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Objective: To evaluate the local incidence of orofacial cleft (OFC) encountered in fetal morphology scan and prenatal diagnosis, genetic etiology of fetuses with or without other structural abnormalities, and their pregnancy outcomes. Design: Retrospective cohort study. Setting: Two maternal fetal medicine units, tertiary hospitals, Hong Kong. Participants: All pregnant women with antenatal diagnosis of fetal OFC between January 2016 and December 2020 (N = 66). Results: OFC has an incidence of 0.13% among pregnancies in Hong Kong and 28.8% (19/66) were syndromic cleft that exhibited other fetal structural anomalies. There were 55 cases (84.6%) who opted for invasive prenatal diagnostic testing. Genetic defects were identified in 25.8% (17/66) of this cohort, including 14 pathogenic variants. The detection rate in the syndromic cases is 68.4% (13/19) which was significantly higher than 8.5% (4/47) among non-syndromic cases. Aneuploidies would be the most common cause, accounting for 9.1% (6/66). Chromosomal microarray analysis (CMA) provided an incremental diagnostic yield of 6.1% compared to conventional karyotyping. A total of 29 live births including 3 cases of a variant of uncertain significance and 26 cases without genetic abnormalities detected have continued pregnancy to birth. There were 87.5% (21/24) without detectable pathogenic genetic abnormality reported good long-term outcomes. The chance of OFC fetuses having a good long-term outcome was significantly higher if no genomic variant was detected (P <.001). Conclusions: Invasive prenatal tests with CMA should be offered to pregnancies with OFC regardless of the type. It has provided incremental diagnostic yield over conventional karyotyping and helped in prenatal and genetic counseling. A negative result in non-syndromic OFC favors couples to keep the pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: There is a rising prevalence in undetected perinatal depression in many countries, more effort in screening and early identification of perinatal depression is needed. While the Whooley questionnaire is the recommended case-finding strategy for perinatal depression, there is no validated Chinese version. The aim was to evaluate the diagnostic accuracy and stability of the translated Chinese Whooley questionnaire against gold standard measurement during and early after pregnancy. Materials and Methods: This observational study recruited 131 pregnant women from an antenatal clinic in Hong Kong from September 2019 to May 2020. We translated the Whooley questionnaire in Chinese and evaluated self-reported responses against an interviewer-assessed diagnostic standard (DSM-IV criteria) in 107 women at 26–28 gestational weeks. We calculated sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio, with DSM-IV diagnosis as the gold standard. Results: The Chinese Whooley questions had a sensitivity of 79% (95% CI 54.4–93.9), a specificity of 97% (95% CI 90.4–99.3), a positive likelihood ratio of 23.2 (95% CI 7.4–72.1) and a negative likelihood ratio of 0.2 (95% CI 0.1–0.5) in identifying perinatal depression. Conclusion: The translated Chinese Whooley questionnaire has an acceptable diagnostic accuracy in identifying perinatal depression. It can be implemented in health services among Cantonesespeaking Chinese population. [ABSTRACT FROM AUTHOR]

Objective: To compare the incidences of early and late‐onset neonatal sepsis, including group B streptococcus (GBS) and Escherichia coli (E. coli) before and after implementation of universal screening and intrapartum antibiotics prophylaxis (IAP). Design: Retrospective cohort study. Setting: Eight public hospitals and 31 Maternal and Child Health Centres (in Hong Kong. Population: 460 552 women attending routine antenatal service from 2009 to 2020. Methods: Universal culture‐based GBS screening has been offered to eligible women since 2012. Total births, GBS screening tests, maternal GBS colonisation and neonatal sepsis with positive blood or cerebrospinal fluid were retrieved from clinical and laboratory database. Main outcome measures: Maternal GBS colonisation rate, early‐ and late‐onset neonatal sepsis (including GBS and E. coli). Results: Of 318 740 women with universal culture‐based screening, 63 767 women (20.0%) screened positive. After implementation of GBS screening and IAP, the incidence of early‐onset neonatal sepsis decreased (3.25 versus 2.26 per 1000 live births, p < 0.05), including those caused by GBS (1.03 versus 0.26 per 1000 live births, p < 0.05). Segmented regression showed that change in early‐onse GBS sepsis incidence after screening was the only significant variable in the outcome trend. There was no significant evidence of increase in incidence of late‐onset neonatal sepsis including those caused by GBS. Conclusions: Universal culture‐based GBS screening and IAP were associated with reduction in early‐onset neonatal sepsis including GBS disease. Although an increase in incidence of late‐onset neonatal sepsis including those caused by GBS cannot be totally ruled out, we did not identify significant evidence that this occurred. This article includes Author Insights, a video abstract available at: https://vimeo.com/736158854 Linked article: This article is commented on by Mark Turrentine, pp. 32 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17275 [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the value of clinical and ultrasound risk factors in predicting severe postpartum haemorrhage (PPH) (≥1.5 L) in pregnancies undergoing caesarean section for placenta praevia. This cohort consists of all cases of placenta praevia undergoing caesarean delivery over a period of 5 years in a service unit. Patients and their delivery data were retrieved from an obstetric database. Ultrasound features were prospectively recorded before caesarean section. The incidence of caesarean section for placenta praevia was 0.98% (n = 215). Of these, 12.1% (n = 26) had severe PPH. A logistic regression model showed that major praevia, antepartum haemorrhage before delivery and anterior placenta remained significant factors associated with severe PPH. The sensitivity/specificity and positive/negative predictive value of the model are 96.2%, 59.8%, 24.8% and 99.1%, respectively. Our model had high sensitivity and negative predictive value for severe PPH during caesarean section for placenta praevia.Impact statementWhat is already known on this subject? Placenta praevia is known to be one of the leading causes of severe PPH. Many risk factors have been associated with severe bleeding during caesarean section for placenta praevia. However, the importance of individual factors in predicting pregnancy outcome remains controversial.What the results of this study add? Our model includes only three simple parameters, namely the presence of significant antepartum haemorrhage (APH) from the history, and anterior or posterior placenta and major or minor praevia from ultrasound findings, but could predict up to 96.2% of all severe PPH. More importantly, the absence of APH, a posterior minor praevia, was associated with a negative predictive value of 99.1% of severe PPH, implying that such cases could be treated as 'normal' low risk caesarean sections.What the implications are of these findings for clinical practice and/or further research? This simple model would allow differential pre-operative counselling of patients on risks and complications, planning and preparation of operation, allocation of staff as well as in contingency measures to be taken during operation. The establishment of a differential protocol for placenta praevia based on these simple risks factors and a prospective trial of such a protocol is suggested. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to explore whether increase in use of second-line conservative surgical procedures will alter the rate of peripartum hysterectomies in management of severe postpartum haemorrhage (PPH).Methods: This is a retrospective cohort. All pregnant patients with gestation > = 28 weeks with severe PPH (> = 1.5 L) within 72 h of delivery from year 2000 to 2015 (16-year period) in an obstetric training unit was recruited. Basic patient anthropometric characteristics and the main causes for PPH were calculated. The incidence of any second-line conservative surgical procedures and peripartum hysterectomies were evaluated. The total number of patients in each category was then stratified into four 4 years-intervals (4 quadrennium) to compare trends.Results: The incidence of severe PPH gradually increased over the study period (lowest 0.21% in 2002 to 0.76% in 2015) (p < .001). There is an obvious increasing trend in the overall use of second-line surgical procedures from nil to 82% (p < .001), with balloon tamponade constituting up to 48%. The incidence of successful second-line procedures increased gradually from 72.2% in the second quadrennium to 89% in the fourth quadrennium. The total peripartum hysterectomy rate among cases of severe PPH could be seen to drop from 40.2% in the first to 10.9% in the fourth quadrennium (p = .04).Conclusions: Despite the increasing trends in PPH, the increasing utilisation of second-line conservative surgical procedures in severe PPH should be able to reduce the need for peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

In this first Asian study, the decision outcomes (decision conflict, decision regret, and anxiety) of 262 pregnant women offered noninvasive prenatal test (NIPT) for high-risk Down screening results were assessed. Decision conflict was experienced by 3.5% and level of decisional regret low (mean score 15.7, 95%CI 13.2-18.3). All 13 cases of decisional regret were NIPT acceptors. Elevated anxiety was experienced by 55.9% at the time of decision making about NIPT and persistent in 30.3%. Insufficient knowledge about NIPT was associated with elevated anxiety at decision making (p = .011) and with decisional regret (p = .016). Decisional regret was associated with prolonged anxiety (p = .010). [ABSTRACT FROM AUTHOR]