Evaluation of a peer counselling programme to sustain breastfeeding practice in Hong Kong.

BACKGROUND: Peer counselling is reported to increase breastfeeding rates. We evaluated an intervention consisting of mainly telephone contact peer counselling programme on breastfeeding duration and exclusivity. METHODS: Peer counsellors (PCs) were mothers who had successfully breastfed and had received formal training. Following a postnatal visit, they provided scheduled telephone consultations (Days 1, 4, 7, Weeks 2, 4, 8, and Month 4) to PC group mothers (n = 100) who continued breastfeeding their infants after discharge. Control group mothers (n = 100) received routine care. RESULTS: After adjusting for mothers' previous breastfeeding experiences, mothers' working status and breastfeeding problems, no statistical differences in mothers' feeding methods (exclusive, almost exclusive or predominant breastfeeding) were noted at the three follow-up times for intervention and control mothers respectively (Day 5: 37%/38%, 46%/53%, 57%/63%; Month 3: 10%/9%, 17%/23%, 20%/26%; Month 6: 2%/1%, 18%/18%, 18%/19%). All differences between the groups were not significant. Also, there was no evidence to suggest that PC intervention prolonged breastfeeding duration. CONCLUSION: The lack of effect of our PC intervention may reflect the low baseline breastfeeding rate and low value placed on breastfeeding in our population, the type of PC intervention or group allocation biases. TRIAL REGISTRATION: ISRCTN93605280.

A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome.

OBJECTIVE: To compare the clinical courses and outcomes of pregnant severe acute respiratory syndrome (SARS) patients and non-pregnant SARS patients. DESIGN: A case-control study. SETTING: Tertiary Hospital for Infectious Disease. Sample Ten pregnant and 40 non-pregnant female patients infected with SARS. METHODS: Clinical course and outcomes of pregnant SARS patients were compared with a group of non-pregnant SARS patient. Cases and controls were matched with respect to sex, age, timing of contracting SARS, health care workers status and underlying illness. MAIN OUTCOME MEASURES: The incidence of intensive care unit admission, intubation, medical complications and death rate. RESULTS: Pregnancy had no discernible impact on clinical symptoms and presentation delay. Four out of the 10 pregnant patients, nevertheless, required endotracheal intubation and six were admitted to the intensive care unit (ICU), as compared with 12.5% intubation rate (P= 0.065) and 17.5% ICU admission rate (P= 0.012) in the non-pregnant group. More pregnant SARS patients developed renal failure (P= 0.006) and disseminated intravascular coagulopathy (P= 0.006), as compared with non-pregnant SARS group. There were three deaths in the pregnant group, whereas there was no death in the non-pregnant control group (P= 0.006). CONCLUSION: Pregnant women with SARS experience a worse clinical course and poorer outcomes compared with non-pregnant women.

Nasal bone hypoplasia: is it a common finding amongst chromosomally normal fetuses of southern Chinese women?

OBJECTIVE: To assess the incidence of nasal hypoplasia among fetuses of southern Chinese women. METHODS: This prospective observational study was conducted at Princess Margaret Hospital, Hong Kong. All pregnant women referred for chromosomal studies before 14 weeks were assessed. The crown-rump length, nuchal translucency thickness, and nasal bone were assessed between 11 and 14 weeks. RESULTS: A total of 143 women were recruited. In 119 fetuses, facial profiles were successfully obtained and the presence or absence of nasal bones was assessed. One hundred and fourteen fetuses had normal karyotypes. The rate of absence nasal bone when assessed between 11-14 weeks was 0.88% in the fetuses with a normal karyotype. During the same period, 2 out of 3 fetuses with Down syndrome had absence of nasal bones. A nasal bone was visualized in one fetus with Edward syndrome and the other with Turner syndrome (45 X). CONCLUSION: The incidence of nasal hypoplasia is not increased among fetuses of southern Chinese women. Assessment of ossification of the nasal bone can be used to supplement first-trimester screening in Chinese women.

Transvaginal sonography in the detection of retained products of conception after first-trimester spontaneous abortion.

PURPOSE: The aim of this study was to assess the use of transvaginal sonography to detect retained products of conception after first-trimester spontaneous abortion. METHODS: All women who arrived at our hospital with spontaneous first-trimester abortions were included in this study and underwent transvaginal sonography. A sonographic diagnosis of "incomplete abortion" was based on a bilayer endometrial thickness of more than 8 mm. The final diagnosis of complete or incomplete abortion was based on the histopathologic findings at dilatation and curettage. The sensitivity and specificity of both clinical and sonographic examinations for detecting products of conception were assessed. RESULTS: A total of 113 women were recruited, and 14 were excluded for various reasons. Among 52 women with a clinically incomplete abortion, only 50% had retained products of conception. The use of transvaginal sonography resulted in a 29% (15/52) reduction of surgical intervention in these women. On the other hand, 30% (14/47) of women with a clinical diagnosis of complete abortion had retained products of conception. The sensitivity and specificity of cervical status for detecting retained products of conception were 65% and 56%, respectively, whereas the overall sensitivity and specificity of transvaginal sonographic examination (bilayer endometrial thickness 8 mm or less) were 100% and 80%, respectively. CONCLUSIONS: Transvaginal sonography is a useful supplement to clinical assessment in women who experience a spontaneous first-trimester abortion. If this modality is used to assess the uterine cavity, the cervical status can be ignored. Use of transvaginal sonography should reduce unnecessary general anesthesia and uterine curettage.

Diabetic family history is an isolated risk factor for gestational diabetes after 30 years of age.

BACKGROUND: Family history of diabetes is regarded as a risk factor for gestational glucose intolerance. Most selective screening policy includes family history as an indication of oral glucose tolerance test. However, few studies had evaluated the actual incidence of glucose intolerance in this group of women. METHODS: Pregnant women with oral glucose tolerance test performed for family history of diabetes over two consecutive years were identified. Receiver operating curve was used to identify the age cut-off that give the highest sensitivity and specificity. The incidence of glucose intolerance was compared between women with age above and below this cut-off. RESULTS: One hundred and eighty-seven women were identified. The age cut-off selected was 30.5 years. In young women (age