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.

Has improved health care provision impacted on the obstetric outcome in teenage women?

OBJECTIVE: To determine the obstetric outcome in teenage women managed in the recent decade with easily accessible health care provision. METHODS: In a retrospective cohort study, maternal demographics, underlying medical conditions, obstetric complications, preterm birth, type of labor, mode of delivery, and perinatal mortality were compared between 1505 women aged ≤ 19 years (study group) with 10,320 women aged 20-24 years (comparison group), who were carrying singleton pregnancies beyond 24 weeks of gestation and managed in our hospital between January 1998 and June 2008. RESULTS: The study and comparison groups accounted for 2.2% and 15.1% respectively of the total deliveries. Despite comparable health status and rates of other obstetric complications, teenage women was associated with birth <34 weeks (aOR 2.45, 95% CI 1.67-3.60), birth at 34-36 weeks (aOR 2.13, 95% CI 1.71-2.65), and reduced instrumental vaginal (aOR 0.62, 95% CI 0.50-0.77) and caesarean (aOR 0.79, 95% CI 0.64-0.97) delivery, without increase in perinatal mortality. CONCLUSIONS: Teenage women had increased preterm birth, despite improved health care provision, nutrition, and similar incidence of other obstetric complications, but the obstetric and perinatal outcome remained favorable.

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.

The force applied to successfully turn a foetus during reattempts of external cephalic version is substantially reduced when performed under spinal analgesia.

OBJECTIVE: To compare the forces exerted during external cephalic version (ECV) on the maternal abdomen between ( 1 ) the primary attempts performed without spinal analgesia (SA), which failed and ( 2 ) the subsequent reattempts performed under SA. METHODS: Patients with an uncomplicated singleton breech-presenting pregnancy suitable for ECV were recruited. During ECV, the operator wore a pair of gloves, which had thin piezo-resistive pressure sensors measuring the contact pressure between the operator's hands and maternal abdomen. For patients who had failed ECV, reattempts by the same operator was made with patients under SA, and the applied force was measured in the same manner. The profile of the exerted forces over time during each attempt was analyzed and denoted by pressure-time integral (PTI: mmHg sec). Pain score was also graded by patients using visual analogue scale. Both PTI and pain score before and after the use of SA were then compared. RESULTS: Overall, eight patients who had a failed ECV without SA underwent a reattempt with SA. All of them had successful version and the median PTI of the successful attempts under SA were lower than that of the previous failed attempts performed without SA (127 386 mmHg sec vs. 298,424 mmHg sec; p = 0.017). All of them also reported a 0 pain score, which was significantly lower than that of before (median 7.5; p = 0.016). CONCLUSIONS: SA improves the success rate of ECV as well as reduces the force required for successful version.

Seroprevalence of varicella zoster virus among pregnant women in Hong Kong: comparison with self-reported history.

OBJECTIVE: To compare seroprevalence (serum IgG titre) with self-reported history of varicella zoster virus (VZV) infection among pregnant women in Hong Kong. METHODS: Pregnant women undergoing first trimester Down screening over a 3-months period were recruited for the study. RESULTS: Positive immunity was found in 477 (95.4%) of the 500 recruited women, and those with positive, negative, or uncertain history of infection had similarly high seroprevalence (96.4, 90.5, 95.9% respectively). The mean age of infection from self-recalled history was 8.61 (SD 4.69) years, and only 3% recalled infection after age 18. Insufficient knowledge on the disease and vaccination was demonstrated. CONCLUSIONS: Despite the absence of a routine vaccination programme, VZV immunity was high among pregnant women, the majority being infected during childhood and infection above age 18 was very rare. Hence, universal antenatal screening or vaccination for all women in the reproductive age would not be cost-effective in Hong Kong.

Maternal understanding of commercial cord blood storage for their offspring - a survey among pregnant women in Hong Kong.

OBJECTIVE: To assess the knowledge on commercial cord blood banking (CCBB) among pregnant women. DESIGN: Cross-sectional survey. Setting. Antenatal clinics of two major public maternity units in Hong Kong. POPULATION: Pregnant women. METHODS: Self-administered questionnaire. MAIN OUTCOME MEASURES: The survey explored knowledge about the use of self-stored umbilical cord blood (UCB) stem cells and attitude towards CCBB. RESULTS: Of the 2,000 women recruited, 1 866 (93.3%) completed the questionnaire. The majority (78.2%) had no idea that there was the chance of using self-stored stem cells. Moreover, most of the respondents were unclear about which diseases other than leukemia are amenable to treatment with UCB stem cells in general. Only 20.3% of women knew that stem cells are available from the Red Cross in case their children need hematopoietic cell transplantation. CONCLUSIONS: The results of this study revealed inadequate knowledge on UCB stem cell banking and its applications among most of our pregnant women. The government and clinicians should combine efforts to provide accurate information on utilization of UCB stem cells during antenatal care.

Do prior contraceptive methods impact maternal carriage in patients with hepatitis B?

BACKGROUND: Hepatitis B virus (HBV) infection is highly endemic in many Asian countries. OBJECTIVES: We examined whether prior contraceptive methods and sexual behavioral factors impact maternal HBV carriage in an obstetric population. PATIENTS AND METHODS: For this study, pregnant women were considered to be representative of the sexually active and fertile female population. Contraceptive methods used prior to the index pregnancy were examined in 1283 pregnant Chinese women attending an antenatal clinic using a self-administered questionnaire, and correlated with the maternal HBV status determined using routine antenatal screening. RESULTS: In our study, 111 (8.7%) women were infected with HBV and there was no difference in the incidence of male condom usage between HBV-positive (88.3%) and HBV-negative (83.5%) women. No contraceptive method was associated with a reduced incidence of maternal HBV carriage, except for coitus interruptus. In multivariate analysis, only multiparity (adjusted odds ratio [aOR], 1.62) and more than 1 sexual partner (aOR, 1.57) were independent factors associated with maternal HBV carriage. CONCLUSIONS: Contraceptive use played only a minimal role in preventing sexual transmission of HBV infection within the sexually active female population in an endemic area.

Determinants of hepatitis B vaccine uptake among pregnant Chinese women in Hong Kong.

OBJECTIVE: To determine the prevalence of a history of hepatitis B vaccination among pregnant Chinese women in Hong Kong, and to identify factors associated with vaccine uptake at their own expense. METHODS: A prospective, cross-sectional survey was conducted in a university obstetric unit in Hong Kong. Pregnant Chinese women who attended the prenatal clinic were invited to complete a self-administered questionnaire, which requested details of their history of hepatitis B vaccination and sociodemographic characteristics. RESULTS: The prevalence of hepatitis B vaccine uptake was 33%. The following factors were associated with higher hepatitis B vaccine uptake: employment as a healthcare worker; a higher education level; higher monthly family income; routine medical checkups; and premarital checkups. CONCLUSION: The findings suggest that the public has insufficient awareness of hepatitis B infection in the community and that providing better information and education to the general public is necessary.