Fertility preservation in Hong Kong Chinese society: awareness, knowledge and acceptance.

BACKGROUND: Fertility preservation for both medical and non-medical reasons are gaining increasing attention world-wide. This study aimed to evaluate the awareness, knowledge and acceptance on fertility preservation in Hong Kong Chinese. METHODS: This was a cross-sectional study carried out between June 2016 to March 2017. A self-administered questionnaire was distributed by convenience sampling. RESULTS: Forty two percent of subjects returned the questionnaire (n = 296/697). Among them, only 54.3% were aware of any means of fertility preservation. Tertiary educated individuals are more aware than less educated individuals (73.6% versus 46.6%, p < 0.001). The most commonly known method is oocyte cryopreservation (94.3%). Most of the respondents (80%) were interested to know about fertility preservation, 84.1% considered fertility preservation counselling necessary and 83.3% would consider undergoing fertility preservation if a treatment has a high chance of causing infertility despite the possibility of delay in cancer treatment. Up to 93.9% agreed to set up a dedicated referral centre with government funding and 73.4% agreed that fertility preservation for medical indication should be provided as a government funded service. In terms of fertility preservation for non-medical reason, 65.5 and 70.4% agreed that fertility preservation should be offered to single men and women without partner respectively, while only 53.3 and 50% agreed that fertility preservation is acceptable for delay in childbearing for career development in female and male respectively. CONCLUSION: There was a low awareness but positive attitude towards fertility preservation among Hong Kong Chinese. Acceptance towards medically indicated fertility preservation is high while a considerable number also accepts it for non-medical reasons. Educational campaigns are required to arouse awareness of fertility preservation to prevent individuals being deprived of the option due to lack of knowledge. Dedicated referral centre with established efficient patient referral pathways and financial support should be provided to improve the provision and uptake of fertility preservation service to enhance the reproductive potential and life options of women.

Prevention of perinatal hepatitis B virus transmission.

PURPOSE: Chronic hepatitis B virus (HBV) infection remains endemic and continues to cause significant morbidity and mortality. It is a global health issue and the World Health Organization aims to eradicate HBV by 2030. Since vertical transmission accounts for the majority of chronic HBV infection, pregnancy offers an excellent opportunity to achieve complete HBV eradication by providing effective immunization of the offspring. METHODS: We reviewed recent publications identified from PubMed database using a combination of the relevant keywords for HBV, pregnancy, vertical transmission, immunoprophylaxis failure and antiviral treatment. RESULTS: We summarized the evidence of factors associated with, and measures to reduce and prevent maternal to child transmission, including the use of antiviral treatment during pregnancy to prevent immunoprophylaxis failure. Evidence suggested that highly viremia mother can be offered antenatal antiviral treatment to prevent immunoprophylaxis failure. We elaborated the viral load threshold to start maternal antiviral treatment and the importance of timely neonatal vaccination. A clinical algorithm to manage HBV carriers during pregnancy was proposed. CONCLUSION: Eradication of HBV is achievable with optimal management of HBV carriers, especially during pregnancy by interruption of vertical transmission. Routine antenatal screening and neonatal immunoprophylaxis remain the key measures to reduce the global HBV burden, and additional antenatal antiviral treatment could further minimize the chance of persistent infection in newborns.

Evaluation of an in-house real-time polymerase chain reaction method to identify group B streptococcus colonization in pregnancy.

AIM: The aim of this study was to evaluate the performance of in-house real-time polymerase chain reaction (qPCR) in detecting group B streptococcus (GBS) colonization compared with the standard culture method in a cohort of pregnant women. MATERIAL AND METHODS: A total of 134 rectovaginal swabs were collected from 125 pregnant women, of whom 108 were known carriers or presented with preterm prelabor rupture of membranes. The swabs were placed in Standard Methods Broth (Todd-Hewitt broth supplemented with 6 µg/mL gentamicin and 15 µg/mL nalidixic acid) for culture identification of GBS. An in-house qPCR was also performed from the broth and after overnight incubation of the broth. RESULTS: The detection rate of GBS in this cohort was 30.6% and 50.7% using standard culture method and qPCR, respectively. GBS-specific qPCR assay gave sensitivities of 97.6% and 100%, specificities of 73.1% and 71.0%, and negative predictive values of 98.6% and 100% from direct specimen and from broth after overnight incubation, respectively. CONCLUSIONS: The in-house qPCR test has high sensitivity in detecting GBS colonization. The high negative predictive value helps to avoid unnecessary use of antibiotics in uncolonized women.

Lifestyle modifications in the development of diabetes mellitus and metabolic syndrome in Chinese women who had gestational diabetes mellitus: a randomized interventional trial.

OBJECTIVES: To study whether lifestyle intervention can reduce the development of type II diabetes mellitus (DM) and metabolic syndrome (MS) among Chinese women who had gestational diabetes mellitus (GDM). METHODS: A prospective randomized controlled interventional trial of 450 women who had GDM and impaired glucose tolerance (IGT) postpartum. Advice on diet and exercise was given to the intervention group and reinforced in each follow-up visit. Women in both arms were followed for 36 months. Blood pressure and anthropometry were measured at each visit and blood tests were repeated. RESULTS: Fewer women in the intervention group developed DM (15 versus 19 %) but this was not statistically significant, and there was a lower incidence of DM among women over 40 years old. No difference was found in fasting glucose, insulin and homeostasis model assessment (HOMA) index. Both systolic and diastolic blood pressures, and triglyceride level, were lower but the significance was inconsistent among visits. BMI and percentage body fat were also significantly lower in the later visits. There was no difference in waist-hip ratio and basal metabolic rate. CONCLUSIONS: Our results demonstrate a trend towards lower incidence of type II DM within 3 years postpartum in GDM women given lifestyle advice, which also potentially offers protection against development of MS, in terms of lower blood pressure and triglyceride level. Women over 40 years old are more likely to benefit. Future studies should address ways to maximize compliance to lifestyle intervention as its potential benefits can be undermined by challenges of motherhood.

Prediction of women's long-term cardiometabolic risks using glycemic indices during pregnancy.

AIMS: To study the prediction of abnormal glucose tolerance (AGT), diabetes mellitus (DM), hypertension (HT) and metabolic syndrome (MetS) among Chinese women using glycemic indices in the mid-trimester of pregnancy. METHODS: A cohort of Chinese women who had had either normal glucose tolerance or gestational diabetes mellitus (GDM) during a pregnancy were assessed at a median of 8 and 15 years post-delivery. All women underwent a 50-g glucose challenge test (GCT) and a 75-g oral glucose tolerance test in the mid-trimester of the index pregnancy. A receiver operating characteristic curve was used to assess the prediction of AGT, DM, HT and MetS. RESULTS: All glycemic indices were significant predictors of AGT and DM, and the 2-h plasma glucose (PG) and GCT were predictive of HT, at both 8 and 15 years post-delivery. MetS can only be predicted by the fasting plasma glucose (FPG) and was confined to 15 years post-delivery. After adjustment for confounding variables, all glycemic indices were still independent predictors of AGT and DM at both 8 and 15 years post-delivery, except for FPG in predicting DM at 8 years, while only the 2-h PG remains an independent predictor of HT at 15 years. The optimal cut-off values for FPG, 2-h PG and GCT are 4.2 mmol/L, 7.2 mmol/L and 7.7 mmol/L, respectively; all are lower than the current cut-off thresholds for the screening and diagnosis of GDM. CONCLUSIONS: Women who had a glycemic level below the criteria for a positive screening test and below the diagnostic threshold for GDM still have a significant cardiometabolic risk.

Effects of skin pressure from compression legwear on resting salivary cortisol and urinary catecholamines excretion in women.

BACKGROUND: The benefits of compression legwear (CL) have been demonstrated in the improvement of vascular function and venous return of the lower extremities, but their effect on autonomic nervous system (ANS) activities and human stress response remain controversial. OBJECTIVE: To investigate the possible effects of CLs on ANS activities and in inducing stress on the human body. MATERIALS AND METHODS: Resting salivary cortisol and urinary catecholamine (adrenaline and noradrenaline) excretions were examined in 12 healthy women. The effects of different skin pressure levels exerted by CL were studied by conducting a 4-hour prolonged standing and sitting wear trial with intermittent sampling of the aforementioned biochemical parameters. RESULTS: No statistically significant differences in resting salivary cortisol and urinary catecholamines were found between control and different clothing pressure conditions (light, mild, moderate, and strong), although the secretion of salivary cortisol (SSC) showed a significant decrease during the 180 minutes of the testing period that was maintained up to 10 minutes after the CL was removed for the studied pressure conditions. Urinary excretion of adrenaline and noradrenaline decreased with increasing pressure levels and was lower in response to higher clothing pressure when tested in the afternoon. CONCLUSION: Constant pressure exerted by CL did not cause any stimulation of the sympathetic nervous system. The prolonged wearing of CL while standing or sitting did not induce any stress on the human body, suggesting that CL can be safely used in the treatment of patients with venous disorders of the lower extremities.

Mode of anaesthesia on fetal acid-base status at caesarean section.

OBJECTIVE: To study fetal acid-base status and its implications under different modes of anaesthesia for caesarean sections. METHODS: A prospective cohort study was conducted of 196 consecutive women with singleton non-anomalous fetuses who underwent either elective or emergency caesarean section after 36 completed weeks. Immediately after the baby was delivered, blood was drawn from the umbilical vein and one of the umbilical arteries and sent in ice for acid-base analysis. Maternal demographics, pre-existing medical conditions and antenatal complications were retrieved from antenatal records. Apgar scores and admissions to neonatal intensive care units (NICUs) were noted. RESULTS: Six women were excluded from analysis because the umbilical venous blood was either not collected or clotted. Another two were excluded because of placental abruption. The number of subjects that received spinal, epidural and general anaesthesia were 134, 36 and 18, respectively. Apgar scores were higher in spinal anaesthesia and epidural anaesthesia group (P<0.01). General anaesthesia was associated with a higher incidence of fetal acidaemia, both in the umbilical artery and vein. Spinal anaesthesia was associated with the highest pH in umbilical venous blood. Base excess in umbilical venous samples was highest in the spinal anaesthesia group (P=0.006), although pH values were similar for the three groups. There was no difference in admissions to NICU. CONCLUSIONS: This study provided evidence of the advantages of spinal anaesthesia over epidural and general anaesthesia. Our findings are in contrast with recent evidence in the literature.

Cardiometabolic risk in Chinese women with prior gestational diabetes: a 15-year follow-up study.

AIMS: The progression to type 2 diabetes mellitus (DM) and other long-term cardiometabolic risks in Chinese women with prior history of gestational diabetes (GD) was studied at 15 years postpartum. METHODS: 139 Chinese women (45 with GD and 94 with normal glucose tolerance (NGT) at the index pregnancy) who had their insulin sensitivity and ß-cell functions examined at 8 years postpartum were again followed up at 15 years for the investigation of the rate of type 2 DM, hypertension and metabolic syndrome. RESULTS: Women with prior history of GD had a significantly higher rate of hypertension (35.6% vs. 16.0%, p = 0.01), type 2 DM (24.4% vs. 5.3%, p < 0.001) and impaired glucose regulation (26.6% vs. 14.9%, p < 0.001) than women with NGT during the index pregnancy. The Matsuda insulin sensitivity index and the quantitative insulin sensitivity check index at 8 years postpartum were independent predictors of both DM and metabolic syndrome at 15 years postpartum. CONCLUSIONS: The conversion rate of type 2 DM increased at an average rate of 1.6% per year after a pregnancy affected by GD. Insulin resistance at 8 years postpartum could refine a future diabetic risk in women with prior history of GD.

Iron deficiency anaemia associated with increased placenta praevia and placental abruption: a retrospective case-control study.

BACKGROUND/OBJECTIVES: A few studies reported association between placenta praevia (PP) and placental abruption (PA) with maternal iron deficiency anaemia (IDA), which is not an established risk factor for these conditions. This retrospective case-control study was performed to determine the relationship between IDA with PP and PA. METHODS: Maternal characteristics, risk factors for and incidence of antepartum haemorrhage overall, and PP and PA, were compared between women with IDA only and controls without IDA or haemoglobinopathies matched for exact age and parity (four controls to each index case), who carried singleton pregnancy to ≥22 weeks and managed under our care from 1997 to 2019. RESULTS: There were 1,176 women (0.8% of eligible women in the database) with IDA only, who exhibited slightly but significantly different maternal characteristics, and increased antepartum haemorrhage overall (3.4% versus 2.2%, p = 0.031, OR 1.522, 95% CI 1.037-2.234) and PP (1.8% versus 0.9%, p = 0.010, OR 1.953, 95% CI 1.164-3.279), but not PA (1.2% versus 1.1%, p = 0.804, OR 1.077, 95% CI 0.599-1.936). When stratified by parity status, increased PP was found in nulliparous women only. On multivariate analysis adjusting for parity, previous abortion history, overweight and obesity, short stature, other antenatal complications as a composite factor, preterm (<37) delivery, previous caesarean delivery, and infant gender, IDA was associated with PP (aOR 3.485, 95% CI 1.959-6.200) and PA (aOR 2.181, 95% CI 1.145-4.155). CONCLUSIONS: Both PP and PA are increased in women with IDA, the prevention of which could be a means to reduce the occurrence of both PP and PA.

Hepatitis B - Vertical transmission and the prevention of mother-to-child transmission.

Hepatitis B virus (HBV) infection is the commonest cause of chronic hepatitis, with an estimated global prevalence of 3.5%, and which leads to significant morbidity and mortality. Mother-to-child transmission (MTCT) during pregnancy is the leading form of transmission in endemic populations, and its interruption is thus crucial as the initial step in the elimination of HBV infection, notwithstanding the availability of potent antiviral medications. The risk of MTCT is dramatically reduced by timely neonatal HBV vaccination and the administration of hepatitis B immunoglobulin after birth in high-risk infants. Maternal HBV DNA quantification during pregnancy allows the assessment of the risk of newborn immunoprophylaxis failure (IF). Maternal antiviral treatment in highly viremic women can reduce the risk of IF. However, the optimal HBV DNA cutoff level for the initiation of antiviral treatment remains to be determined.

Study on the applicability of frontomaxillary facial angle in the first-trimester trisomy 21 fetuses in Chinese population.

OBJECTIVE: To evaluate the measurement of frontomaxillary facial (FMF) angle at 11 weeks to 13 weeks, 6 days in a Chinese population and its applicability in the screening for fetal trisomy 21. METHOD: In a retrospective study, the stored images for the measurement of fetal nuchal translucency (NT) thickness in a Chinese population from August 2003 to March 2007 were reviewed for the comparison of the FMF angle between 22 trisomy 21 fetuses (study group) with 220 randomly selected normal fetuses with satisfactory images (control group). RESULTS: No association between FMF angle and NT, nasal bone length, or fetal heart rate was shown (P > 0.05). But the FMF angle was significantly greater in the trisomy 21 fetuses (89.7 vs 82.8, P < 0.001). The intraobserver and interobserver agreement were assessed in 9.5% (n = 21) normal cases. Mean (SD) differences of two observers were -0.83 (2.69) degrees (P > 0.05). For each observer, mean (SD) differences between the two paired measurements were -0.98 (3.11) degrees and 0.93 (1.80) degrees , respectively (P > 0.05). CONCLUSION: Our results indicated that measurement of the FMF angle in the first trimester can be incorporated into the screening of trisomy 21 in the Chinese population, and its application is not affected by intraobserver and interobserver variability.

Maternal height and length of gestation: does this impact on preterm labour in Asian women?

BACKGROUND: Both maternal height and ethnicity may influence the gestation length, but their independent effect is unclear. AIM: This study was performed to examine the relationship between maternal height and gestational length in women with singleton pregnancies in a Chinese and southeast Asian population. METHODS: A retrospective cohort study was performed on women carrying singleton pregnancies with spontaneous labour in a 48-month period managed under our department to determine the relationship between maternal height, expressed in quartiles, with the mean gestational age and incidence of preterm labour. RESULTS: Of the 16 384 women who delivered within this period, the 25th, 50th and 75th percentile values of maternal height were 153 cm, 156 cm and 160 cm respectively. Excluded from analysis were 6597 women because of multifetal pregnancy, teenage pregnancy (maternal age < or = 19 years old), induction of labour or elective caesarean section, or incomplete data due to no antenatal booking in our hospital. Significant differences were found in the maternal weight and body mass index, incidences of multiparity and smokers, gestational age and birthweight among the four quartiles. There was significantly increased incidence of preterm birth between 32 and 37 weeks gestation in women with shorter stature. CONCLUSIONS: In our population, maternal height has an influence on gestational length, and the lower three quartiles was associated with increased odds of labour at > 32 to < 37 weeks. This effect should be taken into consideration in the adoption of international recommendations in obstetric management and intervention.

Acceptance towards giving birth to a child with beta-thalassemia major - A prospective study.

OBJECTIVE: To explore the acceptance of pregnant Chinese women on giving birth to a child with beta-thalassemia major. MATERIALS AND METHODS: Women's acceptance on having a child with beta thalassemia major was assessed using standard gamble metrics during an interviewer-administered survey on 309 women recruited in the antenatal clinic. Utility scores were determined and the association with sociodemographic factors was assessed. RESULTS: The median utility score for having a child with beta-thalassemia major was 0.5 (0-0.65). Women having either higher educational level or family income had significantly higher utility scores (P < 0.05) corresponding to a higher acceptance. During the interview 59.9% participants indicated that they would elect to undergo a termination of pregnancy if their fetus was diagnosed with beta-thalassemia major but 26.5% participants were unable to decide what action they would take. CONCLUSION: Many Chinese pregnant women are ambivalent about giving birth to a baby with beta-thalassemia major. Women with higher educational level or higher family income had a higher acceptance towards the condition.

In Utero Exposure to Maternal Hyperglycemia Increases Childhood Cardiometabolic Risk in Offspring.

OBJECTIVE: The objective of this study was to evaluate the effect of maternal hyperglycemia during pregnancy on cardiometabolic risk in offspring during early childhood. RESEARCH DESIGN AND METHODS: A total of 970 mothers who had joined the Hyperglycemia and Adverse Pregnancy Outcome study were reevaluated, together with their child born during the study period, 7 years after delivery. RESULTS: Offspring born to mothers diagnosed with gestational diabetes mellitus (GDM), as defined by the World Health Organization 2013 GDM criteria, had higher rates of abnormal glucose tolerance (4.7% vs. 1.7%; P = 0.04), higher rates of overweight or obesity, greater BMI, higher blood pressure (BP), lower oral disposition index, and a trend toward reduced ß-cell function compared with those born to mothers without GDM. For each SD increase in maternal fasting, 1-h, and 2-h glucose levels on oral glucose tolerance tests (OGTTs) between 24 and 32 weeks of the index pregnancy, the risk of abnormal glucose tolerance in the offspring showed a corresponding increase (adjusted odds ratio [OR] 1.85-2.00). The associations were independent of BMI before pregnancy, childhood obesity, or being born large for gestational age. The area under the curve for glucose levels during the five-point OGTT increased to a similar extent in boys and girls with each SD increase in maternal 1-h and 2-h plasma glucose on OGTTs during pregnancy. All three maternal glucose levels were also associated with increased adjusted ORs for childhood overweight or obesity and adiposity among girls, but not boys. CONCLUSIONS: Maternal hyperglycemia in pregnancy is independently associated with offsprings' risk of abnormal glucose tolerance, obesity, and higher BP at 7 years of age. Its effect on childhood adiposity was apparent only in girls, not boys.

Development and validation of prediction models for endometrial cancer in postmenopausal bleeding.

OBJECTIVE: To develop and assess the accuracy of risk prediction models to diagnose endometrial cancer in women having postmenopausal bleeding (PMB). METHODS: A retrospective cohort study of 4383 women in a One-stop PMB clinic from a university teaching hospital in Hong Kong. Clinical risk factors, transvaginal ultrasonic measurement of endometrial thickness (ET) and endometrial histology were obtained from consecutive women between 2002 and 2013. Two models to predict risk of endometrial cancer were developed and assessed, one based on patient characteristics alone and a second incorporated ET with patient characteristics. Endometrial histology was used as the reference standard. The split-sample internal validation and bootstrapping technique were adopted. The optimal threshold for prediction of endometrial cancer by the final models was determined using a receiver-operating characteristics (ROC) curve and Youden Index. The diagnostic gain was compared to a reference strategy of measuring ET only by comparing the AUC using the Delong test. RESULTS: Out of 4383 women with PMB, 168 (3.8%) were diagnosed with endometrial cancer. ET alone had an area under curve (AUC) of 0.92 (95% confidence intervals [CIs] 0.89-0.94). In the patient characteristics only model, independent predictors of cancer were age at presentation, age at menopause, body mass index, nulliparity and recurrent vaginal bleeding. The AUC and Youdens Index of the patient characteristic only model were respectively 0.73 (95% CI 0.67-0.80) and 0.72 (Sensitivity=66.5%; Specificity=68.9%; +ve LR=2.14; -ve LR=0.49). ET, age at presentation, nulliparity and recurrent vaginal bleeding were independent predictors in the patient characteristics plus ET model. The AUC and Youdens Index of the patient characteristic plus ET model where respectively 0.92 (95% CI 0.88-0.96) and 0.71 (Sensitivity=82.7%; Specificity=88.3%; +ve LR=6.38; -ve LR=0.2). Comparison of AUC indicated that a history alone model was inferior to a model using ET alone (difference=0.19, 95% CI 0.15-0.24; p<0.0001) and History plus ET (difference=0.19, 95% CI 0.16-0.23, p<0.0001) and history plus ET was similar to that of using ET alone (difference=0.001 95% CI -0.015 to 0.0018, p=0.84). CONCLUSIONS: A risk model using only patient characteristics showed fair diagnostic accuracy. Addition of patient characteristics to ET did not improve the diagnostic accuracy as compared to ET alone in our cohort.

Normal range of intracranial translucency (IT) assessed by three-dimensional ultrasound at 11 + 0 to 13 + 6 weeks in a Chinese population.

OBJECTIVES: To establish the reference range of intracranial translucency (IT) in the first trimester in a Chinese population. METHODS: In a prospective study from March 2007 to June 2007, three-dimensional (3D) volumes of the fetal profile in the mid-sagittal plane were recorded from 102 normal pregnancies screened for trisomy 21 by the combination of fetal nuchal translucency (NT) thickness, maternal serum free ß-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks. 3D volumes were examined using multiplanar techniques. In the mid-sagittal plane the fourth ventricle presents as an (IT between the brain stem and choroid plexus. The anteroposterior diameter of IT in each case was measured. The relationship between IT with the other parameter was also examined. RESULTS: The IT at first trimester ranged from 1.35 to 2.6 mm. There was no significant association between IT with NT, and serum biochemistry. The intraobserver and interobserver agreement was assessed in 20 (19.6%) normal cases. Mean (SD) differences of two observers was -0.015 (0.132) mm (p > 0.05). For each observer, mean (SD) between the 2 paired measurements were -0.001 (0.097) mm, and 0.010 (0.085) mm, respectively (p > 0.05). CONCLUSIONS: In the first trimester, the reference range of IT in Chinese fetuses has been established. The assessment of IT is feasible and reproducible.

The association between in utero hyperinsulinemia and adolescent arterial stiffness.

AIM: To determine the relationship between in utero hyperinsulinemia and children's arterial stiffness at adolescence. METHODS: Indices of arterial stiffness were measured using the SphygmoCor apparatus in 129 adolescents (42 offsprings of mother with gestational diabetes and 87 offsprings of mother with normal glucose tolerance during pregnancy) at 15 years of age. RESULTS: Adolescent of mothers with gestational diabetes had similar central aortic blood pressure, augmentation pressure (AP), augmentation index (AI), and carotid-femoral pulse wave velocity (PWV) as that of controls. However, both umbilical cord C-peptide and insulin levels correlated positively AI (R=0.28 and 0.24; p=0.011 and 0.035, respectively), and umbilical insulin level correlated positively with AP (R=0.25; p=0.025). The correlations were significant between umbilical cord C-peptide and AP (R=0.24; p=0.035) and AI (R=0.29; p=0.011) after adjustment for subjects' age, sex, body weight and height. Adolescents who had umbilical cord C-peptide levels at highest quartile (n=25), based on the reference ranges of the original cohort, had a significant greater PWV (5.26±0.12 m/s vs 4.98±0.12 m/s; p=0.0049) than those with C-peptide levels at the lower 3 quartiles (n=57) after adjustment for age, sex, body weight and height. CONCLUSIONS: In utero hyperinsulinemia appears to increase the offspring's arterial stiffness at early adolescence.

Frontomaxillary facial angle at 11 + 0 to 13 + 6 weeks in Chinese population.

OBJECTIVES: To establish the normal range of frontomaxillary facial (FMF) angle in the first trimester in a Chinese population. METHODS: In a prospective study from March 2007 to June 2007, three-dimensional (3D) volumes of the fetal profile in the mid-sagittal plane were recorded from 129 Chinese pregnant women who were screened for trisomy 21 by the combination of fetal nuchal translucency (NT) thickness, maternal serum free ß-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 to 13 + 6 weeks. 3D volumes were examined using multiplanar techniques. The FMF angle of each case was measured. The relationship between the measured FMF angle with the other parameter was also examined. RESULTS: The mean FMF angle decreased from 86.8 degree for a crown-rump length (CRL) of 45 mm to 76.0 degree for a CRL of 84 mm (FMF angle = 99.49 - 0.28 x CRL, r=0.377, p<0.0001). There was no significant association between the FMF angle with serum PAPP-A or ß-hCG. The mean (SD) difference between FMF angle derived from Chinese formula and that from the published Caucasian equation was 1.47 (0.61) (95% CI 1.37-1.58) (p<0.0001). CONCLUSIONS: In the first trimester, the FMF angle decreases with fetal CRL. There was similarity in the normal value of FMF angle between the Chinese and Caucasian populations.

Randomised trial of assigned mode of delivery after a previous cesarean section--impact on maternal psychological dynamics.

OBJECTIVE: This randomised trial was designed to study the psychological status and morbidity during and after delivery among women with a previous cesarean section (CS) who were randomised to planned vaginal birth (VBAC) or planned CS. METHODS: Two hundred and ninety-eight women with one previous lower segment CS were randomised to either planned VBAC or planned CS. Women were asked to complete psychometric scales during their pregnancy till 6 months after confinement. The primary outcome studied was the differences in psychometric scores between the two study groups. RESULTS: There were no differences in anxiety, depression, psychological well-being or satisfaction scores between the two groups. Significantly more women in planned VBAC (27/123) requested to change to elective CS, compared to those who were randomised to planned CS (15/135) initially requested to change to planned VBAC (OR: 2.25; 95% CI: 1.13-4.47). Subgroup analyses showed that women who changed from planned CS to VBAC had lower satisfaction at delivery [Client Satisfaction Score: 24.0 (23.0-24.3), 23.0 (22.0-24.0); p=0.009] compared to women who did not change their plan for elective CS. CONCLUSIONS: The planned mode of delivery, either elective CS or VBAC, in pregnant women who had one previous CS did not influence the psychological dynamic during the course of or after the pregnancy. VBAC was not associated with higher psychological morbidity and therefore should be encouraged.