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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) <34 and <37 weeks, (6) delivery of a small for gestational age (SGA) or large for gestational age (LGA) neonate, (7) caesarean section (CS), and (8) postpartum haemorrhage (PPH) were examined after adjusting for confounding factors., Results: The prevalence of maternal overweight (BMI 25-29.9 kg/m 2 ) and obesity (BMI ≥30 kg/m 2 ) were 13.2% and 2.9%, respectively. Women with a BMI ≥30 kg/m 2 were nine times more likely to develop GH (95%CI 7.3-11.7), five times more likely to develop PE (95%CI 4.3-6.8) and GDM (95%CI 5.0-6.5) and 1.5-2 times more likely to deliver SGA/LGA neonate. sPTD, required delivery by CS and developed PPH, than those with a BMI of 18.5-22.9 kg/m 2 , and that maternal underweight (BMI <18.5 kg/m 2 ) significantly reduced the risk of GDM, delivery by CS, and PPH. Increased risk of subsequent development of adverse outcomes was observed when BMI was ≥23.0 kg/m 2 ., Conclusions: Maternal overweight and obesity are associated with an increased risk for subsequent development of various pregnancy complications. The need of increased awareness and health surveillance is essential when BMI ≥23 kg/m 2 .

Objective: To evaluate the perinatal outcome of monochorionic (MC) multiple pregnancies after selective reduction by radiofrequency ablation (RFA)., Methods: A case series of all MC multiple pregnancies with selective reduction by RFA in one single institution was reviewed., Results: Ten consecutive patients with an MC pregnancy (9 pairs of twins and 1 set of triplets) underwent RFA. The median gestational age at the time of the procedure was 15.6 weeks (range, 12.3-19.6). The indications for selective reduction included discordance for fetal anomalies (4 cases), twin reversed arterial perfusion sequence (3 cases), selective intrauterine growth restriction (2 cases) and severe twin-twin transfusion syndrome (1 case). All procedures were technically successful in achieving selective reduction. The overall survival rate of the co-twin was 81.8% (9/11), and the median gestational age at delivery was 35.9 weeks (range, 32.4-38.6). There was one preterm delivery before 34 weeks of gestation (11.1%). Preterm premature rupture of the membranes occurred in 2 patients (20%); however, this was not observed within 4 weeks postoperatively, nor did they deliver before 32 weeks., Conclusions: RFA is a promising technique for selective reduction in complicated MC multiple pregnancies with a high survival rate and low complication rate.

Objectives: To study the perinatal outcome among monochorionic diamniotic (MCDA) twin pregnancies with absent or reversed end-diastolic flow of the umbilical artery (UA-AREDF) at 16-20 weeks of gestation., Methods: This was a retrospective study of 84 MCDA twin pregnancies, which were followed up since first trimester in a single obstetric unit. Pregnancies with fetal structural anomalies or genetic syndromes, and those with single intrauterine death before 16 weeks were excluded. The study group was divided into four groups based on the finding of UA-AREDF at the routine follow-up scan at 16-20 week, and the presence of complications at the same time of recruitment. The perinatal outcome between these groups was compared., Results: AREDF was present in 56.7% of the 30 monochorionic (MC) twins with complications at recruitment. The mortality was significantly higher among those with AREDF. Among the 54 uncomplicated cases at recruitment, only 7.41% had AREDF. The presence of isolated AREDF was associated with significantly higher incidence of growth discordance (25.0% vs. 2%). The incidence of perinatal mortality and twin-to-twin transfusion syndrome was almost doubled (25.0% vs. 9% and 25.0% vs. 14%)., Conclusions: AREDF of the umbilical artery is uncommon in normal MC twin in mid-trimester. Once AREDF is present, the perinatal outcome is much worse. Doppler assessment of the umbilical artery should be considered in all MC twin pregnancies for risk assessment.

Background: Nausea and vomiting in pregnancy (NVP) is the most common pregnancy complication affecting women during the first trimester of pregnancy. The cause of NVP remains unknown and factors associated with the occurrence of NVP are contradictory. There is currently little information on its effects of NVP in general and specifically in the Chinese population., Aims: To assess the prevalence of NVP with different degree of severity and identify their relationship with health-related quality of life (HRQoL) and to determine its association with the sociodemographic and obstetric factors., Methods: In a prospective cross-sectional study, 396 women who attended the antenatal clinic between 10 and 14 weeks of gestation were invited to complete a structured questionnaire covering maternal characteristics, severity of NVP and their HRQoL. The status of NVP and HRQoL was measured by the frequency of symptoms and the Medical Outcomes Study Short-Form-36 (SF-36) respectively. Logistic regression analysis was performed to delineate the factors associated with NVP., Results: The prevalence of NVP was 90.9%. Almost all domains and dimensions of SF-36 were affected by the presence of NVP and its severity. Factors associated with the presence and severity of NVP were non-smoking, younger age and history of NVP in previous pregnancy., Conclusions: The various degrees of severity of NVP significantly impair both physical and mental HRQoL in Hong Kong Chinese women. Awareness and care should be given to women with symptoms of nausea or retching alone, as well as vomiting., (© 2010 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective: To determine the performance of trained midwives in second trimester ultrasound screening for fetal structural abnormalities in a low-risk population., Design: Retrospective study., Setting: University Department of Obstetrics and Gynecology., Population: About 13,882 women with singleton pregnancies., Methods: The findings of routine second trimester anomaly scan performed by midwives were reviewed. Reasons for referral to maternal fetal medicine (MFM) specialists for further assessment were analyzed., Main Outcome Measures: The detection, false positive and false alarm rates for fetal anomalies., Results: One hundred and eighty-nine pregnancies with unknown outcome were excluded from the final analysis. Overall, 617 (4.51%) women were referred to MFM specialists for further assessment, of which 470 (70.2%) were for soft markers alone and 147 (23.8%) for suspected fetal structural abnormalities. In these 13,693 fetuses with known outcome, malformed fetuses were present in 185, a prevalence of 1.35%. Of these, 115 were detected during the second trimester scan and two were detected in the third trimester. The remaining 68 malformed fetuses, most of which had minor anomalies, were identified after birth. The detection rate for a malformed fetus in second trimester scan was 62.2% (115/185) (95% CI 55.2-69.2). There were four cases of false positives and 33 cases of false alarm., Conclusions: Experienced midwives with proper training can detect the majority of major structural abnormalities. Continuous audit and quality control plays a significant role in optimizing the fetal structural examination.

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. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate the feasibility of live xPlane imaging visualizing the in-plane view of IVS in the screening of the fetal conotruncal anomalies. Method: One hundred and fifty-two consecutive normal singleton fetuses and forty-eight fetal cardiac defects (27 conotruncal and 21 non-conotruncal cases), were enrolled in this study. The in-plane view of IVS was firstly acquired with live xPlane imaging and then judged whether it is normal or not by one operator. The focus was put on observing the relationship of pulmonary artery and aorta. The comparison between conotruncal and non-conotruncal anomalies in demonstrating the relationship of pulmonary artery and aorta was performed. Result: There were 27 cases of conotruncal anomalies enrolled in this study and 19 cases (70.4%) had the abnormal relationship of aorta and pulmonary artery in the in-plane view of IVS. In 21 cases of non-conotruncal CHDs, however, there were only 5 cases (23.8%) had the abnormal relationship in the in-plane view of IVS ( p < 0.001). Conclusion: Live xPlane imaging of the in-plane view of IVS is feasible to detect the fetal conotruncal anomalies, which may potentially be a useful tool for the non-experienced operators to screen the fetal conotruncal anomalies. [ABSTRACT FROM AUTHOR]

Objective: To assess the risk of intra-uterine death (IUD) after external cephalic version (ECV). Methods: In this retrospective cohort study, 1078 consecutive ECVs performed between January 1994 and March 2011 in an University teaching hospital were extracted from the computerized database to examine the risk of IUD after ECV. Results: A total of 1078 consecutive ECVs were performed over the study period. The overall successful rate was 72.8%, the successful rate was 63.1% in nulliparous and 82.7% in multiparous, respectively ( p < 0.001). There was no IUD identified within 24 h after the procedure and there was only one case of IUD (0.09%) that occurred 4 weeks after an uncomplicated ECV. Conclusions: ECV is a safe procedure that does not increase the risk of IUD within and after 24 h of enrolment irrespective of outcome of ECV. Our findings have important clinical implication in terms of patient counseling regarding the decision on term breech management. [ABSTRACT FROM AUTHOR]

Objective. To assess the effect of storage time on the stability of placental growth factor (PlGF) and fms-like tyrosine kinase 1 (sFlt-1) levels in frozen serum samples from pregnant women. Methods. This is a matched case-control study using fresh and stored serum samples collected at 6, 12, 18, 24, 30 and 36 months prior to the collection of the fresh samples and frozen at -80°C. Forty-eight samples from each of the seven time-groups were matched for non-smoking Chinese, maternal weight, singleton-term pregnancy without major obstetric complications and extracted for PlGF and sFlt-1 assays. Multivariate analysis was performed to assess residual effects of the case-matching procedure. ANOVA was used to assess the effects of storage time. Results. Multivariate analysis of the 336 samples indicated that log10PlGF was positively correlated with parity ( p = 0.014) and gestational age ( p = 0.029), while log10sFlt-1 was inversely correlated with parity ( p = 0.018). After correcting for the residual effect of gestation and parity, ANOVA showed no significant difference in PlGF and sFlt-1 levels between the fresh samples and all stored samples ( p = 0.410 and p = 0.158, respectively). Conclusions. Serum PlGF and sFlt-1 levels are stable for at least 3 years when stored at -80°C. Parity is an independent factor of PlGF and sFlt-1 levels. PlGF levels are lower and sFlt-1 levels are higher in nulliparous women compared to multiparous. [ABSTRACT FROM AUTHOR]

A retrospective audit identified 10 cases of massive idiopathic subchorionic thrombohematoma. The incidence was 1:3,133. Only six of these pregnancies resulted in a livebirth and only two reached term. In eight cases there were ultrasound abnormalities, including two cases of placentomegaly both of which resulted in a pregnancy loss. There was one placental abruption. Seven of the women were nulliparous. Massive subchorionic thrombohematoma is associated with poor pregnancy outcome. Ultrasound findings of placentomegaly might be a bad prognostic sign. [ABSTRACT FROM AUTHOR]

A response by Fung and colleagues to a letter to the editor on their article "Massive Subchorionic Thrombohematoma: A Series of 10 Cases," published in the previous issue, is presented.