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Biomedical subjects

W W To

Publications and source records attributed to W W To.

At least 19 recordsLinked to original sources
PubMed2001

A protocol of selective antibiotic prophylaxis for caesarean section based on risk factors.

The aim of the study was to identify risk factors associated with increased risks of post Caesarean febrile morbidity from a retrospective epidemiological analysis, and to prospectively evaluate a protocol of selective antibiotic prophylaxis based on these risk factors. Caesarean section births over a three-year period--during which no antibiotic prophylaxis protocol was practised--were reviewed. Risk factors for febrile morbidity were identified using both univariate and multivariate analysis. A protocol of selective antibiotic prophylaxis, incorporating the significant risk factors identified, was then evaluated prospectively over a nine-month period. The incidence of febrile morbidity from the retrospective study was 16.9%. A logistic regression model, with febrile morbidity as the dependent variable, identified only the duration of labour over 10 hours as a significant factor. A protocol of antibiotic prophylaxis using intravenous ampicillin was then practised in the presence of these two factors. Evaluation of this protocol after nine months showed that the incidence of febrile morbidity was reduced significantly from 20% in those not given antibiotics to around 9.6% in those eligible for and given antibiotics. However, the overall incidence of febrile morbidity remained at around 16-18%.

Adult↗
PubMed2000

Bartter's syndrome in pregnancy: a case report and review.

Bartter's syndrome is a rare renal tubular disorder, involving juxtaglomerular cells hyperplasia, characterized by normotensive hyper-reninism and secondary hyperaldosteronism, marked renal loss of potassium and profound hypokalaemia. Both clinical and biochemical features are heterogeneous, ranging from the incidental finding in an asymptomatic patient to marked clinical features of hypokalaemia. Inheritance is likely to be an autosomal recessive. We present a case of Bartter's syndrome complicating pregnancy in a Chinese woman. We documented an increasing demand for potassium supplement during pregnancy which stabilized by mid-trimester. The absence of pregnancy complications such as polyhydramnios indicated that the fetus was unlikely to be affected by the condition.

Adult↗
PubMed2000

The relationship of physical trauma and surgical stress to menstrual dysfunction.

To evaluate the incidence and pattern of menstrual dysfunction in reproductive age group women suffering acute musculoskeletal trauma, 198 women between 15 and 50 years of age admitted consecutively into an acute orthopaedic unit were recruited over a 6-month period. The patients were then followed up for 6 months with menstrual diaries to compare their menstrual pattern with their preadmission status. Excluding those with significant menstrual problems before admission, the menstrual pattern remained normal in 135 (68%) (EM), while 12 (6%) developed polymenorrhoea (PM), and 51 (25%) had oligomenorrhoea or amenorrhoea (OAM) within the 6-month observation. The three groups did not differ in their mean age, body mass index, parity or age of menarche, but previous cycle lengths were shortest in the PM group (25.4 days, SD 7.64) (p<0.05) and history of amenorrhoea in the previous one year was most common in the OAM group (p<0.025). Univariate analysis showed the incidence of moderate to major trauma,operative treatment, longer operative time, general anaesthesia, blood transfusion and immobilisation were significantly higher in the PM and OAM groups compared to the unchanged group (p<0.05). A logistic regression model showed that general anaesthesia and longer surgical operations remained significantly related to the development of menstrual dysfunction. We conclude that the pattern of menstrual dysfunction after acute orthopaedic trauma appeared to be dictated by the woman's pre-existing menstrual characteristics and the stress of surgical treatment.

Adolescent↗
PubMed2000

Occipital posterior and occipital transverse positions: reappraisal of the obstetric risks.

Malpositions in labour in a vertex-presenting fetus are known to be associated with increased risks of operative delivery A retrospective analysis of all deliveries over 4 years in a university teaching obstetric unit was performed using the available obstetric database. All cases of live births with cephalic presenting babies after 36 completed gestational weeks were analysed, and included 17,533 out of 20,533 total deliveries over the study period. The study group included those cases with occipital posterior and transverse positions, based on the documentation of the position of the vertex at the time of delivery, or at the last clinical examination before obstetric intervention, while occipital anterior cases constituted the control group. The overall incidence of malpositions was 14%, and operative delivery rate in the study group was 82.5% versus 20.7% in the control group. After excluding cases of operative delivery for non-mechanical indications, such as fetal distress, the adjusted odds ratio for the malposition group was 9.8 (95% CI 8.91-10.8) for total assisted delivery and 30.2 (95% CI 25.6-35.5) for Caesarean section compared to the occipital anterior group. Malpositions are definitely associated with a marked increase in the risk of operative delivery including Caesarean section. Labour complicated by malposition should be considered high risk, and should warrant due preparation for obstetric intervention.

Adult↗
PubMed2000

Hormonal predisposition to menstrual dysfunction in collegiate dance students.

OBJECTIVE: To evaluate the effect of dance training on menstrual function in teenage dance students and to identify risk factors associated with menstrual dysfunction. METHODS: Dance students from a collegiate school of performing arts were recruited when they were first admitted to the school. Basic epidemiological data and menstrual history were gathered using a structured questionnaire. The subjects' self image appraisal was scored utilizing the Offer Self Image Questionnaire. Anthropometric measurements, body fat percentages and hormonal profiles were measured. The subjects were followed up after 12 months of intensive dance training, and the menstrual pattern, self image scoring and fat composition assays were repeated. RESULTS: A total of 50 students completed the study. The mean age was 18.9 years (s.d. 1.86). While all were eumenorrheic at first assessment, eight were amenorrheic and eight were oligomenorrheic at the second assessment, giving an incidence of menstrual dysfunction of 32%. A general reduction in weight and body fat composition was observed after training. Those with menstrual dysfunction did not differ from those that remained eumenorrheic in their basic anthropometric parameters, nor was the serial change in these parameters in the second assessment different between the two groups. Psychological assessment scores also showed an identical trend. All hormonal values were within the normal range, but the group with menstrual dysfunction showed a significantly higher LH/FSH ratio (p=0.012) and DHEAS levels (p=0.036) at the pre-training assessment while other hormonal parameters did not differ. CONCLUSION: The incidence of menstrual dysfunction in adolescent dance students undergoing intensive training was high. Those with pre-existing hormonal predisposition prior to entering training appeared particularly at risk.

Adolescent↗
PubMed1999

The association between maternal smoking and fetal hydranencephaly.

OBJECTIVE: To evaluate the relationship between maternal smoking and fetal congenital central nervous system malformations. METHODS: Retrospective review of all cases of fetal congenital malformations of the central nervous system (CNS) identified at or shortly after birth over a 10-year period (1986-1995) in a university teaching obstetric department. RESULTS: The total number of CNS abnormalities identified was 79, constituting 0.13% of all deliveries over the period (n = 59,392) and 4.7% of all congenital malformations (n = 1,678). The incidence of smoking mothers was 1.64% over the study period. Four babies had hydranencephaly, 3 of these mothers being smoking teenagers. The odds ratio of having a hydranencephalic fetus in smoking mothers compared to non-smokers was 56 (95% CI 7.41-427) in the group with CNS abnormalities, 136 (95% CI 14.5-1280) in the group including all congenital malformations, and 179 (95% CI 18.6-1719) in the group including all deliveries. CONCLUSION: Maternal smoking did not appear to increase the incidence of fetal congenital CNS abnormalities overall, but might be associated with particular vascular patterns of damage to the developing brain that could predispose to a hydranencephalic malformation.

Adolescent↗
PubMed1999

Antepartum hemorrhage of unknown origin--what is its clinical significance?

BACKGROUND: Antepartum hemorrhage of unknown origin is a common antenatal complication, accounting for more than half of the cases of antepartum hemorrhage. Few investigators had reported the importance of this condition and the proper management. METHOD: The present study reviewed retrospectively 718 cases with singleton pregnancies diagnosed as having antepartum hemorrhage of unknown origin after 24 weeks from 1991 to 1996 and compared their pregnancy outcomes with controls who delivered during the same period of time as the study cases. Clinical and ultrasound examinations were performed in all recruited cases to exclude accidental hemorrhage, placenta previa or lower genital tract bleeding. RESULTS: Patients with antepartum hemorrhage of unknown origin ran a higher risk of spontaneous preterm labor (p<0.001). The birthweight, when adjusted for gestation, did not differ between the two groups. Labor induction rate and cesarean section rates were significantly higher in the antepartum hemorrhage group. The incidences of major antepartum complications and neonatal complications did not differ between the two groups. There were more babies with congenital abnormalities in the antepartum hemorrhage group (p<0.001) and perinatal mortality rate was also higher, though this difference was not statistically significant. CONCLUSION: The main fetal risks associated with antepartum hemorrhage of unknown origin is preterm labor and its subsequent fetal complications. A small but significant proportion of these pregnancies might be associated with fetal congenital abnormalities. Routine induction at term for this group of patients is of questionable value as adverse fetal outcomes are mostly associated with those that delivered prematurely, or with babies with congenital malformations. When gross fetal abnormalities could be reasonably excluded, labor induction at term should only be contemplated in the presence of other obstetric indications.

Adult↗
PubMed1998

Paternal height and weight as determinants of birth weight in a Chinese population.

To evaluate the relationship between paternal weight and height and birth weight, 355 middle class patients with uncomplicated singleton pregnancies who booked within the first trimester were recruited from a homogenous obstetric population from a teaching hospital unit. Maternal height and prepregnant maternal weight were recorded at the booking visit. Paternal height and weight were recorded when the fathers entered the labor ward or visited the postnatal ward at or shortly after the time of delivery. These data were then correlated with the birth weight of the babies. There was a significant correlation between paternal height and weight and the corresponding maternal parameters (correlation coefficients 0.21, p<0.001 and 0.21, p < 0 > 0.01). When the crude birth weight was adjusted for the gestation at delivery, and then controlled for maternal height and weight with the use of a regression model, analysis of variance tests showed that paternal height was significantly correlated to the adjusted birth weight (p<0.01), while paternal weight only showed a marginal correlation (p = 0.05). There was a significant correlation between maternal and paternal height and weight, indicating that couples tend to be of similar sizes. When controlling for maternal size, paternal height was significantly correlated to birth weight, while paternal weight showed only marginal significance. The data suggested that paternal genetic influence could be a significant determinant of in utero fetal growth and thus birth weight.

Adult↗
PubMed1998

The relationship between weight gain in pregnancy, birth-weight and postpartum weight retention.

A total of 292 middle class, nonsmoking Chinese patients with known prepregnant weight who subsequently had uncomplicated singleton pregnancies delivering after 36 weeks' gestation were recruited to assess their serial antenatal weight gain, weight at 6 weeks and 3 months postpartum. The average prepregnant body mass index in the whole group was 20.4 kg/m2 (SD 2.19), and the total pregnancy weight gain was 14 kg (SD 3.75). Those with weight gain over 17.83 kg (one SD above the mean) (n=58) had higher weight gain in all 3 trimesters taken separately, as well as higher weight retention at 6 weeks and 3 months postpartum (p <0.001). Similar differences were noted for those with total weight gain over 2 standard deviations above the mean. The average weight retained at 3 months postpartum was 3.64 kg (SD 2.75). Those with weight retention over 9.14 kg (2 SD above the mean) (n=8) had a significantly higher second and third trimester weight gain (p <0.01) compared to the rest. These data suggest that excessive weight gain during pregnancy for women with prepregnant BMI in the normal range occurred most significantly after the mid-trimester, and was associated with higher postpartum weight retention without significant increase in birth-weight.

Birth Weight↗
PubMed1998

The incidence of abnormal findings from intrapartum cardiotocogram monitoring in term and preterm labours.

A retrospective analysis of 514 consecutive labours delivering 530 babies over a period of 18 months was conducted by a high-risk pregnancy team in a tertiary teaching unit to compare the incidence of abnormal findings from intrapartum monitoring between labours occurring before and at or after 34 weeks' gestation. Those delivered by elective Caesarean section, or Caesarean section at the onset of labour because of contraindications to labour and vaginal delivery, and those with congenitally malformed fetuses were excluded. Tracings were scored using the FIGO 1987 guidelines. Seventy-four labours and 83 babies delivered before 34 weeks, and 440 labours and 447 babies delivered after 34 weeks in the study. There was a slightly higher incidence of suspicious CTG tracings (33.7% versus 19.6%, OR 2.66, 95% CI 1.6-4.4) in the preterm group, due mainly to decreased baseline variability (p<0.001, OR 3.57, 95% CI 1.8-6.9), but the incidence of other pathological patterns did not differ. Using the same set of criteria for interpretation, there was a higher incidence of abnormalities from continuous cardiotocogram monitoring in the preterm group compared to term labours, but the intervention rate for fetal distress was not significantly increased. Appropriate interpretative criteria for intrapartum monitoring of preterm labours should be devised.

Adult↗
PubMed1997

Association between body composition and menstrual dysfunction in collegiate dance students.

OBJECTIVE: To evaluate the relationship between body mass index, body fat composition and fat distribution and menstrual dysfunction in collegiate dancing students. METHOD: A total of 64 dancing students from a collegiate school of dancing were studied through interview by a structured questionnaire to elicit details of menstrual history, and these were correlated to anthropometric measurements obtained by physical examination. RESULTS: There were 22 ballerinas, 16 classic Chinese dancers, and 26 modern or theatrical dancers. Ten (15.6%) had oligomenorrhoea and 12 (18.7%) had amenorrhoea, with a slight, but statistically non-significant preponderance of ballerinas in the amenorrhoeic group. There was no difference in the body mass index among the eumenorrhoeic, oligomenorrhoeic or amenorrhoeic group, but amenorrhoeic dancers had a significantly lower percentage of total body fat as calculated by a 4 site skinfold thickness formula when compared to eumenorrhoeic ones (15.72% vs 17.95%, p < 0.05). Amenorrhoeic dancers also had lower waist to hip (p < 0.001) and waist to thigh circumference ratios (p < 0.001), indicating that they had more feminine figures favoured aesthetically for dancers. CONCLUSION: The data suggests that estimation of percentage of body fat gave a better correlation to menstrual status than either weight or body mass index. Thus, proper nutritional advice based on such evaluation should be an essential component in treating menstrual dysfunction in these dancers.

Adipose Tissue↗
PubMed1996

Kyphoscoliosis complicating pregnancy.

OBJECTIVE: To assess whether the outcome of pregnancies complicated by kyphoscoliosis has improved with modern obstetric and orthopedic care. METHODS: A total of 17 patients with 27 pregnancies complicated by kyphoscoliosis were identified from 91,498 pregnancies between 1980 and 1994 from the obstetric audit database. Their obstetric records and associated orthopedic records were carefully studied. RESULTS: The incidence of kyphoscoliosis complicating pregnancy in the study period was 0.029%. The mean age of these patients in their index pregnancy was 32.7 years (range 23-40), mean height 140.7 cm (range 126-163). The cause of the kyphoscoliosis included traumatic injury, spinal tuberculosis, infantile poliomyelitis and idiopathic kyphoscoliosis. Eight of the patients had previous spinal surgery. The vaginal delivery rate was high and none suffered any cardiorespiratory embarrassment. There was no maternal or perinatal mortality. CONCLUSIONS: The high maternal and perinatal risks associated with kyphoscoliosis reported in earlier literature is no longer valid. The high proportion of patients who had previous spinal surgery before pregnancy might be conducive to the avoidance of harassment and thus a favorable pregnancy outcome.

Adult↗
PubMed1995

Placenta previa and previous cesarean section.

OBJECTIVE: To assess the relationship between previous cesarean section and subsequent development of placenta previa and placenta previa with accreta. METHOD: The records of all patients delivered with the diagnosis of placenta previa during the 10-year period from 1984 to 1993 were reviewed. RESULTS: From a total of 50,485 deliveries, 421 (0.83%) had placenta previa, 43 (10.2%) of whom had a history of previous cesarean section. The incidence of placenta previa was significantly increased in those with a previous cesarean section (1.31%) compared with those with an unscarred uterus (0.75%) (R.R. 1.64). This risk increased as the number of previous cesarean sections increased (R.R. 1.53 for one previous section, 2.63 for two or more). The incidence of an anterior placenta previa and placenta accreta was significantly increased in those with previous cesarean scars. The incidence of placenta accreta was 1.18% among patients with placenta previa, 80% being in patients with previous cesarean section. The relative risk for placenta accreta in patients with placenta previa was 35 times higher in those with a previous cesarean section than in those with an unscarred uterus. CONCLUSION: The association of previous cesarean section with placenta previa and placenta previa accreta is confirmed. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk for developing placenta accreta.

Adult↗
PubMed1995

Pregnancies complicated by acute appendicitis.

Appendicitis is one of the most common acute abdominal conditions that requires operation during pregnancy. The maternal and fetal complications occurring in such situations are well known. However, the diagnostic and therapeutic challenges of acute appendicitis complicating pregnancy persist in current surgical practice. Thirty-eight obstetric cases who had an appendicetomy performed during pregnancy between 1986 and 1993, were reviewed. In 31 cases, acute appendicitis was proven at laparatomy, and by subsequent histopathology. In the confirmed cases, seven occurred in the first trimester, 12 in the second trimester, eight in the third trimester and four in the immediate postpartum period. Two miscarriages occurred in the first trimester group, and two late abortions and two preterm (26 and 28 weeks) deliveries occurred in the second trimester group. In the third trimester/postpartum group, all babies survived, but four patients had Caesarean sections with the appendicetomy and the incidence of perforated/gangrenous appendices was highest. Perinatal outcome was worst, with the highest fetal wastage rate if the acute appendicitis occurred in the second trimester, although maternal morbidity appeared to be the same across different gestational periods.

Abortion, Spontaneous↗
PubMed1995

Pregnancy following renal transplantation: the experience in Hong Kong.

OBJECTIVE: To assess the outcome of pregnancies occurring after renal transplantation, and to review the factors conductive to a favourable outcome. METHOD: A retrospective review of 8 pregnancies occurring after renal transplantation from 1988 to 1992 in a tertiary referral centre in Hong Kong. RESULT: A very high successful pregnancy rate was achieved with minimal maternal and perinatal morbidity in the cases reviewed. CONCLUSION: Good prepregnancy counselling and stringent criteria for pregnancy assessment appears to be crucial factors for a favourable pregnancy outcome.

Adult↗
PubMed1995

The effect of dance training on menstrual function in collegiate dancing students.

A total of 98 dancing students from a collegiate school of dancing were studied through interview using a highly structured questionnaire to elicit details of the duration and intensity of dance training, menstrual patterns and musculoskeletal injuries sustained during training; 70 (72%) of these dancing students were eumenorrhoeic, while 15 (15.4%) had oligomenorrhoea. Thirteen (13.4%) either had amenorrhoea for over 90 days at the time of the study, or were on hormonal treatment because of amenorrhoea for over 3 months in the past 1 year. Those who were amenorrhoeic had longer training hours per week when compared with eumenorrhoeic and oligomenorrhoeic students. Both oligomenorrhoeic and amenorrhoeic students had a lower body mass index (18.25 kg/m2 and 18.26 kg/m2 versus 19.45 kg/m2, p < 0.01), and a higher incidence of musculoskeletal injuries and chronic orthopaedic problems compared to eumenorrhoeic ones. Ballet students had a higher incidence of menstrual dysfunction and musculoskeletal injuries as compared to classic Chinese dance, modern dance and musical theatre dance students as well as a significantly lower average body mass index. These data suggest a proportional correlation between menstrual dysfunction and proneness to musculoskeletal injuries in training, which could be explained by a hormonal mechanism.

Adult↗
PubMed1994

Malignant mixed Müllerian tumors of the uterus.

OBJECTIVE: To review the prognostic factors of Chinese women with mixed Müllerian tumors of the uterus. METHOD: A retrospective review of 21 cases of malignant mixed Müllerian tumors of the uterus treated during the 10-year period from 1980 to 1990. RESULTS: All patients except one were postmenopausal. The incidence of previous pelvic irradiation was 9.5%. The most common presenting symptom was abnormal vaginal bleeding. One-third of patients yielded an abnormal cervical smear. Treatment included surgery, chemotherapy and radiotherapy in the majority of patients. Prognosis was poor with only three long-term survivors, all with stage-I homologous tumors with superficial myometrial invasion. The survival rate for stage-I and -II disease at 2 years was 50% and for more advanced disease extending beyond the uterus was 0%. The survival rate for all stages at 5 years was 14.3%, and the cumulative probability of survival at 5 years was 0.165. CONCLUSION: The most important prognostic factors appear to be the extent of tumor involvement at the time of diagnosis and the depth of myometrial invasion.

Combined Modality Therapy↗