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The objective of this study is to evaluate the feasibility of predicting labor outcome using serial transperineal ultrasound (TPU) in the early active phase of labor.This is a single center prospective observational study in a tertiary obstetrics unit in Hong Kong. Nulliparous women carrying singleton pregnancy at the onset of active phase of labor were recruited. Serial 3D volumes by TPU were acquired and then repeated after 1 and 2 h, which were subsequently analyzed for fetal head symphyseal distance (HSD), angle of progression (AoP), and fetal head progression distance (PD). The women were classified into two groups, according to whether they had vaginal delivery or cesarean section (CS) for reasons other than non-progressive labor (Group A) or CS for non-progressive labor (Group B). The TPU parameters were then compared between the groups.Group A consisted of 74 (60.0%) women with vaginal delivery, 27 (21.8%) with instrumental delivery and 3 (2.4%) CS for reasons other than non-progressive labor, while Group B consisted of 20 (16.1%) women who had a CS for non-progressive labor. Group B had a significant slower hourly progression rate of AoP, HSD, and PD at 1-h and 2-h from the initial assessment, compared with Group A. Multivariate logistic regression analysis demonstrated that PD progression at 2-h and the use of oxytocin were significant independent predictors for CS for non-progressive labor.It is feasible to predict CS for non-progressive labor in the early active phase of labor by a slower rate of fetal head descent determined by TPU.

OBJECTIVES:: The aim of this study was to determine the pattern of dog bites seen at the emergency department of a university hospital. The information will be used to plan prevention and enhance management strategies. METHODS:: All patients (younger than 22 years) assessed at the emergency department between January 2003 and December 2004 with a discharge diagnosis of animal bites were identified through the computerized discharge network. RESULTS:: One hundred forty-four incidents of animal bites (82 males and 62 females) occurred over the 2-year period. Eighty-nine percent was due to dog bites. Among the dog bite victims, the mean age was 11.82 years (SD, 6.39 years; range, 0.06-21.83 years). Family dogs were only involved in 15% of cases. The species of dogs were not recognized in three fifths, and attacks provoked in two fifths of victims. Most bites (90%) of bites involved only single anatomical sites. The extremities were commonly involved (right upper limb [23%], left upper limb [16%], right lower limb [35%], left lower limb [20%]). Torso (4%) and genitalia (0.8%) were uncommonly involved. Pain, erythema, bleeding, and bruising were common symptoms, but 60 patients were asymptomatic at presentation. Compared with older patients, children younger than 10 years had a much higher risk of facial injuries (25% vs. 2%, P = 0.0002; odds ratio, 21.8, 95% confidence interval, 2.9-455.9) and were more likely to be triaged as being urgent (P = 0.01). Most attacks were trivial and did not require hospitalization. Antirabies treatment was given in approximately half, analgesics in two fifths, and antibiotics in one fourth. CONCLUSIONS:: In mammalian attacks, canines are most commonly involved. Most injuries are trivial, and the limbs are usually involved. However, younger children are at higher risk of facial injuries. Extent of pain and adverse psychological impacts are typically not documented in the emergency assessment. Language: en

Introduction: More than 4000 patients with mild head injury are managed in public hospitals in Hong Kong every year. It is a common belief that mild head injuries do not result in long-term disabilities. We aim to: (i) investigate the disability after mild head injury using objective assessment tools; and (ii) analyse risk factors that contribute to these disability. Methods: Patients with a Glasgow Coma Score of 13–15 admitted between January and March 2002 were recruited for study. Their long-term clinical outcome (2 years after initial injury) was prospectively documented with the Glasgow outcome scale – extended (GOSE). Glasgow outcome scale – extended is the primary outcome measure. A GOSE score less than 7 was considered failure to restore to previous working capacity. Results: One hundred and sixty-two patients were recruited, of which 101 were successfully contacted. Two years after injury, 28.7% of the patients scored less than 7 (failure to restore working capacity). Injury on duty was shown to be a significant risk factor for predicting long-term disability (P = 0.03). Radiological abnormality was not a significant predictor in long-term disabilities. Conclusion: Incidence of long-term disability after mild head injury is common among the local working population in Hong Kong and should not be overlooked. Further research is needed to quantify the disability and to identify possible risk factors.

To determine the effectiveness of cerclage pessary in the prevention of preterm birth in asymptomatic Chinese women with a short cervix at 20 to 24 weeks.Low-risk women carrying singleton pregnancies were screened with transvaginal ultrasound, and those with a cervical length25 mm at 20 to 24 weeks were recruited into a randomized controlled trial, comparing the prophylactic use of cerclage pessary with expectant management. The analysis was by intent-to-treat. The primary outcome measure was preterm delivery before 34 weeks.Among 4438 screened women, 203 women (4.6%) met the inclusion criteria and 108 (58%) consented for the study. A total of 53 and 55 women were allocated to pessary and control groups, respectively. There was no difference in background demographics, including the mean cervical length (19.6 mm versus 20.5 mm) and the mean gestational age at randomization (both 21.9 weeks). Delivery before 34 weeks occurred in 9.4% and 5.5% (p = 0.46) in the pessary and the control groups, respectively. No differences in major side effects were noted between the groups.In our population,5% had a cervical length of less than 25 mm at 20 to 24 weeks' gestation. The prophylactic use of cerclage pessary did not reduce the rate of preterm delivery before 34 weeks.

Objective: To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency. Methods: The pregnancy outcome of 20 women carrying singleton pregnancy referred for suspected cervical insufficiency and chose Arabin cerclage pessary for treatment from 2009–2011 were reviewed. Pregnancy outcome were analysed according to presence of risk factors, amniotic fluid sludge, cervical length and gestation at pessary insertion. Results: At presentation, mean cervical length was 1.17 cm (range 0–2.33 cm), mean gestation at pessary insertion and delivery was 20.6 (12.9–26.1) weeks and 32.1 (14.7–40.1) weeks, respectively, and mean prolongation of pregnancy was 11.5 (0.5–25.2) weeks. Overall, 5 (25%) had fetal loss between 14.7–23.1 weeks, while 3 (15%) and 12 (60%) delivered before and after 34 weeks gestation, respectively with no perinatal mortality. Compared with women with cervical length

Hemostasis for placenta previa is notoriously difficult because of the poor contractility of the lower segment. A hemostatic gel offers a new type of hemostatic matrix, which may have advantages.A 35-year-old woman had a postpartum hemorrhage despite the use of uterotonics 2 hours after cesarean delivery for major placenta previa. On relaparotomy, heavy oozing from the placental site was found. Difficult accessibility and profuse bleeding prompted the consideration of alternative treatment with the topical application of hemostatic gel over the lower segment, which achieved hemostasis within minutes.Hemostatic gel is easily applicable and provides quick and effective hemostatic control in the lower segment, where surgical intervention may be difficult.