan · T K Lo · S M Tai · C Sing · Y Y Lam · C M Lo · W L Lau · W C Leung
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    ABSTRACT: OBJECTIVES. To review the pregnancy outcomes of non-booked, non-local pregnant women delivering in Kwong Wah Hospital via admission to the Accident and Emergency Department 1 year after the announcement by the Hospital Authority to stop antenatal booking for non-eligible persons; and to perform a literature review of local studies about non-eligible person deliveries over the last decade. DESIGN. Case series. SETTING. A public hospital in Hong Kong. PARTICIPANTS. All women who held the People's Republic of China passport or the two-way permit and those non-eligible persons whose spouses were Hong Kong Identity Card holders, who delivered in Kwong Wah Hospital from 1 April 2011 to 31 March 2012. RESULTS. Overall, 219 women who were non-eligible persons delivered 221 live births during the study period. Compared with the annual statistics of Kwong Wah Hospital in 2011, non-local mothers were of higher parity; more likely to have hypertensive disease (including pre-eclamptic toxaemia), preterm deliveries (ie at <37 weeks), babies needing admission to the special care baby unit, and macrosomic babies (ie weighing >4.0 kg). The rates of induction of labour and caesarean section were lower in this group. There was no significant difference in the maternal and neonatal outcomes between women who had no booking and those who had a booking in another Hospital Authority or private hospital. There were many incidents of near-miss obstetric complications or suboptimally managed obstetric conditions due to lack of well-structured and continuous antenatal care in this group of non-eligible persons. CONCLUSION. Non-eligible person delivering babies in Hong Kong has become a social obstetrics phenomenon. Despite the introduction of policies, reduction in the number of deliveries (quantity) did not improve the obstetric outcomes (quality). Health care professionals should continue to be prepared for managing the potential near-miss clinical complications in this group of 'travelling mothers'.
    No preview · Article · May 2014 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • Vivian KS Ng · T K Lo · H H Tsang · W L Lau · W C Leung
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    ABSTRACT: OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.
    No preview · Article · Jun 2013 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • T.K. Lo · T.K. Ng · W.L. Lau · W.C. Leung

    No preview · Article · Apr 2013 · International Journal of Cardiology
  • Tsz Kin Lo · Wai Lam Lau · Wing Cheong Leung

    No preview · Article · Jan 2013 · American Journal of Obstetrics and Gynecology
  • Tsz Kin Lo · Wai Lam Lau · Wing Cheong Leung

    No preview · Article · Jan 2013 · American Journal of Obstetrics and Gynecology
  • TK Lo · K. Liu · WL Lau · WC Leung
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    ABSTRACT: Objectives When the first twin is in cephalic presentation without other contraindications for vaginal delivery, vaginal birth is an option. Information on how women choose is scant. In this pilot study, we attempted to identify factors influencing women's choice on mode of delivery when twin I is presenting by vertex. Methods This is a retrospective review of all the twin pregnancies with twin I presenting vertex delivered in a regional hospital between April 2006 and March 2009. Without other contraindications for vaginal delivery, women carrying such twin pregnancies were allowed a choice between vaginal and caesarean birth in our unit. Results A total of 98 sets of twins fulfilled our inclusion criteria, 47 (48%) attempted vaginal delivery and 51 (52%) opted for cesarean section. On univariate analysis, education level below tertiary, history of vaginal birth, spontaneously conceived twin pregnancy, monochorionicity and second twin presenting vertex as well were statistically significantly associated with attempted vaginal birth, while maternal age and gestational age (>= 34 weeks versus <34 weeks) were not. On logistic regression, only spontaneous conception and second twin in cephalic presentation remained statistically significant factors associated with an attempt at vaginal delivery. The adjusted odds ratios were 6.16 (p=0.013) and 13.21 (p<0.001) respectively. Conclusion Mothers carrying spontaneously conceived twin pregnancy with both fetuses in cephalic presentation were more willing to opt for vaginal birth.
    No preview · Article · Apr 2012 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • TK Lo · WL Lau · WC Leung
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    ABSTRACT: Objective The common types of compression sutures are less effective with abnormal placentation. In this study, we reported our experience with the use of two parallel vertical compression sutures over the lower uterine segment for cases of major placenta previa and accreta. This is the largest series reported on the use of this type of compression sutures. Methods Clinical details for cases of major placenta previa with parallel vertical compression sutures applied during caesarean section were collected and reviewed. Results Twenty-eight women with major placenta previa (including 2 with accreta) had parallel vertical compression sutures inserted during caesarean delivery. It was successfully applied for both term and preterm uterus (from 30 to 39 weeks) and in both elective (15 cases) and in emergency settings (13 cases). Bleeding immediately decreased and all successfully had their uterus conserved. In 17 cases, major postpartum haemorrhage (>=1000ml) was prevented. In 79% of cases (22/28), it was performed by trainee under supervision, 45% (10/22) without assistance by consultant. B-lynch sutures were applied in addition in three cases and uterine artery embolisation for the two cases of accreta. All had normal return of menstruation. Conclusion In women with major placenta previa or accreta, two vertical compression sutures placed in the lower uterine segment are an easy and effective way for rapid control of massive bleeding, and should be considered first-line surgical measure.
    No preview · Article · Apr 2012 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • A L Liu · W K Yung · H N Yeung · S F Lai · M T Lam · F K Lai · T K Lo · W L Lau · W C Leung
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    ABSTRACT: To determine current trends for different modes of delivery in twin pregnancies, factors affecting the mode of delivery, and associated outcomes. Retrospective cohort study. A public hospital in Hong Kong. All twin pregnancies booked at Kwong Wah Hospital during a 3-year period from 1 April 2006 to 31 March 2009. Of 197 sets of twins, 35 (18%) were delivered vaginally and 162 (82%) by caesarean section (47% were emergencies and 53% elective). In all, 32 (37%) of the elective and 21 (28%) of the emergency caesarean sections were in response to maternal requests. Vaginal delivery was more common in mothers with a history of vaginal delivery and monochorionic diamniotic twins. Women who conceived by assisted reproduction or those who had a tertiary education were more likely to deliver by caesarean section. The type of conception and the presentation of the second twin were statistically significant factors affecting maternal choice on the mode of delivery. Maternal age did not affect the choice of delivery mode. Except for the higher frequency of sepsis and cord blood acidosis in second twins delivered vaginally, there were no significant differences in neonatal morbidity between the groups that attempted vaginal delivery or requested caesarean sections. All the women who had compression sutures or hysterectomy to control massive postpartum haemorrhage were delivered by caesarean section. A high caesarean section rate observed in our cohort was associated with maternal requests for this mode of delivery. The type of conception and the presentation of the second twin were statistically significant factors affecting maternal choice on mode of delivery. Women's requests for caesarean delivery out of the concern for their babies are not supported by current evidence. In response to a woman with a twin pregnancy requesting caesarean delivery, the pros and cons of vaginal deliveries and caesarean sections should be fully explained before the woman's autonomy is respected.
    No preview · Article · Apr 2012 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • TK Lo · LL Chan · WL Lau · SH Wong · M. Wong · KY Lo · WC Leung
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    ABSTRACT: A 31-year-old primiparous women with haemoglobin H disease complained of epigastric pain one day after giving uneventful vaginal birth to a 2.0kg boy at 38 weeks. Epigastric pain temporarily settled with oral antacid, she became dizzy and sweaty associated with back pain. She was pale and hypotensive, abdomen distended. Ultrasound showed free fluid inside the abdomen. Diagnostic tapping yielded blood. Haemoglobin was 6.4g/dl. Emergency laparotomy was performed. Splenomegaly (20cm in span) with rupture and 2.5L hemoperitoneum was found. Splenectomy was done. The total blood loss was 3.5L. Seven units of pack cells and 4 units of fresh frozen plasma were transfused. Histology showed congestive splenomegaly (605gm). Further investigations showed normal G6PD activity, negative blood smears for malaria parasites, normal red cell morphology and negative monospot test. This is the first report of postpartum splenic rupture related to thalassemic splenomegaly.
    No preview · Article · Apr 2012 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • T K Lo · W L Lau · Y.Y. Lam · M H Y Tang · T.Y. Leung · W C Leung
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    ABSTRACT: We report the first case of successful fetal pleurodesis with OK-432 for recurrent severe fetal primary chylothorax after failing repeated pleuroamniotic shunting. Shunting and pleurodesis could be complementary to each other in the treatment of fetal chylothorax.
    No preview · Article · Feb 2012 · Fetal Diagnosis and Therapy
  • L Y Cho · W L Lau · T K Lo · Helen H T Tang · W C Leung
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    ABSTRACT: To study the success rate, predictors for success, and pregnancy outcomes after external cephalic version. Historical cohort study. Regional hospital, Hong Kong. All women who had singleton term breech pregnancies at term and opted for external cephalic version during 2001 and 2009. Their demographic data, clinical and ultrasound findings, procedure details, complications, and delivery outcomes were analysed. Predictive factors for successful external cephalic version. A total of 209 external cephalic versions were performed during the 9-year period. The success rate was 63% (75% for multiparous and 53% for nulliparous women). There was no significant complication. On univariate analysis, predictors of successful external cephalic version were: multiparity, unengaged presenting part, higher amniotic fluid index (≥ 10 cm), thin abdominal wall, low uterine tone, and easily palpable fetal head (subjective assessment by practitioners before external cephalic version). On multivariate analysis, only multiparity, non-engagement of the fetal buttock and thin maternal abdomen were associated with successful external cephalic version. In all, 69% of those who had successful external cephalic version succeeded in the first roll (P<0.001), and 82% of the women with successful external cephalic versions had vaginal deliveries (93% in multiparous and 69% in nulliparous women). Uptake rate of external cephalic version was studied in the latter part of the study period (2006-2009). Whilst 735 women were eligible for external cephalic version, 131 women chose to have the procedure resulting in an uptake rate of 18%. External cephalic version was effective in reducing breech presentations at term and corresponding caesarean section rates, but the uptake rate was low. Further work should address the barriers to the low acceptance of external cephalic version. The results of this study could encourage women to opt for external cephalic version.
    No preview · Article · Feb 2012 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • S Lai · W L Lau · W C Leung · F K Lai · R Chin
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    ABSTRACT: To evaluate ultrasound scan and other prenatal screening tests for trisomy 18 in a regional obstetric unit and to review the management approach for women with positive trisomy 18 screening results. Prenatal diagnosis databases were accessed to identify fetuses that had confirmed trisomy 18 karyotypes or were at high risk for trisomy 18 on second-trimester biochemical screening or first-trimester combined screening tests over a period of 10 years from 1 September 1997 to 30 September 2007. Sixty-nine women were confirmed to have trisomy 18 fetuses by karyotyping either prenatally (n = 61) or postnatally/post-miscarriage (n = 8) during the study period. The detection rate of ultrasound scan ≤ 14 weeks and 18 to 21 weeks to detect trisomy 18 was 92.7 and 100%, respectively. A total of 80 and 87% of fetuses had two or more ultrasound abnormalities detected in the ≤ 14 weeks and 18 to 21 weeks anomaly scans, respectively. Forty-eight women screened positive for trisomy 18 by second-trimester biochemical screening with human chorionic gonadotrophin (hCG) and alpha fetoprotein (AFP). Only one was true positive (positive predictive value = 1/48 or 2%). Eleven women screened positive for trisomy 18 by first-trimester combined screening with nuchal translucency scan and maternal serum for pregnancy-associated plasma protein A (PAPP-A) and hCG between 11 and 13 + 6 weeks. Three were true positive (positive predictive value = 3/11 or 27%). All four cases with positive screening had ultrasound abnormalities. Ultrasound scan for fetal anomalies is the most effective screening test for trisomy 18. A policy of conservative management for women with positive second-trimester biochemical screening or first-trimester combined screening for trisomy 18 is reasonable in the absence of ultrasound fetal abnormalities. Unnecessary invasive tests can be avoided.
    No preview · Article · Nov 2010 · Prenatal Diagnosis
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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.
    No preview · Article · Nov 2009 · 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
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    ABSTRACT: We present an evaluation of the diagnosis, management and outcome of a pair of heterokaryotypic monozygotic dichorionic twins. The heterokaryotype was an incidental finding from an amniocentesis performed for prenatal diagnosis of beta-thalassaemia major in a pair of dichorionic twins. Monozygocity was revealed by QF-PCR showing identical short tandem repeat markers on chromosomes 21, 18, 13, X and Y. The twins were heterokaryotypic for duplication chromosome 2q13-q23.3, as shown by array comparative genomic hybridization. Selective foeticide was performed. This case demonstrates that heterokaryotypic monozygotic dichorionic twins are a genetic possibility that does occur.
    No preview · Article · Sep 2009 · Fetal Diagnosis and Therapy