Shing-Kai Yip

Urinary retention in the post-partum period: The relationship between obstetric factors and the post-partum post-void residual bladder volume

Objective. The three objectives of this study are: to investigate the incidence of post‐partum urinary retention after vaginal delivery, to investigate the relationship between various obstetric parameters and the post‐partum post‐void residual bladder volume and to study the natural progression of the post‐void residual bladder volume in patients with covert post‐partum urinary retention.

The prevalence of urinary dysfunction in Hong Kong Chinese women

Objective To determine the prevalence of urinary dysfunction in Hong Kong Chinese women. Methods A telephone survey was conducted in the territory of Hong Kong. The subjects were a sample of women between the ages of 10 and 90 years. The main outcome determined was the prevalence of urinary dysfunction. Results We made 3248 calls, resulting in 819 evaluable responses. Stress incontinence was reported by 21% (174) of respondents, urgency or urge incontinence in 15% (120), urinary frequency in 19% (154), nocturia in 20% (166), bed-wetting in 4% (31), and voiding difficulties in 13% (109). Stress incontinence occurred as the only symptom in 7% (53), the combination of urgency and frequency in 1% (11), and mixed symptoms in 6% (52). Four percent required protective underwear or pads, with 2% wearing protective underwear continuously; 4% were incapacitated by their incontinence. Symptoms of urgency, urge incontinence, frequency, and nocturia increased with increasing age, but voiding difficulties and nocturnal enuresis were unrelated to age. Stress incontinence, urgency, urge incontinence, frequency, nocturia, and voiding difficulties increased with increasing parity to para 4. Conclusion Urinary dysfunction and its patterns appear to be as common and incapacitating in Hong Kong Chinese as they are in other populations.

Postpartum urinary retention

Postpartum urinary retention (PUR) is a common condition in obstetric units. It is also known as puerperal urinary retention (1) or insidious urinary retention after vaginal delivery (2). Despite its ubiquity, morbidity, and the distress brought on to postpartum women, PUR remains a poorly understood subject. Unlike urinary incontinence, female urinary retention in particular PUR, has not received much attention. Scientific publications on this subject are relatively sparse. In this review the scientific background, clinical significance, and management alternatives of PUR are discussed.

Misoprostol’s effect on uterine arterial blood flow and fetal heart rate in early pregnancy

Objective To determine whether a single oral dose of misoprostol is associated with change in Doppler resistance indices (RIs) of the uterine artery in early pregnancy. Methods Forty pregnant women seeking legal termination of pregnancy at 7–15 completed gestational weeks were each given a single oral dose of 200 μg misoprostol. Resistance indices (A/B ratio) and pulsatility index (PI) of the uterine arteries (UA) and fetal heart rate (FHR) were assessed by Doppler ultrasound before and 1 hour after administration of misoprostol. Results Doppler RIs (UA-A/B and UA-PI) of the right and left uterine arteries increased significantly 1 hour after misoprostol administration. The right UA–A/B increased from 7.16 ± 1.09 (mean ± SEM) to 10.26 ± 0.67 (P < .001), and the left UA–A/B increased from 7.40 ± 0.72 to 9.21 ± 0.82 (P = .04). The right UA–PI increased from 2.38 ± 0.11 to 2.90 ± 0.12 (P < .001), and the left UA–PI increased from 2.38 ± 0.17 to 2.70 ± 0.18 (P = .03). No significant changes in FHR were noted 1 hour after misoprostol administration. None of the fetuses died during that time. Conclusion Doppler RIs of the uterine arteries increased significantly after single oral doses of misoprostol during the first trimester, implying a reduction in arterial blood flow. Those changes were not associated with fetal death, possibly explaining congenital abnormalities associated with misoprostol in early pregnancy.

Effect of the Duration of Labor on Postpartum Postvoid Residual Bladder Volume

In order to investigate the possibility of protracted labor as a risk factor for postpartum urinary retention and to study the relation between duration of labor and postpartum day 1 postvoid residual bladder volume, the postpartum postvoid residual bladder volume (PVRBV) of a group of patients was studied using ultrasonography. Out of 707 patients investigated during a 2-month study period, a homogeneous group of 164 patients, with possible risk factors for postpartum urinary retention being controlled, was studied. The homogeneous group’s postpartum day 1 postvoid residual bladder volumes were assessed by ultrasonography and analyzed with respect to the duration of labor. The incidence of postpartum urinary retention (≥150 ml) was 11% in this homogeneous group. Labor duration longer than or equal to 800 min was associated with a higher incidence of postpartum urinary retention (χ2 test; p < 0.05). Moreover, there is a direct relationship between the duration of labor and PVRBV which is described by a quadratic regression curve. Protracted labor longer than or equal to 800 min is a risk factor for postpartum urinary retention. The PVRBV is directly related to the duration of labor.

Genital Prolapse: A Legacy of the West?

A retrospective study was undertaken to determine if there has been a change in the incidence of genital prolapse and urinary stress incontinence in Chinese women in Hong Kong. The medical records of 2,312 consecutive patients admitted for major gynaecological surgery for benign conditions in 5 out of 7 major public teaching hospitals in Hong Kong for the calendar year of 1993 were reviewed by way of an audit of all gynaecological operations performed in these hospitals. A total of 578 cases (25%) were identified as having genital prolapse and or urinary problems.

Adipose-derived stem cells from pregnant women show higher proliferation rate unrelated to estrogen

BACKGROUND Adipose tissue contains an abundant population of multipotent adipose-derived stem cells (ASCs) and has been an excellent source of mesenchymal stem cells for cell therapy and tissue engineering. To ensure successful cell therapies, consistency of stem cell performance across donors is critical. However, the effect of the donors reproductive status on ASC proliferation rate and differentiation capacity is undefined. METHODS We investigated whether the yield and function of ASCs are affected by the womans reproductive status: pregnancy, premenopause or menopause. ASCs were isolated from the abdomen of 15 women and their proliferation rates and differentiation capacities were compared by cell count. The capacity of ASCs to differentiate into the chondrogenic lineage was investigated by quantitative real-time polymerase chain reaction and immunohistochemistry. RESULTS There was no significant difference in the differentiation capacity between the three groups, whereas the proliferation rate of ASCs from pregnant women was significantly higher than from the other two groups (P < 0.05). The proliferation rate of ASCs after estrogen treatment remained unchanged. CONCLUSIONS Despite the higher proliferation rate in pregnant women, ASCs showed consistency in cell differentiation capacity and were unaffected by donor status. This suggests that factors other than estrogen are responsible for the difference in proliferation.

Spontaneous expulsion of a Filshie clip through the anterior abdominal wall.

Tubal occlusion using Filshie clip is one of the most commonly performed operations for female sterilization. It is usually a simple and safe procedure, and operative complications are uncommon. We report a rare case of spontaneous expulsion of a Filshie clip through the anterior abdominal wall 5 years after sterilization. The management and possible underlying mechanisms are discussed and the related literature is reviewed.

A study on prophylactic antibiotics in cesarean sections - is it worthwhile?

Background. To study the effect of single‐dose prophylactic Augmentin™ on patients under‐going cesarean section.

Accuracy of Clinical Diagnostic Methods of Threatened Abortion

Objective: To examine the accuracy of clinical diagnostic methods in assessing vaginal bleeding in pregnant women before 28 weeks’ gestation. Methods: 772 consecutive women who presented with threatened abortion before 28 weeks’ gestation were studied. Structured history and physical examination were performed on each woman as initial clinical assessment. This was followed by transvaginal sonography to determine the status of pregnancy. The accuracy of diagnoses at different clinical stages (history, physical examination, and transvaginal sonography) relative to the final diagnosis was compared using the kappa coefficient (ĸ). Results: Clinicians were unable to accurately diagnose or predict the status of the pregnancy from history alone (ĸ = 0.33; 95% CI 0.28, 0.38) or after physical examination (ĸ = 0.57; 95% CI 0.52, 0.62). Transvaginal sonography led to an accurate diagnosis of pregnancy status (ĸ = 0.96; 95% CI 0.95, 0.98) in most cases, except where an ectopic pregnancy existed. Absence of abdominal tenderness (p = 0.04), cervical excitation (p = 0.02), and incorrect identification of retained products of conception on transvaginal sonography (p = 0.01) were features of missed ectopic pregnancy. Conclusions: The clinical assessment of threatened abortion by history and physical examination is unreliable in most cases. The diagnostic accuracy is improved by the addition of transvaginal sonography. Even with the help of transvaginal sonography, a small proportion of ectopic pregnancies will be missed.