Lai Ping Cheung

Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol

OBJECTIVE To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion. DESIGN A prospective, randomized, controlled trial. SETTING A university teaching hospital. PATIENT(S) Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization. INTERVENTION(S) Routine surgical evacuation or medical evacuation of the uterus using misoprostol. MAIN OUTCOME MEASURE(S) Immediate, short-term (2-3 weeks), and medium-term (6 months) medical complications. RESULT(S) There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia. CONCLUSION(S) Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.

Infertility, blood mercury concentrations and dietary seafood consumption: a case–control study

Objective To compare blood mercury concentrations of infertile couples with those of fertile couples in Hong Kong, and to examine the relationship between blood mercury concentrations and seafood consumption.

Misoprostol in the management of spontaneous abortion

* Relative risk is the risk of dying from childhood cancer if the mother received pregnancy ultrasound relative to the risk of dying from childhood cancer if the mother did not receive pregnancy ultrasound. Relative risks and 95 % confidence intervals calculated from conditional logistic regression applied to matched case-control pairs. ** Four levels of social class (I, 11, 111, IVt-V), six levels of maternal age (< 20, 20-24, 25-29, 30-34, 35-39, 2 40) and five levels of sibship position (1, 2, 3, 4, > 5). t Diagnosis based on supplementary information received from the National Registry of Childhood Tumours.

Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome

BACKGROUND Women with polycystic ovary syndrome (PCOS) frequently exhibit central obesity, glucose intolerance, atherogenic dyslipidaemia and hypertension which are characteristic features of the metabolic syndrome (MetS). METHODS A total of 295 premenopausal Chinese women with PCOS diagnosed by the Rotterdam criteria (mean age: 30.2 +/- 6.4 years) and 98 control subjects without PCOS were evaluated for prevalence of MetS and cardiovascular risk factors, including dyslipidaemia and dysglycaemia. RESULTS Using the 2005 modified Adult Treatment Panel III criteria, MetS (presence of three or more risk factors) was found in 24.9% of PCOS women compared to 3.1% of controls. The prevalence of MetS in PCOS women increased from 16.7% at under 30 years of age to 53.3% at over 40 years. MetS was also more prevalent in overweight and obese (41.3%) than normal-weight PCOS women (0.9%). However, multivariate regression analysis showed that women with PCOS had a 5-fold increase in risk of MetS (odds ratio 4.90; 95% confidence interval: 1.35-17.84) compared with women without PCOS even after controlling for age and BMI, suggesting PCOS alone is an independent risk factor for MetS. CONCLUSIONS There is high prevalence of MetS in Hong Kong Chinese women with PCOS despite their relatively young age. Recognition of these cardiometabolic risk factors requires a high level of awareness in conjunction with early and regular screening.

Intrauterine adhesions after conservative and surgical management of spontaneous abortion.

STUDY OBJECTIVE To determine the frequency of intrauterine adhesions (IUA) after conservative management, medical evacuation, and surgical evacuation for spontaneous abortion. DESIGN Prospective follow-up study (Canadian Task Force classification II-2). SETTING Gynecology unit in a teaching hospital. PATIENTS Eighty-two women who had been treated with conservative management, medical evacuation, or surgical evacuation of retained products of conception after spontaneous abortions in a randomized, controlled trial. MEASUREMENTS AND MAIN RESULTS Hysteroscopic diagnosis of IUA 6 months after initial treatment was the primary outcome measure. No cases of IUA were found in patients managed conservatively or by medical evacuation, whereas two cases (7.7%) of filmy IUA were detected in those managed by surgical evacuation. There was no statistical significant difference in the rate of self-reported reduced menstrual flow 6 months after initial treatment by any method. CONCLUSION The prevalence of IUA was low after each modality of treatment for spontaneous abortion. Conservative management and medical evacuation are both acceptable alternatives to standard surgical evacuation.

A medical approach to management of spontaneous abortion using misoprostol. Extending misoprostol treatment to a maximum of 48 hours can further improve evacuation of retained products of conception in spontaneous abortion.

BACKGROUND To compare a 48 hour non surgical policy in the management of spontaneous abortion with a policy of routine, universal uterine curettage. METHODS A prospective, observational study on 354 women admitted to hospital with spontaneous abortion. Of these, 225 who had retained products of conception were treated with misoprostol for up to 48 hours after 101 were excluded because they had an empty uterus on transvaginal scan (TVS) and another 28 women because they were unsuitable for conservative management. Follow-up was conducted over a 3 week period to assess morbidity. A reference group of 137 women, all of whom had an evacuation of retained products of conception (ERPC) as a routine after they had a TVS documenting retained products of conception (POCs), was used for comparison. RESULTS Evacuation of the uterus occurred within 24 hours in 107 women and in 148 at 48 hours after misoprostol treatment was started. There were three uterine curettages up to 14 days after discharge from hospital for persistent bleeding and two cases of pelvic infection. An ectopic pregnancy was diagnosed at follow-up in one woman. In the reference group, there were nine women who had complications, four requiring another ERPC and five had infection, an overall complication rate of 6.6% in the reference group and 1.7% in the protocol treatment group. CONCLUSION A 48 hour regimen using transvaginal ultrasound and misoprostol for the management of spontaneous abortion was successful in avoiding surgery in 249 out of a possible 354 (70.6%) women with spontaneous abortion, with a low rate of subsequent morbidity.

Spontaneous Abortion: Short‐term Complications Following Either Conservative or Surgical Management

Summary: Spontaneous abortion is a common gynaecological condition. It is a commonly held belief that medical morbidity associated with this condition is low and that routine treatment should be surgical evacuation of the uterus. This study was performed to study the short‐term complications of spontaneous abortion and its management. Transvaginal sonography (TVS) was used to determine whether retained products of conception (POCs) were visible inside the uterus in women presenting with spontaneous abortion. If tissue was present, surgical evacuation of retained products of conception (ERPC) was performed. If the uterus was empty, the patients were managed expectantly. Four hundred and seventy women were treated with ERPC and 297 were managed expectantly. The complication rate was 3.0% in those managed expectantly compared with 5.8% for those treated by ERPC. Subjects with no POCs on TVS can therefore be managed expectantly without increasing the risk of morbidity associated with this condition.

Vascular Endothelial Growth Factor in the Human Oviduct: Localization and Regulation of Messenger RNA Expression In Vivo

Abstract In this study, we examined the localization of vascular endothelial growth factor (VEGF) and the changes in VEGF mRNA expression in various regions of the oviduct in fertile women throughout the ovulatory cycle. Oviduct tissue was collected from 22 women undergoing laparoscopic tubal sterilization or hysterectomy for a benign gynecological condition. Oviduct sections were divided into isthmus, ampullary, and infundibular regions. Serial cross sections were analyzed for the presence of VEGF by specific immunohistochemical staining. The mucosal layer was isolated, and a semiquantitative reverse transcription polymerase chain reaction was performed. Immunohistochemical study revealed VEGF in the oviduct luminal epithelium, smooth muscle cells, and blood vessels within the oviduct. VEGF mRNA expression in oviduct was the highest during the periovulatory stage, and the expression in the ampullary and infundibular regions was higher than that in the isthmus. There was a significant positive correlation between serum FSH and LH concentrations and VEGF mRNA expression. There was no significant correlation between serum estradiol and progesterone concentrations and VEGF mRNA expression. These results suggest that VEGF in human oviduct may play an important role related the early reproductive events, which occur predominantly in the ampulla during the periovulatory phase when serum FSH and LH concentrations are high.

Screening psychiatric morbidity after miscarriage: application of the 30-item General Health Questionnaire and the Edinburgh Postnatal Depression Scale.

Objective Psychiatric morbidity affects 48% to 51% of women who have miscarried. This study evaluated the utility of two simple and brief self-report questionnaires in screening psychiatric morbidity after miscarriage. Method One hundred fifty-six subjects completed the 30-item General Health Questionnaire (GHQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Beck Depression Inventory (BDI) 6 weeks after miscarriage. Then there was a blind assessment using the Structured Clinical Interview for DSM-III-R (SCID) to establish psychiatric diagnosis. The criterion validity of GHQ and EPDS were tested against this yardstick diagnosis and the concurrent validity against the BDI scores. The internal consistency of the scales was measured by Cronbachs alpha-coefficient. Results Both GHQ and EPDS had good sensitivity and specificity in screening for psychiatric morbidity after miscarriage. The concurrent validity and the internal consistency of both scales were satisfactory. The EPDS could only identify those subjects with major depression. The GHQ was longer to perform, but was able to detect both anxiety and depressive disorders. Furthermore, the GHQ had better psychometric properties when compared with the EPDS. Conclusions These scales will be particularly useful for nonpsychiatric medical personnel. We recommend routine application of the GHQ 6 to 8 weeks after miscarriage to identify women who may require psychiatric management.

A medical approach to management of spontaneous abortion using misoprostol

Background. To compare a 48 hour non surgical policy in the management of spontaneous abortion with a policy of routine, universal uterine curettage.