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Adams S, Lee CP, Au Yeung E, Leung WC. Travelling back to the 1940s: inspirations from a midwifery casebook written between 1947 and 1948. Hong Kong Med J 2024; 30:82-84. [PMID: 38385215 DOI: 10.12809/hkmj-hkmms202402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- S Adams
- Guest Authors, Education and Research Committee, Hong Kong Museum of Medical Sciences, Hong Kong SAR, China
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China
| | - C P Lee
- Guest Authors, Education and Research Committee, Hong Kong Museum of Medical Sciences, Hong Kong SAR, China
- Department of Obstetrics and Gynaecology, Tsan Yuk Hospital, Hong Kong SAR, China
| | - E Au Yeung
- Guest Authors, Education and Research Committee, Hong Kong Museum of Medical Sciences, Hong Kong SAR, China
- School of Midwifery, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - W C Leung
- Guest Authors, Education and Research Committee, Hong Kong Museum of Medical Sciences, Hong Kong SAR, China
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China
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2
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Wang MP, Luk TT, Lam TH, Li WHC, Leung WC, Leung KY, Cheung KW, Kwa C, Siong KH, Tang KK, Lee KW. Combination of brief advice, nicotine replacement therapy sampling, and active referral for smoking expectant fathers: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 2:25-28. [PMID: 36951002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
- M P Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - T T Luk
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - W H C Li
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K W Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong SAR, China
| | - C Kwa
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong SAR, China
| | - K H Siong
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong SAR, China
| | - K K Tang
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K W Lee
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong SAR, China
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Kannan P, Cheing G, Fung B, Leung WC, Tang G, Chung R, Chan P. A new biofeedback device to improve adherence to pelvic floor muscle training in women with urinary incontinence: a randomised controlled pilot trial (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 6:23-24. [PMID: 36535794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- P Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
| | - G Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
| | - B Fung
- Physiotherapy Department, Kwong Wah Hospital
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital
| | - G Tang
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital
| | - R Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
| | - P Chan
- The University of Hong Kong
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4
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Wong CK, Cho LY, Lau WL, Cheung IYY, Yu CHT, Law IC, Leung WC. Candida glabrata fungal ball cystitis is a rare complication of conservative treatment of placenta accreta: a case report. Hong Kong Med J 2022; 28:324-327. [PMID: 35989434 DOI: 10.12809/hkmj219449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- C K Wong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - L Y Cho
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - W L Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - I Y Y Cheung
- Department of Pathology, Kwong Wah Hospital, Hong Kong
| | - C H T Yu
- Department of Surgery, Kwong Wah Hospital, Hong Kong
| | - I C Law
- Department of Surgery, Kwong Wah Hospital, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
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Chan KL, Leung WC, Tiwari A, Or KL, Ip P. Effectiveness of the iParent app for postnatal depression: a randomised controlled trial (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 1:17-18. [PMID: 35260510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- K L Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital
| | - A Tiwari
- School of Nursing, Hong Kong Sanatorium and Hospital
| | - K L Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong
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Leung HHY, Kwok CYT, Sahota DS, Leung MBW, Lui GCY, Ng SSS, Leung WC, Chan PKS, Poon LCY. Effects of strict public health measures on seroprevalence of anti-SARS-CoV-2 antibodies during pregnancy. Hong Kong Med J 2022; 28:294-299. [PMID: 35086966 DOI: 10.12809/hkmj219653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION A substantial number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain asymptomatic throughout the course of infection. Nearly half of pregnant women with coronavirus disease 2019 (COVID-19) are asymptomatic upon diagnosis; these cases are not without risk of maternal morbidity. Here, we investigated the seroprevalence of anti-SARS-CoV-2 antibodies in an unselected sample of pregnant women in Hong Kong. METHODS This prospective cohort study included pregnant women who presented for routine Down syndrome screening (DSS) between November 2019 and October 2020; all women subsequently delivered at the booking hospitals. Serum antibodies against SARS-CoV-2 were analysed using a qualitative serological assay in paired serum samples taken at DSS and delivery for all participants. RESULTS In total, 1830 women were recruited. Six women (0.33%) were seropositive at the DSS visit; this seropositivity persisted until delivery. Of the six women, none reported relevant symptoms during pregnancy; one reported a travel history before DSS and one reported relevant contact history. The interval between sample collections was 177 days (range, 161-195). Among women with epidemiological risk factors, 1.79% with travel history, 50% with relevant contact history, and 0.77% with community SARS-CoV-2 testing history, were seropositive. CONCLUSION The low seroprevalence in this study suggests that strict public health measures are effective for preventing SARS-CoV-2 transmission. However, these measures cannot be maintained indefinitely. Until a highly effective therapeutic drug targeting SARS-CoV-2 becomes available, vaccination remains the best method to control the COVID-19 pandemic.
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Affiliation(s)
- H H Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - C Y T Kwok
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - M B W Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - G C Y Lui
- Division of Infectious Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - S S S Ng
- Division of Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - P K S Chan
- Division of Infectious Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - L C Y Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
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Leung WC, Tai SM, Sham A, Yip W, See S. Labour room birth records of Kwong Wah Hospital since 1935. Hong Kong Med J 2021; 27:374-376. [PMID: 34667131 DOI: 10.12809/hkmj219582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - S M Tai
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - A Sham
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - W Yip
- Records and Heritage Office, Tung Wah Group of Hospitals, Hong Kong
| | - S See
- Records and Heritage Office, Tung Wah Group of Hospitals, Hong Kong
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8
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Leung WC, Lo R, Teoh JYC, Cheng A, Wong MCS, Leung GKK. Well-being of Academy Fellows and specialty trainees: what is the problem? Hong Kong Med J 2021; 27:324-325. [PMID: 34607971 DOI: 10.12809/hkmj215123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- W C Leung
- Honorary Secretary, Hong Kong Academy of Medicine
| | - R Lo
- Honorary Advisor, Task Force on Well-being, Hong Kong Academy of Medicine
| | - J Y C Teoh
- Chair, Young Fellows Chapter, Hong Kong Academy of Medicine
| | - A Cheng
- Chief Executive Officer, Hong Kong Academy of Medicine
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Poon LC, Leung BW, Ma T, Yu FNY, Kong CW, Lo TK, So PL, Leung WC, Shu W, Cheung KW, Moungmaithong S, Wang CC. Relationship between viral load, infection-to-delivery interval and mother-to-child transfer of anti-SARS-CoV-2 antibodies. Ultrasound Obstet Gynecol 2021; 57:974-978. [PMID: 33798280 PMCID: PMC8250926 DOI: 10.1002/uog.23639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and infection-to-delivery interval with maternal and cord serum concentrations of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies and transplacental transfer ratio in pregnant women with active or recovered SARS-CoV-2 infection. METHODS This was a prospective case series of consecutive pregnant women with laboratory-confirmed SARS-CoV-2 infection between 27 March 2020 and 24 January 2021. We collected information regarding deep throat saliva or nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) test results, serial cycle threshold (Ct) values at and after diagnosis, demographic, clinical and outcome data, and neonatal NPS RT-PCR results. Qualitative and quantitative analysis of IgG and immunoglobulin M (IgM) antibodies against SARS-CoV-2 was performed in maternal and cord blood serum samples obtained at delivery. Correlation of maternal Ct values, infection-to-delivery interval, infection duration and viral load area under the curve (AUC) with gestational age (GA) at diagnosis, maternal and cord serum IgG concentrations and transplacental transfer ratio of IgG were evaluated using Pearson's correlation. RESULTS Twenty pregnant women who consented to participate and who had delivered their babies by 31 January 2021 were included in the study, comprising 14 who had recovered from coronavirus disease 2019 (COVID-19) and six with active infection at delivery. The median GA at clinical manifestation was 32.7 (range, 11.9-39.4) weeks. The median infection-to-delivery interval and infection duration were 41.5 (range, 2-187) days and 10.0 (range, 1-48) days, respectively. The median GA at delivery was 39.1 (range, 32.4-40.7) weeks and the median seroconversion interval was 14 (range, 1-19) days. Of 13 neonates born to seropositive mothers with recovered infection at delivery, 12 tested positive for anti-SARS-CoV-2 IgG. All neonatal NPS samples were negative for SARS-CoV-2 and all cord sera tested negative for IgM. The median transplacental transfer ratio of IgG was 1.3 (interquartile range, 0.9-1.6). There was a negative correlation between infection-to-delivery interval and anti-SARS-CoV-2 IgG concentrations in maternal (r = -0.6693, P = 0.0087) and cord (r = -0.6554, P = 0.0068) serum and a positive correlation between IgG concentration in maternal serum and viral load AUC (r = 0.5109, P = 0.0310). A negative correlation was observed between transfer ratio and viral load AUC (r = -0.4757, P = 0.0409). CONCLUSIONS In pregnant women who have recovered from COVID-19, anti-SARS-CoV-2 IgG concentrations at delivery increased with increasing viral load during infection and decreased with increasing infection-to-delivery interval. The median transplacental transfer ratio of IgG was 1.3 and it decreased with increasing viral load during infection. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. C. Poon
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong KongSARChina
| | - B. W. Leung
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong KongSARChina
| | - T. Ma
- Department of Obstetrics and GynaecologyQueen Elizabeth HospitalHong KongSARChina
| | - F. N. Y. Yu
- Department of Obstetrics and GynaecologyQueen Elizabeth HospitalHong KongSARChina
| | - C. W. Kong
- Department of Obstetrics and GynaecologyUnited Christian HospitalHong KongSARChina
| | - T. K. Lo
- Department of Obstetrics and GynaecologyPrincess Margaret HospitalHong KongSARChina
| | - P. L. So
- Department of Obstetrics and GynaecologyTuen Mun HospitalHong KongSARChina
| | - W. C. Leung
- Department of Obstetrics and GynaecologyKwong Wah HospitalHong KongSARChina
| | - W. Shu
- Department of Obstetrics and GynaecologyPamela Youde Nethersole Eastern HospitalHong KongSARChina
| | - K. W. Cheung
- Department of Obstetrics and GynaecologyQueen Mary HospitalHong KongSARChina
| | - S. Moungmaithong
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong KongSARChina
| | - C. C. Wang
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong KongSARChina
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Lai SF, Choi SN, Ho YB, Hung WY, Lam MT, Law T, Ng YT, Tam CT, Wan SF, Li R, Leung WC, Yeung W, Ng E. A questionnaire survey on patients' willingness to pay with reference to the waiting time of public in-vitro fertilization treatment in Hong Kong. Eur J Obstet Gynecol Reprod Biol 2021; 258:430-436. [PMID: 33550218 DOI: 10.1016/j.ejogrb.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate patients' willingness to pay (WTP) with reference to the waiting time of public in-vitro fertilisation (IVF) treatment in order to improve the public IVF service in Hong Kong. STUDY DESIGN A prospective multi-centred questionnaire survey. Infertile women attending infertility clinics of nine public hospitals in Hong Kong between October 2017 and August 2018 were asked to complete a questionnaire in their first clinic visit. RESULTS Out of 1092 respondents, 10.4 % had private IVF cycles prior to their first visit at public hospitals. In general, patients were willing to pay more for a shorter waiting time for public IVF service. The proportion of respondents who were willing to pay more than HK$10,000 (US$1282) for one IVF cycle increased from 54.6% to 80.7% if the waiting time for public IVF service were hypothetically shortened from four years to one year. Likewise, 22.5 % versus 45.5 % were willing to pay more than HK$ 25,000 (US$3205) with a waiting time of four versus one year respectively. Assuming the cost per IVF cycle was HK$ 25,000 (US$3205), 23.4 % of respondents could afford one IVF cycle, 40.0 % of them could afford two IVF cycles and 31.5 % could afford three IVF cycles. A multivariate regression model demonstrated that only family income and presence of existing child(ren) were significant independent determinants of the maximum amount that an individual was willing to pay for IVF (p < 0.05). Those with family monthly income below HK$100,000 ($12,820) were less than half as likely, and those without existing child(ren) were more than double as likely, to be willing to pay higher for IVF. CONCLUSION Patients were willing to pay more for a shorter waiting time for public IVF service. Those with family income below HK$100,000 (US$ 12,820) were less than half as likely, and those without existing children were more than double as likely, to be willing to pay higher for IVF.
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Affiliation(s)
- S F Lai
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
| | - S N Choi
- Department of Obstetrics and Gynaecology, Tseung Kwan O Hospital, Hong Kong
| | - Y B Ho
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - W Y Hung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong
| | - M T Lam
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tsm Law
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
| | - Y T Ng
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - C T Tam
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong
| | - S F Wan
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong
| | - Rhw Li
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wsb Yeung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ehy Ng
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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11
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Affiliation(s)
- W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
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12
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Sham GTW, Chung PHY, Chan IMC, Leung WC, Wong KKY. Thoracoscopic removal of a displaced thoracoamniotic shunt in a newborn with antenatal pleural effusion-a case report. Transl Pediatr 2020; 9:702-706. [PMID: 33209734 PMCID: PMC7658768 DOI: 10.21037/tp-20-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thoracoamniotic shunt has been considered as a treatment for antenatal pleural effusion and complication is rare. In majority of cases, the shunt can be removed uneventfully. In this article, we reported a rare complication of shunt migration resulting in the need of thoracoscopic removal at newborn period. The patient born at 39+3 weeks of gestation suffered from antenatal chylothorax detected at 28 weeks and was managed by intrauterine thoracoamniotic shunt insertion. This was complicated by shunt displacement, which caused respiratory distress after birth requiring ventilatory support and progressive pleural effusion in this patient. To prevent further neonatal compromise, thoracoscopic removal of the retained shunt was done on day 7 of life followed by post-op chest drain insertion. Post-op condition was stable with resolution of respiratory distress, and the patient was discharge on post-op day 16. We would like to remind clinicians about this potential complication of thoracoaminotic shunt, which can pose a potential risk of severe neonatal compromise, and that it can be managed by minimal invasive surgery even in the newborn period.
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Affiliation(s)
- Goby T W Sham
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Patrick H Y Chung
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Iris M C Chan
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong, China
| | - Kenneth K Y Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Ng VKS, Chan AL, Lau WL, Leung WC. Second tier non-invasive prenatal testing in a regional prenatal diagnosis service unit: a retrospective analysis and literature review. Hong Kong Med J 2020; 26:10-18. [PMID: 32051331 DOI: 10.12809/hkmj198197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The Hong Kong Hospital Authority has newly introduced a new Down's syndrome screening algorithm that offers free-of-charge non-invasive prenatal testing (NIPT) to women who screen as high risk. In preparation for this public-funded second tier NIPT service, the present study was conducted to retrospectively analyse women eligible for NIPT and to review the local literature. METHODS Our retrospective study included women screened as high risk for Down's syndrome (adjusted term risk ≥1:250) during the period of 1 January 2015 to 31 December 2016. We performed descriptive statistics and multivariable logistic regression to examine the factors associated with women's choice between NIPT and invasive testing. We also reviewed existing local literature about second tier NIPT. RESULTS The study included 525 women who screened positive: 67% chose NIPT; 31% chose invasive diagnostic tests; and 2% declined further testing. Our literature review showed that in non-research (self-financed NIPT) settings, NIPT uptake rates have been increasing since 2011. Nulliparity, first trimester status, higher education, maternal employment, and conception by assisted reproductive technology are common factors associated with self-financed NIPT after positive screening. Among women choosing NIPT, the rates of abnormal results have typically been around 8% in studies performed in Hong Kong. CONCLUSION Implementation of second tier NIPT in the public setting is believed to be able to improve quality of care. We expect that the public in Hong Kong will welcome the new policy.
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Affiliation(s)
- V K S Ng
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - A L Chan
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong.,Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - W L Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
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14
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Leung TY, Au Yeung KC, Leung WC, Leung KY, Lo TK, To WWK, Lau WL, Chan LW, Sahota DS, Choy RKW. Prenatal diagnosis of pathogenic genomic imbalance in fetuses with increased nuchal translucency but normal karyotyping using chromosomal microarray. Hong Kong Med J 2019; 25 Suppl 5:30-32. [PMID: 31416984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- T Y Leung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong
| | - K C Au Yeung
- Department of Obstetrics & Gynaecology, Tuen Mun Hospital
| | - W C Leung
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital
| | - K Y Leung
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital
| | - T K Lo
- Department of Obstetrics & Gynaecology, Princess Margaret Hospital
| | - W W K To
- Department of Obstetrics & Gynaecology, United Christian Hospital
| | - W L Lau
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital
| | - L W Chan
- Department of Obstetrics & Gynaecology, United Christian Hospital
| | - D S Sahota
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong
| | - R K W Choy
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong
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15
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Lau WL, Yung WY, Leung WC, Kan A, Chan K, Luk HM, Kan E, Lam YY. Prenatal diagnosis of familial atretic encephalocele. Ultrasound Obstet Gynecol 2019; 54:277-279. [PMID: 30151917 DOI: 10.1002/uog.20109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
- W L Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong SAR
| | - W Y Yung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong SAR
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong SAR
| | - A Kan
- Prenatal Diagnostic Laboratory, Obstetrics and Gynecology, Tsan Yuk Hospital, Sai Ying Pun, Hong Kong SAR
| | - K Chan
- Prenatal Diagnostic Laboratory, Obstetrics and Gynecology, Tsan Yuk Hospital, Sai Ying Pun, Hong Kong SAR
| | - H M Luk
- Clinical Genetic Service, Hong Kong SAR
| | - E Kan
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon, Hong Kong SAR
| | - Y Y Lam
- Department of Paediatrics, Kwong Wah Hospital, Kowloon, Hong Kong SAR
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Cheng YKY, Leung WC, Leung TY, Choy KW, Chiu RWK, Lo TK, Kwok KY, Sahota DS. Women's preference for non-invasive prenatal DNA testing versus chromosomal microarray after screening for Down syndrome: a prospective study. BJOG 2018; 125:451-459. [DOI: 10.1111/1471-0528.15022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Affiliation(s)
- YKY Cheng
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - WC Leung
- Department of Obstetrics and Gynaecology; Kwong Wah Hospital; Hong Kong China
| | - TY Leung
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - KW Choy
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - RWK Chiu
- Department of Chemical Pathology; The Chinese University of Hong Kong; Hong Kong China
| | - T-K Lo
- Department of Obstetrics and Gynaecology; Princess Margaret Hospital; Hong Kong China
| | - KY Kwok
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - DS Sahota
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
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Abstract
Policies on whether student and qualified nurses should be screened for bloodborne infections and whether infected individuals should be excluded from work must be based on sound ethical principles. Patients have rights, and nurses and employers have duties to respect these rights. However, nurses also have rights that must be respected by their employers and the State. Balancing these competing rights and duties is a complex procedure. In this article, these rights and duties are discussed and applied to a selection of issues.
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Affiliation(s)
- W C Leung
- Epidemiology and Public Health, 1st floor, Milvain Building, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK
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18
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Abstract
INTRODUCTION This review covers the recent literature on fetal brain magnetic resonance imaging, with emphasis on techniques, advances, common indications, and safety. METHODS We conducted a search of MEDLINE for articles published after 2010. The search terms used were "(fetal OR foetal OR fetus OR foetus) AND (MR OR MRI OR [magnetic resonance]) AND (brain OR cerebral)". Consensus statements from major authorities were also included. As a result, 44 relevant articles were included and formed the basis of this review. RESULTS One major challenge is fetal motion that is largely overcome by ultra-fast sequences. Currently, single-shot fast spin-echo T2-weighted imaging remains the mainstay for motion resistance and anatomical delineation. Recently, a snap-shot inversion recovery sequence has enabled robust T1-weighted images to be obtained, which is previously a challenge for standard gradient-echo acquisitions. Fetal diffusion-weighted imaging, diffusion tensor imaging, and magnetic resonance spectroscopy are also being developed. With multiplanar capabilities, superior contrast resolution and field of view, magnetic resonance imaging does not have the limitations of sonography, and can provide additional important information. Common indications include ventriculomegaly, callosum and posterior fossa abnormalities, and twin complications. There are safety concerns about magnetic resonance-induced heating and acoustic damage but current literature showed no conclusive evidence of deleterious fetal effects. The American College of Radiology guideline states that pregnant patients can be accepted to undergo magnetic resonance imaging at any stage of pregnancy if risk-benefit ratio to patients warrants that the study be performed. CONCLUSIONS Magnetic resonance imaging of the fetal brain is a safe and powerful adjunct to sonography in prenatal diagnosis. It can provide additional information that aids clinical management, prognostication, and counselling.
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Affiliation(s)
- L Mf Tee
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - E Yl Kan
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - J Cy Cheung
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
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Chan LLK, Leung TW, Lo TK, Lau WL, Leung WC. Indications for and pregnancy outcomes of cervical cerclage: 11-year comparison of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage. Hong Kong Med J 2015; 21:310-7. [PMID: 26183455 DOI: 10.12809/hkmj144393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To review and compare pregnancy outcomes of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage. DESIGN Case series with internal comparison. SETTING A regional obstetric unit in Hong Kong. PATIENTS Women undergoing cervical cerclage at Kwong Wah Hospital between 1 January 2001 and 31 December 2011. INTERVENTIONS Cervical cerclage. MAIN OUTCOME MEASURES Pregnancy outcomes including miscarriage, gestational age at delivery, birth weight, and duration of pregnancy prolongation. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Lucia L K Chan
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - T W Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - T K Lo
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W L Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Hong Kong
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20
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Yung WK, Hui W, Chan YT, Lo TK, Tai SM, Sing C, Lam YY, Lo CM, Lau WL, Leung WC. Social obstetrics: non-local expectant mothers admitted through accident and emergency department in a public hospital in Hong Kong. Hong Kong Med J 2014; 20:213-21. [PMID: 24812199 DOI: 10.12809/hkmj134181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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'.
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Affiliation(s)
- W K Yung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - Winnie Hui
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - Y T Chan
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - T K Lo
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - S M Tai
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - C Sing
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - Y Y Lam
- Department of Paediatrics, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - C M Lo
- Department of Accident and Emergency, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - W L Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong
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Abstract
The accuracy of new molecular diagnostics, fluoresence in situ hybridization or quantitative fluorescence-PCR (collectively known as rapid aneuploidy screening), in prenatal diagnosis has already been demonstrated in a number of large studies. The challenge now is how to apply them clinically in the most cost-effective manner. It is now time to appraise whether rapid aneuploidy screening can replace traditional karyotyping when amniocenteses are performed for increased risk of Down's syndrome by maternal serum screening or advanced maternal age in the absence of ultrasound abnormality. The ten most recent studies from the literature within this research theme are reviewed and the pros and cons of this new approach in prenatal diagnosis are discussed, including the suggestion of future studies.
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Affiliation(s)
- W C Leung
- Prenatal Diagnostic and Counseling Department, Tsan Yuk Hospital, University of Hong Kong, Hong Kong SAR, China.
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Lo TK, Yung WK, Lau WL, Law B, Lau S, Leung WC. Planned conservative management of placenta accreta - experience of a regional general hospital. J Matern Fetal Neonatal Med 2013; 27:291-6. [PMID: 23796273 DOI: 10.3109/14767058.2013.818118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are only a few series treating ≥10 cases of accreta conservatively, all from university teaching hospitals, with reported success rate of 60-85%. We reported the first series of accreta managed by planned uterine conservation in the setting of non-university district general hospital. METHODS Women with placenta previa overlying previous cesarean scar who desired uterine conservation were included. For cases with accreta confirmed during cesarean delivery, placenta was purposefully left behind, followed immediately by uterine artery embolization. Cases were followed in our special postnatal clinic. Charts were reviewed to retrieve clinical details. RESULTS Among 15 cases of placenta previa overlying cesarean scar opting for conservative management, 12 (80%) were confirmed to be accreta intra-operatively. They had 20-100% of the adherent placentae retained (median 90%) and their uterus preserved. Postpartum, abnormal vaginal bleeding and/or infection led to unscheduled readmission in 67% (8/12), all managed conservatively. Sonographic resolution of placenta took 2-13 months (median 6.6), and was later than menstrual return in 11 cases. CONCLUSIONS Successful planned conservative management of placenta accreta is feasible in the setting of district general hospital with facilities for interventional radiology.
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Leung RWC, Li JFP, Leung MKM, Fung BKY, Fung LCW, Tai SM, Sing C, Leung WC. Efficacy of birth ball exercises on labour pain management. Hong Kong Med J 2013; 19:393-9. [PMID: 23878201 DOI: 10.12809/hkmj133921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of a birth ball exercise programme conducted by physiotherapists on pain relief, psychological care, and facilitation of the labour process at a labour ward in a regional hospital. DESIGN Case series with before-after comparisons. SETTING Kwong Wah Hospital, Hong Kong. PARTICIPANTS Chinese women admitted to the labour ward for spontaneous vaginal delivery between April and August 2012 were recruited. Physiotherapists taught birth ball exercises in groups or individually for 30 minutes. Labour pain intensity, back pain intensity, frequency of labour pain, stress and anxiety levels, and subjective pressure level over the lower abdomen were captured before and after birth ball exercises. Most of the parameters were measured using self-reported visual analogue scales. After the exercise session, physiotherapists measured the women's satisfaction level. Midwives recorded pethidine usage. RESULTS A total of 203 pregnant women participated in this programme; 181 were in the latent phase group, whereas 22 were categorised into the no-labour-pain group. In both groups, there were statistically and clinically significant differences in back pain level, stress and anxiety levels, as well as pressure level over the lower abdomen before and after the exercise (P<0.05). In the latent phase group, significant decreases in labour pain and frequency of labour pain were demonstrated. Mean satisfaction scores were high, with visual analogue scale scores higher than 8.2 in both groups. Pethidine usage showed a further decreasing trend (6.4%) compared with the past 2 years. CONCLUSION Birth ball exercise could be an alternative means of relieving back pain and labour pain in the labour ward, and could decrease pethidine consumption in labouring women.
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Affiliation(s)
- R W C Leung
- Physiotherapy Department, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
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Ng VKS, Lo TK, Tsang HH, Lau WL, Leung WC. Intensive care unit admission of obstetric cases: a single centre experience with contemporary update. Hong Kong Med J 2013; 20:24-31. [PMID: 23784532 DOI: 10.12809/hkmj133924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
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Affiliation(s)
- Vivian K S Ng
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yaumatei, Kowloon, Hong Kong
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Sahota DS, Leung WC, Chan WP, To WW, Lau ET, Leung TY. Prospective assessment of the Hong Kong Hospital Authority universal Down syndrome screening programme. Hong Kong Med J 2013; 19:101-108. [PMID: 23535668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To evaluate the performance of the locally developed universal Down syndrome screening programme. DESIGN Population-based cohort study in the period July 2010 to June 2011 inclusive. SETTING Four Hong Kong Hospital Authority Departments of Obstetrics and Gynaecology and a central university-based laboratory for maternal serum processing and risk determination. PARTICIPANTS Women were offered either a first-trimester combined test (nuchal translucency, free beta human chorionic gonadotropin, and pregnancy-associated plasma protein-A) or nuchal-translucency-only test, or a second-trimester double test (alpha-fetoprotein and total human chorionic gonadotropin) for detection of Down syndrome according to their gestational age. Those with a trisomy 21 term risk of 1:250 or higher were offered a diagnostic test. RESULTS A total of 16 205 pregnancies were screened of which 13 331 (82.3%) had a first-trimester combined test, 125 (0.8%) had a nuchal-translucency test only, and 2749 (17.0%) had a second-trimester double test. There were 38 pregnancies affected by Down syndrome. The first-trimester screening tests had a 91.2% (31/34) detection rate with a screen-positive rate of 5.1% (690/13 456). The second-trimester test had a 100% (4/4) detection rate with a screen-positive rate of 6.3% (172/2749). There were seven (0.9%) pregnancies that miscarried following an invasive diagnostic test. There were two Down syndrome-affected live births, both with an estimated first-trimester trisomy 21 term risk lower than 1:250. CONCLUSION The universal screening programme offered at the four units was effective and achieved the expected detection rates and low false-positive rates, and to maintain these, the current emphasis on training, quality control, and regular auditing must continue.
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Affiliation(s)
- Daljit S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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Liu AL, Yung WK, Yeung HN, Lai SF, Lam MT, Lai FK, Lo TK, Lau WL, Leung WC. Factors influencing the mode of delivery and associated pregnancy outcomes for twins: a retrospective cohort study in a public hospital. Hong Kong Med J 2012; 18:99-107. [PMID: 22477732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES To determine current trends for different modes of delivery in twin pregnancies, factors affecting the mode of delivery, and associated outcomes. DESIGN Retrospective cohort study. SETTING A public hospital in Hong Kong. PARTICIPANTS All twin pregnancies booked at Kwong Wah Hospital during a 3-year period from 1 April 2006 to 31 March 2009. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- A L Liu
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong.
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Cho LY, Lau WL, Lo TK, Tang HHT, Leung WC. Predictors of successful outcomes after external cephalic version in singleton term breech pregnancies: a nine-year historical cohort study. Hong Kong Med J 2012; 18:11-19. [PMID: 22302905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To study the success rate, predictors for success, and pregnancy outcomes after external cephalic version. DESIGN Historical cohort study. SETTING Regional hospital, Hong Kong. PATIENTS 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. MAIN OUTCOME MEASURES Predictive factors for successful external cephalic version. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- L Y Cho
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong.
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Kwan WY, So CH, Chan WP, Leung WC, Chow KM. Re-emergence of late presentations of fetal haemoglobin Bart's disease in Hong Kong. Hong Kong Med J 2011; 17:434-440. [PMID: 22147311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES To compare early and late presentations of fetal haemoglobin Bart's disease in the Kowloon West Cluster in Hong Kong, and to find reasons for the re-emergence of late presentations. DESIGN Case series with internal comparisons. SETTING Two tertiary obstetric units in Hong Kong. PATIENTS All cases with confirmed diagnosis of fetal haemoglobin Bart's disease from 1 January 2000 to 31 December 2009. PRIMARY OUTCOME antenatal care in the current pregnancy. SECONDARY OUTCOMES clinical presentations, ultrasound features, and pregnancy outcomes. RESULTS A total of 59 cases (46 early presentations and 13 late presentations) of fetal haemoglobin Bart's disease were identified during the study period. All the late presentations were identified from year 2003 onwards. Late presentations were significantly associated with non-eligible obstetric patients (69% vs 11%; P<0.001), non-booked status at our antenatal service (62% vs 0%; P<0.001), and unavailability of partner's mean corpuscular volume status (23% vs 0%; P=0.009). Mothers presenting late were more likely to have symptoms or signs (85% vs 0%; P<0.001) and to suffer from gestational hypertensive disorder (54% vs 0%; P<0.001). Ultrasound features of these pregnancies included cardiomegaly (94%), placentomegaly (98%), and hydrops fetalis (77%). All pregnancies presenting early were either legally terminated or miscarried. The perinatal mortality in late presentations was 85%. CONCLUSION The re-emergence of late presentations of fetal haemoglobin Bart's disease after 2003 was related to influx of non-eligible obstetric patients without proper antenatal screening and diagnosis of thalassaemia. Maternal low mean corpuscular volume and characteristic prenatal ultrasound features such as cardiomegaly, placentomegaly, and hydrops fetalis are useful for detecting affected pregnancies in this group of patients. Better education of both patients and doctors is necessary to explain the importance of early diagnosis of the disease and the seriousness of complications due to late presentations, so as to reduce undesirable maternal and perinatal outcomes.
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Affiliation(s)
- W Y Kwan
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Laichikok, Hong Kong.
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Lai S, Lau WL, Leung WC, Lai FK, Chin R. Is ultrasound alone enough for prenatal screening of trisomy 18? A single centre experience in 69 cases over 10 years. Prenat Diagn 2010; 30:1094-9. [PMID: 20925041 DOI: 10.1002/pd.2623] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S Lai
- Prenatal Diagnosis and Counselling Clinic, Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, HKSAR, China.
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Lo TK, Lau WL, Lai FK, Lam HS, Tse HY, Leung WC, Chin RK. Effect of fetal diagnosis on the outcomes of second-trimester pregnancy termination for fetal abnormalities: A pilot study. J Matern Fetal Neonatal Med 2009; 21:523-7. [DOI: 10.1080/14767050802104835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lo TK, Lai FK, Leung WC, Lau WL, Ng LS, Wong WC, Tam SS, Yee YC, Choi H, Lam HSW, Sham ASY, Tang LCH, Chin RKH. Screening options for Down syndrome: how women choose in real clinical setting. Prenat Diagn 2009; 29:852-6. [DOI: 10.1002/pd.2292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lau ET, Tang L, Wong C, Yung Hang L, Ghosh A, Leung WC, Sin WK, Lau TK, Kung YY, Tang MHY. Assessing discrepant findings between QF-PCR on uncultured prenatal samples and karyotyping on long-term culture. Prenat Diagn 2009; 29:151-5. [DOI: 10.1002/pd.2194] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leung WC, Hessel S, Méplan C, Flint J, Oberhauser V, Tourniaire F, Hesketh JE, Lintig J, Lietz G. Two common single nucleotide polymorphisms in the gene encoding β‐carotene 15,15′‐monoxygenase alter β‐carotene metabolism in female volunteers. FASEB J 2008; 23:1041-53. [DOI: 10.1096/fj.08-121962] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- W. C. Leung
- Human Nutrition Research CentreNewcastle UniversityNewcastle upon TyneUK
| | - S. Hessel
- Human Nutrition Research CentreNewcastle UniversityNewcastle upon TyneUK
- Institute of Biology I, Animal Physiology and NeurobiologyFreiburgGermany
| | - C. Méplan
- Human Nutrition Research CentreNewcastle UniversityNewcastle upon TyneUK
- Institute of Cell and Molecular BiosciencesNewcastle University Newcastle upon TyneUK
| | - J. Flint
- Institute of Cell and Molecular BiosciencesNewcastle University Newcastle upon TyneUK
| | - V. Oberhauser
- Institute of Biology I, Animal Physiology and NeurobiologyFreiburgGermany
| | - F. Tourniaire
- Human Nutrition Research CentreNewcastle UniversityNewcastle upon TyneUK
- School of Agriculture, Food and Rural DevelopmentNewcastle UniversityNewcastle upon TyneUK
| | - J. E. Hesketh
- Human Nutrition Research CentreNewcastle UniversityNewcastle upon TyneUK
- Institute of Cell and Molecular BiosciencesNewcastle University Newcastle upon TyneUK
| | - J. Lintig
- Institute of Biology I, Animal Physiology and NeurobiologyFreiburgGermany
- Department of PharmacologyCase Western Reserve UniversityClevelandOhioUSA
| | - G. Lietz
- Human Nutrition Research CentreNewcastle UniversityNewcastle upon TyneUK
- School of Agriculture, Food and Rural DevelopmentNewcastle UniversityNewcastle upon TyneUK
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Chan BC, Hui PW, Leung WC, Leung KY, Pun TC, Lee CP. Application of transcervical hysterofetoscopy and cord blood collection at first trimester termination of pregnancy for fetal abnormalities. Prenat Diagn 2008; 28:939-42. [PMID: 18792922 DOI: 10.1002/pd.2085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the applicability of hysterofetoscopy and cord blood collection at first trimester termination of pregnancy for fetal abnormalities. METHODS From 2004 to 2007, transcervical hysterofetoscopy was performed in seven patients at the same operation setting of surgical termination of pregnancy. The findings were compared with prenatal diagnosis. Feasibility of cord blood collection was also examined. RESULTS Out of these seven patients, six of them had prenatal ultrasound diagnosis of cystic hygroma. All of them had chromosomal abnormalities. Subcutaneous oedema was confirmed by hysterofetoscopy with good view. Another pregnancy was complicated by homozygous alpha thalassaemia and the diagnosis was confirmed by electrophoresis of fetal haemoglobin collected from umbilical cord vessel. Cord blood collection was also attempted in two other patients yielding fetal blood with minimal maternal contamination. CONCLUSION Transcervical hysterofetoscopy is a feasible tool in confirming external fetal structural abnormalities before surgical termination of pregnancy. It can be performed under either general anaesthesia or conscious sedation. Umbilical cord blood collection can facilitate confirmation of genetic diseases. It may also allow the potential of isolating fetal mesenchymal stem cell in first trimester.
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Affiliation(s)
- B C Chan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
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Abstract
Alpha-thalassaemia is one of the most common human genetic disorders. Couples in which both partners carry alpha(0)-thalassaemia traits have a 25% risk of having a fetus affected by homozygous alpha-thalassaemia or haemoglobin Bart's disease, with severe fetal anaemia in utero, hydrops fetalis, stillbirth or early neonatal death, as well as causing various maternal morbidities. This disorder is common in southeast Asia and southern China, and the expanding populations of southeast Asian immigrants in the US, Canada, UK and Europe mean that this disorder is no longer rare in these countries.
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Affiliation(s)
- W C Leung
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong.
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Tiwari A, Chan KL, Fong D, Leung WC, Brownridge DA, Lam H, Wong B, Lam CM, Chau F, Chan A, Cheung KB, Ho PC. The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 2008; 115:377-84. [PMID: 18190375 PMCID: PMC2253706 DOI: 10.1111/j.1471-0528.2007.01593.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective The objective of this first population-based study in Hong Kong was to assess the impact of psychological abuse by an intimate partner on the mental health of pregnant women. Design Survey. Setting Antenatal clinics in seven public hospitals in Hong Kong. Population Three thousand two hundred and forty-five pregnant women. Methods The Abuse Assessment Screen (AAS) and demographic questionnaires were administered face-to-face at 32–36 weeks of gestation. At 1 week postpartum, the AAS, Edinburgh Postnatal Depression Scale and SF-12 Health Survey were administered by telephone. Main outcome measures Intimate partner violence, postnatal depression and health-related quality of life. Results Two hundred and ninety six (9.1%) of the participants reported abuse by an intimate partner in the past year. Of those abused, 216 (73%) reported psychological abuse only and 80 (27%) reported physical and/or sexual abuse. Forty six (57.5%) in the physical and/or sexual abuse group also reported psychological abuse. Women in the psychological abuse only group had a higher risk of postnatal depression compared with nonabused women (adjusted OR: 1.84, 95% CI: 1.12–3.02). They were also at a higher risk of thinking about harming themselves (adjusted OR: 3.50, 95% CI: 1.49–8.20) and had significantly poorer mental health-related quality of life (P < 0.001). The higher risks of postnatal depression and thinking of harming themselves were not observed in the physical and/or sexual abuse group although significantly poorer mental health-related quality of life (P < 0.001) was observed. Conclusions Psychological abuse by an intimate partner against pregnant women has a negative impact on their mental health postdelivery. Furthermore, psychological abuse in the absence of physical and/or sexual abuse can have a detrimental effect on the mental health of abused women. The findings underscore the importance of screening pregnant women for abuse by an intimate partner and the need for developing, implementing and evaluating interventions to address psychological abuse. Please cite this paper as: Tiwari A, Chan K, Fong D, Leung W, Brownridge D, Lam H, Wong B, Lam C, Chau F, Chan A, Cheung K, Ho P. The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 2008;115:377–384.
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Affiliation(s)
- A Tiwari
- Department of Nursing Studies, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Leung WC, Lau ET, Lau WL, Tang R, Wong SF, Lau TK, Tse KT, Wong SF, To WK, Ng LKL, Lao TT, Tang MHY. Rapid aneuploidy testing (knowing less) versus traditional karyotyping (knowing more) for advanced maternal age: what would be missed, who should decide? Hong Kong Med J 2008; 14:6-13. [PMID: 18239237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES The application of rapid aneuploidy testing as a stand-alone approach in prenatal diagnosis is much debated. The major criticism of this targeted approach is that it will not detect other chromosomal abnormalities that will be picked up by traditional karyotyping. This study aimed to study the nature of such chromosomal abnormalities and whether parents would choose to terminate affected pregnancies. DESIGN Retrospective study on a cytogenetic database. SETTING Eight public hospitals in Hong Kong. PARTICIPANTS The karyotype results of 19 517 amniotic fluid cultures performed for advanced maternal age (>or=35 years) from 1997 to 2002 were classified according to whether they were detectable by rapid aneuploidy testing. The outcomes of pregnancies with abnormal karyotypes were reviewed from patient records. RESULTS In all, 333 (1.7%) amniotic fluid cultures yielded abnormal karyotypes; 175 (52.6%) of these were detected by rapid aneuploidy testing, and included trisomy 21 (n=94, 28.2%), trisomy 18 or 13 (n=21, 6.3%), and sex chromosome abnormalities (n=60, 18.0%). The other 158 (47.4%) chromosomal abnormalities were not detectable by rapid aneuploidy testing, of which 63 (18.9%) were regarded to be of potential clinical significance and 95 (28.5%) of no clinical significance. Pregnancy outcomes in 327/333 (98.2%) of these patients were retrieved. In total, 143 (42.9%) of these pregnancies were terminated: 93/94 (98.9%) for trisomy 21, 20/21 (95.2%) for trisomy 18 or 13, 19/60 (31.7%) for sex chromosome abnormalities, and 11/63 (17.5%) for other chromosomal abnormalities with potential clinical significance. There were no terminations in the 95 pregnancies in which karyotyping results were regarded to be of no clinical significance. CONCLUSIONS 'Knowing less' by the rapid aneuploidy stand-alone testing could miss about half of all chromosomal abnormalities detectable by amniocentesis performed for advanced maternal age. Findings from two fifths of the latter were of potential clinical significance, and the parents chose to terminate one out of six of the corresponding pregnancies. If both techniques are available, parents could have enhanced autonomy to choose.
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Lo TK, Lau WL, Lai FK, Lam H, Tse HY, Leung WC, Chin RKH. The effect of gestational age on the outcome of second-trimester termination of pregnancies for foetal abnormalities. Prenat Diagn 2008; 28:508-11. [DOI: 10.1002/pd.2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lo TK, Lau WL, Lam HSW, Leung WC, Chin RKH. Obstetric cholestasis in Hong Kong--local experience with eight consecutive cases. Hong Kong Med J 2007; 13:387-91. [PMID: 17914146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Obstetric cholestasis is associated with maternal morbidity and adverse foetal outcomes. No information on local incidence is available. We present our experience with eight consecutive cases of obstetric cholestasis diagnosed between January 2003 and December 2005 in a regional hospital in Hong Kong. Three patients presented with pruritus without rash, three with impaired liver function, and two with elevated blood pressure postpartum. Meconium-stained liquor was present in five patients and four had spontaneous preterm delivery (between 34 and 36 weeks). The higher the bile acid level, the more marked the prematurity (correlation coefficient, -0.771; P=0.025). All those presenting with itchiness delivered preterm. Two patients developed pre-eclampsia. The rates of labour induction and abdominal delivery were both 38%. Heightened awareness among clinicians is required to recognise patients with obstetric cholestasis. Affected pregnancies are associated with meconium passage and prematurity. In our locality, affected women may also have an increased risk of pre-eclampsia. In affected women, the bile acid level is useful in assessing the risk of prematurity.
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Affiliation(s)
- T K Lo
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong.
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Tiwari A, Fong DYT, Chan KL, Leung WC, Parker B, Ho PC. Identifying intimate partner violence: comparing the Chinese Abuse Assessment Screen with the Chinese Revised Conflict Tactics Scales. BJOG 2007; 114:1065-71. [PMID: 17617187 PMCID: PMC1974837 DOI: 10.1111/j.1471-0528.2007.01441.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the measurement accuracy and the utility of the Chinese Abuse Assessment Screen (AAS). DESIGN A cross-sectional study. SETTING An antenatal clinic of a public hospital and a community centre in Hong Kong. SAMPLE A total of 257 Chinese women consisting of 100 pregnant women and 157 nonpregnant women. METHOD The Chinese AAS was administered first, followed by the Chinese Revised Conflict Tactics Scales (CTS2). This was performed in the same sitting, and each participant was interviewed once either at an antenatal clinic (for the pregnant women sample) or at a community centre (for the nonpregnant women sample). MAIN OUTCOME MEASURES Estimates of the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios. RESULTS Using the Chinese CTS2 as the standard, the specificity estimates of the Chinese AAS for emotional, physical and sexual abuse were > or = 89%, while the sensitivity estimates varied from 36.3 to 65.8%. The sensitivity improved in the screening for more severe cases (66.7%). The positive predictive values were > or = 80%, and the negative predictive values varied from 66 to 93%. Factors such as the age difference between the couple and the woman's need for financial assistance were found to be associated with intimate partner violence (IPV). CONCLUSION The Chinese AAS has demonstrated satisfactory measurement accuracy and utility for identifying IPV when the Chinese CTS2 was used as the standard.
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Affiliation(s)
- A Tiwari
- Department of Nursing Studies, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
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Yung C, Liu K, Lau WL, Lam H, Leung WC, Chin R. Two cases of postmaturity-related perinatal mortality in non-local expectant mothers. Hong Kong Med J 2007; 13:231-3. [PMID: 17548913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
We present two cases of postmaturity-related perinatal mortality with delivery at 42 weeks 6 days' and 44 weeks' gestation, respectively. No cause beyond postmaturity was found. Neither induction of labour nor foetal monitoring had been performed despite these gestations going post 41 weeks because of a current 'social obstetrics' phenomenon--non-local expectant mothers coming to Hong Kong from mainland China for delivery.
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Affiliation(s)
- Cherrie Yung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong
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Au WY, Leung WC. Challenges and pitfalls in prenatal screening in pregnancies involving allogeneic stem cell transplantation recipients. Bone Marrow Transplant 2007; 39:379-82. [PMID: 17310136 DOI: 10.1038/sj.bmt.1705604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Increasing numbers of successful pregnancies are reported in recipients of allogeneic hemopoietic stem cell transplantation (HSCT). These may occur naturally, or more commonly, through assisted reproduction. The pregnancy outcomes are usually normal. There are currently no guidelines on the prenatal management of pregnancies involving HSCT recipients. HSCT recipients are unique in that their red cells, lymphocytes and even the DNA in the circulation are donor derived. As a result, typical prenatal screening tests in parents, including mean cell volume (MCV), hemoglobin pattern, blood group, infective serology and DNA screening, are all affected. The MCV cannot be used as guide for iron and folate supplements, or for thalassemia and sickle cell anemia screening. Such screening must be based on pre-HSCT indices and pre-HSCT DNA samples. The risks for hemolytic disease of newborn and hepatitis B virus transmission have to be re-evaluated, based on both pre- and post-HSCT patient as well as donor blood group and serology results. Good communication between obstetricians and the HSCT physician is paramount to promote successful pregnancies in this distinct patient population.
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Affiliation(s)
- W Y Au
- Bone Marrow Transplant Unit, Department of Medicine, Queen Mary Hospital, Hong Kong.
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Leung WC, Chan BCP, Ma G, Lam KW, Leung KY, Pun TC, Lao TT, Lee CP. Continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries after the study period: Was this the Hawthorne effect? Eur J Obstet Gynecol Reprod Biol 2007; 130:165-8. [PMID: 16567034 DOI: 10.1016/j.ejogrb.2006.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/19/2005] [Accepted: 02/08/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The incidence of birth trauma and birth asphyxia related to instrumental deliveries in our obstetric unit was high (2.8%) in 1998-1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied). OBJECTIVES The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period (2001-2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect. METHOD To compare the hospital obstetric statistics among the pre-study period (1998-1999), the study period (2000) and the post-study period (2001-2003), in particular the incidence of birth trauma and birth asphyxia related to instrumental deliveries, the instrumental delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of labour, the incidence of failed instrumental delivery, the incidence of attempted instrumental delivery in the operating theatre, and incidence of direct second-stage Caesarean sections. RESULTS The incidence of birth trauma and birth asphyxia related to instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998-1999; RR 0.27, 95% CI 0.11-0.70). This phenomenon continued into the post-study period (2001-2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20-0.64). The instrumental delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and pre-study (19.5%) periods (RR 0.81, 95% CI 0.75-0.89 and RR 0.69, 95% CI 0.65-0.74, respectively). There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1%) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05-49.73 and RR 9.77, 95% CI 5.28-18.08, respectively). CONCLUSION A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period.
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Affiliation(s)
- W C Leung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, HKSAR, China.
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Lau WL, Lam HSW, Leung WC. Reversed diastolic flow in the uterine artery - a new Doppler finding related to placental insufficiency? Ultrasound Obstet Gynecol 2007; 29:232-5. [PMID: 17203461 DOI: 10.1002/uog.3872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Increased uterine artery pulsatility and resistance indices with or without notching of the waveform have been associated with an increased risk of pre-eclampsia and fetal growth restriction. However, reversed diastolic flow in the uterine artery has not previously been reported. We present two high-risk obstetric cases complicated by severe placental insufficiency: pre-eclampsia followed by eclampsia in one case and intrauterine growth restriction with abnormal cardiotocography in the other. Doppler studies of the uterine arteries revealed reversed diastolic flow in both cases. The pathophysiology and potential implications are discussed.
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Affiliation(s)
- W L Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, HKSAR.
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Chan KL, Tiwari A, Leung WC, Ho HWY, Cerulli C. Common correlates of suicidal ideation and physical assault among male and female university students in Hong Kong. Violence Vict 2007; 22:290-303. [PMID: 17619635 DOI: 10.1891/088667007780842766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study examined prevalence and correlates of suicidal ideation and dating partner violence in a cohort of 651 university students in social sciences classes at three universities in Hong Kong. A standard questionnaire was completed within one class period to examine the rates of occurrence of physical assault perpetration and suicidal ideation. Separate rates are presented for male and female perpetrators and for severe and overall levels of violence. The differences between subjects having suicidal ideation are compared using t tests. Logistic regression is used to predict the presence or absence of physical assault in the preceding year of reporting and suicidal ideation based on the variables such as Personal Relationship Profile, age, relationship length, and socioeconomic status. Results showed that 55% of suicidal persons had a history of violence, whereas 39% of violent people had a history of suicidal ideation. Logistic regression showed that physical assault shared a total of seven associated factors with suicidal ideation. Suicidal ideation seems to have no direct relation to physical and sexual assault, but they do share some common associated factors that are essential for the development of suicide prevention.
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Affiliation(s)
- Ko Ling Chan
- Department of Social Work and Social Administration, University of Hong Kong, Pokfulam.
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Wong MK, Leung WC, Wang JK, Lao TT, Ip MS, Lam WK, Ho JC. Recurrent pneumothorax in pregnancy: what should we do after placing an intercostal drain. Hong Kong Med J 2006; 12:375-80. [PMID: 17028358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Recurrent pneumothorax is rare during pregnancy. We describe a Chinese woman, with a history of spontaneous pneumothorax managed with an intercostal drain, who developed a recurrent pneumothorax during her 32nd week of pregnancy. There is no consensus on management in this situation. We review the literature and discuss different management approaches. Thirty-six cases of antepartum pneumothorax have been reported in 31 case reports. An intercostal drain only (n=11) or surgeries (thoracotomy, n=9; or video-assisted thoracoscopy, n=2) were common treatment options with no surgical complications reported. Twenty-two (61%) patients progressed to a normal vaginal delivery, while the rest required forceps delivery (22%) or Caesarean section (14%). No single treatment option outweighed the others. There were no maternal or foetal complications reported in those who underwent antepartum surgical intervention. Surgical management of recurrent pneumothorax during pregnancy is well tolerated.
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Affiliation(s)
- M K Wong
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Leung KY, Ngai CSW, Lee A, Chan HY, Leung WC, Lee CP, Tang MHY. The effects on maternal anxiety of two-dimensional versus two- plus three-/four-dimensional ultrasound in pregnancies at risk of fetal abnormalities: A randomized study. Ultrasound Obstet Gynecol 2006; 28:249-54. [PMID: 16909403 DOI: 10.1002/uog.2844] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To test the hypothesis that the use of two-dimensional (2D) ultrasonography with three-dimensional/four-dimensional (3D/4D) ultrasonography can reduce anxiety to a greater extent in women at risk of having a fetus with congenital abnormalities than the use of 2D ultrasonography alone. METHODS A total of 124 women attending the prenatal diagnostic clinic of a teaching hospital were randomized into the intervention group (2D ultrasonography followed by 3D/4D ultrasonography) or control group (2D ultrasonography alone). The primary outcome was maternal anxiety levels, which were assessed by the Spielberger state-trait anxiety inventory. We measured the anxiety levels in all women at the first visit, at around 18 weeks' gestation (immediately after ultrasound examinations) and at 28 weeks' gestation. RESULTS A short-term reduction of the state-anxiety score (by around 2 points) from the first visit to after ultrasound examinations was observed in both the intervention group and the control group. Unexpectedly, a small increase in the state-anxiety score from the first visit to 28 weeks' gestation was observed in the intervention group but not in the control group, though there was no significant difference in the changes between the two groups. Repeated measures ANOVA (analysis of variance) also showed that there was no significant interaction effect between groups and time of assessment on the state-anxiety scores (F = 1.072 and P = 0.344). About 80% of women reported a better understanding that their baby was normal after viewing 3D rather than 2D images. CONCLUSION This randomized study indicates that the addition of 3D/4D ultrasound does not cause a significant reduction in maternal anxiety in pregnancies at risk of fetal abnormalities compared with conventional 2D ultrasound alone.
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Affiliation(s)
- K Y Leung
- The Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR.
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Kwok RPW, Law YK, Li KE, Ng YC, Cheung MH, Fung VKP, Kwok KTT, Tong JMK, Yen PF, Leung WC. Prevalence of workplace violence against nurses in Hong Kong. Hong Kong Med J 2006; 12:6-9. [PMID: 16495582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES To determine the prevalence and nature of workplace violence against nurses, and how nurses deal with such aggression; and to identify the risk factors related to violence in the hospital environment. DESIGN Cross-sectional questionnaire study. SETTING University teaching hospital, Hong Kong. PARTICIPANTS All nursing staff in the hospital, except nurses who were unable to read Chinese or who did not have patient contact (eg those worked in administrative positions), were invited to complete a questionnaire. MAIN OUTCOME MEASURES Demographic data of the respondents, incidence of and risk factors contributing to workplace violence. RESULTS A total of 420 nurses returned the completed questionnaire (response rate, 25%). Three hundred and twenty (76%; 95% confidence interval, 72-80%) nurses reported abuse of any kind--verbal abuse, 73%; bullying, 45%; physical abuse, 18%; and sexual harassment, 12%. Most (82%) nurses who experienced verbal abuse tended to confide in friends, family members, or colleagues. Some (42%) ignored the incident. Risk factors for workplace violence included: working in male wards and in certain specialties such as the Accident and Emergency Department, Community Nursing Service, and the Orthopaedics and Traumatology Department. CONCLUSION Workplace violence against nurses is a significant problem in Hong Kong. Further large-scale studies should be conducted to more closely examine the problem.
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Affiliation(s)
- R P W Kwok
- Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
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Ting JY, Lam BCC, Ngai CSW, Leung WC, Chan KL. Splenic rupture in a premature neonate. Hong Kong Med J 2006; 12:68-70. [PMID: 16495593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Splenic injuries are very rare in neonates. We report a case of splenic injury in a premature neonate, highlighting the importance of a high-index suspicion in early recognition of this rare but potentially fatal intra-abdominal injury. We also review the literature on possible aetiologies and mechanism of splenic injury, as well as its management. This is the first reported case of a very low-birth-weight neonate with splenic rupture who survived with intact neurology.
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Affiliation(s)
- J Y Ting
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
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Tse KY, Leung WC, Leung KY, Lee CP, Ng LKL, Lau ET, Chan V, Tang MHY. Full karyotyping, rapid aneuploidy diagnosis or both when invasive prenatal testing is performed for diagnosis of thalassaemia? ACTA ACUST UNITED AC 2006; 12:55-9. [PMID: 16421217 DOI: 10.1093/molehr/gal003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A retrospective study was performed to compare the detection rate of chromosomal abnormalities by different approaches of full karyotyping, rapid aneuploidy diagnosis (RAD) or both when invasive prenatal testing is performed for diagnosis of thalassaemia. The karyotype results of 1120 prenatal samples obtained from thalassaemia couples from January 1985 to December 2002 in a referral centre for prenatal diagnosis were studied. The detection rate of chromosomal abnormalities by four different approaches were compared: (i) karyotyping for all samples; (ii) RAD (21,18,13,X,Y) for all samples; (iii) RAD for all samples + karyotyping for cases with ultrasound abnormalities; and (iv) RAD (21,18,13) for all + RAD (X,Y) for cases with ultrasound abnormalities consistent with Turner syndrome + karyotyping for cases with ultrasound abnormalities. Normal karyotypes were found in 1103 samples (98.5%). There were 17 cases (1.5%) of chromosomal abnormalities: four cases (0.36%) were clinically significant, eight cases (0.7%) were of borderline clinical significance and five cases (0.44%) were not confirmed by subsequent prenatal or postnatal tests. The incidences of autosomal (7/1120 = 0.63%) and sex chromosomal (5/1120 = 0.45%) abnormalities were not higher than those (0.41 and 0.22%, respectively) from newborn surveys (Hook and Hamerton, 1977) (P = 0.398 and 0.216, respectively). Approach 1 would detect all 17 chromosomal abnormalities. Approach 2 would detect three of four clinically significant chromosomal abnormalities but not detect six of eight chromosomal abnormalities of borderline clinical significance and three of five chromosomal abnormalities not confirmed by subsequent prenatal or postnatal tests. Approach 3, in addition, would be able to detect all four clinically significant chromosomal abnormalities. Approach 4 would detect all four clinically significant chromosomal abnormalities but would not detect seven of eight chromosomal abnormalities of borderline clinical significance and four of five chromosomal abnormalities not confirmed by subsequent prenatal or postnatal tests. RAD (21,18,13) for all + RAD (X,Y) for cases with ultrasound abnormalities consistent with Turner syndrome + karyotyping for cases with ultrasound abnormalities seemed to be the best approach for the detection of chromosomal abnormalities when invasive prenatal testing is performed for diagnosis of thalassaemia.
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Affiliation(s)
- K Y Tse
- Prenatal Diagnostic and Counselling Department, Tsan Yuk Hospital, University of Hong, HKSAR, China
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