Mary Rauff

Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial

Objective To investigate whether antenatal breast feeding education alone or postnatal lactation support alone improves rates of exclusive breast feeding compared with routine hospital care. Design Randomised controlled trial. Setting A tertiary hospital in Singapore. Participants 450 women with uncomplicated pregnancies. Main outcome measures Primary outcomes were rates of exclusive breast feeding at discharge from hospital and two weeks, six weeks, three months, and six months after delivery. Secondary outcomes were rates of any breast feeding. Results Compared with women who received routine care, women in the postnatal support group were more likely to breastfeed exclusively at two weeks (relative risk 1.82, 95% confidence interval 1.14 to 2.90), six weeks (1.85, 1.11 to 3.09), three months (1.87, 1.03 to 3.41), and six months (2.12, 1.03 to 4.37) postnatally. Women receiving antenatal education were more likely to breast feed exclusively at six weeks (1.73, 1.04 to 2.90), three months (1.92, 1.07 to 3.48), and six months (2.16, 1.05 to 4.43) postnatally. The numbers needed to treat to achieve one woman exclusively breast feeding at six months were 11 (6 to 80) for postnatal support and 10 (6 to 60) for antenatal education. Women who received postnatal support were more likely to exclusively or predominantly breast feed two weeks after delivery compared with women who received antenatal education (1.53, 1.01 to 2.31). The rate of any breastfeeding six weeks after delivery was also higher in the postnatal support group compared with women who received routine care (1.16, 1.02 to 1.31). Conclusions Antenatal breast feeding education and postnatal lactation support, as single interventions based in hospital both significantly improve rates of exclusive breast feeding up to six months after delivery. Postnatal support was marginally more effective than antenatal education. Trial registration Clinical Trials NCT00270920.

Simple antenatal preparation to improve breastfeeding practice: a randomized controlled trial.

OBJECTIVE: To address the impact of simple antenatal educational interventions on breastfeeding practice. METHODS: A randomized controlled trial was carried out in a tertiary referral center from May 2002 to December 2004. A random sample of eligible low-risk antenatal patients was recruited from clinics in the National University Hospital, Singapore. Group A received breastfeeding educational material and individual coaching from a lactation counselor. Group B received breastfeeding educational material with no counseling. Group C received routine antenatal care only. RESULTS: A total of 401 women were recruited. Mothers receiving individual counseling and educational material practiced exclusive and predominant breastfeeding more often than mothers receiving routine care alone at 3 months (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.2–5.4) and 6 months (OR 2.4, 95% CI 1.0–5.7) postpartum. More mothers practiced exclusive and predominant breastfeeding at 6 months among women receiving individual counseling compared with women exposed to educational material alone (OR 2.5, 95% CI 1.0–6.3). CONCLUSION: Where breastfeeding practices are suboptimal, simple one-encounter antenatal education and counseling significantly improve breastfeeding practice up to 3 months after delivery. Provision of printed or audiovisual educational material is not enough. Health care workers should make every effort to have one face-to-face encounter to discuss breastfeeding with expectant mothers before they deliver. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT002770192 LEVEL OF EVIDENCE: I

Carbetocin versus syntometrine for the third stage of labour following vaginal delivery-a double-blind randomised controlled trial

Objective  Prevention of postpartum haemorrhage is essential in the pursuit of improved health care for women. However, limited literature is available for comparing the use of oxytocin agonist carbetocin with syntometrine in women undergoing vaginal deliveries. We aimed to compare intramuscular carbetocin with intramuscular syntometrine for the routine prevention of postpartum haemorrhage in women who deliver vaginally.

Noninvasive prenatal exclusion of haemoglobin Bart's using foetal DNA from maternal plasma†

Prenatal diagnosis of alpha‐thalassaemia requires invasive testing associated with a risk of miscarriage. Cell‐free foetal DNA in maternal plasma presents an alternative source of foetal genetic material for noninvasive prenatal diagnosis. We aimed to exclude HbBarts noninvasively by detection of unaffected paternal alleles in maternal plasma using quantitative fluorescence PCR (QF‐PCR).

Lipid Profiles during and after Normal Pregnancy

Lipid profiles were estimated in two groups of normal healthy women comprising 39 non-pregnant women and 67 pregnant women at 28 and 32 weeks gestation and 6 weeks after delivery. Triglycerides, total, HDL and LDL cholesterols were high during pregnancy. Except for LDL cholesterols which remained constant, all the above decreased at 6/52 postnatally, but levels were still above those of normal non-pregnant women. Compared to the later, the atherogenic index, LDL/HDL cholesterol ratio was unchanged during pregnancy but significantly increased at 6/52 postnatally. These results may suggest that while total lipid levels increase during pregnancy, this is balanced by an even distribution of the lipoprotein fractions. After delivery, though lipid levels had decreased, the decrease in HDL cholesterol and increase in LDL cholesterol caused unfavourable changes in lipid-lipoprotein ratios. These changes may be due to the change in metabolism of the pregnant women as well as diet during and after pregnancy.

Transient blindness associated with pregnancy‐induced hypertension. Case reports

Transient blindness with pregnancy-induced hypertension without other neurological symptoms is a rare phenomenon, and few cases have been reported in the world literature (Gandhi e( al. 1978; Beck ef al. 1980; Chew & Tay 1981). Permanent loss of vision with severe preeclampsia has also been documented (Sonimerville-Large 1950; Carpenter et al. 1953). We report three cases of transient blindness associated with pregnancy-induced hypertension out of 30 867 deliveries in the University Unit, Kandang Kerbau Hospital, Singapore during the period 198C-1983, when the incidence of hypertensive disease of pregnancy was 6.6% and that of eclampsia was 0.13%.

In vivo model to determine fetal‐cell enrichment efficiency of novel noninvasive prenatal diagnosis methods

To develop an in vivo model to determine fetal‐cell enrichment efficiency of novel noninvasive prenatal diagnosis methods.

Limited benefit of hepatitis B immunoglobulin prophylaxis in children of hepatitis B e antigen-negative mothers.

INTRODUCTION In 2006, Singapore adopted the universal hepatitis B immunoglobulin (HBIg) policy. Since then, all infants of hepatitis B surface antigen (HBsAg)-positive mothers receive HBIg, irrespective of maternal hepatitis B e antigen (HBeAg) status. However, the benefits of HBIg for infants of HBeAg-negative mothers are unclear. We compared the vertical transmission rates among children of HBeAg-negative mothers who were given HBIg versus a retrospective cohort who were not given HBIg, to determine its protective effect. METHODS This observational study involved pregnant HBsAg-positive women seen at National University Hospital, Singapore, between June 2009 and December 2013. If the infants of these mothers completed the recommended vaccination schedule, they were recruited into the study, along with their older siblings. Serological testing for the children was performed three months after completion of the last dose of vaccine, and hepatitis B virus (HBV) surface gene sequencing was carried out if HBV DNA was detected. RESULTS A total of 111 infants and 47 siblings were recruited. 2 (1.5%) children were found to have vertical transmission despite receiving HBIg, while no incidences of vertical transmission were found among the historical controls who did not receive HBIg (p = 1.00). CONCLUSION The overall effectiveness of the hepatitis B vaccination programme for children of HBsAg-positive mothers was high, regardless of HBIg administration. The addition of HBIg did not appear to confer additional benefits, in terms of vertical transmission rate, among infants born to HBeAg-negative mothers.

Prenatal Detection of Isochromosome 21 by QF-PCR

Objective: To compare rapid aneuploidy diagnostic tests with traditional karyotyping in the prenatal detection of Down syndrome due to isochromosome 21. Methods: Quantitative fluorescence PCR (QF-PCR) and fluorescent in situ hybridization (FISH) for chromosomes 13, 18, 21, X and Y were performed on uncultured amniotic fluid, followed by routine karyotyping. Chromosomal and microsatellite analysis of peripheral blood from parents was also carried out. Results: The QF-PCR screening showed a trisomic diallelic pattern for 5 of 6 markers spanning the long arm of chromosome 21. FISH showed 3 signals in the interphase cells for the region 21q22.13-q22 during LSI 21 probe mapping. Cultured amniotic fluid revealed an isochromosome 21 resulting in a 46,XX,i(21)(q10),+21 karyotype. Parental microsatellite analysis proved that the isochromosome was paternal in origin. Conclusion: The most informative analytical tool in this case appears to be QF-PCR, although a combination of QF-PCR and karyotyping provided the most evidence.

Uterine activity in myotonia dystrophica. Case report.

The patient was a 28-year-old woman in her fourth pregnancy. She has had myotonia dystrophica since the age of 4 years diagnosed by electromyographic (EMG) investigations and abnormal serum creatinine phosphokinase levels. One of her sisters also has the disease but not her parents or two other siblings. Her first pregnancy resulted in a growthretarded (1800 g) macerated stillbirth at term 6 years ago. The second pregnancy terminated in spontaneous abortion at 3 months gestation. Her third pregnancy was complicated by massive polyhydramnios with preterm labour at 32 weeks when 2.5 litres of amniotic fluid were drained with membrane rupture. The baby was born by caesarean section for fetal distress under 0.5% bupivicaine lumbar epidural anaesthesia. The baby had an Apgar score of 1 at 1 min, 2 at 5 min, and died 24 h later. Within hours of surgery her temperature rose to 39°C and was controlled by tepid sponging. The possibility of malignant hyperpyrexia was entertained but was not confirmed due to the lack of facilities to perform caffeine sensitivity test. In this, her fourth pregnancy, she was booked at 20 weeks and had eight subsequent antenatal visits. Initial ultrasound confirmed the period of gestation and excluded major fetal abnormality. Serial ultrasound examination for growth of the fetus was satisfactory and there was no evidence of excess amniotic fluid. She complained of generalized weakness during this pregnancy but there was no paraesthesia, sensory defect or visual problems. She had no frontal balding but had poor facial expression and symmetrical wasting of both arms and legs. Cardiovascular and respiratory systems were normal. Investigations revealed normal ECG, haemoglobin, phosphate, calcium, urea potassium, sodium and chloride levels. Serum