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Currently, popular methods for prenatal risk assessment of fetal aneuploidies are based on multivariate probabilistic modelling, that are built on decades of scientific research and large-scale multi-center clinical studies. These static models that are deployed to screening labs are rarely updated or adapted to local population characteristics. In this article, we propose an adaptive risk prediction system or ARPS, which considers these changing characteristics and automatically deploys updated risk models. 8 years of real-life Down syndrome screening data was used to firstly develop a distribution shift detection method that captures significant changes in the patient population and secondly a probabilistic risk modelling system that adapts to new data when these changes are detected. Various candidate systems that utilize transfer -and incremental learning that implement different levels of plasticity were tested. Distribution shift detection using a windowed approach provides a computationally less expensive alternative to fitting models at every data block step while not sacrificing performance. This was possible when utilizing transfer learning. Deploying an ARPS to a lab requires careful consideration of the parameters regarding the distribution shift detection and model updating, as they are affected by lab throughput and the incidence of the screened rare disorder. When this is done, ARPS could be also utilized for other population screening problems. We demonstrate with a large real-life dataset that our best performing novel Incremental-Learning-Population-to-Population-Transfer-Learning design can achieve on par prediction performance without human intervention, when compared to a deployed risk screening algorithm that has been manually updated over several years.

Pregnancy presents a teachable moment to engage male smokers whose partners are pregnant in smoking cessation. Evidence on how to approach and help these smokers quit smoking in antenatal settings has remained scarce. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a brief intervention model for promoting smoking cessation in expectant fathers.BANSAR is a pragmatic randomised controlled trial conducted in antenatal clinic in seven public hospitals in Hong Kong, China. An estimated 1148 fathers who smoke at least one cigarette daily and whose partners are pregnant and non-smoking will be randomised (1:1) to receive brief advice combined with 1-week sample of nicotine replacement therapy (NRT) and active referral to smoking cessation services, or brief advice only (usual care). Outcome will be assessed at 3 and 6 months after treatment initiation. The primary outcome is carbon monoxide-verified (4 part per million) abstinence at 6 months post-treatment initiation. Secondary outcomes include self-reported 7-day point-prevalence abstinence and 24-week continuous abstinence, use of smoking cessation service and NRT and quit attempt, and smoking reduction, change in nicotine dependence and intention to quit in continuing smokers.This trial will provide real-world evidence on the effectiveness of a combined brief intervention model for smoking cessation in expectant fathers, an understudied population. The findings may be particularly relevant to low and middle-income countries, where male-to-female smoking ratios and birth rates tend to be higher than higher-income countries.ClinicalTrials.gov, number NCT03671707.

The administration of aspirin16 weeks gestation to women who are at high risk for preeclampsia has been shown to reduce the rate of preterm preeclampsia by 65%. The traditional approach to identify such women who are at risk is based on risk factors from maternal characteristics, obstetrics, and medical history as recommended by the American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. An alternative approach to screening for preeclampsia has been developed by the Fetal Medicine Foundation. This approach allows the estimation of patient-specific risks of preeclampsia that requires delivery before a specified gestational age with the use of Bayes theorem-based model.The purpose of this study was to examine the diagnostic accuracy of the Fetal Medicine Foundation Bayes theorem-based model, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence recommendations for the prediction of preterm preeclampsia at 11-13There were 224 women (2.05%) who experienced preeclampsia, which included 73 cases (0.67%) of preterm preeclampsia. In pregnancies with preterm preeclampsia, the mean multiples of the median values of mean arterial pressure and uterine artery pulsatility index were significantly higher (mean arterial pressure, 1.099 vs 1.008 [P.001]; uterine artery pulsatility index, 1.188 vs 1.063[P=.006]), and the mean placental growth factor multiples of the median was significantly lower (0.760 vs 1.100 [P.001]) than in women without preeclampsia. The Fetal Medicine Foundation triple test achieved detection rates of 48.2%, 64.0%, 71.8%, and 75.8% at 5%, 10%, 15%, and 20% fixed false-positive rates, respectively, for the prediction of preterm preeclampsia. These were comparable with those of previously published data from the Fetal Medicine Foundation study. Screening that used the American College of Obstetricians and Gynecologists recommendations achieved detection rate of 54.6% at 20.4% false-positive rate. The detection rate with the use of National Institute for Health and Care Excellence guideline was 26.3% at 5.5% false-positive rate.Based on a large number of women, this study has demonstrated that the Fetal Medicine Foundation Bayes theorem-based model is effective in the prediction of preterm preeclampsia in an Asian population and that this method of screening is superior to the approach recommended by American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. We have also shown that the Fetal Medicine Foundation prediction model can be implemented as part of routine prenatal care through the use of the existing infrastructure of routine prenatal care.

Objective To assess the impact of intimate partner violence (IPV) against pregnant women on subsequent perpetration of child abuse and neglect (CAN) by parents; and to test the mediation effect of recent IPV on the link between IPV during pregnancy and subsequent CAN. Methods This study was a longitudinal follow-up of a population-based study on pregnancy IPV conducted in antenatal clinics in 7 public hospitals in Hong Kong in 2005. Of all participants in the 2005 study, we recruited 487 women (with 184 having reported pregnancy IPV in the 2005 study) with newborn babies for a follow-up telephone interview in 2008. Participants responded to the Abuse Assessment Screen (AAS), the Parent-Child Conflict Tactics Scale, and some questions assessing demographic information. Results The most common form of physical violence was corporal punishment, with a prevalence rate of 75.1% in the preceding year and 75.4% over their lifetime. Physical maltreatment was less likely to be reported, accounting for 4.7% in the preceding year and 4.9% over their lifetime. The preceding-year and lifetime prevalence rates of neglect were 11.3% and 11.5%, respectively. Findings from logistic regression analyses showed that IPV experienced by participants during pregnancy was associated with greater odds of both lifetime (aOR = 1.74) and preceding-year child physical maltreatment (aOR = 1.78). Results of the regression analyses also provided supportive evidence for the mediation effect of recent IPV victimization on the relationship between IPV during pregnancy and recent CAN against children. Conclusion IPV against women during pregnancy predicted subsequent CAN on newborns in Chinese populations. This underscores the importance of screening pregnant women for IPV in order to prevent CAN at an early stage. Home visitations are suggested to break the cycle of violence within a nuclear family.

Tsz Kin Lo, Wai Lam Lau, Wing Cheong Leung Kwong Wah Hospital, Obstetrics & Gynecology, Hong Kong, China OBJECTIVE: To review and share our experience in conservative management of placenta accreta during cesarean delivery. STUDY DESIGN: From 2006, cesarean delivery in our unit for cases high risk for accreta (placenta previa with either uterine scar, sonographic evidence of accreta, or both) followed a proforma, which included insertion of femoral sheaths by radiologist before operation, classical cesarean section if necessary to avoid placental incision, leaving behind adherent part of placenta should it fail to separate, followed by uterine artery embolization (UAE) and/or other appropriate hemostatic measures. Postpartum, 2-week antibiotics was given. Cases managed this way with accreta confirmed intra-operatively were included in this review. The clinical details were retrieved from the case notes for individual cases. RESULTS: A total of 12 cases of accreta had the adherent part of their placenta left behind during caesarean section. (Table) Absence of sonographic features of accreta was not associated with smaller extent of placental retention or less intra-operative blood loss. Those with 50% of placenta left behind due to lack of separation from placental bed had lower risk of heavy bleeding intra-operatively compared to those with 50% of placenta retained (bleeding 3000ml: 14% vs 60%, significant clinically although statistically p 0.222) but higher chance of passing placental tissue postpartum (passage rate 71% vs 0%, p 0.028) The extent of placenta left behind, while not affecting the timing of menstrual return, correlated positively with the time taken for sonographic resolution of retained placenta (p 0.012). CONCLUSION: It’s our experience that in high risk cases (major placenta previa with uterine scar), sonographic features have relatively low sensitivity for accreta. A dedicated proforma to leave accreta untouched intra-operatively allows high risk cases to be delivered safely. The postpartum course is favorable. 166 The peri-partum period is characterized by a major alteration in brain neurotransmitters levels–a possible connection to postpartum depression Yael Hants, Yosefa Avraham, David Mankuta, Lia Vorobeiv, Shira Merchavia, Eithan Galun, Elliot Berry, Sagit Arbel-Alon Hadassah Hebrew University Medical Center, Obstetrics & Gynecology, Jerusalem, Israel, Hadassah Hebrew University Medical Center, Goldyne Savad Institute of Gene Therapy, Jerusalem, Israel, Hadassah Hebrew University Medical Center, Clinical Nutrition, Jerusalem, Israel OBJECTIVE: Postpartum depression (PPD) which affects 10% to 15% of pregnant women is detrimental to both mother and child. The mechanisms of PPD development are poorly understood. It was recently shown that the placenta is the source of fetal brain serotonin levels and essential for normal fetal brain development. This observation raised a thought that the placenta could also affect maternal serotonin levels, and that upon delivery, major abrupt serotonin level changes take place that may lead to PPD. In this study we investigated the levels of brain serotonin and catecholamines at different stages of pregnancy including midpregnancy, prepartum and postpartum periods. STUDY DESIGN: We monitored the levels of brain catecholamines, serotonin and their metabolites of 48 BALB/C mice, 12 weeks old which were divided into five experimental groups: control (10 mice, not pregnant), on days 11, 16 and 19 of pregnancy (11 mice each group) and one week postpartum (5 mice). The levels of serotonin, tryptophan, norepinephrine and dopamine were assessed in the hypothalamus, hippocampus, and striatum performed by HPLC-ECD and GC-MS while the assessment of 5HT1A message levels were performed by Real Time PCR. Characteristics of 20 cases of PPH