Siew-Fei Ngu

Dysmenorrhoea among Hong Kong university students: prevalence, impact, and management

OBJECTIVE. To evaluate the prevalence of dysmenorrhoea, its impact, and management approaches in Hong Kong university students, and to compare between medical and non-medical students for any potential differences in coping strategies. DESIGN. Cross-sectional questionnaire survey. SETTING. The University of Hong Kong, Hong Kong. PARTICIPANTS. A total of 240 undergraduate (128 medical and 112 non-medical) students. MAIN OUTCOME MEASURES. Data on the presence and severity of dysmenorrhoea, its impact on daily life, management approaches, specific strategies, and their self-perceived effectiveness were obtained and analysed. RESULTS. In these subjects, the prevalence of dysmenorrhoea was 80% (95% confidence interval, 75-85%) with a mean (standard deviation) pain score of 5.0 (1.7). The most common impacts on daily life included reduced ability to concentrate and/or disturbance with study (75%) and changes in normal physical activity (60%). Only 6% sought medical advice, while 70% practised self-management. Pain scores and pain affecting normal physical activities were important predictive factors for self-management and for management based on pharmacological or non-pharmacological means. The commonest specific strategies used were a warm beverage (62%), paracetamol (57%), and sleeping (45%), while the most effective strategies were non-steroidal anti-inflammatory drugs (100%), traditional Chinese medicine (93%), and dietary/nutritional supplements (92%). Regarding the comparison of medical and non-medical students, the former used fewer pharmacological strategies among the various management approaches investigated. CONCLUSION. With data showing dysmenorrhoea as a very common condition having a significant impact in the Hong Kong community, primary care doctors should reassure young women with dysmenorrhoea that it is a common experience in the same age-group. Health education on the existence of effective treatment from medical practitioners could help women whose dysmenorrhoea was not controlled by self-management.

Predictors of maternal and paternal depressive symptoms at postpartum

OBJECTIVES Postnatal depression has emerged as a major public health concern, which has deleterious effects on the well-being of the entire family. The aim of this study was to examine the predictive role of prenatal family sense of coherence, stress, social support and family, and marital functioning; the effect that any changes in these factors from pregnancy to postpartum; and partners depressive symptoms on depressive symptoms at 6 months postpartum. METHODS This study used a longitudinal design. A convenience sample of 200 childbearing couples in Hong Kong completed assessments of family sense of coherence, stress, social support, family, and marital functioning and depressive symptoms during pregnancy and at 6 months postpartum. Multiple regression analyses were employed. RESULTS The results showed that a low level of family sense of coherence and a high level of depressive symptoms during pregnancy and partners depressive symptoms were significantly associated with an increase in depressive symptoms for both mothers and fathers at 6 months postpartum. A lack of social support was significantly associated with increased risk of depressive symptoms for mothers, but not for fathers. CONCLUSION The results suggest that couple-based interventions that foster a sense of family coherence may be helpful in promoting parental well-being. Well-designed trials to test the effects of such interventions are recommended for future research.

Non-tubal ectopic pregnancy

doi:10.1016/j.ijgo.2011.06.021 were no changes in lipid parameters or liver function tests. Dysmenorrhea, deep dyspareunia, and pelvic pain decreased significantly after 3 months of treatment (Pb0.001), and women remained significantly pain free after 6 months of treatment (Pb0.001). The present study showed the efficacy of low-dose vaginal danazol for the treatment of recurrent pain in severe endometriosis, with subjective assessment of pain intensity by visual analog scale providing an adequate assessment of 3 pain components. Locally administered danazol is absorbed and transported directly to the tissues, with serum concentrations being lower than after oral administration [4]. Vaginal danazol is reliably effective for pain relief, with limited adverse effects. However, further studies are needed to confirm the effects of long-term use in severe endometriosis. Conflict of interest

Translation and validation of a chinese version of the family sense of coherence scale in Chinese childbearing families.

Background:Family sense of coherence is central to successful coping with family stressors and facilitates positive adaptation. Little is known about the implications of family sense of coherence for family adaptation during the transition to parenthood in Chinese society. Objectives:The aims of this study were to translate the Family Sense of Coherence Scale-Short Form (FSOC-S) into Chinese FSOC-S (C-FSOC-S) and to evaluate the psychometric properties. Methods:In Phase 1, the FSOC-S was translated into Chinese using the translation/back-translation technique and was reviewed by an expert panel for cultural equivalence. In Phase 2, a cross-sectional survey was conducted using a convenience sample of 128 Chinese childbearing couples recruited from the antenatal clinics. Participants completed the C-FSOC-S, Sense of Coherence Scale, Medical Outcomes Study Family and Marital Functioning Measures, and State-Trait Anxiety Inventory. Results:The C-FSOC-S showed good internal consistency (Cronbachs &agr; = .83) and test-retest reliability (intraclass correlation coefficient = .75). Significant correlations with Sense of Coherence Scale (r = .55, p < .01), Medical Outcomes Study Family and Marital Functioning Measures (r = .71, p < .01), and State-Trait Anxiety Inventory (r = −.50, p < .01) indicated good construct validity. Exploratory factor analysis revealed a single-factor structure of the C-FSOC-S. Discussion:The C-FSOC-S has satisfactory psychometric properties and has the potential to be used as a clinical and research instrument for measuring family sense of coherence in Chinese childbearing families.

Cesarean scar molar pregnancy

BACKGROUND: Molar pregnancy found in a cesarean scar is exceedingly rare. It can be challenging to manage and can have potentially catastrophic consequences. CASE: A 34-year-old multigravid woman presented with persistent symptoms of pregnancy after a surgical termination of pregnancy. Cesarean scar molar pregnancy was suspected on ultrasonography, and suction evacuation was performed under ultrasound guidance. This was followed by bimanual compression, oxytocin, and uterine artery embolization to reduce bleeding. CONCLUSION: A high index of suspicion is needed for early diagnosis and management of cesarean scar molar pregnancy.

Left upper quadrant approach in gynecologic laparoscopic surgery

Objective. To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine‐year period. Design. Retrospective review. Setting. University‐affiliated hospital. Population. Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010. Methods. Medical records were reviewed. Main outcome measures. Demographic data, past surgical histories, indications for surgery and the use of the left upper quadrant approach, intraoperative findings, diagnosis and any complications. Results. 143 patients were identified, accounting for 4.9% of all gynecologic laparoscopic surgery. The indications for using the left upper quadrant approach were: previous open abdominal surgery (113, 79.0%), surgery in the second trimester of pregnancy (16, 11.1%), presence of large pelvic mass (9, 6.2%), previous transverse rectus abdominis myocutaneous flap for breast reconstruction (3, 2.0%), previous periumbilical hernia repair (1, 0.6%) and previous laparoscopic umbilical wound dehiscence (1, 0.6%). In women with previous abdominal surgery, the overall incidence of adhesions between omentum and/or bowel to the anterior abdominal wall in the umbilical region was 58.4%. Twelve (8.3%) patients required conversion to laparotomy. One patient had subcutaneous surgical emphysema over the left upper quadrant entry site. Conclusions. The left upper quadrant approach is an effective, safe and easy technique for peritoneal cavity access in women undergoing laparoscopic gynecologic surgery and should be considered in women with risk factors of periumbilical adhesions and in the presence of a large pelvic mass.

Surgical Management of Adnexal Masses in Pregnancy

Surgical management of adnexal masses during pregnancy appears to have favorable outcomes for both mother and fetus.

Family sense of coherence and quality of life

PurposeThe purpose of this study was to examine the relationships between family sense of coherence, social support, stress, quality of life and depressive symptoms among Chinese pregnant women.MethodsA cross-sectional design was used. A convenience sample of 267 Chinese pregnant women was recruited at the antenatal clinic and completed the Family Sense of Coherence Scale, Medical Outcomes Study Social Support Survey, Social Readjustment Rating Scale, Medical Outcome Study Short Form 12-Item Health Survey and General Health Questionnaire. Path analysis was employed.ResultsFamily sense of coherence and social support had a direct impact on the mental health component of quality of life and depressive symptoms during pregnancy. Family sense of coherence also mediated the effect of stress on quality of life and depressive symptoms.ConclusionsThe study provides evidence that family sense of coherence and social support play a significant role in promoting quality of life and reducing depressive symptoms during the transition to motherhood. Culturally competent healthcare should be developed to strengthen women’s family sense of coherence and foster social support to combat the stress of new motherhood, thereby promoting quality of life during that period of their lives.

Quality of life during the transition to parenthood in Hong Kong: a longitudinal study

Abstract Objective: Quality of life has emerged as an important health outcome in the care of perinatal families. This study was designed to examine the changes in quality of life among Chinese couples during the transition to parenthood. Methods: A longitudinal design was used. Participants comprised a convenience sample of 203 Chinese-childbearing couples attending the antenatal clinics, who completed data collection during pregnancy and at six weeks and six months postpartum. At each point, couples completed the Medical Outcomes Study Short Form 12-Item Health Survey. Results: The results showed that women experienced substantial changes in their quality of life during pregnancy and postpartum, whereas the changes in their partners’ quality of life were less noteworthy. Women had a poorer quality of life than their partners during the early postpartum period. The mental health component of women’s quality of life was closely related to their partners’ across the perinatal period. Conclusions: The findings of the present study highlight the need for more attention to a couple’s quality of life during the transition to parenthood. Couple-based and culturally relevant interventions should be developed to assist both parents to cope with the new challenges and demands of parenthood, and thus achieve a better quality of life.

Chemotherapy in pregnancy

Cancer diagnosed during pregnancy is uncommon, complicating between 0.02% and 0.1% of all pregnancies. Nonetheless, due to increasing age of childbearing, the incidence of cancer during pregnancy is likely to increase due to higher incidence of several age-dependent malignancies. The most common malignancies include breast cancer, cervical cancer, malignant melanoma and lymphoma. One of the key challenges in the management of cancer in pregnancy is treating the women with standard chemotherapy regimen, without compromising the safety of the developing foetus. Exposure of chemotherapy in the first trimester is associated with an increased risk of major birth defects, whereas use in the second and third trimesters is associated with intrauterine growth restriction, low birthweight and stillbirth. In this article, we review available data regarding the use of chemotherapeutic agents in pregnancy, and we summarise the neonatal outcomes, including malformations, perinatal complications and long-term follow-up. In addition, the management plan during pregnancy is also discussed.