The impact of antenatal massage practice on intrapartum massage application and their associations with the use of analgesics during labour : Sub-analysis of a randomised control trial.

BACKGROUND: Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour. METHODS: This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women's application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class. RESULTS: Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour. CONCLUSIONS: More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia. TRIAL REGISTRATION: (CCRBCTR) Unique Trial Number CUHK_ CCRB00525 .

Menstrual disorders in a Paediatric and Adolescent Gynaecology Clinic: patient presentations and longitudinal outcomes.

OBJECTIVE. To study the presentations, diagnoses, and outcomes in adolescents with menstrual disorders. DESIGN. Prospective cohort study. SETTING. Paediatric and Adolescent Gynaecology Clinic, Hong Kong. PARTICIPANTS. A total of 577 adolescents aged 14 to 19 years. MAIN OUTCOME MEASURES. The presentations and diagnoses of adolescents with menstrual disorders were reviewed and their menstrual outcomes determined by a telephone survey. RESULTS. In all, 47% presented with menorrhagia, prolonged menstruation, and short menstrual cycles; 27% had secondary amenorrhoea, 12% had dysmenorrhoea, 11% had oligomenorrhoea, and 3% had primary amenorrhoea. Significant diagnoses included congenital genital tract anomalies, premature ovarian failure, anorexia nervosa, and polycystic ovarian syndrome. Polycystic ovarian syndrome was diagnosed in 16% of the cohort. In all, 24% of these 577 patients had abnormal menstrual cycles 4 years later. Direct logistic regression analysis indicated a cycle length of more than 35 days at presentation (adjusted odds ratio=2.8; 95% confidence interval, 1.8-4.5), previous diagnosis of polycystic ovarian syndrome (adjusted odds ratio=2.0; 95% confidence interval, 1.1-3.4), and current body mass index of 23 kg/m(2) or higher (adjusted odds ratio=1.8; 95% confidence interval, 1.0-3.0) were risk factors for persistently long menstrual cycle exceeding 35 days. Adolescents who were screened out with a definitive diagnosis after initial assessment were at low risk of persistently long menstrual cycles at follow-up (adjusted odds ratio=0.3; 95% confidence interval, 0.1-0.8). CONCLUSIONS. Adolescent menstrual disorders should not be ignored. Long cycle, diagnosis of polycystic ovarian syndrome at first consultation, and a current body mass index of 23 kg/m(2) or higher were statistically associated with persistent problems.

Urinary incontinence should be added to the manifestation in women with Marfan syndrome.

INTRODUCTION AND HYPOTHESIS: We aimed to compare the incidence of urinary incontinence in women with Marfan syndrome and controls, hypothesizing that connective tissue abnormality could contribute to urinary incontinence. METHODS: A cross-sectional historical cohort study was conducted on 14 premenopausal women with Marfan syndrome and 534 controls using Urogenital Distress Inventory Short Form and Incontinence Impact Questionnaire Short Form. RESULTS: Marfan subjects had significantly higher incidence of urinary symptoms, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) than controls (P = 0.02, P = 0.03, P = 0.02), despite their lower parity (P = 0.01). Direct logistic regression analysis indicated that Marfan syndrome, parity and age were associated with SUI; while Marfan syndrome was the only significant predictor of UUI. CONCLUSIONS: Premenopausal women with Marfan syndrome had a higher incidence of reported urinary symptoms. Urinary incontinence should be added to the list of clinical manifestations in women with Marfan syndrome.

Epidemiology and spectrum of positive bacteriological culture in intrauterine fluid collected from women with postmenopausal bleeding.

OBJECTIVE: This study aims to examine the prevalence and bacteriological findings of different types of intrauterine fluid collection in women presenting with postmenopausal bleeding and the risk factors for predicting positive microbiological culture, mixed growth, and anaerobic growth. METHODS: This is a retrospective cohort study. Data from all of the women who were assessed in our one-stop postmenopausal bleeding clinic between 2008 and 2011 and who were found to have intrauterine fluid collection were reviewed. Endometrial aspirates of all women were sent for bacterial culture and histological examination. The risk factors for positive culture were assessed by both univariate and multivariate analyses. RESULTS: A total of 228 cases of intrauterine fluid collection were included for analysis. There were 109 (47.8%) cases of pyometra, 98 (43.0%) cases of hydrometra, and 21 (9.2%) cases of hematometra. Escherichia coli, Bacteroides fragilis, and Enterococcus were the commonest microorganisms isolated from endometrial aspirates. Both endometrial malignancy and benign intrauterine pathologies are not risk factors for positive culture. Advanced age (>75 y) is an independent risk factor for positive culture (odds ratio, 2.89; 95% CI, 1.39-6.01) and mixed growth (odds ratio, 2.18; 95% CI, 1.02-4.67). Residency in nursing homes is an independent risk factor for mixed growth (odds ratio, 2.61; 95% CI, 1.21-5.63) and anaerobic growth (odds ratio, 2.55; 95% CI, 1.01-6.44). CONCLUSIONS: E. coli, B. fragilis, and Enterococcus are the commonest microorganisms isolated from intrauterine fluid. Apart from drainage of the intrauterine fluid collection, successful management also requires appropriate antibiotics and improvement in perineal hygiene.

The impact of maternal height on intrapartum operative delivery: a reappraisal.

AIM: To clarify the relationship between maternal height and intrapartum operative delivery in women with singleton pregnancies. METHODS: A retrospective cohort study was performed on Asian, mostly southern Chinese, women managed by our department in a 48-month period. They were categorized into four quartile groups according to their height ranking, with the 25th, 50th and 75th percentile values of height generated from the entire obstetric population. The labor and pregnancy outcomes of different quartile groups were compared. RESULTS: A total of 13 606 pregnancies were recruited in the study cohort. The 25th, 50th and 75th percentile values of maternal height were 153 cm, 156 cm, and 160 cm, respectively, and the number of cases from the lowest to the highest quartile groups was 4153, 2698, 3445, and 3310, respectively. Significant differences were found in maternal weight, body mass index, incidences of multiparity and smokers, and birthweight and Apgar score at the first minute among the four quartiles. There was a significantly increasing incidence of cesarean delivery for mechanical reasons in spite of higher incidences of small-for-gestational age (SGA) and low birthweight (LBW) infants in decreasing quartiles. Regression analysis confirmed that the lower three quartile groups were associated with significantly increased cesarean delivery rates compared with the highest quartile group. CONCLUSION: Maternal height is inversely correlated with the risk of cesarean delivery for labor arrest The effect of height acts as a continuum rather than in a dichotomous manner. The use of height percentile ranking may allow comparison between different populations on the effect on labor outcome.

Effects of differential glycosylation of glycodelins on lymphocyte survival.

Glycodelin is a human glycoprotein with four reported glycoforms, namely glycodelin-A (GdA), glycodelin-F (GdF), glycodelin-C (GdC), and glycodelin-S (GdS). These glycoforms have the same protein core and appear to differ in their N-glycosylation. The glycosylation of GdA is completely different from that of GdS. GdA inhibits proliferation and induces cell death of T cells. However, the glycosylation and immunomodulating activities of GdF and GdC are not known. This study aimed to use ultra-high sensitivity mass spectrometry to compare the glycomes of GdA, GdC, and GdF and to study the relationship between the immunological activity and glycosylation pattern among glycodelin glycoforms. Using MALDI-TOF strategies, the glycoforms were shown to contain an enormous diversity of bi-, tri-, and tetra-antennary complex-type glycans carrying Galbeta1-4GlcNAc (lacNAc) and/or GalNAcbeta1-4GlcNAc (lacdiNAc) antennae backbones with varying levels of fucose and sialic acid substitution. Interestingly, they all carried a family of Sda (NeuAcalpha2-3(GalNAcbeta1-4)Gal)-containing glycans, which were not identified in the earlier study because of less sensitive methodologies used. Among the three glycodelins, GdA is the most heavily sialylated. Virtually all the sialic acid on GdC is located on the Sda antennae. With the exception of the Sda epitope, the GdC N-glycome appears to be the asialylated counterpart of the GdA/GdF glycomes. Sialidase activity, which may be responsible for transforming GdA/GdF to GdC, was detected in cumulus cells. Both GdA and GdF inhibited the proliferation, induced cell death, and suppressed interleukin-2 secretion of Jurkat cells and peripheral blood mononuclear cells. In contrast, no immunosuppressive effect was observed for GdS and GdC.

Objective evaluation of skin pressure distribution of graduated elastic compression stockings.

BACKGROUND: The beneficial effects of graduated elastic compression stockings (GCSs) have been demonstrated. However, their pressure performances are variable and unstable in practical applications owing to many influencing factors. Comprehensive assessment of skin pressure profiles may help elucidate the mechanisms of action of compression stockings. OBJECTIVE: The objective of this study was to quantify and objectively evaluate the magnitude and distribution of skin pressure applied by different GCSs and to analyze the possible reasons influencing the stocking pressure performances. METHODS: Six healthy females were required to wear eight kinds of GCSs with different pressure levels while standing upright. The skin pressures of 16 different positions located in four heights and four directions of the lower limb were measured and recorded by FlexiForce interface pressure sensors (Tekscan, Inc., Boston, MA, USA) and a multichannel measuring system. RESULTS: The pressure gradients, pressure levels, and testing locations significantly influenced skin pressure (p < .001). All tested GCSs exerted the highest pressure at the ankle region, and the pressure gradually decreased toward the thigh, which follows the gradient design of GCSs. However, many of them failed to produce the perfect pressure gradients from the ankle region to the calf region. Obviously, reversed pressure gradients occurred in the medial side of the leg, where the pressure at the ankle region was lower than that on the prominent part of the calf by 36% on average. GCSs with higher pressure levels applied higher skin pressure on the lower limb. The pressure at the anterior side was far higher than that in the medial and lateral directions. The distribution patterns of skin pressure at transverse sections were similar to the anatomic outlines of cross sections of the leg. The measured average ankle pressure of all tested GCSs did not reach the pressures specified by the manufacturers. CONCLUSION: Skin pressure distributions and magnitudes applied by GCSs were significantly influenced by the locations of testing points in terms of height and direction, which are determined by the specific anatomic structure and body shape of individual human legs and potentially influenced by the pressure sensor and testing methods.