Mimi T.Y. Seto

Towards complete eradication of hepatitis B infection from perinatal transmission: review of the mechanisms of in utero infection and the use of antiviral treatment during pregnancy

Hepatitis B infection remains the most common form of chronic hepatitis. Mother to child transmission occurs despite immunoprophylaxis with vaccination and immunoglobulin. In utero infection is suggested to account for most of the cases with immunoprophylaxis failure. Infants who suffer from hepatitis B infection at birth have a higher risk of becoming chronic carriers and may develop liver cirrhosis or hepatocellular carcinoma in the future. Infected germ cells, transplacental infection, invasive prenatal diagnostic tests and various perinatal factors are possible factors leading to in utero infection and subsequent immunoprophylaxis failure. Hepatitis B e antigen positive status and high viral load increase the risk of immunoprophylaxis failure. Recent evidence shows promising results regarding the use of antiviral treatment in late gestation to suppress viral load, so as to decrease the risk of vertical transmission. This review discusses the possible mechanisms of in utero infection and the use of antiviral treatment during pregnancy.

Positive predictive value of endometrial polyps in Pipelle aspiration sampling: a histopathological study of 195 cases.

OBJECTIVE To estimate the positive predictive value of Pipelle endometrial sampling in detecting the presence of an underlying endometrial polyp. The secondary objective is to examine the histologic features that can predict the presence of endometrial polyps. STUDY DESIGN This is a retrospective case review study. 195 women who had undergone diagnostic hysteroscopy and/or polypectomy were identified in a University teaching hospital. All patients had a prior polyp diagnosis in the Pipelle endometrial sample. The histology of these samples were compared and analyzed with subsequent DH findings and final hysteroscopic biopsies. Slides were reviewed by 2 gynaecological pathologists. RESULTS 162 women were premenopausal (mean age 46.1, SD=4.6) and 33 were postmenopausal (mean age 57.2, SD=8.1). The commonest indication for a Pipelle endometrial sampling was abnormal uterine bleeding. Presence of polyp was confirmed by DH in 56.3% (111/195) cases. Of these, 81.1% (90/111) were confirmed histologically. The positive predictive value of detection of polyps in Pipelle endometrial samples for premenopausal and postmenopausal women was 53.7% and 72.7%, respectively (p=.05). The most reliable histologic features that can predict the presence of an underlying polyp was fibrous stroma (p=.01) and focal glandular clustering (p=.03). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was 11.7% (13/111). CONCLUSION The positive predictive value of Pipelle endometrial samples in detecting endometrial polyps was 56.3%. It was higher in the postmenopausal women (72.7%) compared to premenopausal women (53.7%). The prevalence of endometrial hyperplasia and carcinoma in women who was confirmed to have polyp was consistent with the rate reported in the literature. Using ultrasonography as an adjunct maybe helpful in diagnosing endometrial polyps.

A questionnaire study on the acceptability of self-sampling versus screening by clinicians for Group B Streptococcus

Background Group B Streptococcus (GBS) is a leading cause of neonatal morbidity and mortality. In an effort to reduce the impact of this serious affliction, universal screening for GBS has been adopted in many countries. The objective of this study was to examine the acceptability of self‐collected GBS swabs in a local population in Hong Kong. Methods This study is a cross‐sectional questionnaire survey conducted in a tertiary teaching hospital. A total of 327 pregnant women who attended the antenatal clinic for GBS screening from April 2012 to May 2012 were included in our study. The acceptability of GBS self‐screening and its associated factors were analyzed. Results Of these women, 200/320 (62.5%) participants preferred screening by healthcare workers, whereas only 18/320 (5.6%) preferred self‐screening. The most common reasons why some participants preferred to be screened by clinicians were that professionals had greater knowledge, and the added worry about the accuracy of self‐screening. 22/320 (69.4%) and 195/320 (60.9%) women believed that they felt comfortable enough to self‐perform the vaginal swab and rectal swab respectively. Previous use of tampons was associated with higher perceived capability of self‐performing the vaginal swab. Perceived capability to self‐perform the rectovaginal swabs was associated with a willingness to self‐perform the swabs (p < 0.001). The majority of women, 303/320 (94.7%), found the current practice of an additional clinic visit for GBS screening acceptable. However, 218/320 (68.1%) participants would like to undertake self‐screening if they were given the chance to do so in the next pregnancy, and 187/320 (58.4%) would recommend others have self‐screening for GBS as well. Conclusion Most women in the local population still preferred physician‐collected samples for GBS screening, but they welcomed the option of self‐screening in future pregnancies. Improved health education about the importance of GBS screening may improve the willingness of women to perform self‐screening.

Thermal bowel injury after ultrasound‐guided high‐intensity focused ultrasound treatment of uterine adenomyosis

Adenomyosis can cause significant impact in the quality of life of reproductive age women. Increasing importance on uterine preservation and advances in technology have resulted in the emerging use of minimally invasive treatment options, including high-intensity focused ultrasound (HIFU) therapy.

Second Trimester Medical Abortion In A Woman With Prior Classical Caesarean Section And A Uterine Leiomyoma - A Case Report.

Abstract Background Medical abortion in women with the scar of a classical caesarean section (CS) and a large uterine leiomyoma is rarely attempted; it carries the risk of uterine rupture and haemorrhage. Case A 34-year-old multiparous woman with prior classical CS and a 14 × 10 × 9 cm leiomyoma arising from the uterine isthmus had an induced abortion at 14 weeks’ gestation. Mechanical cervical priming with Dilapan®-S followed by vaginal misoprostol administration resulted in the uncomplicated expulsion of the uterine contents. Conclusions An early second trimester medical abortion with misoprostol was successfully performed in a woman with prior classical CS and a large uterine leiomyoma.

P09.01: Two cases of internal iliac artery thrombosis following internal iliac balloon inflation in placenta accreta: Poster discussion hub abstracts

Results: 100 women were recruited. The variability of the Intra-observer MCI PI versus UA PI and the MCA PSV is shown in figure 1. The Interclass correlation coefficient (ICC) was determined and ”best” ICC was found in the MCA measurement (K=0.888) versus a ”good” ICC found in the UA measurement (K=0.755). A statistically significant decrease was found in the MCA PI measurements during the interval close to term (37-42 weeks gestation), and between the group of women assessed before 40+0 weeks (n=26) and the group of women assessed between 40+0 to 42+0 weeks gestation (n=76). There was no statistically significant difference in the MCA PSV and UA PI during the interval close to term. A similar difference was found. Conclusions: MCA PI measured at the interval close to term is highly reliable and superior to the UA PI measurement near term. The MCA PI significantly decreases in the weeks close to term.

EP11.19: Prenatal diagnosis and ultrasound features of harlequin ichthyosis: Electronic Poster Abstracts

Objectives: To evaluate the application of Crystal Vue in fetal gastrointestinal tract. Methods: We compared the Samsung WS80A Crystal Vue with two dimension and three dimension in 24 fetuses of different gestational weeks (GW) between January 2017 and January 2018, 1 case of 13 GW, 15 cases of 18∼25 GW, 5 cases of 28∼32 GW, 4 cases over 35 GW. Crystal Vue imaging were compared with 2D, 3D, MRI and pathologic examination in 4 fetuses with malformation, 2 cases with duodenal atresia (DA), 2 cases with congenital diaphragmatic hernia (CDH). Results: Crystal Vue could delineate the fetal intestinal wall and lumen in different GW, and is considered better than 2D, 3D and MRI T2WI. For the cases with CDH, the imaging of intestinal tract herniating into the thoracic cavity on Crystal Vue is similar to MRI; as for the cases with DA, the dilated esophagus, stomach and duodenum were better delineated on Crystal Vue than MRI. Conclusions: Samsung WS80A Crystal Vue is a non-invasive and convenient fast imaging technology, and is evaluable in evaluating the fetal gastrointestinal tract, not only in normal development, but also in diagnosis of gastrointestinal malformation.

Immunoprophylaxis Failure of Infants Born to Hepatitis B Carrier Mothers Following Routine Vaccination

*Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China; Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China; Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China; kDepartment of Obstetrics and Gynaecology, Tuen Mun Hospital, Hong Kong SAR, China; Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China; and Department of Paediatrics and Adolescent Medicine, the University of Hong Kong, Hong Kong SAR, China

Pregnancy outcomes of women randomized to receive real versus placebo acupuncture on the day of fresh or frozen-thawed embryo transfer

INTRODUCTION Acupuncture is commonly used in various aspect of Western medicine in recent years including in-vitro fertilization (IVF) treatment. Although there are many clinical trials of acupuncture in IVF and the Cochrane meta-analysis did not find benefit of adjuvant acupuncture for IVF, there is no report on the pregnancy outcomes of women who had received acupuncture during their IVF treatment. OBJECTIVES To compare the pregnancy outcomes of women randomized to receive real versus placebo acupuncture during their IVF treatment. METHODS A retrospective chart review was performed on the 212 women with on-going pregnancies after receiving real or placebo acupuncture by sterile disposable stainless steel needles or Streitbergers placebo needles to the acupoints before and after the embryo transfer on the day of fresh or frozen-thawed embryo transfer. The pregnancy outcomes were obtained from the Hospital Authority Clinical Management System for deliveries in the public sector or from a self-returned questionnaire if those in the private sector. RESULTS No significant differences were found between the demographics of the two groups including their age, gravida, parity and the duration of subfertility. Maternal adverse outcomes including gestational diabetes and hypertensive disorder were comparable for the real acupuncture group (35.3% and 4.4% respectively) and the placebo acupuncture group (39.7% and 5.5% respectively). None of the patients had placenta accreta. The preterm delivery (<37 weeks gestation) rate in the real acupuncture group (23/86, 26.7%) was similar to that in the placebo acupuncture group (25/97, 25.8%). No statistical significant difference was found in the mode of delivery. There were no significant differences between the two groups for Apgar scores and birthweight. CONCLUSION Acupuncture during IVF treatment does not influence pregnancy outcomes.

Prolapsus urétral chez une femme postménopausée

J Obstet Gynaecol Can 2014;36(2):106 U femme de 71 ans presentait des saignements postmenopausiques, une dysurie, des difficultes mictionnelles et une masse faisant saillie a partir de l’orifice. L’examen physique a revele la presence d’une tumefaction non reductible en forme de beigne au niveau du meat uretral, le tout s’accompagnant de saignements de contact, ce qui etait compatible avec la presence d’un prolapsus uretral (Figure).