Are Hong Kong babies getting bigger?

OBJECTIVE: To establish recent birth weight trends in Hong Kong. METHOD: A total of 10,512 confinements for the years 1985-86, and 7857 for the years 1995-96 were analyzed. RESULT: There was a significant increase in maternal height, weight at booking, and maternal age, whereas the body-mass index was reduced slightly (P < 0.0001). Parity increased significantly, with the percentage of parous women rising from 44.1% to 55.6% (P < 0.0001). The percentage of female infants decreased from 49.5% to 47.9%. Despite these changes there was no significant difference in mean birth weights between the two groups. When birth weight was controlled for sex, parity, maternal height and weight there was a trivial increase of 15 g over time (P = 0.01). CONCLUSION: Birth weight has reached a plateau in Hong Kong despite a continuing increase in the regions' socioeconomic status, and evidence of improved nutritional well-being.

Transvaginal sonographic assessment of cervical dynamics during the third trimester of normal pregnancy.

BACKGROUND: To obtain a normogram of measurements of the uterine cervix by transvaginal sonography during the third trimester of normal primiparous pregnancies and to relate these measurements to the events surrounding labor. METHODS: A prospective observational study, set in Guangzhou, Peoples Republic of China, was undertaken. Fifty-five normal nulliparous Chinese women with singleton pregnancies were studied from 30 weeks gestation until delivery. Serial transvaginal ultrasound examinations were performed at 30, 32, 34 and 36 weeks gestation and weekly thereafter. RESULTS: There was a significant correlation between gestational age and cervical length and width. Funnelling of the internal os was present in 25% of cases, and its earliest appearance was at 36 weeks. There was no consistent relationship between funnel length and width and gestational age. The duration of the first stage of labor was inversely correlated with the last ultrasound measurement of cervical length, but there was no relationship with either cervical width nor the presence of funnelling. The cervical changes in this population differed from those found in Caucasians. CONCLUSIONS: There is a direct relationship between both cervical width and length and gestational age and an inverse relationship with cervical length and the duration of labor. Funnelling of the internal os was not a predictor of the early onset of labor. The dimensions and features of the Asian cervix differ from those of the Europeans, and this should be considered when conducting further studies of a similar nature.

The epidemiology of urinary dysfunction in Chinese women.

The epidemiology of urinary dysfunction in a Chinese population living in Hong Kong was investigated. Fifteen hundred ethnic Chinese women answered a telephone questionnaire including symptoms of urinary dysfunction, anthropometric measurements, obstetric history and place of birth. The relative predictive value of these factors was analyzed using logistic regression. The prevalence of urinary dysfunction was 13%. Ten percent reported stress incontinence, and 4% had urgency or urge incontinence. The strongest predictor was place of birth, with women born in mainland China having the highest prevalence of pure stress incontinence (OR 1.33, CI 1.1-1.6). For the symptoms of detrusor instability age was the strongest predictor, with women over 50 years being at greater risk (OR 2.8, CI 1.6-5.0). Contrary to earlier beliefs, urinary dysfunction in Chinese women is as common as in Caucasian women. Place of birth is the strongest predictor for pure stress incontinence, with women born in mainland China being at greater risk. This suggests that environmental factors in early life have a differential effect on the development of urinary incontinence.

The prevalence of urinary dysfunction in Hong Kong Chinese women.

OBJECTIVE: To determine the prevalence of urinary dysfunction in Hong Kong Chinese women. METHODS: A telephone survey was conducted in the territory of Hong Kong. The subjects were a sample of women between the ages of 10 and 90 years. The main outcome determined was the prevalence of urinary dysfunction. RESULTS: We made 3248 calls, resulting in 819 evaluable responses. Stress incontinence was reported by 21% (174) of respondents, urgency or urge incontinence in 15% (120), urinary frequency in 19% (154), nocturia in 20% (166), bed-wetting in 4% (31), and voiding difficulties in 13% (109). Stress incontinence occurred as the only symptom in 7% (53), the combination of urgency and frequency in 1% (11), and mixed symptoms in 6% (52). Four percent required protective underwear or pads, with 2% wearing protective underwear continuously; 4% were incapacitated by their incontinence. Symptoms of urgency, urge incontinence, frequency, and nocturia increased with increasing age, but voiding difficulties and nocturnal enuresis were unrelated to age. Stress incontinence, urgency, urge incontinence, frequency, nocturia, and voiding difficulties increased with increasing parity to para 4. CONCLUSION: Urinary dysfunction and its patterns appear to be as common and incapacitating in Hong Kong Chinese as they are in other populations.

Abdomino perineal repair of pulsion enterocele.

OBJECTIVES: To review the techniques, results and complications of the combined abdomino perineal repair and mersilene mesh sacrocolpopexy. METHODS: From March 1988 to December 1993; 45 cases of pulsion enterocele were treated by a combination of the Zacharin type abdomino perineal repair and mersilene mesh sacrocolpopexy. Forty cases were followed from between 1 month and 18 months (mean 5.95 months). The notes were reviewed retrospectively. RESULTS: There were 3 recurrences (7.5%). Complications were not insignificant: wound infection in 3, urinary tract infection in 6, bowel dysfunction in 8, ventral hernia, vaginal stricture necessitating surgical release, and brachial nerve plexus injury occurred once. In one patient a peritoneal cyst developed necessitating laparoscopic aspiration. CONCLUSIONS: The combined abdomino perineal and sacrocolpopexy procedure offers the restoration of normal anatomy and the relief of the symptoms of prolapse in 92.5% of patients. The complication rate is significant and it should be undertaken as a secondary procedure.

Genital prolapse: a legacy of the West?

A retrospective study was undertaken to determine if there has been a change in the incidence of genital prolapse and urinary stress incontinence in Chinese women in Hong Kong. The medical records of 2,312 consecutive patients admitted for major gynaecological surgery for benign conditions in 5 out of 7 major public teaching hospitals in Hong Kong for the calendar year of 1993 were reviewed by way of an audit of all gynaecological operations performed in these hospitals. A total of 578 cases (25%) were identified as having genital prolapse and or urinary problems.

Cushing syndrome in pregnancy secondary to an adrenal cortical adenoma.

Cushing syndrome in pregnancy is rare. This is explained by the syndrome's association with amenorrhoea, oligomenorrhoea, infertility and abortions. Cushing syndrome commonly presents with hypertension, weight gain, diabetes, striae or truncal obesity, all of which can be consistent with pregnancy in women without Cushing syndrome. We describe a case of Cushing syndrome in pregnancy secondary to an adrenal cortical tumour which was discovered after an abnormal glucose tolerance test. The woman developed classical features of Cushing syndrome including gestational diabetes and hypertension and was managed successfully to term after a unilateral adrenalectomy at 23 weeks. The case is reported not only because of its rarity but also because the diagnosis was made after a routine screening test for gestational diabetes. Early diagnosis and treatment of adrenal adenoma causing Cushing syndrome in pregnancy reduces maternal and fetal morbidity and mortality.

Sacrospinous colpopexy.

Sacrospinous colpopexy is a useful procedure in the cure of pulsion enterocele, high rectocele, and posthysterectomy vault prolapse. It allows the surgeon to correct coincident cystocele and rectocele and permits restoration of a relatively normal and comfortable vaginal depth and axis. It is a quick procedure, avoids intraabdominal trauma, has a high success rate and a low complication rate (1) and is useful in the management of patients who wish to maintain coital function. This paper retrospectively reviews the techniques, results and complications of 107 sacrospinous colpopexies performed in 104 patients over an 8-year interval.