Study on the management of Pre-term labour in Singleton and Twin Pregnancies
The prediction and treatment of pre-term labour in singleton and twin pregnancies has been controversial. Retrospective studies on the epidemiology, and prospective studies on the cervical changes are being conducted. Twin pregnancy is associated with a higher risk of preterm labour when compared with singleton pregnancy. Various preventive measures have been suggested, including prophylactic hospitalization, bedrest, beta agonist, magnesium sulphate and cerclage. A recent study showed that prophylactic administration of vaginal progesterone suppository in high risk obstetric patients with singleton pregnancy could reduce the number of preterm birth before 34 weeks from 18.5% (placebo group) to 2.7% (progesterone group) (p<0.05). In this study, the effects of vaginal progesterone in twin pregnancy will be studied. Patients will be randomised into progesterone group and placebo group. The incidence of preterm birth and perinatal outcomes will then be compared
Pilot study of the use of fetal fibronectin test on Chinese women with symptoms of preterm labour
Preterm birth is a major challenge in perinatal health care resulted in significant proportion of perinatal mortality and long-term neurological disabilities. Symptoms and signs are often vague and non-specific with poor sensitivity and positive predictive value. Hence, over-diagnosis and early initiation of tocolysis and corticosteroids are common. Fetal fibronectin (FFN) test has been used to predict preterm labour. Negative test helps to predict symptomatic women, who will not deliver within 7 days by its high negative predictive value (NPV). Its use is advocated by the American College of Obstetricians and Gynecologists and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. A prospective observational study was carried out in women presented with symptoms of preterm labour from 1st January 2010 to 30th June 2012 in Queen Mary Hospital. The objective of this study is to provide local experience and evaluate the accuracy of the fetal fibronectin test. Twenty two women were recruited. Twelve (54.5%) women had a negative fetal fibronectin test: none delivered within 7 days; six received corticosteroid and tocolysis, of which one delivered within 14 days. Ten (45.5%) women had a positive fetal fibronectin test: five delivered within 7 days and two delivered within 14 days, all received corticosteroid and tocolysis. The sensitivity and negative predictive value were 100% to predict delivery within 7 days. Our study demonstrated the high negative predictive value of fetal fibronectin test. The test should be considered in women presented with threatened preterm labour.
Fetal growth in pregnancies conceived after assisted reproduction
Studies have shown that the obstetric complications and pregnancy outcomes in women conceived after in vitro fertilization were different from those conceived spontaneously. There have been reports of an increased incidence of preterm labour and small for gestational age babies in pregnancies conceived after assisted reproduction. We have carried out a study to compare the fetal parameters and the levels of various biochemical markers pregnancies from natural conception and assisted reproduction. Results suggested that the growth velocity for fetuses from assisted reproduction was comparable to that from natural conception.
Psychosocial Aspects of Pregnancy (In collaboration with the Department of Nursing Studies and the Department of Psychiatry)
We have collaborated with the Department of Nursing Studies and the Department of Psychiatry in studying various psychosocial aspects of pregnancy and childbirth, including anxiety, depression, eating disorder and domestic violence. Recently, we studied the relationships between family sense of coherence, stress, social support, family and marital functioning, and emotional well-being in Chinese childbearing families.In the past, we have studied the prevalence of domestic violence, its effects of the pregnancy and interventions to prevent domestic violence. We have also studied the interventions to decrease postpartum depression. Future study include a prospective study on paternal and maternal depression and anxiety from the antenatal to postnatal period, a pilot study on acupuncture in treatment of postnatal depression and a pilot study on influence of perinatal environment on postnatal brain development
Studies on Intrapartum Care for Pregnant Women
Pharmacological pain relief methods during labour have side effects. Non-pharmacological pain relief methods such as TENS, massage have been found to be effective in small studies overseas. A pilot study had been performed and showed that the use of Pethidine had dropped off significantly from 11.5% (October 2006 to March 2007) to 7.8% (April to September 2007) after the introduction of TENS in our unit during the early phase of labour. In 2007, another study was also conducted over a 5-month period by purposive sampling of all the women who had requested TENS for pain relief during the early phase of labour. The result showed that TENS alone was sufficient for pain relief in 38% of these women, and 87% achieved spontaneous delivery. The duration of first and second stage were shortest in the TENS group. We are also studying the effect of a birth plan on the anxiety levels in Chinese pregnant women. Birth Plan is a documented plan that is made by the woman to select certain aspects of care during labour and their selection or wishes is being documented in a more structured manner. It had been widely used in foreign countries as it is believed that individualized care and feeling of control by the women during labour can be enhanced. We are investigating if there is any significant difference in the anxiety levels of the Hong Kong Chinese pregnant women in relation to the use of a birth plan. Basic demographic data, the presence of antenatal/postnatal complications and the pregnancy outcome will be obtained. All of these factors can affect the anxiety levels of the women.