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The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks’ gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different ( p >0.05). There was no significant association between gestational age at delivery and log 10 sFlt-1 and log 10 sFlt-1 MoM ( p >0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-13 weeks’ gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.

Objective To examine attitudes toward prenatal testing and termination of pregnancy (TOP) among parents and obstetric providers in relation to their views on raising a child with disability. Methods An explanatory sequential mixed methods study. A survey among 274 parents and 141 providers was followed by interviews with 26 parents and 10 providers. Using multivariate analysis, the relationships between attitudes were examined. Thematic analysis was used to identify the reasons behind the attitudes. Results In comparison with providers, parents reported more positive attitudes toward raising a child with disability and more moral views about TOP. Providers reported more variations in attitudes toward offering prenatal testing and TOP. Significant associations were found between attitudes toward prenatal testing, raising a child with disability, reproductive autonomy, and TOP. Three major themes were identified: (1) meanings of parenthood from genetic tests; (2) views toward TOP and parental responsibility; and (3) implications of advanced extended prenatal genetic testing. Conclusions Perceived social–cultural norms of disabilities and parental expectations of raising a child with disability influence decision-making regarding TOP. Practice Implications As more conditions of the fetus are able to be detected, the social–cultural implications of the technology and disabilities need to be addressed in antenatal care.

Background: A population-based reference interval (RI) of thyroid hormones in pregnancy using a standardized methodology is crucial for clinicians to make accurate diagnoses and important for the comparison of test results obtained from different analytic platforms. Methods: We enrolled 600 healthy Chinese women to obtain longitudinal serum samples across gestation, after exclusion of subjects with antibodies to thyroid peroxidase, thyroglobulin or thyrotropin receptor. Gestational age-specific RIs were constructed by using polynomial regression equations with MLwiN. Results: Free thyroxine (fT4) levels rose to a peak at the 7th-8th gestational weeks and then declined gradually till 28th week, while thyrotropin (TSH) level decreased from early pregnancy to a nadir at the 9th week. The data support the recent notion by the American Thyroid Association to raise the TSH upper RI to 4.0 mIU/L. We also demonstrate that thyroid hormone reference ranges are not affected in a mildly iodine-deficient population and by including women with the presence of antibodies against thyroid peroxidase and thyroglobulin who are otherwise healthy. Conclusions: The study highlights a methodology in constructing gestational age-specific thyroid function test RIs on different analytic platforms to provide a better interpretation and comparison of results obtained across different platforms.

To evaluate second-trimester Down syndrome screening performance of the new ThermoFisher BRAHMS GOLD unconjugated estriol (uE3) and inhibin-A assays. Serum samples were analyzed for levels of uE3 and inhibin-A using the ThermoFisher BRAHMS GOLD immunoanalyzer and compared to other platforms. Levels were transformed to multiples of the median (MoM) in unaffected pregnancies. Log10 MoM distributions in unaffected and Down syndrome pregnancies were assessed for central tendency (mean) and dispersion (SD). Empirical and estimated screening performances were determined. Correlation between BRAHMS and AutoDELFIA® uE3 and inhibin-A were 0.63 and 0.97, respectively, the respective mean difference was 31.3% [95%CI 50.2% to -112.8%] and -23.3% [95%CI -41.9% to -4.7%]. Passing-Bablok indicated significant systematic (-2.78 [95%CI -3.57 to -2.04]) and proportional bias (1.30 [95%CI 1.15 to -1.47]) between uE3 assays and significant proportional bias (0.71[95%CI 0.65-0.78]) between inhibin-A assays. The uE3 and inhibin-A log10 MoM distribution mean [SD] in unaffected and Down syndrome pregnancies were 0.0024 [SD = 0.2341] and -0.0001 [SD = 0.2078], and -0.2028 [SD = 0.2495] and 0.3645 [SD = 0.2576], respectively. The new BRAHMS uE3 and inhibin-A assays had an 81-83% detection rate for Trisomy21 for a 5% false-positive rate. The new BRAHMS assays achieved the expected screening performance provided the risk estimation model is adjusted to account for the higher BRAHMS uE3 MoM measurement distribution variance.

Objectives: To assess whether adding placental growth factor (PlGF) or replacing pregnancy-associated plasma protein-A (PAPP-A) improves the first trimester combined test performance for trisomy 21. Design: Prospective observation Cohort Setting: The Chinese University of Hong Kong, China Sample: 11,518 women having a singleton pregnancy screened for trisomy 21 between December 2016 and December 2019 using the first trimester combined test. Methods: PlGF was prospectively measured and estimated term risk for trisomy 21 was calculated by 1) replacing PAPP-A with PlGF and 2) adding PlGF to the combined test which includes nuchal translucency, PAPP-A and free β-human chorionic gonadotropin (hCG). Main Outcome Measure: Screening performance, area under curve (AUC), detection rate (DR), screen positive rate (SPR) and false positive rate (FPR) Results: 29 women had trisomy 21. The combined tests DR, FPR and SPR were 89.7%, 5.7% and 6% respectively. DR when replacing PAPP-A or adding PlGF to the combined test remained unchanged. Replacing PAPP-A by PlGF increased FPR and SPR to 6.2% and 6.4% respectively. Adding PlGF to the combined test gave FPR and SPR rates of 5.5% and 5.7% respectively. Adding or replacing PlGF did not give a significant increase in AUC (p>0.48) over that of the combined test. Conclusion: Adding PlGF to the combined test or replacing PAPP-A with PlGF in the combined test did not improve trisomy 21 detection rate. Replacing PAPP-A by PlGF increased SPR, whilst adding PlGF resulted in only a marginal reduction in SPR.

INTRODUCTION Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision-to-delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia-to-delivery or decision-to-delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse. MATERIAL AND METHODS This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia-to-delivery, deceleration-to-delivery, and decision-to-delivery were performed for the different groups with Spearman test. RESULTS There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision-to-delivery interval in any of the groups, but they were inversely correlated with bradycardia-to-delivery interval in Group 1 (Spearman's ρ = -.349; P = .043 and Spearman's ρ = -.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia-to-delivery interval in Group 1 (95% CI 0.0180-0.0003). The risk of significant acidosis (pH 20 minutes, and 17.2% when the interval was

Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early-onset disease requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. Evidence suggests that the administration of low-dose aspirin initiated before 16 weeks' gestation significantly reduces the rate of preterm preeclampsia. Therefore, it is important to identify pregnant women at risk of developing preeclampsia during the first trimester of pregnancy, thus allowing timely therapeutic intervention. Several professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) and National Institute for Health and Care Excellence (NICE) have proposed screening for preeclampsia based on maternal risk factors. The approach recommended by ACOG and NICE essentially treats each risk factor as a separate screening test with additive detection rate and screen-positive rate. Evidence has shown that preeclampsia screening based on the NICE and ACOG approach has suboptimal performance, as the NICE recommendation only achieves detection rates of 41% and 34%, with a 10% false-positive rate, for preterm and term preeclampsia, respectively. Screening based on the 2013 ACOG recommendation can only achieve detection rates of 5% and 2% for preterm and term preeclampsia, respectively, with a 0.2% false-positive rate. Various first trimester prediction models have been developed. Most of them have not undergone or failed external validation. However, it is worthy of note that the Fetal Medicine Foundation (FMF) first trimester prediction model (namely the triple test), which consists of a combination of maternal factors and measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has undergone successful internal and external validation. The FMF triple test has detection rates of 90% and 75% for the prediction of early and preterm preeclampsia, respectively, with a 10% false-positive rate. Such performance of screening is superior to that of the traditional method by maternal risk factors alone. The use of the FMF prediction model, followed by the administration of low-dose aspirin, has been shown to reduce the rate of preterm preeclampsia by 62%. The number needed to screen to prevent 1 case of preterm preeclampsia by the FMF triple test is 250. The key to maintaining optimal screening performance is to establish standardized protocols for biomarker measurements and regular biomarker quality assessment, as inaccurate measurement can affect screening performance. Tools frequently used to assess quality control include the cumulative sum and target plot. Cumulative sum is a sensitive method to detect small shifts over time, and point of shift can be easily identified. Target plot is a tool to evaluate deviation from the expected multiple of median and the expected median of standard deviation. Target plot is easy to interpret and visualize. However, it is insensitive to detecting small deviations. Adherence to well-defined protocols for the measurements of mean arterial pressure, uterine artery pulsatility index, and placental growth factor is required. This article summarizes the existing literature on the different methods, recommendations by professional organizations, quality assessment of different components of risk assessment, and clinical implementation of the first trimester screening for preeclampsia.

Introduction A scoring system combining clinical history and simple ultrasound parameters was developed to predict early pregnancy viability beyond the first trimester. The scoring system has not yet been externally validated. This study aimed to externally validate this scoring system to predict ongoing pregnancy viability beyond the first trimester. Methods This prospective observational cohort study enrolled women with singleton intrauterine pregnancies before 12 weeks of gestation. Women underwent examination and ultrasound scan to assess gestational sac size, yolk sac size, and fetal pulsation status. A pregnancy-specific viability score was derived in accordance with the Bottomley score. Pregnancy outcomes at 13 to 16 weeks were documented. Receiver-operating characteristic curve analysis was used to assess the discriminatory performance of the scoring system. Results In total, 1508 women were enrolled; 1271 were eligible for analysis. After adjustment for covariates, miscarriage (13%) was significantly associated with age ≥35 years (odds ratio [OR]=1.99, 95% confidence interval [CI]: 1.19-3.34), higher bleeding score (OR=2.34, 95% CI: 1.25-4.38), gestational age (OR=1.17, 95% CI: 1.13-1.22), absence of yolk sac (OR=4.73, 95% CI: 2.11-10.62), absence of fetal heart pulsation (OR=3.57, 95% CI: 1.87-6.84), mean yolk sac size (OR=1.25, 95% CI: 1.06-1.47), and fetal size (OR=0.82, 95% CI: 0.77-0.88). The area under the receiver operating characteristic curve was 0.91 (95% CI: 0.89-0.93). Viability score of ≥1 corresponded to a >90% probability of viable pregnancy. Conclusions The scoring system was easy to use. A score of ≥1 could be used to counsel women who have a high likelihood of viable pregnancy beyond the first trimester.

OBJECTIVE To ascertain whether stress biomarkers and psychological indices of stress may predict both conception and miscarriage rates in women undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). DESIGN Prospective observational study. SETTING A university-affiliated tertiary hospital. POPULATION Infertile women who were undergoing fresh or frozen IVF/ICSI cycles. METHODS Women were recruited to (1) complete validated psychological questionnaires (visual analogue scale of stress, state-trait anxiety inventory, perceived stress scale, fertility problem inventory, Beck depression inventory, and general health questionnaire), at the time of embryo transfer (ET) and pregnancy testing (PT), and (2) provide saliva samples for α-amylase (sAA) measurement before and after ET and at PT. MAIN OUTCOME MEASURES Women were grouped according to subsequent reproductive outcome; scores/levels of all tests were then compared between groups at each time-point. RESULTS In all, 197 women completed the study, of which 92 conceived and 28 miscarried. The level of psychological stress, as measured by questionnaires, was highest at the time of PT, whereas the level of biological stress as measured by sAA level (IU/l) post-ET (1.8 × 105 ± 1.5 × 105 ) was significantly (P

Purpose First, to describe a new method of assessing cephalopelvic disproportion by measuring the retropubic tissue thickness (RTT), and second, to determine whether RTT was associated with an eventual delivery by cesarean section. Methods Three-dimensional transperineal ultrasound scans were performed on 129 laboring nulliparous women to obtain 3-dimensional volume datasets for assessing RTT. RTT was measured off-line by three operators (A, B, and C) as the shortest distance between the capsule of the pubic symphysis and the outer border of the fetal skull. The intraoperator repeatability of operator A and the interoperator reproducibility among A, B, and C were determined. The RTT in women who were delivered by cesarean section due to failure to progress was compared to that of women who had a vaginal delivery. Results The intraoperator repeatability for RTT was 1.2 mm. The overall RTT interoperator interclass correlation was 0.97 (0.95-0.98). The RTT in women who had a spontaneous, instrumental, or cesarean delivery was 1.16±0.32 cm, 1.12±0.25 cm, and 0.94±0.25 cm, respectively. Women who were delivered by cesarean section had a significantly smaller RTT than women who had a spontaneous delivery (P=0.008). There was no statistically significant difference in RTT between patients who had a normal vaginal delivery and patients who had an instrumental delivery (P=0.990), or between those who had an instrumental delivery and those who had a cesarean delivery after the Bonferroni correction (P=0.120). Conclusion RTT can be measured with satisfactory intraoperator repeatability and interoperator reproducibility. RTT was significantly smaller in women who eventually had a cesarean delivery than in those who had a vaginal delivery.

To evaluate the impact of three decades of hepatitis B vaccination in infancy on antenatal prevalence of hepatitis B surface antigen (HBsAg) carriage in 93,134 Hong-Kong born gravidae managed in 1997-2015.Annual prevalence of HBsAg carriage on routine antenatal screening was examined with respect to maternal year of birth in three periods i.e. pre-1983 (before availability of vaccination), 1983-1988 (vaccination of infants born to HBsAg-carriers), and after 1988 (universal vaccination).Overall HBsAg carriage was 8.3% (7737/93,134), decreasing from 10.5% in 1997 to 6.5% in 2015 (p 0.001), and from 8.8%, 7.0% to 3.1%, respectively, for the three period-of-birth cohorts (p 0.001). Annual prevalence decreased from 9.9% in 1997 to 7.5% in 2015 (p 0.001) in the pre-1983 cohort, but showed neither difference nor trend in the other two cohorts. However, the annual prevalence showed significantly falling trends from the pre-1983 to the post-1988 cohorts for the years 2007-2008 and 2010-2015.A progressive decline in overall annual prevalence of antenatal HBsAg carriage was found, with a consistently significant decline among the three cohorts for the years 2007-2008 and 2010-2015, providing evidence that universal hepatitis B vaccination in infancy has reduced significantly antenatal prevalence of HBsAg carriage in Hong Kong.

Objective: To assess the association between body mass index (BMI) and adverse pregnancy outcomes.Materials and methods: A multicentre retrospective cohort study was conducted in three hospitals in Hong Kong including 67,248 women with singleton pregnancy at 11–13 weeks between 2010 and 2016. The relationship between maternal BMI and (1) miscarriage or stillbirth, (2) development of preeclampsia (PE), (3) gestational hypertension (GH), (4) development of gestational diabetes mellitus (GDM), (5) spontaneous preterm delivery (sPTD)

Objective To examine preferences for follow-up testing in women screened with high or intermediate risk for Down syndrome in the first or second trimester. Design Prospective cohort study. Setting Three public hospitals in Hong Kong, China. Sample Women with pregnancies termed as high risk (≥1:250; HR) or intermediate risk (1:251–1200; IR) for Down syndrome. Methods Women with pregnancies screened as HR were offered the choices of: (1) an invasive test plus chromosomal microarray (CMA) to obtain more detailed fetal genetic information; (2) non-invasive cell-free prenatal DNA screening (NIPT) to detect trisomies 13, 18 and 21, and to avoid procedure-related miscarriage; and (3) to decline any further testing. Women received standardised counselling informing them that the reporting times were identical, the procedure miscarriage risk was 0.1–0.2% and that there was no charge for screening. Women with IR pregnancies (1:251–1200) were offered NIPT as a secondary screening test. Main outcome measures Uptake rate for NIPT. Results Three hundred and forty-seven women had pregnancies deemed as HR; 344 (99.1%) women opted for follow-up testing, 216 (62.2%) of whom chose NIPT. Five hundred and seven of 614 women (82.6%) with IR risk chose NIPT. Seven (21%) of 34 women with nuchal translucency ≥3.5 mm opted for NIPT. Conclusion In a setting where reporting times are similar and there is no cost difference between options, approximately 60% of women with pregnancies classed as HR would opt for NIPT, offering simple but limited aneuploidy assessment, over a diagnostic procedure with comprehensive and more detailed assessment. Tweetable abstract 60% of pregnant Chinese women prefer NIPT over CMA when screened as high risk for Down syndrome.

OBJECTIVE To assess the potential of screening for pre-eclampsia (PE) in a Chinese population. DESIGN Case-control study. SETTING Teaching hospital in Hong Kong. POPULATION A total of 3330 women having a viable singleton pregnancy attending first-trimester Down-syndrome screening. METHODS Mean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC). MAIN OUTCOME MEASURES PE detection rate. RESULTS A total of 30 (0.9%) women developed either early (

To assess the clinical utility of the sFlt-1:PlGF ratio rule-in/rule-out pre-eclampsia either directly or after correcting each marker for gestation and maternal weight.This was a prospective cohort study. sFlt-1, PlGF were measured in 965 women randomized to undergo a single blood withdraw between 20 and 39 weeks of gestation. sFlt-1, PlGF and the sFlt-1:PlGF ratio temporal relationship was determined. sFlt-1 and PlGF were converted to multiples of the expected gestational median (MoM) and adjusted for maternal weight. The 90th centile of the adjusted sFlt-1MoM:PlGFMoM ratio was determined. Clinical utility of the sFlt-1:PlGF ratio (≥38) to rule in/rule-out pre-eclampsia (PE) after 20 weeks of gestation versus that of the sFlt-1MoM:PlGFMoM 90th percentile was assessed in 81 women admitted for management of antenatal hypertension.The sFlt-1:PlGF ratio had quadratic relationship with gestation whereas the sFlt-1MoM:PlGFMoM ratio log distribution that was Gaussian with a mean of zero and a standard deviation of 0.85 with a 90th percentile equal to 1.08. Thirty-four (42%) of the 81 women admitted for management of their antenatal hypertension had PE, 26 (76.4%) had a sFlt-1:PlGF ratio ≥ 38. Four of the remaining 8 PE affected pregnancies with sFlt-1:PlGF ratio38 delivered within 7 days, 3 were preterm. Two of the 3 preterm PE pregnancies had sFlt-1MoM:PlGFMoM exceeding 90th percentile.The relative level of the sFlt-1 to PlGF carries prognostic value. A sFlt-1MoM:PlGFMoM ratio exceeding the 90th centile resulted in additional detection of pregnancies which developed PE compared to the conventional sFlt-1:PlGF ratio.

Objectives To (i) evaluate the applicability of the European-derived biomarker multiples of the median (MoM) formulae for risk assessment of preterm pre-eclampsia (PE) in seven Asian populations, spanning the east, southeast and south regions of the continent, (ii) perform quality-assurance (QA) assessment of the biomarker measurements and (iii) establish criteria for prospective ongoing QA assessment of biomarker measurements. Methods This was a prospective, non-intervention, multicenter study in 4023 singleton pregnancies, at 11 to 13 + 6 weeks' gestation, in 11 recruiting centers in China, Hong Kong, India, Japan, Singapore, Taiwan and Thailand. Women were screened for preterm PE between December 2016 and June 2018 and gave written informed consent to participate in the study. Maternal and pregnancy characteristics were recorded and mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI) and maternal serum placental growth factor (PlGF) were measured in accordance with The Fetal Medicine Foundation (FMF) standardized measurement protocols. MAP, UtA-PI and PlGF were transformed into MoMs using the published FMF formulae, derived from a largely Caucasian population in Europe, which adjust for gestational age and covariates that affect directly the biomarker levels. Variations in biomarker MoM values and their dispersion (SD) and cumulative sum tests over time were evaluated in order to identify systematic deviations in biomarker measurements from the expected distributions. Results In the total screened population, the median (95% CI) MoM values of MAP, UtA-PI and PlGF were 0.961 (0.956-0.965), 1.018 (0.996-1.030) and 0.891 (0.861-0.909), respectively. Women in this largely Asian cohort had approximately 4% and 11% lower MAP and PlGF MoM levels, respectively, compared with those expected from normal median formulae, based on a largely Caucasian population, whilst UtA-PI MoM values were similar. UtA-PI and PlGF MoMs were beyond the 0.4 to 2.5 MoM range (truncation limits) in 16 (0.4%) and 256 (6.4%) pregnancies, respectively. QA assessment tools indicated that women in all centers had consistently lower MAP MoM values than expected, but were within 10% of the expected value. UtA-PI MoM values were within 10% of the expected value at all sites except one. Most PlGF MoM values were systematically 10% lower than the expected value, except for those derived from a South Asian population, which were 37% higher. Conclusions Owing to the anthropometric differences in Asian compared with Caucasian women, significant differences in biomarker MoM values for PE screening, particularly MAP and PlGF MoMs, were noted in Asian populations compared with the expected values based on European-derived formulae. If reliable and consistent patient-specific risks for preterm PE are to be reported, adjustment for additional factors or development of Asian-specific formulae for the calculation of biomarker MoMs is required. We have also demonstrated the importance and need for regular quality assessment of biomarker values. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Objective To assess the impact of adopting the INTERGROWTH-21st biometry standards in a Chinese population. Design Retrospective cohort study. Setting A teaching hospital in Hong Kong. Population A total of 10 527 Chinese women with a singleton pregnancy having a second- or third-trimester fetal anomaly or growth scan between January 2009 and June 2014. Methods Z-scores were derived for fetal abdominal circumference (AC), head circumference (HC), and femur length (FL) using the INTERGROWTH-21st and Chinese biometry standards. Pregnancies with aneuploidy, structural or skeletal abnormalities, or that developed pre-eclampsia were excluded. Z-scores were stratified as 90th, >95th, or >97.5th percentile. Birthweight centile, adjusted for gestation and gender, was categorised as ≤3rd, 3rd to ≤5th, 5th to ≤10th, and >10th. Pairwise comparison and the McNemar test were performed to assess biometry Z-score differences and concordance between the INTERGROWTH-21st and Chinese standards. Main outcome measures The sensitivity of both the local and INTERGROWTH-21st AC standards to identify pregnancies that were small-for-gestational-age (SGA) was assessed. Results INTERGROWTH-21st AC, HC, and FL Z-scores were significantly lower than those obtained using our local reference for AC, HC, and FL (P 90th, >95th, or >97.5th percentiles was statistically significant (P

To develop and assess the accuracy of risk prediction models to diagnose endometrial cancer in women having postmenopausal bleeding (PMB).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.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; p0.0001) and History plus ET (difference=0.19, 95% CI 0.16-0.23, p0.0001) 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).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.

To evaluate the potential of maternal serum placental growth factor (PlGF) as a marker for Trisomy 21 in Chinese pregnant women.Serum samples were collected and stored from 600 women who have a viable singleton pregnancy and underwent first trimester screening for Trisomy 21 between 2011 and 2014. Serum concentration of PlGF was measured using the automated time-solved immunofluorometric assay and expressed as Multiples of the expected median (MoM) from the 600 women available stored serum samples (558 Euploidy and 42 Trisomy 21). The levels of PlGF MoM were compared between Trisomy 21 cases and Euploid pregnancies. Expected median PlGF levels in Chinese were also compared to that published for Caucasians. Multivariate Gaussian modeling was performed to predict detection and false-positive rates.In euploid pregnancies the concentrations of PlGF increased with Crown Rump Length(CRL) and decreased with maternal weight. The overall median MoM of PlGF in Chinese was higher than that of Caucasian. The median PlGF level was 0.63 MoM in the cases and 1.00 MoM in the controls (p0.0001). The prediction of Trisomy 21 has been slightly improved by the addition of PlGF to the standard screening test in China. The detection rate of screening after adding PlGF data was increased from 93.4% to 94.6% at a false-positive rate of 3% and the false positive rate decreased from 0.23% to 0.17% for a detection rate of 80%.The median PlGF concentrations in Chinese is higher than those of Caucasians. Results suggest adding PlGF may substantially improve the performance of current first trimester screening strategy for Trisomy 21 in Chinese pregnant women.

Background Placenta previa remains one of the major causes of massive postpartum hemorrhage and maternal mortality worldwide. Objective To determine whether internal iliac artery balloon occlusion during cesarean delivery for placenta previa could reduce postpartum hemorrhage and other maternal complications. Study Design This was a prospective randomized controlled trial conducted at a tertiary university obstetric unit in Hong Kong. Pregnant women who were diagnosed to have placenta previa at 34 weeks (defined as lower placenta edge within 2 cm from the internal os) and required cesarean delivery were invited to participate. Eligible pregnant women were randomized into internal iliac artery balloon occlusion (Occlusion) group or standard management (Control) group. Those randomized to the Occlusion group had internal iliac artery balloon catheter placement performed before cesarean delivery and then balloon inflation after delivery of the baby. The primary outcome was the reduction of postpartum hemorrhage in those with internal iliac artery balloon occlusion. Secondary outcome measures included hemoglobin drop after delivery; amount of blood product transfusion; incidence of hysterectomy; maternal complications including renal failure, ischemic liver, disseminated intravascular coagulation, and adult respiratory distress syndrome; length of stay in hospital; admission to intensive care unit; and maternal death. Results Between May 2016 and September 2018, 40 women were randomized (20 in each group). Demographic and obstetric characteristics were similar between the 2 groups. In the Occlusion group, 3 women did not receive the scheduled procedure, as it was preceded by antepartum hemorrhage that required emergency cesarean delivery, and 1 woman had repeated scan at 36 weeks showing the placental edge was slightly more than 2 cm from the internal os. Intention-to-treat analysis found no significant differences between the Occlusion and the Control groups regarding to the median intraoperative blood loss (1451 [1024–2388] mL vs 1454 [888–2300] mL; P = .945), the median length of surgery (49 [30–62] min vs 37 [30–51] min; P = .204), or the need for blood transfusion during operation (57.9% vs 50.0%; P = .621). None of the patients had rebleeding after operation, complication related to internal iliac artery procedure, or any other maternal complications. Reanalyzing the data using on-treatment approach showed the same results. Conclusion The use of prophylactic internal iliac artery balloon occlusion in placenta previa patients undergoing cesarean delivery did not reduce postpartum hemorrhage or have any effect on maternal or neonatal morbidity.

To compare the whole genomic microRNA (miRNA) between the selective fetal growth restriction (sFGR) twin and the normally growing (control) co-twin in monochorionic (MC) twin pregnancies. MC twin pregnancies with or without sFGR were recruited, and their placental miRNAs were profiled by microarray. The ratio of the placental miRNA of the sFGR twin to that of the normally larger co-twin were calculated and compared to that of the control twin pairs. The miRNA microarray intensity amongst normal and sFGR large and small twins are shown. The expression data presented here will facilitate other researchers who are working on placental regulation and mechanism in pregnancy complicated by fetal growth restriction. The dataset supports the research article entitle “Whole genome miRNA profiling revealed miR-199a as potential placental pathogenesis of selective fetal growth restriction in monochorionic twin pregnancies” [1].

Background Polycystic ovary syndrome (PCOS) is associated with increased metabolic risk, though data on long-term follow-up of cardiometabolic traits are limited. We postulated that Chinese women with PCOS would have higher risk of incident diabetes and cardiometabolic abnormalities than those without PCOS during long-term follow-up. Methods and findings One hundred ninety-nine Chinese women with PCOS diagnosed by the Rotterdam criteria and with a mean age of 41.2 years (SD = 6.4) completed a follow-up evaluation after an average of 10.6 ± 1.3 years. Two hundred twenty-five women without PCOS (mean age: 54.1 ± 6.7 years) who underwent baseline and follow-up evaluation over the same period were used for comparison. Progression of glycaemic status of women both with and without PCOS was assessed by using 75-g oral glucose tolerance test (OGTT) screening with the adoption of 2009 American Diabetes Association diagnostic criteria. The frequency of impaired glucose regulation, hypertension, and hyperlipidaemia of women with PCOS at follow-up has increased from 31.7% (95% CI 25.2%–38.1%) to 47.2% (95% CI 40.3%–54.2%), 16.1% (95% CI 11.0%–21.2%) to 34.7% (95% CI 28.1%–41.3%), and 52.3% (95% CI 45.3%–59.2%) to 64.3% (95% CI 57.7%–71.0%), respectively. The cumulative incidence of diabetes mellitus (DM) in follow-up women with PCOS is 26.1% (95% CI 20.0%–32.2%), almost double that in the cohort of women without PCOS (p < 0.001). Age-standardised incidence of diabetes among women with PCOS was 22.12 per 1,000 person-years (95% CI 10.86–33.37) compared with the local female population incidence rate of 8.76 per 1,000 person-years (95% CI 8.72–8.80) and 10.09 per 1,000 person-years (95% CI 4.92–15.26, p < 0.001) for women without PCOS in our study. Incidence rate for women with PCOS aged 30–39 years was 20.56 per 1,000 person-years (95% CI 12.57–31.87), which is approximately 10-fold higher than that of the age-matched general female population in Hong Kong (1.88 per 1,000 person-years, [95% CI 1.85–1.92]). The incidence rate of type 2 DM (T2DM) of both normal-weight and overweight women with PCOS was around double that of corresponding control groups (normal weight: 8.96 [95% CI 3.92–17.72] versus 4.86 per 1,000 person-years [95% CI 2.13–9.62], p > 0.05; overweight/obese: 28.64 [95% CI 19.55–40.60] versus 14.1 per 1,000 person-years [95% CI 8.20–22.76], p < 0.05). Logistic regression analysis identified that baseline waist-to-hip ratio (odds ratio [OR] = 1.71 [95% CI 1.08–2.69], p < 0.05) and elevated triglyceride (OR = 6.63 [95% CI 1.23–35.69], p < 0.05) are associated with the progression to T2DM in PCOS. Limitations of this study include moderate sample size with limited number of incident diabetes during follow-up period and potential selection bias. Conclusions High risk of diabetes and increased cardiovascular disease risk factors among Chinese women with PCOS are highlighted in this long-term follow-up study. Diabetes onset was, on average, 10 years earlier among women with PCOS than in women without PCOS., Ronald Ching Wan Ma and colleagues reveal the higher incidence of diabetes and CVD in Chinese women with polycystic ovary syndrome., Author summary Why was this study done? Besides reproductive abnormality, it is known that women with polycystic ovary syndrome (PCOS) are at high risk of metabolic complications, such as insulin resistance (IR), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM). The majority of the accessible longitudinal studies regarding the progression of T2DM in women with PCOS are from the United States, Australia, and Europe. Previous studies have mainly relied on self-report of diabetes status or linkage through national patient registries, which might underestimate the prevalence and incident rate of T2DM in women with PCOS. What did the researchers do and find? During 2016–2017, we prospectively investigated the progression of glycaemic status among 199 Chinese women with PCOS and compared the data with those of 242 women without PCOS by using oral glucose tolerance test (OGTT) for comprehensive glycaemic status screening. We found that the age-standardised incidence rate of T2DM among women with PCOS was around 2.5-fold higher compared with the local female population incidence rate. We noted that the incidence rate of T2DM of both normal-weight and overweight women with PCOS was around double that of respective control groups. This is a key controversial area in international literature and differs from data on individuals of European descent. Diabetes onset was, on average, 10 years earlier among women with PCOS than in women without PCOS. Chinese women with PCOS were at 6-fold higher risk of developing T2DM compared with those without PCOS. High waist-to-hip ratio (WHR), elevated triglyceride, and presence of hyperandrogenism are associated with the progression to T2DM in PCOS. What do these findings mean? This study highlighted the risk of diabetes and metabolic abnormalities in women with PCOS. The study has shed some light on the potential burden of young-onset diabetes associated with PCOS. This work has already been considered in the recent international guidelines, suggesting the clinical relevance of this work. Our data provide useful insights that universal screening should be considered in all Chinese adult women with PCOS. Our data suggested WHR, elevated triglyceride, and hyperandrogenism are associated with the progression to T2DM in PCOS, although we were unable to explore relationships with IR. Therefore, further research is clearly warranted.

Objectives To explore the relationship between prior abortion history with incidence of pregnancy hypertensive disorders (PHD), including gestational hypertension (GH) and pre-eclampsia (PE), to determine whether the secular increases in GH and PE in developed countries could be related in part to the decreased incidence of abortion. Study design A single center retrospective cohort study on primiparous Chinese gravidae managed in 1997–2015 in our hospital. Main outcome measures The occurrence of PHD, GH and PE with respect to the presence or otherwise of prior abortions, with the analysis stratified for risk factors that include advanced age, high body mass index (BMI), history of medical disorders, birth before 34 weeks, and maternal hepatitis B virus (HBV) infection and rubella non-immunity which have been shown to influence the occurrence of PHD in our population. Results The 23,698 (39.3%) of the 60,335 gravidae in the cohort with ≥ one prior abortion had higher incidence of advanced age, HBV infection, rubella non-immunity, and high BMI, but lower incidence of PHD, GH, PE and birth before 34 weeks gestation. The difference in the incidence of GH and PE between gravidae having one versus those with two or more abortions was minimal, and the effect of abortion on PHD was influenced by the other risk factors. On regression analysis, prior abortion reduced PHD (aRR 0.761, 95% CI 0.684–0.846), GH (aRR 0.660, 95% CI 0.563–0.773), and PE (aRR 0.857, 95% CI 0.745–0.987). Conclusions Prior abortion reduces the subsequent development of GH and PE in primiparous women.

OBJECTIVE To assess the quality of mean uterine artery (UtA) pulsatility index (PI) measurement in a first-trimester pre-eclampsia screening program. METHODS Consecutive women with a singleton pregnancy attending first-trimester screening for fetal chromosomal abnormalities also had combined screening for pre-eclampsia based on the Fetal Medicine Foundation (FMF) algorithm, at a large practice in Sydney, Australia, from May 2014 to February 2017. Distributions of mean UtA-PI multiples of the median (MoM) on a logarithmic scale were plotted in relation to the normal median with 95% CI for each operator and for each month. Central tendency and dispersion and cumulative sum charts were produced. Mean UtA-PI MoM values between 0.95 and 1.05 were considered ideal and those between 0.90 and 1.10 were considered acceptable. The screen-positive rates for preterm pre-eclampsia in different groups of sonographers according to their mean log10 UtA-PI MoM were calculated and compared using the chi-square test. RESULTS A total of 21 010 women attended for first-trimester ultrasound and had screening for pre-eclampsia. The overall median UtA-PI MoM was 1.042 (interquartile range (IQR), 0.85-1.26). Of 46 sonographers, 42 (91.3%) performed more than 50 examinations and, of those, 41 (97.6%) measured UtA-PI within the acceptable range. Sonographers measuring UtA-PI MoM on average below 0.95 and those measuring it above 1.05 had, respectively, lower and higher screen-positive rates when compared with those with measurements within the 0.95-1.05 UtA-PI MoM interval (7.2% and 13.2% vs 11.2%, respectively, P

Objective The objective of the study was to evaluate the uptake of non-invasive cell-free fetal DNA screening test (NIDT) after a high-risk screening result for trisomy 21 Methods Association between maternal and pregnancy characteristics on women's test choice was assessed after adjusting for confounding factors in Hong Kong Chinese women who had a high-risk (term risk ≥1:250) first-trimester or second-trimester screening test at three public hospitals. Main outcome measures were rate of declining further testing and obstetric and maternal factors impacting on patient's selection of testing options. Results Compared with the pre-NIDT period, the availability of NIDT resulted in a 45% (P 1:10’ (aOR = 7.36, 95% CI 4.22–12.8) and ‘1:10 to 1:50’ (aOR = 1.53, 95% CI 1.01–2.32) were more likely to opt for chorionic villi sampling or amniocentesis. Conclusions NIDT reduced the refusal rate. Uptake of NIDT was highest in pregnancies of nulliparous women. © 2014 John Wiley & Sons, Ltd.

Purpose The relationship between maternal height and gestational hypertensive disorders was examined in a cohort of Chinese gravidae managed in 1997-2013 to clarify the association between short stature with preeclampsia (PE) and gestational hypertension (GH). Materials and methods Retrospective study of 87 290 gravidae categorized by their height into four quartile groups. The impact of short stature, defined as height in the lowest quartile, on incidence of PE and GH was studied in relation to the presence of risk factors. The independent role of short stature was determined by regression analysis. Results The 25th, 50th, and 75th percentile values of height were 154 cm, 158 cm, and 161 cm respectively. The incidence of PE, but not GH, was inversely correlated with height (p = .025). Short stature altered the impact of parity status, advanced age, high body mass index, infant gender, and medical history, on incidence of PE but not GH. On regression analysis, short stature increased risk of PE (adjusted RR 1.134, 95%CI 1.005-1.279) but reduced GH (adjusted RR 0.836, 95%CI 0.718-0.974). Conclusions Maternal short stature should be defined according to distribution in a specific ethnic group, and it exerts a significant but opposite effect on the incidence of PE versus GH.

OBJECTIVE This study compared the incidence of rubella seronegativity among gravidae of 25 year-old and younger, between those born in Hong Kong after 1983 when the two-dose rubella vaccination was implemented, versus gravidae born before, to examine the impact of the two-dose regimen. METHODS In this retrospective cohort study, the incidence of antenatal rubella seronegativity in our parturients managed in1997-2015 was analysed by their age from ≤16 to 25 years, and the effect of year of birth was determined adjusting for confounding factors including teenage status, obstetric history, anthropometric factors, and health parameters including anaemia, thalassaemia trait and hepatitis B carrier status. RESULTS Among the 12743 gravidae, the 6103 gravidae born after 1983 had overall higher rubella seronegativity (9.1% versus 4.4%, OR 2.061, 95% CI 1.797-2.364), with significant difference (p = 0.006) and inverse correlation (p

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

Problem It is unclear if the immunologic alterations induced by pregnancy could persist. Method of study Antenatal rubella sero-negativity was correlated with gravidity, abortions and parity in 112 083 gravidae managed during 1997-2015, with further analysis stratified for factors known to influence rubella serology. Results The 10.2% sero-negative gravidae had different characteristics, and the incidence showed significant difference and positive trend (P

Introduction Triplet and higher-order multiple pregnancies are well known to be associated with increased adverse outcomes. This study reviewed the perinatal outcomes in women with a triplet pregnancy who underwent fetal reduction versus expectant management at a university hospital in Hong Kong. Methods This was a retrospective review of triplet pregnancies at Prince of Wales Hospital in Hong Kong from 1 January 2008 to 30 September 2014. Women carrying a triplet pregnancy were classified as having had expectant management, fetal reduction to twins, or fetal reduction to a singleton. Maternal and pregnancy characteristics were compared. Outcome measures included fetal loss, gestational age at delivery, birth weight, neonatal survival rate, neonatal death, neonatal complications, and need for and length of neonatal intensive care unit stay. Results A total of 52 triplet pregnancies were identified. One pregnancy that was lost to follow-up and one that was terminated were excluded. The majority of pregnancies (84%) were the result of assisted reproductive technology. Fetal reduction was performed in 26 (52%) pregnancies, of which 22 were reduced to twins and four to a singleton. The mean gestations at delivery were 32.6, 35.2, and 39.6 weeks in the expectant management, fetal reduction to twins, and fetal reduction to a singleton groups, respectively. Significantly more pregnancies with expectant management resulted in a preterm birth. All pregnancies with fetal reduction to a singleton resulted in a term birth. A higher mean birth weight, lower neonatal death rate, and reduced need for admission to and length of stay in the neonatal intensive care unit were observed in the fetal reduction groups. Conclusions Approximately 50% of women with a triplet pregnancy in Hong Kong elected to undergo fetal reduction. This was associated with a significant reduction in extreme preterm delivery and associated morbidity and mortality.

To determine intersonographer, intersampling site pulsatility index differences in the ascending branch of the uterine artery (UtA-PI) and their effect on detection rates (DR) for early onset preeclampsia (PE).A prospective observational study was conducted including 52 women with singleton viable pregnancy at 11-13 weeks' gestation. Consecutive bilateral UtA-PI measurements were performed by two sonographers. Both sonographers hold the Fetal Medicine Foundation (FMF) uterine artery Doppler assessment competency certificates. Sonographer "A" underwent mentorship-based specialist training at the FMF; whilst sonographer "B" is a fetal maternal specialist who was deemed competent to measure UtA-PI based on completion of the FMF online course. Both sonographers were unaware of each other's UtA-PI and peak systolic velocity (PSV) measurements throughout the study. UtA-PI was measured by sonographer "A" at 1, 2 and 3 cm distally from the internal os. UtA-PI minimum ("Low-PI") and mean ("Mean-PI") were determined. Intraclass correlation (ICC), Bland-Altman analysis and Wilcoxon signed rank test were performed to determine bias, 95% limits of agreement (LOA) for intersonographer and intersampling site differences. Simulation studies were performed to determine the effect on early onset PE screening DR.(1) Intersite assessment indicated that UtA-PI and PSV decreased by 7-8% per centimeter relative to the measurement taken at the internal os; (2) Sonographer "B" UtA-PI measurements were significantly lower than those of sonographer "A" for "Low-PI" (p = .001), "Mean-PI" (p = .002) and PSV (p = .004) determined by Wilcoxon signed rank test. The mean reduction in "Low-PI", "Mean-PI" and PSV of sonographer "B" relative to sonographer "A" were 14.04%, 11.09% and 10.99%, respectively; (3) Measurements taken by sonographer "B" at the level of the internal os were comparable to measurements taken by sonographer "A" at 2 cm distal to the internal os (low-PI: p = .98, Mean-PI: p = .49 and PSV: p = .24); (4) Between sonographer ICC for UtA-PI was asymmetrical strong (left ICC = 0.72, 95%CI: 0.51-0.84) to fair (right ICC = 0.38, 95%CI: -0.08-0.64); and (5) The 14% mean intersonographer difference in lowest UtA-PI would have resulted in an 7% difference in PE screening performance.The measurement of UtA-PI is sampling site dependent with the potential for significant intersonographer differences despite the availability of a prescriptive measurement protocol. This is an important observation as it implies that sonographer "B" inadvertently measured the UtA-PI at a distal site, not at the level of internal os, compared to those measured by sonographer "A", resulting in a lower DR for early onset PE.

To evaluate the efficacy of transcervical intralesional vasopressin injection to submucous myoma in hysteroscopic myomectomy from 2011 to 2014.This was a prospective, randomized, double-blind study in a single center. Forty premenopausal women with symptomatic submucous myoma requiring hysteroscopic myomectomy were randomized to transcervical intralesional vasopressin injection or placebo in a 4:4 ratio. The primary outcome was operative time. Secondary outcomes including fluid volumes, blood loss, and visual clarity were compared between the two groups.The median duration for myomectomy was 19.9 minutes (range 3.1-54.2 minutes) in the vasopressin group compared with 29.0 minutes (range 8.0-60.9 minutes) in the placebo group, a nonsignificant difference (P=.14). There were significant reductions in the median volume of fluid used (4,200 mL [range 1,300-21,000 mL] compared with 9,800 mL (range 1,500-23,000 mL; P=.004) and fluid intravasation (0 mL [range 0-3,100] compared with 300 mL [range -150-3,150 mL; P=.029) in the vasopressin group. The median intraoperative blood loss was reduced (5 mL [range 1-50 mL] compared with 20 mL [range 1-150 mL; P=.002). The operative surgeon rated that 95% of the vasopressin group had "minimal" bleeding compared with 36.8% in the placebo group. The surgical field (visual analog scale [VAS] 9 [range 2-10] compared with 6 [range 2-10; P.001]; 0=worst visual clarity, 10=best visual clarity) and the effluent fluid (VAS 1 [range 0-7] compared with 4 [range 0-8; P.001]; 0=clear, 10=unclear) were statistically significantly clearer in the vasopressin group.Transcervical intralesional vasopressin injection in hysteroscopic myomectomy did not reduce operative time but did reduce volume of inflow fluid, fluid intravasation, intraoperative blood loss, and improving visual clarity.Centre for Clinical Research and Biostatistics, http://www.cct.cuhk.edu.hk/Registry/publictriallist.aspx, CUHK_CCT00291.

To investigate the age-specific prevalence of hepatitis B virus (HBV) infection in young pregnant women in Hong Kong Special Administrative Region (SAR), China, and to determine whether an increase in prevalence occurs during adolescence.HBV prevalence was quantified using data from routine antenatal screening for hepatitis B surface antigen (HBsAg) in 10 808 women aged 25 years or younger born in Hong Kong SAR and managed at a single hospital between 1998 and 2011. The effect on prevalence of maternal age, parity and birth before or after HBV vaccine availability in 1984 was assessed, using Spearman's correlation and multiple logistic regression analysis.Overall, 7.5% of women were HBsAg-positive. The prevalence ranged from 2.3% to 8.4% in those aged ≤ 16 and 23 years, respectively. Women born in or after 1984 and those younger than 18 years of age were less likely to be HBsAg-positive (odds ratio, OR: 0.679; 95% confidence interval, CI: 0.578-0.797) and (OR: 0.311; 95% CI: 0.160-0.604), respectively. For women born before 1984, there was no association between HBsAg carriage and being younger than 18 years of age (OR: 0.60; 95% CI: 0.262-1.370) Logistic regression analysis showed that the prevalence of HBsAg carriage was influenced more by the woman being 18 years old or older (adjusted OR, aOR: 2.80; 95% CI: 1.46-5.47) than being born before 1984 (aOR: 1.42; 95% CI: 1.21-1.67).Immunity to HBV in young pregnant women who had been vaccinated as neonates decreased in late adolescence.Étudier la prévalence selon l'âge de l'infection par le virus de l'hépatite B (VHB) chez les jeunes femmes enceintes dans la Région administrative spéciale (RAS) de Hong Kong de Chine, et déterminer si une augmentation de la prévalence a lieu pendant l'adolescence.La prévalence du VHB a été quantifiée en utilisant les données des dépistages prénataux de routine pour détecter l'antigène de surface de l'hépatite B (HBsAG) chez 10 808 femmes âgées de moins de 25 ans nées dans la RAS de Hong Kong et suivies dans un seul hôpital entre 1998 et 2011. Les effets sur la prévalence de l'âge maternel, de la parité et de la naissance avant ou après la disponibilité du vaccin anti-VHB en 1984 ont été évalués en utilisant la corrélation de Spearman et une analyse de régression logistique multiple.Globalement, 7,5% des femmes étaient positives pour l'antigène HBsAg. La prévalence était comprise entre 2,3% et 8,4% chez les femmes âgées de ≤ 16 et 23 ans, respectivement. Les femmes nées en 1984 ou après 1984 et les femmes âgées de moins de 18 ans étaient moins susceptibles d'être positives pour l'antigène HBsAg (rapport des cotes, RC: 0,679; intervalle de confiance à 95%, IC 95%: 0,578–0,797) et (RC: 0,311; IC 95%: 0,160–0,604), respectivement. Pour les femmes nées avant 1984, il n'y avait pas d'association entre être dépistée positive pour l'antigène HBsAG et avoir moins de 18 ans (RC: 0,60; IC 95%: 0,262–1,370). L'analyse de régression logistique a montré que la prévalence de la présence de l'antigène HBsAg chez les femmes était davantage influencée par le fait d'avoir 18 ans ou plus (RC ajusté, RCa: 2,80; IC 95%: 1,46–5,47) que par le fait d'être née avant 1984 (RCa: 1,42; IC 95%: 1,21–1,67).L'immunité contre le VHB chez les jeunes femmes enceintes qui ont été vaccinées dès leur naissance a diminué à la fin de l'adolescence.Investigar la prevalencia por edad de la infección por el virus de la hepatitis B (VHB) en mujeres embarazadas jóvenes en Hong Kong, Región Administrativa Especial (SAR) de China, y determinar si durante la adolescencia se produce un aumento de la prevalencia.La prevalencia del VHB se cuantificó a partir de datos de las pruebas rutinarias de detección prenatal para el antígeno de superficie del virus de la hepatitis B (HBsAg) en 10 808 mujeres de 25 años o menores nacidas en Hong Kong SAR y gestionados en un solo hospital entre 1998 y 2011. Se evaluó el efecto de la edad de la madre, el número de veces que habían dado a luz y el nacimiento antes o después de la disponibilidad de la vacuna del VHB en 1984 sobre la prevalencia. Para ello se empleó la correlación de Spearman y análisis de regresión logística múltiple.En general, el 7,5% de las mujeres dio resultados positivos para el HBsAg. La prevalencia varió del 2,3% al 8,4% en las mujeres de 16 años o mayores y 23 de años o mayores, respectivamente. Las mujeres nacidas en el año 1984 o más tarde, y las menores de 18 años de edad tenían menos probabilidad de dar positivo para el HBsAg (proporción de probabilidad, OR: 0,679; intervalo de confianza del 95%, IC: 0,578–0,797) y (OR: 0,311; 95% IC: 0,160–0,604), respectivamente. Para las mujeres nacidas antes de 1984, no hubo asociación entre ser portadoras de HBsAg y ser menores de 18 años de edad (OR: 0,60; 95% IC: 0,262–1,370). El análisis de regresión logística mostró que la prevalencia de las portadoras de HBsAg se vio más influida por tener 18 o más años de edad (OR ajustada, proporción de probabilidades ajustadas: 2,80; 95% IC: 1,46–5,47) que por haber nacido antes de 1984 (proporción de probabilidades ajustadas: 1,42; 95% IC: 1,21–1,67).La inmunidad frente al VHB en mujeres jóvenes embarazadas que habían sido vacunadas como recién nacidos disminuyó a finales de la adolescencia.تحري معدل انتشار عدوى فيروس التهاب الكبد "باء" حسب الفئة العمرية بين النساء الحوامل صغار السن في منطقة هونغ كونغ الصينية الإدارية الخاصة وتحديد ما إذا كانت هناك زيادة في معدل الانتشار خلال سن المراهقة.تم تحديد مقدار انتشار فيروس التهاب الكبد "باء" باستخدام البيانات المستمدة من الفحص الروتيني السابق للولادة للمستضد السطحي لالتهاب الكبد "باء" (HBsAg) لدى 10808 امرأة في سن 25 عاماً أو أصغر ممن ولدن في منطقة هونغ كونغ الإدارية الخاصة وتلقين التدبير العلاجي في مستشفى واحد في الفترة من عام 1998 إلى عام 2011. وتم تقييم التأثير على معدل انتشار سن الأم والتكافؤ والولادة قبل توافر لقاح فيروس التهاب الكبد "باء" في عام 1984 أو بعده، باستخدام ارتباط سبيرمان وتحليل الارتداد اللوجيستي المتعدد.بشكل عام، كانت نسبة 7.5 % من النساء إيجابيات للمستضد السطحي لالتهاب الكبد "باء". وتراوح معدل الانتشار من 2.3 % إلى 8.4 % بين النساء في سن 16 و23 سنة، على التوالي. وكانت احتمالية الإيجابية للمستضد السطحي لالتهاب الكبد "باء" أقل لدى النساء اللاتي ولدن في عام 1984 أو بعده والنساء دون سن 18 سنة (نسبة الاحتمال: 0.679؛ فاصل الثقة 95 %، فاصل الثقة: من 0.578 إلى 0.797) و(نسبة الاحتمال: 0.311؛ فاصل الثقة 95 %: من 0.160 إلى 0.604)، على التوالي. ولم يكن هناك ارتباط بين انتقال المستضد السطحي لالتهاب الكبد "باء" (HBsAg) والسن الذي هو دون 18 سنة لدى النساء اللاتي ولدن قبل عام 1984 (نسبة الاحتمال: 0.60؛ فاصل الثقة 95 %: من 0.262 إلى 1.370) وأظهر تحليل الارتداد اللوجيستي تأثر معدل انتشار انتقال المستضد السطحي لالتهاب الكبد "باء" (HBsAg) على نحو أكبر بسن المرأة التي تبلغ من العمر 18 سنة أو أكبر (نسبة الاحتمال المصححة: 2.80؛ فاصل الثقة 95 %: من 1.46 إلى 5.47) عنه بالميلاد قبل عام 1984 (نسبة الاحتمال المصححة: 1.42؛ فاصل الثقة 95 %: من 1.21 إلى 1.67).انخفضت المناعة ضد فيروس التهاب الكبد "باء" بين النساء الحوامل صغار السن اللاتي حصلن على التطعيم كمواليد في المراهقة المتأخرة.调查中国香港特别行政区（SAR）年轻孕妇的特定年龄段乙型肝炎病毒（HBV）感染流行率，并确定青春期流行率是否有增加。使用在1998年至2011年在单所医院进行管理的10808名25岁以下特区出生女性的乙型肝炎表面抗原（HBsAg）常规产前筛查数据量化HBV流行率。使用斯皮尔曼相关性和多元逻辑回归分析评估产妇年龄、胎次以及1984年乙型肝炎病毒疫苗上市前后出生等因素对发病率的影响。总体而言，7.5%女性为HBsAg阳性。不超过16岁和不超过23岁女性发病率分别为2.3%至8.4%。在1984年或之后出生的女性以及未满18岁的女性HBsAg阳性可能性更低，分别为（优势比，OR：0.679；95%置信区间，CI：0.578-0.797）和（OR：0.311；95% CI：0.160-0.604）。对于在1984年之前出生的女性，在HBsAg携带和未满18岁（OR：0.60；95% CI：0.262-1.370）之间没有关联。逻辑回归分析显示，较之1984年之前出生（aOR：1.42；95% CI：1.21-1.67），女性年满18岁对HBsAg携带影响更大（调整的OR，aOR：2.80；95% CI：1.46-5.47）。在新生儿期间接种疫苗的年轻孕妇在青春晚期乙肝病毒免疫力降低。Исследовать зависимость распространения вируса гепатита B (HBV) от возраста среди молодых беременных женщин в Специальном административном округе Гонконг, Китай, и определить, возрастает ли уровень распространения заболевания в подростковом возрасте.Количественные показатели распространения вируса гепатита B (HBV) были определены на основе данных, полученных в ходе планового предродового скринингового обследования на наличие поверхностного антигена гепатита B (HBsAg) среди 10 808 женщин в возрасте 25 лет или менее, рожденных в Специальном административном округе Гонконг, Китай, с 1998 по 2011 гг. Была выполнена оценка влияния на распространение вируса таких факторов, как возраст матери, количество родов, рождение до или после появления вакцины от гепатита B в 1984 году; для выполнения оценки использовались корреляция Спирмана и многочисленные методы регрессивного анализа.Было обнаружено, что в общей сложности 7,5% женщин являются носителями поверхностного антигена вируса гепатита B. Уровень распространения варьировался от 2,3% до 8,4% в возрастных группах ≤ 16 лет и 23 лет соответственно. Женщины, рожденные в 1984 году и позднее, а также женщины младше 18 лет реже являются носителями поверхностного антигена вируса гепатита B (коэффициент вероятности: 0,679, 95%; доверительный интервал: 0,578–0,797) и (коэффициент вероятности: 0,311, 95%; доверительный интервал: 0,160–0,604) соответственно. Для женщин, рожденных до 1984 года, не было установлено связи между наличием поверхностного антигена вируса гепатита B и возрастом младше 18 лет (коэффициент вероятности: 0,60, 95%; доверительный интервал: 0,262–1,370). Метод логистического регрессивного анализа показал, что поверхностный антиген вируса гепатита B чаще распространен среди женщин 18 лет и старше (откорректированный коэффициент вероятности: 2,80, 95%; доверительный интервал: 1,46–5,47), чем среди рожденных до 1984 года (откорректированный коэффициент вероятности: 1,42, 95%; доверительный интервал: 1,21–1,67).Иммунитет к вирусу гепатита B у молодых женщин, которые прошли вакцинацию в младенческом возрасте, снижается в позднем подростковом периоде.

Objective To compare the incidence of neonatal group B streptococcus (GBS) infection in active GBS carriers with preterm prelabor rupture of membranes (PPROMs) after penicillins and erythromycin prophylaxis. Materials and methods Patients diagnosed to have PPROM between 2004 and 2009 inclusive were treated using erythromycin (erythromycin group), ampicillin, amoxicillin or co-amoxiclav (penicillin group), or no antibiotics (control group) according to department protocols depending on their gestation and their GBS status at the time of presentation. Patients receiving both erythromycin and penicillins were included in the penicillin group. The incidence of neonatal GBS infection was compared between groups categorized according to the antibiotic regime received. Results A total of 680 women were diagnosed to have PPROM of which 85 (12.5%) were active GBS carriers. GBS isolates were 100% sensitive to penicillins but only 35% were sensitive to erythromycin. There were 16, 22, and 47 patients in the penicillin, erythromycin, and control groups, respectively. The incidence of neonatal GBS infection in the three groups was 0%, 36%, and 13%, respectively, and was statistically significant ( p = 0.023). Conclusion Penicillins are more effective than erythromycin in preventing neonatal GBS infection in women with PPROM who were active GBS carriers. Because most women do not know their GBS status at the time of PPROM and it is practically difficult to identify the active carriers before delivery, ampicillin/amoxicillin should be used as a prophylactic antibiotic for active GBS carriers and women with unknown GBS carriage status to prevent neonatal GBS infection following PPROM.

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.

Frailty and diastolic dysfunction (DD) are prevalent in the elderly and may be associated with the development of heart failure (HF). The Undiagnosed heart Failure in frail Older individuals (UFO) study aims to investigate the epidemiology, natural history and predictors of HF development in a

To determine the relationship between advanced maternal age (≥35 years) and incidence of postpartum hemorrhage (PPH) in singleton pregnancies managed over a 10-year period.Retrospective cohort study comparing demographics, risk factors, complications, infant outcome, and incidence of PPH between parturients aged ≥35 and35 years at delivery.Parturients aged ≥35 years (12 686/64 886 or 19.6%) had significantly increased obstetric risk factors, complications, cesarean delivery, large-for-gestational age infants, and incidence of PPH, but no difference in the attributed cause of PPH such as uterine atony, retained placenta, genital lacerations, except for multiple factors. Multivariate analysis indicated that aging was actually associated with decreased PPH, the risk decreasing progressively from those aged 25-29 years to those aged ≥40 years compared with the 20-24 years group.Advanced maternal age only served as a surrogate factor for PPH due to the associated increased risk factors, obstetric complications and interventions.

Objective To assess the incidence of macrosomia and the influence of birth weight on shoulder dystocia risk among a cohort of Chinese women. Methods A retrospective analysis was conducted of 80 953 singleton deliveries recorded at the Prince of Wales Hospital, Hong Kong, between 1995 and 2009. The incidences of macrosomia (birth weight ≥ 4000 g) and shoulder dystocia were assessed by birth weight; risk factors for shoulder dystocia were examined by multiple logistic regression analysis. Results The incidence of macrosomia was 3.4%. The overall incidence of shoulder dystocia was 0.3%; however, the incidence rose with increasing birth weight. The odds ratio (OR) for a birth weight of 4000–4199 g was 22.40, while the OR for a birth weight of 4200 g or above was 76.10. Other independent risk factors for shoulder dystocia included instrumental delivery (OR 12.11), short stature (OR 2.16), maternal diabetes mellitus (OR 1.78), and obesity (OR 1.58). Conclusion Although the overall incidences of macrosomia and shoulder dystocia were low, the risk of shoulder dystocia was strongly linked to increasing birth weight. International guidelines for elective cesarean delivery in suspected cases of macrosomia may not, therefore, apply to Chinese women.

As multiparas have high prevalence of chronic hepatitis B virus (HBV) infection, we examined here the relationship between the number of pregnancies with HBV infection.Retrospective cohort study examining the prevalence of HBV infection by actual gravidity and parity in 104 242 gravidae managed during 1997-2013.Infection rate increased from 8.5% to 10.6% for G1 to G≥6 and from 8.8% to 10.0% for P0 to P≥3 (P.001). When stratified by parity, correlation with gravidity was maintained in the nulliparous gravidae. For the same gravidity, increasing parity was associated with higher rate of HBV infection for G2 and G3. Multiparas had higher HBV infection prevalence (all10%) than nulliparas (10%) for G2 to G≥4.Prior pregnancies, especially successful ones, are associated with increased HBV infection in an endemic population, which could have enhanced reproduction and in the process facilitated its transmission to the following generations.

Objective: The aim was to determine the institutional procedure-related fetal loss rate after chorionic villus sampling (CVS) and the factors which may identify pregnancies at increased risk of having a procedure-related loss. Materials and Methods: Pregnancy outcomes were retrieved of all women having a singleton pregnancy and undergoing a CVS procedure between 2004 and 2013 at a university hospital in Hong Kong. The incidence of procedure-related fetal loss due to unintended miscarriages adjusted for the background loss incidence of miscarriages was determined. Multivariate regression was performed to examine the factors contributing to an unintended fetal loss and miscarriage. Results: CVS was performed on 1,906 fetuses. The procedure-related fetal loss rate was 0.17% (95% CI -0.2 to 0.7). After multivariate analysis, a decreased plasma protein-A (PAPP-A) multiple of the median (OR 0.27; 95% CI 0.08-0.98, p = 0.046) was significantly associated with miscarriage in women who did not undergo a CVS. Patient-specific prediction of spontaneous abortion in women who did not undergo CVS was not statistically significant (AUC 0.56; 95% CI 0.49-0.6, p = 0.14). Conclusions: The CVS-related fetal loss rate adjusted for background loss was 0.17%. Pregnancies with reduced PAPP-A carry an increased risk of miscarriage irrespective of whether they had undergone an invasive procedure.

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.

To elucidate the effect of hepatitis B virus (HBV) infection on breastfeeding uptake in Chinese mothers in an endemic region.A retrospective cohort study on 63 885 consecutive pregnant delivered between January 1997 and June 2008, were extracted from computerized database to examine the relationship between breastfeeding uptake and maternal HBV status, adjusted for demographic factors.A total of 6593 (10.3%) women were hepatitis B surface antigen (HBsAg)-positive, with an annual prevalence of around 10%. In the study period, 29 869 (46.8%) practised breastfeeding, and its prevalence ranged from 35.4 to 54.8% with an increasing trend throughout the years (p0.001). HBsAg-positive mothers had a significantly lower rate of breastfeeding (39.2 vs. 47.6% p0.001). Multiparas had higher incidence of HBV infection (10.9 vs. 9.8%, p0.001) and lower breastfeeding rate (42.2% versus 51.0%, p0.001) when compared with primiparas. Among those factors, maternal HBV infection had the strongest negative association with breastfeeding (adjusted odd ratio (aOR) = 0.726, 95% confidence interval (CI): 0.689-0.765).Our results suggested maternal HBV infection was one of the factors for the persistently low breastfeeding rate in Hong Kong over the past decades. To promote breastfeeding, it is necessary to generate definitive data on its safety regarding to mother-to-child transmission (MTCT) of HBV in order to allay the fear and anxiety in HBsAg-positive mothers.

To determine the obstetric outcome in teenage women managed in the recent decade with easily accessible health care provision.In a retrospective cohort study, maternal demographics, underlying medical conditions, obstetric complications, preterm birth, type of labor, mode of delivery, and perinatal mortality were compared between 1505 women aged ≤ 19 years (study group) with 10,320 women aged 20-24 years (comparison group), who were carrying singleton pregnancies beyond 24 weeks of gestation and managed in our hospital between January 1998 and June 2008.The study and comparison groups accounted for 2.2% and 15.1% respectively of the total deliveries. Despite comparable health status and rates of other obstetric complications, teenage women was associated with birth34 weeks (aOR 2.45, 95% CI 1.67-3.60), birth at 34-36 weeks (aOR 2.13, 95% CI 1.71-2.65), and reduced instrumental vaginal (aOR 0.62, 95% CI 0.50-0.77) and caesarean (aOR 0.79, 95% CI 0.64-0.97) delivery, without increase in perinatal mortality.Teenage women had increased preterm birth, despite improved health care provision, nutrition, and similar incidence of other obstetric complications, but the obstetric and perinatal outcome remained favorable.

Information on the impact of maternal hepatitis B virus (HBV) infection on pregnancy outcome is conflicting. Some studies reported an association with increased infant birthweight, which could be interpreted as advantageous to pregnancy. A retrospective study was performed to compare birthweight outcome between 6261 and 55,817 singleton pregnancies in mothers screened positive and negative for hepatitis B surface antigen (HBsAg), respectively. The HBsAg positive women were younger, had higher body mass index (BMI) and incidence of overweight, but less gestational weight gain, and were associated with increased macrosomia (birthweight ≥4000 g) in mothers 90th percentile) infants in nulliparas (OR 1.13), age

To assess the quality of nuchal translucency, (NT) measurements were performed at four public institutions performing routine first trimester combined prenatal screening for Down syndrome.The median of the NT-MoM distribution and standard deviation (SD) of the log(10) NT-MoM were determined. Sonographers and screening centres distributions were assessed for measures of central tendency (median) and dispersion (log(10) SD). Cumulative Sum (CUSUM) charts were created to assess whether screening centres and individual sonographers who had performed at least 30 NT measurements exhibited any systematic bias by checking whether their CUSUM scores exceeded predefined upper and lower control limits.Of the 36 sonographers, only 67% (n = 24) had performed 30 or more scans. The median NT-MOM at each screening centre ranged from 1.02 to 1.09. Screening centre standard deviations ranged from 0.073 to 0.099. CUSUM charts indicated that only one screening centre remained within the predefined control limits throughout the assessment period. Analysis of variance indicated that a statistically significant difference existed between the log NT-MoM distributions of the individual sonographers (F = 10.7; p0.0001). Inspection of the individual sonographer CUSUM charts indicated that 11 (45%) of the 24, with more than 30 NT measurements were either under or over measuring the NT.Prospective monitoring and feedback of quality assurance assessment results of sonographers and screening centres should be routinely reported as both are responsible, if equity of screening performance is to be maintained.

Background: The rates of preterm birth in Chinese women and the potential effects of differing environments are poorly understood. Aim: To determine the rate of preterm birth in Chinese women in China, Hong Kong and Western Australia. Methods: The rates of preterm birth were obtained from records of 26 611 pregnancies in Jiangsu Province in mainland China, 48 976 pregnancies in Hong Kong and 185 798 pregnancies in Western Australia. Results: Preterm birth rates increased from 2.6 and 2.9% in urban and rural Jiangsu Province, respectively, and 2.5% in China-born women in Western Australia who required an interpreter; to 4.9% in China-born women in Western Australia who did not require an interpreter; to 5.6% in non-resident Chinese women in Hong Kong; and 7.6% for women resident in Hong Kong. Within Western Australia, the rate of preterm birth was significantly less in women who were born in China and declared themselves to be Chinese (4.4%) than Caucasians (7.8%), other women who declared themselves to be ‘Asian’ (8.7%) and women of Aboriginal heritage (14.5%). Conclusions: The rate of preterm birth in China is relatively low but appears to differ in Chinese women in other environments. Differences between traditional Chinese and contemporary Western lifestyles, possibly including smoking and sexual practices, may contribute to the different rates of preterm birth. Further research in this area may provide avenues for the prevention of preterm birth and also help to prevent a possible rise in this complication of pregnancy as Chinese society continues on the path of economic and social reform.

To investigate the association between first trimester maternal placental growth factor (PlGF) and fms-like tyrosine kinase 1 (sFlt-1) levels with subsequent development of pre-eclampsia (PE).This is a matched case-control study using stored serum samples collected from non-smoking Chinese women with singleton pregnancies who underwent first trimester screening for aneuploidy. Each case that developed PE was matched with a control whose maternal age, weight, gestational age and date of blood collection were within ± 2 years, ± 5 kg, ± 1 day, and ± 2 weeks of the index case, respectively. Non-parametric paired test was used to compare the PlGF and sFlt-1 levels. PlGF and sFlt-1 were transformed to their equivalent multiple of the median (MoM) using the matched control as the expected median value. The 95% confidence interval (CI) of the estimated median PlGF and sFlt-1 MoM in those with PE was determined.The median PlGF level in the 27 study cases with PE was lower than that of the matched controls (42.9 pg/ml versus 59.8 pg/ml; p = 0.001). The median PIGF MoM was 0.71 (95% CI 0.63-0.92). There was no statistically significant difference in sFlt-1 levels between those with PE and their matched control (p = 0.648). The median sFlt-1 MoM was 1.01 (95% CI 0.65-1.3).Women who developed PE had lower serum PlGF levels but normal sFlt-1 levels in the first trimester.