Vivian C. W. Wong

Homozygous α‐thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases

Summary. Forty‐six hydropic infants with homozygous α‐thalassaemia born during a period of 10 years have been reviewed. The incidence was 1: 1550 total births, and accounted for 81% of all non‐immune hydrops. The male to female ratio was 1: 1.4. There was increased incidence of anaemia, pregnancy induced hypertension, antepartum haemorrhage, malpresentation, prematurity, fetal distress, difficult vaginal delivery, caesarean section, retained placenta. postpartum haemorrhage and congenital abnormalities. Antenatal diagnosis by DNA hybridization with subsequent abortion of the affected fetuses is the best method to decrease maternal morbidity and to reduce the incidence of hydrops fetalis in couples at risk. For those with no previous history, but with early onset hypertension and/or polyhydramnios, sonography is useful in making an earlier diagnosis, and in reducing avoidable morbidity, because DNA analysis can be done before caesarean section and aggressive neonatal management is instituted.

TRANSMISSION OF HEPATITIS B ANTIGENS FROM SYMPTOM FREE CARRIER MOTHERS TO THE FETUS AND THE INFANT

Materno‐fetal transmission of hepatitis B was studied in 97 healthy carriers of hepatitis B surface antigen (HBsAg). Antepartum transmission occurred in at least 10 per cent. Intrapartum transmission may have occurred in about 40 per cent as a result of swallowing of the infective fluid by the baby during delivery, and materno‐fetal transfusion during labour. Person to person transmission after delivery played a minor role. The presence of hepatitis B associated e antigen (HBeAg) in 48 per cent of maternal serum correlated strongly with the subsequent presence of antigen in the infants. There was a linear association between the incidence of antigens in cord blood and the duration of the first stage of labour, with a significant association when labour exceeded nine hours. Caesarean section is recommended if mothers have HBeAg; likewise amniocentesis and breast feeding should be discouraged if mothers have HBeAg.

Glucose and Lipid Metabolism with Triphasic Oral Contraceptives in Women with History of Gestational Diabetes

The glucose and lipid metabolism in a group of women with previous history of gestational diabetes were evaluated before and after 6 months treatment with a low-dose triphasic oral contraceptives pill (TP). This group was compared with a control group of women, also with history of gestational diabetes, using intrauterine devices (IUD). In the TP group, 26.7% of the women developed impaired glucose tolerance which reverted to normal in all but one after cessation of the TP. The IUD group showed no change in glucose tolerance. The integrated insulin response to a 75g OGTT in the TP group increased by 48.3% at 6 months compared with an increase of 23.4% for the same period in the IUD group. In the TP group there was a significant decrease in serum total cholesterol without changes in HDL-cholesterol and triglycerides level. We conclude that even low-dose triphasic oral contraceptive pills can cause glucose intolerance in women with previous gestational diabetes mellitus.

Pregnancy in patients with mitral valve prolapse

The obstetrical performances and outcomes of 37 pregnancies in women with mitral valve prolapse between 1979 and 1982 are reviewed. Thirteen patients were diagnosed before pregnancy and 24 patients were detected at antenatal examinations. Three ended in cesarean sections for obstetrical complications and 34 in uneventful vaginal deliveries at term. No cardiac complications occurred in these patients. There was no maternal mortality. Thirty‐six babies were born without congenital abnormalities. One baby was hydropic due to haemoglobinopathy and died. Prophylactic antibiotics is recommended in selected cases. Early detection and treatment of cardiac arrhythmias is mandatory.

Evaluation of the WHO criteria for 75 g oral glucose tolerance test in pregnancy

Summary. A group of pregnant women at high risk of developing diabetes in pregnancy had paired oral glucose tolerance tests (OGTT) using a 100 g load followed by 75 g load. When the World Health Organization (WHO) criteria and the National Diabetes Data Group (NDDG) criteria were compared, the 2‐h plasma glucose value after the 100 g load was the most discriminative in differentiating those with normal glucose tolerance, impaired glucose tolerance and gestational diabetes mellitus. When only the 2‐h plasma glucose values were assessed, the WHO test (75 g: 8 mmol/1) agreed with the NDDG test (100 g load: 9·2 mmol/1) in the diagnosis of glucose intolerance in 60% of subjects only. Using the same criteria at 2‐h (8 mmol/1) the agreement between these tests was 47%. Reducing the glucose load from 100 g to 75 g produced a reduced glucose response in 49% of the subjects, with a significant decrease in the area under the glucose response curve.

Chorioangioma of the placenta: an ultrasonic study. Case report

Chorioangioma and trophoblastic tumours are the most common primary tumours of the placenta. The incidence of chorioangioma is about 1% (Wallenburg 1971; Sprit & Kagan 1980). Apparently, only tumours that exceed 5 cm in diameter. or that are multiple, are clinically significant and these cases are relatively rare (Wallenburg 1971). In the majority of patients diagnosis is made after the delivery of the placenta. The role of ultrasound in the diagnosis of placental abnormalities has now been recognized (Mulhern ef al. 1980), but only a few reports have described the ultrasound appearance of chorioangioma in situ (Asokan et al. 1978; Dao et al. 198 1 ; OMalley et ai. 198 1).

Estimation of Fetal Weight in Utero from Symphysisfundal Height and Abdominal Girth Measurements

Summary: The ability to estimate fetal weight accurately from symphysisfundal height (SFH) and abdominal girth (AG) measurements was evaluated. Multivariate regression analysis was performed on measurements made on 208 primigravidas within 48 hours of delivery. A better correlation with birth‐weight was obtained with the SFH than with the AG. The equation BW = ‐1.515 + 0.092 (SFH) + 0.016 (AG) yielded a coefficient of multiple correlation of 0.7259. Using this equation, the mean percentage prediction errors were 5.7%± 4.2(SD) in fetuses between 2,500 and 3,500g (n=156), 9.4%± 5.25(SD) in those larger than 3,500g (n = 33), and 19.1 %± 8.2(SD) in those smaller than 2,500g (n = 19). All the generated equations similarly underestimated the fetal weight in the larger babies and overestimated in the smaller babies. Inclusion of quadratic and logarithmic functions as well as skin‐fold thickness measurements into the equations did not decrease the error or alter the distribution of errors. It was concluded that although fetal weight estimation may be reasonably accurate between 2,500g and 3,500g, the error is too great for the method to be clinically useful in the smaller and larger babies. Moreover, a theoretical basis for a high sensitivity in the detection of small for dates fetuses from these parameters would be difficult to establish.

Assessment of the glucose tolerance test in unselected pregnancy using 75 g glucose load

A 75 g oral glucose tolerance test (OGTT) was performed in 618 unselected pregnant Chinese women between 24 and 28 weeks gestation. The glucose response at fasting, 1, 2 and 3 h were studied. At 2 h the glucose level at 2‐standard deviation and 4‐standard deviation above the mean came very close to the criteria of abnormality suggested by the World Health Organization (WHO): 8.3 mmol/l vs. 8.0 mmol/l for impaired glucose tolerance and 10.8 mmol/l vs. 11.0 mmol/l for gestational diabetes mellitus. The area under the glucose response curve also correlates best with the glucose levels at 2 h during the OGTT (y = 2.1x + 4.6, r = 0.885). The 75‐g OGTT interpreted with the WHO criteria seems appropriate for pregnant Chinese women. The 75‐g test has the added advantages of reducing administration cost and discomfort of the patients.

Intrauterine death from ergotamine overdosage

Fetal death in a primigravid patient who had taken an overdose of ergotamine tartrate is presented. Non-stress cardiotocography performed shortly after admission was technically unsatisfactory for interpretation but revealed the presence of very frequent uterine contractions. The cause of fetal death in this patient is discussed. Overdosage of ergotamine must be considered a serious threat to the well-being of the fetus in utero.

Trends in perinatal mortality at a Hong Kong hospital.

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the “P” list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970–1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre‐eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.