Breastfeeding initiation: is this influenced by maternal hepatitis B infection?

OBJECTIVE: To elucidate the effect of hepatitis B virus (HBV) infection on breastfeeding uptake in Chinese mothers in an endemic region. PATIENTS AND METHODS: A retrospective cohort study on 63 885 consecutive pregnant delivered between January 1997 and June 2008, were extracted from computerized database to examine the relationship between breastfeeding uptake and maternal HBV status, adjusted for demographic factors. RESULTS: A total of 6593 (10.3%) women were hepatitis B surface antigen (HBsAg)-positive, with an annual prevalence of around 10%. In the study period, 29 869 (46.8%) practised breastfeeding, and its prevalence ranged from 35.4 to 54.8% with an increasing trend throughout the years (p < 0.001). HBsAg-positive mothers had a significantly lower rate of breastfeeding (39.2 vs. 47.6% p < 0.001). Multiparas had higher incidence of HBV infection (10.9 vs. 9.8%, p < 0.001) and lower breastfeeding rate (42.2% versus 51.0%, p < 0.001) when compared with primiparas. Among those factors, maternal HBV infection had the strongest negative association with breastfeeding (adjusted odd ratio (aOR) = 0.726, 95% confidence interval (CI): 0.689-0.765). CONCLUSIONS: Our results suggested maternal HBV infection was one of the factors for the persistently low breastfeeding rate in Hong Kong over the past decades. To promote breastfeeding, it is necessary to generate definitive data on its safety regarding to mother-to-child transmission (MTCT) of HBV in order to allay the fear and anxiety in HBsAg-positive mothers.

External cephalic version does not increase the risk of intra-uterine death: a 17-year experience and literature review.

OBJECTIVE: To assess the risk of intra-uterine death (IUD) after external cephalic version (ECV). METHODS: In this retrospective cohort study, 1078 consecutive ECVs performed between January 1994 and March 2011 in an University teaching hospital were extracted from the computerized database to examine the risk of IUD after ECV. RESULTS: A total of 1078 consecutive ECVs were performed over the study period. The overall successful rate was 72.8%, the successful rate was 63.1% in nulliparous and 82.7% in multiparous, respectively (p < 0.001). There was no IUD identified within 24 h after the procedure and there was only one case of IUD (0.09%) that occurred 4 weeks after an uncomplicated ECV. CONCLUSIONS: ECV is a safe procedure that does not increase the risk of IUD within and after 24 h of enrollment irrespective of outcome of ECV. Our findings have important clinical implication in terms of patient counseling regarding the decision on term breech management.

Normal range of intracranial translucency (IT) assessed by three-dimensional ultrasound at 11 + 0 to 13 + 6 weeks in a Chinese population.

OBJECTIVES: To establish the reference range of intracranial translucency (IT) in the first trimester in a Chinese population. METHODS: In a prospective study from March 2007 to June 2007, three-dimensional (3D) volumes of the fetal profile in the mid-sagittal plane were recorded from 102 normal pregnancies screened for trisomy 21 by the combination of fetal nuchal translucency (NT) thickness, maternal serum free ß-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks. 3D volumes were examined using multiplanar techniques. In the mid-sagittal plane the fourth ventricle presents as an (IT between the brain stem and choroid plexus. The anteroposterior diameter of IT in each case was measured. The relationship between IT with the other parameter was also examined. RESULTS: The IT at first trimester ranged from 1.35 to 2.6 mm. There was no significant association between IT with NT, and serum biochemistry. The intraobserver and interobserver agreement was assessed in 20 (19.6%) normal cases. Mean (SD) differences of two observers was -0.015 (0.132) mm (p > 0.05). For each observer, mean (SD) between the 2 paired measurements were -0.001 (0.097) mm, and 0.010 (0.085) mm, respectively (p > 0.05). CONCLUSIONS: In the first trimester, the reference range of IT in Chinese fetuses has been established. The assessment of IT is feasible and reproducible.