Hedy Yun Mei Fung

Calcium and Low-Dose Aspirin Prophylaxis in Women at High Risk of Pregnancy-Induced Hypertension

OBJECTIVE The objectives of the study were to confirm the validity of using oscillometric measurement of MAP in the left lateral position to identify those at high risk for developing pregnancy-induced hypertension (PIH), and to assess and compare the efficacy of prophylaxis with low-dose aspirin or calcium supplementation in high-risk patients. STUDY DESIGN A prospective study in pregnancy; 500 normotensive, primigravid Chinese women were recruited in the second trimester of pregnancy on the basis of 80 mm Hg > or = MAP < 106 mm Hg in the antenatal clinic. They were then screened by Dinamap in a research setting, measuring MAP in the left lateral position after rest and using a cutoff value of 60 mm Hg for inclusion in the randomized study. Randomization was divided into three groups: control, low-dose aspirin, and calcium supplementation. After delivery, patients were classified as either having remained normotensive or having developed PIH, with or without proteinuria. RESULTS The incidence of both proteinuric and nonproteinuric PIH was significantly lower in patients screened out as low risk than in those selected as high risk using a critical value of 60 mm Hg for left lateral MAP (p < 0.05). The incidence of proteinuric PIH was significantly lower in patients given low-dose aspirin than in the control group (p < 0.05). However, the confidence intervals for the effect were wide, comparable with aspirin having no effect or leading to a 16-fold reduction in the risk of preeclampsia. For those given calcium supplementation, the reduction was not significant. There was no significant difference in the incidence of nonproteinuric PIH between the control group and the two groups receiving prophylaxis. CONCLUSION Oscillometric measurement of second-trimester left lateral MAP is a valid predictor of proteinuric PIH. Low-dose aspirin may offer a degree of protection from proteinuric PIH in these high-risk women. Calcium supplementation was not shown to significantly reduce the incidence of PIH.

Racial variation in incidence of trisomy 21 : Survey of 57,742 Chinese deliveries

The objective of this study was to establish whether the influence of advanced maternal age on the incidence of trisomy 21 in the local Chinese population is similar to that seen among European patients by comparing the observed number of trisomy 21 cases against the expected number which was calculated from age-specific Caucasian data and adjusted for intrauterine lethality and rate of amniocentesis. The obstetric and neonatal data of 57,742 pregnancies in ethnic Chinese were reviewed, of which 10.5% were from mothers age 35 or over. A total of 74 cases of trisomy 21 was detected (overall incidence of 1.28 per 1,000 deliveries). The expected number of trisomy 21 cases in mothers younger than 35 was 45.6, which was similar to the observed number of 43. Among mothers age 35 or above, the expected and observed numbers of cases were 38.52 and 31, respectively, again a difference not statistically significant. Therefore we conclude that there is no significant racial variation in the incidence of trisomy 21, both in the younger and older age groups, when comparing Chinese to Caucasian populations.

Study of Oestrogen and Progesterone Receptors in Normal Human Endometrium during the Menstrual Cycle by Immunocytochemical Analysis

Monoclonal antibodies to human oestrogen and progesterone receptors were applied to frozen sections of normal endometrium in various phases of the menstrual cycle. Both oestrogen and progesterone receptors were localised within the nuclei of target cells. There are no oestrogen or progesterone receptors in endometrial vessels. Oestrogen receptor contents remained fairly constant during the proliferative and early secretory phases but decreased markedly in the late secretory phase. This decline was more obvious in the glandular cells than in the stromal cells, where receptor staining disappeared in most cases. The receptors were localised predominantly in the glandular cells at most stages of the menstrual cycle except in the late secretory phase, where the reverse was observed. In contrast, progesterone receptors rose gradually throughout the proliferative and early secretory phases followed by a decrease to various degrees depending on the cell types in the late secretory phase. This decrease was more marked in the glandular cells where again receptor staining disappeared in most cases, whereas the receptor contents in the stromal cells only decreased to the level of the late proliferative phase. The progesterone receptors were also localised predominantly in the glandular cells at most stages in the cycle apart from the late secretory phase.

Intra-uterine growth retardation and transverse lie due to massive subchorionic thrombohematoma and overlying large subchorionic cyst

Early diagnosis of molar pregnancy co-existent with a live fetus is difficult due to its rarity. Vaginal bleeding is often the first clinical symptom (2) along with fast-growing uterus, severe hyperemesis, hyperthyroidism and pre-eclampsia (3). Even theca lutein cysts and ascites can appear (4). Very high serum hCG values (up to 1 000 000 IU/1) are possible. In our case vaginal bleeding was the only symptom during the first trimester of pregnancy. High serum hCG and the fast-growing uterus appeared during the second trimester. The prognosis of molar pregnancy co-existent with a live fetus is often so poor that termination of pregnancy is advisable if the diagnosis is certain (1, 5). The most important factor regarding prognosis is the karyotype of the fetus. Therefore chorion villus biopsy or amniotic fluid sample should be taken. In case of partial hydatidous mole mosaicism must be borne in mind (1). The best tool for diagnostics is ultrasound examination by which hydatidous tissue can usually be seen. Abnormal placental echoes may be misinterpreted as hematomas (6) as in our case until the hydatidous mass was bigger. Besides the chorion villus biopsy or amniotic fluid sample also the structure and bioprofile of the fetus can be followed by ultrasound. After the pregnancy invasive mole or chorioncarcinoma may develop from the original mole in 20% of patients who have had complete mole and 4% after partial mole (3). Careful follow-up is therefore essential. In conclusion, hydatidous mole co-existent with a live fetus is a rare condition with poor prognosis. Karyotype of the fetus is important for prognosis since fetuses with partial mole usually have an abnormal karyotype and are often triploid in genome (3). In a complete mole co-existent with a live fetus the molar pregnancy usually has an abnormal karyotype while the fetal pregnancy may be normal and have some potential for a successful outcome.

Pulmonary edema in association with an intravenous infusion of sulprostone

We encountered a patient with pre‐eclampsia who developed pulmonary edema whilst receiving an infusion of sulprostone. Recent evidence suggests that pulmonary hypertension following the administration of prostaglandins may result from stimulation of an EP3 or thrombox‐ane receptor in the pulmonary artery, This has implications for therapeutic use of prostaglandins.

Exposure to angiotensin‐converting enzyme inhibitors during first trimester, Is it safe to fetus?

A 34-year-old, para 1, woman was treated with 5mg lisinopril daily for essential hypertension until 8 weeks of gestation. Treatment was changed to methyldopa with good control of blood pressure throughout the rest of pregnancy. Serial ultrasound monitoring showed a normal fetus with normal liquor volume and normal growth rate. Induction of labor was performed at 40 weeks of gestation for persistent 2π proteinuria. A 2.8 kg baby boy was delivered with good Apgar scores and normal morphology. No abnormality was detected.

The Influence of Glucose Tolerance tests on Subsequent Carbohydrate Metabolism in Pregnancy

5 September 1995

A Study of Fetal Sex Determination in Coelomic Fluid

Coelomic fluid and fetal parts were obtained in 35 patients undergoing surgical termination of pregnancy. Fetal gender was determined by Y-sequence-specific polymerase chain reactions (PCR). Fourteen male pregnancies out of 35 cases were identified by examination of fetal parts. The overall concordance rate of gender determination between coelomic fluid and fetal parts was 91.4%. There were 2 cases of male pregnancies not being identified and 1 case of false positive result by coelocentesis. The gestation of pregnancy and the volume of coelomic fluid obtained appeared not to be related to the discrepancy in the paired results. We conclude that sex determination using coelocentesis and PCR remains unreliable to be used as a definitive prenatal diagnostic test for sex-linked disorders.

A benign polypoid adenomyoma: An unusual cause of persistent fetal transverse lie

Persistent fetal transverse lie at term is uncommon. A case of benign polypoid adenomyoma, found during Caesarean section, as a cause of abnormal lie in a primigravida is reported. A clear distinction as shown can be drawn between breech presentation and transverse lie at term, and between transverse lie in multiparous and nulliparous women. Prophylactic external version was not performed in this case and the reasons are discussed. Careful search for the cause of transverse lie especially in a primigravida is recommended.

Diurnal Variation in Excretion of N-Acetyl-β-Glucosaminidase during Pregnancy: Implications for the Prediction of Pre-Eclampsia

Significant differences in urinary excretion of N-acetyl-β-glycosaminidase (NAG) were observed between nulliparous and multiparous patients and between fasted and nonfasted individuals. No significant difference was observed between patients with normal and those with abnormal glucose tolerance. Multiple regression analysis confirmed that the significant independent determinants of NAG/creatinine ratio were age, parity, gestation and fasting state. Significant diurnal variation in urinary NAG/Cr ratio was observed, the highest levels being recorded in early morning fasting specimens, falling in each postprandial specimen and beginning to rise again by midnight. The urinary NAG/Cr ratio is influenced by fasting, parity, gestation and age. More consistent results for prediction of pre-eclampsia are therefore likely to be obtained using fasting (early morning) urine specimens and adjusting cut-off criteria for the other factors.