Sheng-Wen Shaw

Factors influencing women's decisions regarding pertussis vaccine: A decision-making study in the Postpartum Pertussis Immunization Program of a teaching hospital in Taiwan.

We conducted surveys to determine factors influencing womens decisions to accept or decline postpartum pertussis (Tdap) vaccination. Survey response rate among eligible individuals was 97%. Of respondents, 53% accepted and 47% declined postpartum Tdap. Women, who declined vaccination were more likely to rate maternal or infant risk of exposure to pertussis as low, report that they did not trust information about postpartum pertussis vaccination, and report being very concerned about the safety of the vaccine. Awareness about pertussis, its risk to infants, and prevention via vaccination need to be further increased among women of child-bearing age, particularly pregnant women.

Anxiety levels in women undergoing prenatal maternal serum screening for Down syndrome: the effect of a fast reporting system by mobile phone short-message service

To study the effect of fast reporting by mobile phone short‐message service (SMS) on anxiety levels in women undergoing prenatal biochemical screening for Down syndrome.

Ectopic twin pregnancy in cesarean scar after in vitro fertilization/embryo transfer: case report

OBJECTIVEnTo present two cases of ectopic twin pregnancy in a Cesarean section scar following IVF-embryo transfer.nnnDESIGNnCase report.nnnSETTINGnTertiary referral case center.nnnPATIENT(S)nTwo women who had ectopic twin pregnancy in a Cesarean section scar, in both cases following IVF and embryo transfer.nnnINTERVENTION(S)nThree-dimensional power Doppler ultrasound and diagnostic hysteroscopy were performed for early recognition and treatment.nnnMAIN OUTCOME MEASURE(S)nPrevention of pregnancy complications such as hemorrhage, uterine rupture, and preservation of fertility.nnnRESULT(S)nCase 1: diagnosis was made in a 31-year-old woman after IVF; she was managed with laparotomy excision of the twin pregnancy. Case 2: an early such pregnancy was diagnosed in a 37-year-old woman following IVF. She was treated successfully with hysteroscopy and laparoscopic surgery.nnnCONCLUSION(S)nBecause ectopic pregnancy in a Cesarean scar carries high risk of uterine rupture and uncontrollable hemorrhage, such a twin pregnancy presumably carries similar risks. Focused application of high-resolution ultrasound and diagnostic hysteroscopy may help lead to early recognition of ectopic twin pregnancy in a Cesarean scar and prevention of complications such as hemorrhage and uterine rupture.

Difference in nuchal translucency between monozygotic and dizygotic spontaneously conceived twins

To assess nuchal translucency (NT) thickness and differences in inter‐twin NT thickness among naturally conceived monozygotic and dizygotic twins.

Sonographic diagnosis of fetal malformations associated with mycophenolate mofetil exposure in utero

Mycophenolate mofetil has been shown to have teratogenic properties in animal studies and clinical reports. We report a case of major fetal malformation likely caused by mycophenolate mofetil exposure in utero in a 36 year old patient with systemic lupus erythematosus. The diagnosis was made by ultrasonography at 22 weeks of gestation.

Maternal anxiety about first trimester nuchal translucency screening and impact of positive screening results

Background. To assess pre‐ and post‐procedural maternal anxiety about nuchal translucency thickness screening for Down syndrome in the first trimester of pregnancy, and the psychological impact of positive screening results. Methods. A total of 172 women whose screens were positive for excess fetal nuchal translucency thickness, and 180 women whose screens were within normal limits (controls) were recruited. Anxiety levels were measured with the Spielberger State‐Trait Anxiety Inventory just before screening, 1 week after screening, at 22 weeks’ gestation, and 6 weeks after delivery. After delivery, all women were asked to respond using a Likert‐type scale regarding their attitudes toward fetal nuchal translucency screening. Results. Women with positive screening results reported significantly greater psychological distress on state‐anxiety scores after the full report was received. The trait‐ and state‐anxiety scores before screening, at 22 weeks’ gestation, and after delivery did not differ between groups. Both groups of women were strongly positive about nuchal translucency screening, both in the current pregnancy and in future pregnancies. Conclusion. Women with positive screening results did not have a sustained increase in anxiety and remained supportive about the value of screening. Clinician concerns about causing maternal anxiety should not be an impediment to screening.

Factors associated with the intention to recommend pertussis vaccination for postpartum women: A survey in Taiwan of obstetrician–gynecologists' knowledge, beliefs, and attitudes

OBJECTIVEnTo examine obstetrician-gynecologists knowledge, beliefs, and attitudes associated with the intention to recommend adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccination to postpartum women.nnnMATERIALS AND METHODSnA survey instrument was mailed to a total of 2686 members of the Taiwan Association of Obstetrics and Gynecology to assess provider demographic characteristics, occupational information, pertussis knowledge, and beliefs and attitudes about vaccination. The intention to recommend pertussis vaccination to postpartum women was evaluated. Trend chi-square statistics and multivariate logistic models were used to determine variables that were significantly associated with intention to recommend vaccination.nnnRESULTSnOf the 676 surveys returned (25.2%), 510 participants were active in obstetric practice. A statistically significant difference was found in meanxa0±xa0SD knowledge scores for pertussis disease and pertussis vaccination between obstetrician-gynecologists who intended to recommend and those who did not intend to recommend postpartum Tdap vaccination (disease: 2.99xa0±xa02.2 vs. 2.31xa0±xa01.9, respectively, pxa0<xa0.001; vaccination: 2.64xa0±xa02.2 vs. 1.36xa0±xa01.8, respectively, pxa0<xa0.001). Obstetrician-gynecologists who were in favor of postpartum Tdap vaccination were more likely to: (1) rate the change in pertussis incidence among adults as increased; (2) rate pertussis disease among newborn infants as highly severe; (3) rate pertussis as highly contagious; and (4) understand the current recommendation of important organizations for protecting infants against pertussis.nnnCONCLUSIONnOur study of obstetrician-gynecologists attitudes and intentions concerning postpartum Tdap vaccination may be useful in guiding the design of effective perinatal Tdap immunization programs nationwide.

X pentasomy in an intracytoplasmic sperm injection pregnancy detected by nuchal translucency testing.

Althoughmaternally derived X pentasomy following intracytoplasmic sperm injection (ICSI) is rare, prenatal detection of a case offers insight into etiology and diagnosis. A 29-year-old gravida 1 whose pregnancy resulted from ICSI was referred for ultrasound screening at 11 weeks’ gestation. Nuchal translucency thickness was 3.2 mm, and the fetal nasal bone was absent. Subsequent evaluation revealed karyotype 49,XXXXX. DNA microsatellite analysis showed the extra X chromosomes were maternal in origin. Termination of pregnancy was performed at 15 weeks. Because of the increased risk of sex chromosomal abnormalities in ICSI pregnancies, patients should be counseled prior to fertilization and standard prenatal care should include nuchal translucency measurement and any other elements necessary for indicated pregnancies to obtain a diagnosis.

EVALUATION OF FETAL SPINE BIOMETRY BETWEEN 11 AND 14 WEEKS OF GESTATION

This study was designed to establish a fetal spine nomogram for age 11 through 14 weeks of gestation and to document relations among fetal spine length, distance and angle. These parameters were prospectively measured during the first trimester of singleton pregnancies, along with nuchal translucency, over a 3-year period. A total of 430 fetuses were included in the study. The regression equations among fetal spine parameters and gestational age were as follows: Spine length (mm) = 1.116 x gestational age (days) - 59.169; spine distance (mm) = 1.079 x gestational age (days) - 59.038; head-spine angle = 0.740 x gestational age (days) + 4.735; spine length:spine distance ratio = -0.002 x gestational age (days) + 1.234. Prenatal age-specific reference intervals for fetal spine biometry between 11 and 14 weeks of gestation may assist in evaluation of fetuses investigated for genetic abnormalities that can be expressed by deviation in spine length, distance, or angle.

Prenatal diagnosis of fetal glutaric aciduria type 1 with rare compound heterozygous mutations in GCDH gene

OBJECTIVEnGlutaric aciduria type 1 is a rare disease, with the estimated prevalence about 1 in 100,000 newborns. GCDH gene mutation can lead to glutaric acid and 3- OH glutaric acid accumulation, with clinical manifestation of neuronal damage, brain atrophy, microencephalic macrocephaly, decreased coordination of swallowing, poor muscle coordination, spasticity, and severe dystonic movement disorder.nnnCASE REPORTnA 22-year-old female, Gravida 4 Para 2, is pregnancy at 13 weeks of gestational age. Her first child is normal, however, the second child was diagnosed as glutaric aciduria type I after birth. She came to our hospital for prenatal genetic counselling of her fetus at 13 weeks of gestational age. We performed GCDH gene mutation analysis of maternal blood showed IVS 3xa0+xa01 Gxa0>xa0A heterozygous mutation, GCDH gene mutation analysis of paternal blood showed c. 1240 Gxa0>xa0A heterozygous mutation, and the second child has compound heterozygous IVS 3xa0+xa01 Gxa0>xa0A and c. 1240 Gxa0>xa0A mutations. Later, we performed amniocentesis at 16 weeks of gestational age for chromosome study and GCDH gene mutation analysis for the fetus. The fetal chromosome study showed normal karyotype, however, GCDH gene mutation analysis showed compound heterozygous IVS 3xa0+xa01 Gxa0>xa0A and c. 1240 Gxa0>xa0A mutations. The couple decided to termination of pregnancy thereafter.nnnCONCLUSIONnGlutaric acidemia type 1 is an autosomal recessive disorder because of pathogenic mutations in the GCDH gene. Early diagnosis and therapy of glutaric acidemia type 1 can reduce the risk of neuronal damage and acute dystonia. We report a case of prenatal diagnosis of fetal glutaric aciduria type 1 with rare compound heterozygous GCDH gene mutation at IVS 3xa0+xa01 Gxa0>xa0A and c. 1240 Gxa0>xa0A mutations, which provide better genetic counselling for the couples.