The incidence of pregnancy-induced hypertension among patients with carbohydrate intolerance.

OBJECTIVE: To determine the association between pregnancy-induced hypertension (PIH) and carbohydrate intolerance in pregnancy. METHODS: Data on singleton pregnancies were retrieved from the obstetric database of University Hospital, Kuala Lumpur. Gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM) were defined according to the World Health Organization criteria. Established diabetes mellitus (EDM) was defined as diabetes mellitus diagnosed prior to pregnancy. PIH was diagnosed according to the criteria of the International Society for the Study of Hypertension in Pregnancy. Maternal characteristics were compared between groups using analysis of variance (ANOVA) and incidence counts using the chi-squared test. Logistic regression analysis using the presence of PIH as the response variable was used to study the association among GDM, GIGT, EDM, and PIH, controlling for maternal factors. MAIN OUTCOME MEASURES: To determine the incidence of PIH among patients with glucose intolerance and the independent risk factors for the development of PIH. RESULTS: There were 24,290 singleton pregnancies retrieved from the database. Both the prevalence of carbohydrate intolerance and the incidence of PIH differed among the three principal ethnic groups (p < 0.0001). There was a significant association between PIH and both a higher maternal age (OR = 1.04, p < 0.0001) and a higher maternal body mass index (BMI) at delivery (OR = 1.14 per unit increment, p < 0.0001). After adjusting for maternal age, BMI, parity, and ethnic origin, using logistic regression, there was a significant residual risk of PIH among individuals with GIGT, GDM, or EDM. CONCLUSIONS: Patients with carbohydrate intolerance of varying severity are at increased risk of developing PIH. Our findings lend credence to the theory that carbohydrate intolerance and PIH share a common etiology.

Pregnancy outcome beyond 41 weeks gestation.

OBJECTIVE: To determine maternal and perinatal morbidity and the spontaneous labor rate beyond 41 weeks of gestation. METHOD: Patients with uncomplicated pregnancy were recruited at 41 weeks and screened for fetal or maternal well-being. Following observation between 41 and 42 weeks, patients were randomized to either serial monitoring by cardiotocography and measurement of amniotic fluid index, or to immediate induction. Comparisons were made using the chi(2) test. Results after 42 weeks were analyzed according to intention at randomization. RESULTS: Morbidity was not increased before 42 weeks. After 42 weeks, the cesarean section rate and incidence of meconium below the vocal cords were increased in monitored patients. The median gestational age in patients who were monitored was 298.5 (294-321) days. In patients observed from 41 weeks, 91.6% labored spontaneously. CONCLUSION: It is reasonable to observe uncomplicated pregnancy until 42 weeks with adequate monitoring. After 42 weeks, induction of labor is preferred.

The accuracy of references in the Hong Kong Medical Journal.

We have reviewed the reference citations in volume 1 (1995) and volume 2 (1996) of the Hong Kong Medical Journal to determine their accuracy. One hundred references were randomly selected from each volume. After excluding references not from indexed journals, all citations were examined in detail by dividing them into six component elements and comparing them with the original. We found that 61% of references in volume 1 and 51% of references in volume 2 contained inaccuracies, giving an overall error rate of 56%. Thirty-eight percent of references contained errors in one element, 16% contained errors in two elements, and 2% contained errors in three or more elements. The most common errors were those of the title or authors' names. The rate of citation errors in the Hong Kong Medical Journal is at the high end of the range compared with other medical journals. Contributors to this journal need to take more care in checking their references before publication.

Caesarean section in a patient with paramyotonia congenita.

This case report details spinal anaesthesia for an elective caesarean section in a patient with the rare condition of paramyotonia congenita. There are few case reports of anaesthesia in this condition and none in the Australian anaesthetic literature. This case highlights the need for the avoidance of hypothermia and depolarizing muscle relaxants, the safety of spinal anaesthesia and a conservative approach to the management of plasma potassium concentration. The subsequent review outlines the current literature and discusses other issues involved in the anaesthetic management of this disorder.

Incidence of preterm delivery in Hong Kong Chinese.

A retrospective analysis of the obstetric database between January, 1995 and December, 1996 was conducted to establish the rate of preterm birth and the incidence of babies with low birth-weight amongst Hong Kong Chinese in an obstetric teaching unit in Hong Kong, and to investigate possible risk factors for spontaneous preterm deliveries. In the series of 13,641 Chinese women who delivered during the study period, the incidence of preterm births before 37 weeks' gestation was 7.4% while the incidence of low birth-weight infants (<2,500g) was 6.4%. When only singleton pregnancies were included, the incidences of preterm births and low birth-weight were 6.5% and 5.1% respectively. This study has demonstrated results contrary to the belief that premature delivery is uncommon in a Chinese population. In addition, we have found that, similar to Caucasian populations, hypertensive disorders of pregnancy, gestational diabetes, antepartum haemorrhage and congenital malformation are significant risk factors for spontaneous preterm labour in singleton pregnancy in our Chinese population.

How accurate are references in the Australian and New Zealand Journal of Surgery?

BACKGROUND: The accuracy of reference citations in The Australian and New Zealand Journal of Surgery was evaluated. All of the references from 1995 (Volume 65) were included (n = 4092). METHODS: A sample of 100 references was randomly selected and examined in detail by comparison with the original references. RESULTS: Overall, 60% of citations contained errors. Errors were categorized by dividing references into six elements. A total of 38.8% of citations contained an error in one element, 15.6% contained errors in two elements, 4.4% contained errors in three elements, and 4.4% contained errors in four elements of the reference. The most common errors were errors of authors' names and errors in the title. CONCLUSIONS: Contributors to this journal should take more care in checking references in the manuscripts before publication.

The quality of citations in major international obstetrics and gynecology journals.

OBJECTIVE: Our goal was to determine the error rate in references in articles published in three major international journals in obstetrics and gynecology. STUDY DESIGN: All issues (excluding supplements) for the year 1995 of the American Journal of Obstetrics and Gynecology, the Australian and New Zealand Journal of Obstetrics and Gynaecology, and the British Journal of Obstetrics and Gynaecology were examined. References were numbered sequentially, and 50 randomly selected references from each journal were checked against the original for accuracy. RESULTS: Errors were found in the majority of references. The lowest error rate was 55.6% from the Australian and New Zealand Journal of Obstetrics and Gynaecology, and the highest was 66.7% from the British Journal of Obstetrics and Gynaecology. The difference between journals was not statistically significant. The most frequent types of error were in the title of the article or in the authors' names. CONCLUSIONS: Error rates in major international journals in obstetrics and gynecology are high, and care must be taken by authors and journal staff to improve the quality of published articles.

Perioperative documentation: are we doing enough?

We performed a retrospective analysis to assess the content and accuracy of operative and anaesthetic records for Caesarean section in a large unit. The obstetric record was considered adequate if it included patient identification, participating doctors, operative date, title, details and findings and a signature. The anaesthetic record was evaluated by The Australian and New Zealand College of Anaesthetists guidelines. We analysed 104 operative and 101 anaesthetic records. There was inadequate identification in 17 (16.3%) of the operative records. Documentation of a previous scar or the presence or absence of intraabdominal adhesions was incomplete in 22 of the 35 patients (63%) with a previous laparotomy. Sixty per cent of records had incomplete skin closure information. Common anaesthetic record deficiencies were patient position, patient airway, investigation results and postoperative plan. Our findings identified deficiencies that could lead to inadequate medical care and indicate the need for improved standards of perioperative records.

Evaluation of glucose intolerance in pregnancy using biochemical markers of fetal hyperinsulinemia.

We aimed to evaluate gestational impaired glucose tolerance (GIGT) in untreated patients using umbilical cord blood insulin and connecting peptide (C-peptide) concentrations to indicate fetal hyperinsulinemia. A 75 g, 2-hour oral glucose tolerance test, evaluated using WHO criteria, was performed in 722 antenatal patients. Cord C-peptide (p = 0.001) and insulin (p = 0.008) concentrations were significantly higher in patients with GIGT in comparison to those with normal glucose tolerance. The WHO test failed to identify abnormal C-peptide concentrations (p = 0.057), but did identify abnormal insulin concentrations (p = 0.006) and cases where either or both were raised (p = 0.002), with a low Youden's index (range 8.1-11.3) in all 3 cases. A significant biochemical difference exists in patients with GIGT. The WHO criteria for GIGT predict abnormal biochemical outcomes, but they do so poorly.

Phytoestrogens: dietary intake and excretion in postmenopausal Chinese women.

OBJECTIVES: The aims of this study were to estimate the dietary intake of phytoestrogens and to measure urinary phytoestrogen excretion in postmenopausal Chinese women. METHODS: Postmenopausal Chinese women were recruited from the hormone replacement clinic of the Prince of Wales Hospital. Dietary intake of phytoestrogen-rich foods was estimated using a food frequency questionnaire. Urinary output of the isoflavonoids daidzein and genistein and the metabolite of daidzein, equol, was measured using high-performance liquid chromatography. RESULTS: The mean daily excretion of daidzein, genistein and equol was 3.24 (+/- 3.63), 1.47 (+/- 1.75) and 0.64 (+/- 1.53) mumol, respectively. The total mean daily isoflavonoid excretion was 5.36 (+/- 5.27) mumol. CONCLUSIONS: Urinary excretion of isoflavonoid phytoestrogens in this Chinese population was lower than that reported in Japanese subjects. This may be due to the higher consumption of legumes, especially soy products, in the Japanese compared to the Chinese diet. The intake of green vegetables was higher in the Chinese subjects, and this food group may be the main contributor to their total phytoestrogen intake.