Man Wah Pang

Dysregulated microRNAs and their predicted targets associated with endometrioid endometrial adenocarcinoma in Hong Kong women

The objective of this study, a parallel study to global gene expression profiling, was to identify dysregulated microRNAs (miRNAs) associated with endometrioid endometrial adenocarcinoma (EEC), examine their correlation with clinico‐pathological characteristics and identify predicted target genes of the dysregulated miRNAs. Using real‐time quantitative reverse transcription‐polymerase chain reaction (qRT‐PCR), profiling of miRNA expression was performed in 30 EECs and 22 normal counterparts in which genome‐wide gene expression had been previously profiled and reported. Clustering analysis identified 30 miRNAs which were significantly dysregulated in EEC. The expression of a sub‐group of miRNAs was significantly correlated with clinico‐pathological characteristics including stage, myometrial invasion, recurrence and lymph node involvement. By searching for predicted miRNA targets that were linked to the dysregulated genes previously identified, 68 genes were predicted as candidate targets of these 30 dysregulated miRNAs. miR‐205 was significantly overexpressed in EECs compared with normal controls. After transfection of a miR‐205 inhibitor, the expression of miR‐205 in endometrial cancer cell line RL95‐2 cells decreased whereas its predicted target gene, JPH4, showed increased protein expression. JPH4 seems to be a real miR‐205 target in vitro and in vivo, and a candidate tumor suppressor gene in EEC. Based on this study in EEC, miRNAs predicted to be involved in tumorigenesis and tumor progression have been identified and placed in the context of the transcriptome of EEC. This work provides a framework on which further research into novel diagnosis and treatment of EEC can be focused.

Impact of First Childbirth on Changes in Women’s Preference for Mode of Delivery: Follow-up of a Longitudinal Observational Study

BACKGROUND A womans childbirth experience has an influence on her future preferred mode of delivery. This study aimed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth. METHODS This prospective longitudinal observational study involved two units that provide obstetric care in Hong Kong. A mail survey was sent to 259 women 6 months after their first childbirth. These women had participated in a longitudinal cohort study that examined their preference for elective cesarean section in the antenatal period of their first pregnancies. Univariate and multivariate analyses were performed to identify determinants for women who changed from preferring vaginal birth to elective cesarean section. RESULTS Twenty-four percent (23.8%, 95% CI 18.4-29.3) of women changed from preferring vaginal birth to elective cesarean section after their first childbirth. Determinants found to be positively associated with this change included actual delivery by elective cesarean section (OR 106.3, 95% CI 14.7-767.4) intrauterine growth restriction (OR 19.5, 95% CI 1.1-353.6), actual delivery by emergency cesarean section (OR 8.4, 95% CI 3.4-20.6), higher family income (OR 3.2, 95% CI 1.1-8.8), use of epidural analgesia (OR 2.6, 95% CI 1.0-6.8), and higher trait anxiety score (OR 1.1, 95% CI 1.0-1.3). The most important reason for women who changed from preferring vaginal birth to elective cesarean section was fear of vaginal birth (24.4%). CONCLUSIONS A significant proportion of women changed their preferred mode of delivery after their first childbirth. Apart from reducing the number of cesarean sections in nulliparous women, prompt provision of education to women who had complications and investigations into fear factors during vaginal birth might help in reducing womens wish to change to elective cesarean section.

A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women

Objective  To establish whether women’s preference for elective caesarean section (ELCS) changes as gestation advances.

Cervical length at 18-22 weeks of gestation for prediction of spontaneous preterm delivery in Hong Kong Chinese women.

To assess the value of a single cervical length measurement by transvaginal sonography (TVS) at the time of mid‐trimester anomaly scan for predicting spontaneous preterm delivery (SPD) among Chinese women.

Randomised trial of assigned mode of delivery after a previous cesarean section – Impact on maternal psychological dynamics

Objective. This randomised trial was designed to study the psychological status and morbidity during and after delivery among women with a previous cesarean section (CS) who were randomised to planned vaginal birth (VBAC) or planned CS. Methods. Two hundred and ninety-eight women with one previous lower segment CS were randomised to either planned VBAC or planned CS. Women were asked to complete psychometric scales during their pregnancy till 6 months after confinement. The primary outcome studied was the differences in psychometric scores between the two study groups. Results. There were no differences in anxiety, depression, psychological well-being or satisfaction scores between the two groups. Significantly more women in planned VBAC (27/123) requested to change to elective CS, compared to those who were randomised to planned CS (15/135) initially requested to change to planned VBAC (OR: 2.25; 95% CI: 1.13–4.47). Subgroup analyses showed that women who changed from planned CS to VBAC had lower satisfaction at delivery [Client Satisfaction Score: 24.0 (23.0–24.3), 23.0 (22.0–24.0); p = 0.009] compared to women who did not change their plan for elective CS. Conclusions. The planned mode of delivery, either elective CS or VBAC, in pregnant women who had one previous CS did not influence the psychological dynamic during the course of or after the pregnancy. VBAC was not associated with higher psychological morbidity and therefore should be encouraged.

Impact of hypertensive disorders of pregnancy at term on infant birth weight

This study was performed to investigate the impact of hypertensive disorders of pregnancy at term on neonatal birth weight. All singleton live births delivered between 37 and 42 weeks of gestation complicated by hypertensive disorders over a 7‐year period (n = 362) was compared to 34 783 uncomplicated singleton deliveries in the same period. The individualized gestation‐related optimal weight (GROW) was calculated for each individual case adjusted for the effects of maternal booking weight, height, parity, gestation at delivery, and fetal sex. Small‐for‐gestational‐age (SGA) was defined as a birth weight less than the 10th percentile of the GROW. The incidence of SGA babies was significantly higher in subjects with preeclampsia and eclampsia than in control subjects (24.6 versus 11.3%; odds ratio = 2.55; 95% CI: 1.84, 3.55). Preeclampsia significantly reduced fetal birth weight by 130 g or 4.3%. Those with eclampsia on average had a neonatal birth weight 349 g or 11.0% below that of the GROW. In contrast, there was no significant difference in the incidence of SGA babies or degree of deviation from GROW between those with or without gestational hypertension.

Sociodemographic factors and pregnancy events associated with women who declined vaginal birth after cesarean section

OBJECTIVE Certain sociodemographic characteristics and pregnancy events were shown to pre-dispose women to decline vaginal birth after cesarean section (CS) in the Western population. The study aimed to identify the sociodemographic factors and pregnancy events associated with Chinese women who declined to attempt vaginal birth after CS. STUDY DESIGN This was a retrospective study of Hong Kong Chinese women who delivered in a public obstetric unit between 2002 and 2006. It was the units policy that women should attempt vaginal birth after one previous lower segment CS. During the study period, 1317 healthy Hong Kong Chinese women carrying a singleton pregnancy had had one previous lower segment CS. Of these women, 787 had had no antenatal complications during their index pregnancy. Univariate and multivariate analyses were performed to identify the sociodemographic factors and pregnancy events associated with women who declined vaginal birth after CS. RESULTS Thirty-nine percent (39.26%; 95%CI 35.85, 42.67) of women had elective CS because they had declined a vaginal birth. A history of a previous successful vaginal birth was the strongest determinant negatively associated with declining a vaginal birth (OR 0.15; 95%CI 0.06, 0.37). Determinants that were positively associated with declining a vaginal birth were higher family social class (OR 1.61; 95%CI 1.02, 2.55); family income of more than US

An unusual case of bilateral ureteric obstruction after anterior colporrhaphy and vaginal hysterectomy for pelvic organ prolapse

3850 per month (OR 1.56; 95%CI 1.03, 2.34), and women who attended private antenatal care before their first visit to the public unit (OR 1.47; 95%CI 1.02, 2.12). CONCLUSIONS Women who experienced a previous successful vaginal birth were positively associated with attempting vaginal birth after CS. Women who declined vaginal birth after CS exhibited certain social characteristics and treatment-seeking behavior. Future studies into the social context of this group of women may help us understand the underlying reasons why they decline vaginal birth.

An Unusual Case of a Vesicovaginal Stone

We report a case of bilateral ureteric obstruction after anterior colporrhaphy. The excessive folding of the bladder trigone after anterior colporrhaphy led to occlusion of both ureteric orifices.

Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation

We report a case of an unusual vesicovaginal stone. The dumb-bell-shaped stone created a ball valve effect in the fistula, therefore giving rise to only mild urinary leakage despite the large size of the fistula.