Ozonation of endocrine disrupting chemical BHA under the suppression effect by salt additive--with and without H(2)O(2)

The oxidation of fresh and saline wastewater containing an endocrine disrupting chemical (butylated hydroxyanisole, BHA) under different reaction conditions by ozonation and O(3)/H(2)O(2) was investigated at various pH levels. The observed pseudo-first-order reaction kinetics was justified through a combined direct ozone and indirect radical oxidation approach for the ozonation process. The BHA decay rates increased with the increase of the solution pH, but decreased as the NaCl concentration increased because of the consumption of ozone by chloride. A kinetic model was therefore derived for predicting BHA degradation at various initial pH levels and NaCl concentrations. For the O(3)/H(2)O(2) and O(3)/H(2)O(2)/Cl(-) processes, the rate of BHA removal was investigated at hydrogen peroxide concentration ranged from 0.5 to 5mM at pH 7. Different optimal H(2)O(2) dosages and decay rates were found for both processes due to the participation of reactions among O(3), H(2)O(2), OH* and Cl(-) as discussed in the paper.

Determinants of preference for elective caesarean section in Hong Kong Chinese pregnant women

OBJECTIVE

To find the clinical and socio-demographic determinants for Hong Kong Chinese women who preferred elective caesarean section.

DESIGN

Cross-sectional interview survey.

SETTING

University teaching hospital, Hong Kong.

PARTICIPANTS

A cohort of consecutive Hong Kong Chinese pregnant women (n=660) attending a government-funded obstetric unit catering deliveries in the New Territories in Hong Kong in 2002.

MAIN OUTCOME MEASURES

The clinical and socio-demographic determinants of preference for elective caesarean section, in women who could have a trial of vaginal delivery.

RESULTS

The overall prevalence for maternal preference for elective caesarean section was 16.7% (95% confidence interval, 13.8-19.6). The factors associated with preferring elective caesarean section were: previous elective caesarean section (odds ratio=7.6; 95% confidence interval, 2.0-28.7) and previous emergency caesarean section (3.8; 1.8-8.2). Among nulliparous women, the prevalence of preference for elective caesarean section was 16.8% (95% confidence interval, 13.0-20.6). Conception by in-vitro fertilisation was found to be significantly associated with preferring elective caesarean section in nulliparous women (odds ratio=5.2; 95% confidence interval, 1.0-26.4).

CONCLUSION

Previous caesarean section and conception by in-vitro fertilisation were determinants for women preferring elective caesarean section.

A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women

OBJECTIVE

To establish whether women's preference for elective caesarean section (ELCS) changes as gestation advances.

DESIGN

A prospective longitudinal observational study.

SETTING

Two units providing obstetric care in Hong Kong, one public and one private.

SAMPLE

Five hundred and one nulliparous Chinese pregnant women attending their routine fetal anomaly scan in either unit.

METHODS

Consented subjects had two interviews using a structured questionnaire at 18-22 weeks and 35-37 weeks of gestation, respectively. Multivariate analysis was performed to identify determinants for preferring ELCS at the two gestational ages.

MAIN OUTCOME MEASURE

The preferences for the mode of delivery at the two gestational ages.

RESULTS

The prevalence of maternal preference for ELCS in the study cohort was 17.2% (95% CI 13.9-20.5) and 12.7% (95% CI 9.6-15.8) at mid-trimester and at term, respectively. Significantly more women who preferred ELCS at mid-trimester changed to a trial of vaginal delivery (VD) at term than vice versa (42.0 versus 3.8%). The partner's preference for ELCS was a significant determinant for women preferring ELCS throughout the antenatal period. Among the women booked in the public sector, more women who preferred ELCS at term changed to deliver in private hospitals than those who preferred VD (46.2 versus 9.7%).

CONCLUSIONS

Many women changed from preferring ELCS to preferring VD as their pregnancy approached term. The partner's preference was a significant determinant for the women's choice. If a decrease in the proportion of women preferring ELCS is desired, the intervention programme should target the women and their partners who hold such a preference at 20 weeks.

Reaction pathways and kinetics of butylated hydroxyanisole with UV, ozonation, and UV/O(3) processes

The chemical degradation of the endocrine disrupting chemical, butylated hydroxyanisole (BHA), was investigated by different treatment processes including ultraviolet (UV) irradiation, ozonation (O(3)), and UV/O(3). O demethylation, dimerization, and oxidation have been found to be the main degradation mechanisms. A systematic decay pathway was proposed based on ten identified intermediates in the studied processes, including a unique pathway leading to the formation of precipitates in the ozonation process. An unconventional minimum-type variation of BHA decay rate constants from acidic to caustic range has been found for both ozonation and UV/O(3) processes. The precipitates formed during ozonation can be removed during the process to optimize the treatment, while the UV/O(3) process can offer a relatively fast and clean process to degrade BHA and its associated intermediates.

First-trimester combined screening for trisomy 21 in a predominantly Chinese population

OBJECTIVE

To examine the effectiveness of first-trimester fetal trisomy 21 screening using a combination of maternal age, nuchal translucency thickness (NT) and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels in a predominantly Chinese population in Hong Kong.

METHODS

This was a prospective study over a 1.5-year period of 2990 women who underwent combined screening for trisomy 21 between 11+0 and 13+6 weeks of gestation in a university fetal medicine unit. NT was measured according to the criteria set by The Fetal Medicine Foundation (FMF), maternal serum free beta-hCG and PAPP-A levels were measured, and the risk of trisomy 21 was calculated using The FMF's algorithm. Fetal karyotyping was advised when the risk was 1 : 300 or above. All subjects were followed up for pregnancy and fetal outcome.

RESULTS

Of the 2990 women who underwent the screening program, 99% were Chinese. There were 57 twin pregnancies, giving a total of 3047 fetuses. Thirty-one percent of the women were 35 years old or above. One hundred and eighty-five (6.1%) fetuses were screen-positive; this included 14 cases of trisomy 21 and 17 cases of other chromosomal abnormalities. The positive predictive value was 16.7%. Among the 2862 screen-negative fetuses, only 18 (0.6%) cases had an unknown fetal outcome. There were no cases in which trisomy 21 was missed and the infant was liveborn.

CONCLUSION

First-trimester combined screening for fetal trisomy 21 is highly effective among Chinese subjects.

Degradation of the endocrine disruptor carbofuran by UV, O3 and O3/UV

The photodegradation of a carbamate insecticide, Carbofuran (CBF), which has been recognised as a potential endocrine disrupting chemical, was studied via different wastewater treatment processes. This study has shown the efficiency of advanced oxidation process, AOP (UV/O3) than those of the direct UV photolysis and ozonation process, by completely removing 0.2 mM CBF and achieving 24% mineralisation within 30min. The initial decay of CBF by UV/O3 accelerated from 0.05 to 0.16 min(-1) as the initial pH increasing from 3.0 to 11.3. The pH-dependency of CBF has also been shown in both ozonation and UV/O3 process. A linear relationship could be found for the latter process in all pH, while for the former process, two stages of reactions (steady and accelerating) were found in the acidic and alkaline pH condition, respectively.

Left ventricular diastolic function during normal pregnancy: assessment by spectral tissue Doppler imaging

OBJECTIVE

Tissue Doppler imaging (TDI) is an echocardiographic technique for assessing the diastolic function that is relatively independent of preload. Since loading conditions change significantly during pregnancy, a load-independent technique will give a more accurate assessment of diastolic function in pregnant women. The aim of this study was to evaluate maternal diastolic function using tissue Doppler imaging.

METHODS

This was a prospective observational study on 35 healthy pregnant women. M-mode, transmitral inflow (peak transmitral flow velocities during early diastole (E wave) and atrial contraction (A wave)) and TDI studies (peak myocardial velocities during early diastole (Em wave), during atrial contraction (Am wave) and peak systole in ejection phase (Sm)) were performed in each trimester and postpartum. The differences in variables between trimesters were analyzed.

RESULTS

The peak transmitral inflow velocity during early diastole (E wave) was significantly decreased during the third trimester and postpartum. The peak flow velocity during atrial contraction (A wave) was increased in the second trimester, but decreased again in the third trimester and postpartum period. As a result, the E/A ratio progressively reduced as pregnancy advanced. TDI showed that peak myocardial velocities during early diastole (Em) tended to increase during the second trimester, and then decreased significantly in the third trimester or postpartum period. The peak myocardial velocities during atrial contraction (Am) increased significantly with advancing gestational age. As a consequence, both Em/Am and E/Em ratios decreased significantly throughout pregnancy.

CONCLUSIONS

This study demonstrates the changes in myocardial relaxation velocity throughout pregnancy. Because of its advantage of being relatively load-independent, TDI may be a useful non-invasive technique for monitoring maternal cardiac function in high-risk pregnancies to detect the early signs of cardiac failure and to prevent further deterioration with prompt interventions.

The influence of fetal position on amniotic fluid index and single deepest pocket

OBJECTIVE

To evaluate the effect of fetal position on measurement of amniotic fluid index (AFI) and of the single deepest pocket (SDP).

METHODS

This was a prospective observational study, in a university obstetric unit, of women with an uncomplicated singleton pregnancy with longitudinal lie and cephalic presentation at or beyond 28 weeks of gestation. AFI was calculated and SDP measured and the fetal position was characterized in terms of three parameters. These were: the side of the maternal abdomen on which the fetus lay; a numerical representation (laterality score) of the distance that the fetus was from the sagittal midline plane of the maternal abdomen; the orientation of the fetal trunk (ventral anterior, lateral or posterior).

RESULTS

Eighty-one women were recruited into the study. There was a significant relationship between the laterality score and the AFI (P = 0.005) but not the SDP (P = 0.23): AFI was on average 4.35 cm higher in fetuses lying centrally compared with those lying laterally inside the uterus. There was no significant difference for either SDP (P = 0.8) or AFI (P = 0.3) between fetuses lying on the right or the left side of the maternal abdomen. Similarly, there was no significant difference in SDP (P = 0.9) or AFI (P = 1.0) for the different orientations of the fetal trunk.

CONCLUSION

Fetal position affects the measurement of AFI but not that of SDP. Therefore, SDP may be a more consistent parameter for the estimation of amniotic fluid volume.

Prediction of intrapartum Cesarean delivery for non-reassuring fetal status after a successful external cephalic version by a low pre-version pulsatility index of the fetal middle cerebral artery

OBJECTIVE

To determine whether a pre-version Doppler assessment of fetal cerebral and umbilical blood flow can predict the ultimate need for intrapartum Cesarean delivery after a successful external cephalic version (ECV).

METHODS

A prospective observational study on women undergoing ECV between 36 and 38 gestational weeks was performed over a 5-year period. The pulsatility index (PI) of the fetal middle cerebral artery (MCA) and umbilical artery, heart rate and amniotic fluid index were measured before ECV. Women who had successful ECV were then divided into three groups according to the mode of delivery: (1) vaginal delivery, (2) intrapartum Cesarean delivery for poor progress and (3) intrapartum Cesarean delivery for non-reassuring fetal status. The fetal blood flow parameters were compared between the groups. Potential predictors were further analyzed using receiver-operating characteristics curves.

RESULTS

Of 174 women with successful ECV, 140 (80.5%) had vaginal delivery, 19 (10.9%) required emergency intrapartum Cesarean delivery for non-reassuring fetal status and 15 (8.6%) for poor progress. MCA-PI was significantly lower in the group with non-reassuring fetal status. MCA-PI is predictive of intrapartum Cesarean delivery (area under the curve = 0.68, P = 0.021). The sensitivity and specificity at a cut-off level of 1.4 were 62.5% and 76%, respectively, while at a cut-off level of 1.5 they were 68.8% and 63.5%, respectively.

CONCLUSION

Intrapartum Cesarean delivery for non-reassuring fetal status after successful ECV is associated with a lower pre-version fetal MCA-PI.

First-trimester maternal serum levels of placental hormones are independent predictors of second-trimester fetal growth parameters

OBJECTIVE

To determine whether first-trimester maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (fbeta-hCG) are independent predictors of second-trimester fetal growth parameters.

METHODS

This was a cohort study over a 1-year period involving 594 Chinese women who underwent both first-trimester combined screening for Down syndrome and a routine second-trimester ultrasound examination. Maternal PAPP-A and fbeta-hCG levels (expressed in log(10) of multiples of median (MoM)), crown-rump length (CRL) (expressed in standardized Z-score (Z-CRL)), and maternal height and weight, were correlated with the Z-score of biparietal diameter (Z-BPD), femur length (Z-FL) and abdominal circumference (Z-AC) measured in the second trimester, using the Pearson test, followed by multiple regression analysis.

RESULTS

Z-BPD, Z-FL and Z-AC were positively correlated with log(10) PAPP-A MoM, CRL and maternal height (all P < 0.05), while log(10) fbeta-hCG MoM was negatively correlated with Z-AC (P < 0.05). After controlling for the effects of CRL, maternal height and weight, log(10) PAPP-A MoM was found to be an independent positive predictor of Z-FL (r = 0.797, P < 0.001) and Z-AC (r = 0.305, P = 0.049), and log(10) fbeta-hCG MoM was an independent negative predictor of Z-FL (r = -0.381, P = 0.023) and Z-AC (r = -0.418, P = 0.002). Neither hormonal level was related to Z-BPD.

CONCLUSIONS

First-trimester PAPP-A and fbeta-hCG are independent factors that influence subsequent fetal growth. PAPP-A level is positively correlated with FL and AC in the second trimester, while fbeta-hCG level is negatively correlated with them. However, BPD is not affected by either of the hormones.

Molecular characterization of the developmental gene in eyes: through data-mining on integrated transcriptome databases

OBJECTIVES

Our aim was to utilize publicly available and proprietary sources to discover candidate genes important for ocular development.

DESIGN AND METHODS

The collated information on our 5092 non-redundant clusters was grouped and functional annotation was conducted using gene ontology (FatiGO) for categorizing them with respect to molecular function. The web-based viewer technological platform (H-InvDB) was employed for transcription analyses of in-house high quality fetal eye Expressed Sequence Tags (ESTs). Eye-specific ESTs were also analyzed across species by using EMBEST.

RESULTS

According to adult eye cDNA libraries, nucleic acid binding and cell structure/cytoskeletal protein genes were the most abundant among the ESTs of fetal eyes. Using cDNA assembly in H-InvDB, 20 (80%) of the 25 most commonly expressed genes in the human eye are also expressed in extraocular tissues. The crystalline gamma S gene is highly expressed in the eye, but not in other tissues. We used EMBEST to compare human fetal eye and octopus eye ESTs and the expression similarity was low (1.6%). This indicated that our fetal eye library contains genes necessary for the developmental process and biological function of the eye, which may not be expressed in the fully developed octopus eyes. The human fetal eye cDNA library also contained highly abundant eye tissue genes, including alphaA-crystallin, eukaryotic translation elongation factor 1 alpha 1 (EEF1A1), bestrophin (VMD2), cystatin C, and transforming growth factor, beta-induced (BIGH3).

CONCLUSIONS

Our annotated EST set provides a valuable resource for gene discovery and functional genomic analysis. This display will help to appreciate the strengths and weaknesses of the different technological platforms, so that in future studies the maximum amount of beneficial information can be derived from the appropriate use of each method.

First-trimester maternal serum level of pregnancy-associated plasma protein-A is an independent predictor of fetal maxillary bone length

OBJECTIVE

To derive a nomogram of fetal maxillary bone length (MAX) for a Chinese population and to study whether first-trimester maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) is an independent predictor of fetal MAX.

METHODS

This was a prospective observational study over 10 months examining Chinese women with a singleton pregnancy who attended the first-trimester screening program for Down syndrome. The subjects had the fetal crown-rump length (CRL), nuchal translucency, MAX, maternal serum PAPP-A and free beta-human chorionic gonadotropin (fbeta-hCG) levels measured. A nomogram of MAX was derived using normal pregnancies with reliable dates. The correlations between MAX, CRL, PAPP-A and fbeta-hCG levels were studied, after correction for gestational dependency using Z-score transformation for the ultrasound markers (Z-MAX and Z-CRL), and logarithmic transformation of multiple of gestation-specific medians for the biochemical markers (log10PAPP-A multiples of the median (MoM) and log10fbeta-hCG MoM), using the Pearson test and multiple regression analysis.

RESULTS

During the study period, 607 Chinese women met the inclusion criteria. The mean gestational age at the first-trimester screening was 12 + 4 weeks (SD, 4 days). Curve estimation analysis showed that a linear relationship fit best between MAX and CRL (MAX (mm) = -0.01 + 0.101 * CRL (mm); r = 0.826; P < 0.0001), and between MAX and gestational age (MAX (mm) = -8.465 + 0.170 * gestational age (day); r = 0.754; SD = 0.71; P < 0.0001). There were significant positive correlations between Z-MAX and Z-CRL (r = 0.627; P = < 0.0001), Z-MAX and log10PAPP-A MoM (r = 0.239; P = < 0.0001). Multiple regression analysis showed that both Z-CRL (P = < 0.0001) and log10 PAPP-A MoM (P = 0.048) were independent predictors for Z-MAX.

CONCLUSION

Both CRL and maternal levels of PAPP-A are independent predictors of the fetal MAX measured during the first trimester. The positive correlation between PAPP-A levels and fetal MAX is consistent with the known biological function of PAPP-A on bone growth. This association must be adjusted for when both PAPP-A and MAX are combined for screening of Down syndrome.

Genomic annotation of 15,809 ESTs identified from pooled early gestation human eyes

To complement cDNA libraries from the human eye at early gestation and to discover candidate genes associated with early ocular development, we used freshly dissected human eyeballs from week 9-14 of gestation to construct the early human fetal eye cDNA library. A total of 15,809 clones were isolated and sequenced from the unamplified and unnormalized library. We screened 11,246 good-quality ESTs, leading to the identification of 5,534 nonredundant clusters. Among them, 4,010 (72%) genes matched in the human protein database (Ensembl). The remaining 28% (1,524) corresponded to potentially novel or previously unidentified ESTs. We used BLASTX to compare our EST data with eight organisms and found common expression of a high portion of genes: Caenorhabditis briggsae (26%), Caenorhabditis elegans (27%), Anopheles gambiae (37%), Drosophila melanogaster (32%), Danio rerio (42%), Fugu rubripes (49%), Rattus norvegicusvalitus (52%), and Mus musculus (59%). Nevertheless, 48% (2,680 of 5,534) of the genes expressed in the early developing eye were not shared with current NEIBank human eye cDNA data. In addition, eight known retinal disease genes existed in our ESTs. Among them, six (COL11A1, BBS5, PDE6B, OAT, VMD2, and PGK1) were conserved among the genomes of other organisms, indicating that our annotated EST set provides not only a valuable resource for gene discovery and functional genomic analysis but also for phylogenetic analysis. Our foremost early gestation human eye cDNA library could provide detailed comparisons across species to identify physiological functions of genes and to elucidate evolutionary mechanisms.

Cervical length at 18-22 weeks of gestation for prediction of spontaneous preterm delivery in Hong Kong Chinese women

OBJECTIVE

To assess the value of a single cervical length measurement by transvaginal sonography (TVS) at the time of mid-trimester anomaly scan for predicting spontaneous preterm delivery (SPD) among Chinese women.

METHODS

A prospective observational study was carried out involving 2880 subjects with singleton pregnancies and confirmed gestational age. Cervical length was measured at 18-22 weeks of gestation.

RESULTS

The incidence of SPD < 34 weeks and < 37 weeks were 0.7% and 3.7%, respectively. Women with SPD < 34 weeks and SPD < 37 weeks had shorter median cervical lengths (32.6 mm and 36.2 mm, respectively) than those with term deliveries (37.6 mm) (P = 0.006 and 0.025, respectively). The predictive performance of cervical length was better for SPD < 34 weeks compared with < 37 weeks. A cervical length < or = 27 mm, which corresponded to the 4th centile, occurred in 36.8%, 62.5% and 100% of those with SPD < 34, < 30 and < 26 weeks, respectively. The positive likelihood ratio (LR) of a cervical length < or = 27 mm in predicting SPD < 34 weeks was 9.8. Using logistic regression, both short cervix and funneling were independent predictors for SPD < 34 weeks of gestation. The coexistence of funneling and a cervical length < or = 27 mm gave a positive predictive value (PPV) and LR of SPD < 34 weeks of 14.7% and 26.0, respectively.

CONCLUSIONS

Mid-trimester cervical length is predictive of SPD in Chinese women. However, given the low PPV of a short cervical length, its clinical utility is still limited in low-risk populations.

Expression of divalent metal transporter 1 (DMT1) isoforms in first trimester human placenta and embryonic tissues

BACKGROUND

Divalent metal transporter 1 (DMT1) is a transmembrane glycoprotein which mediates the proton-coupled transport of a variety of divalent metal ions. Two isoforms, which differ by the presence (DMT1-IRE) or absence (DMT1-nonIRE) of an iron-responsive element (IRE) in their 3' untranslated region, are implicated in apical iron transport and endosomal iron transport respectively. Although the expression pattern of DMT1 isoforms is tissue specific in adult, data regarding its expression in embryonic tissues are lacking.

METHODS

Semiquantitative RT-PCR and immunohistochemistry were used to study the mRNA and protein expression of both DMT1 isoforms in embryonic tissues between 8 and 14 weeks gestational age.

RESULTS

DMT1-IRE and DMT1-nonIRE expressions were ubiquitous in embryonic tissues examined. In the lung, statistically significant correlations were found between the levels of DMT1 isoform expression and gestational age. In the placenta, DMT1-IRE was the predominantly expressed isoform. Both isoform proteins were localized in embryonic epithelial cellular membrane.

CONCLUSION

Both DMT1 isoforms are ubiquitously expressed in embryonic tissues in the first trimester. Predominant DMT1-IRE isoform expression in placenta suggests an iron-regulatory mechanism reminiscent of that in the adult duodenum. Epithelial distributions of both DMT1 isoforms are associated with the absorptive or excretory functions of the expressed tissues.

The degradation of endocrine disruptor di-n-butyl phthalate by UV irradiation: a photolysis and product study

The direct photolysis of an important endocrine disruptor compound, di-n-butyl phthalate (DBP), has been investigated under monochromatic UV irradiation at 254 nm over a wide pH range (3-11). The investigation was carried out under idealized conditions and has considered both reaction kinetics and the degradation mechanism. It was found that more than 90% of DBP can be degraded within an hour of irradiation in water. A simple model has been developed and used to predict the initial DBP photolysis rate constant at different pH values and initial DBP concentrations. The major decomposition mechanism of DBP is believed to involve the hydrolytic photolysis of the carbon in the alpha and/or beta-position of the ester chain with the production of aromatic carboxylic derivatives. Additionally, multi-degradation pathways are proposed for acid-catalyzed hydrolytic photolysis (pH 3-5), which was found to be useful in explaining the photo-degradation of DBP under acidic conditions. The use of 254 nm UV to photo-degrade DBP was found to be a relatively fast and clean process, especially in neutral to basic conditions.

Duplex ultrasound screening for deep vein thrombosis in Chinese after cesarean section

BACKGROUND

To evaluate the incidence of asymptomatic deep vein thrombosis (DVT) in Chinese after cesarean section (CS).

METHODS

This is a prospective observational study. Ethnic Chinese women who were asymptomatic for DVT and delivered by CS were included. Duplex ultrasound scan (US) of the lower limbs was carried out 3-7 days after CS.

RESULTS

From July 2000 to March 2001, a total of 93 women were examined. The mean age was 32.1 years (SD 5.0). Forty-nine of 93 CSs were elective (52.7%). The median time from CS to US was 4 days (interquartile range, 4-5 days). No case of DVT was found in these 93 women.

CONCLUSION

The incidence of asymptomatic DVT is low in Chinese women after CS. Routine screening for DVT after CS is not warranted.

Fetal intra-abdominal umbilical vein varix: what is the clinical significance?

OBJECTIVE

To assess the clinical significance of fetal intra-abdominal umbilical vein (FIUV) varix.

METHODS

We reviewed all cases of FIUV varix diagnosed in a university hospital from 1994 to 2003 and searched the English literature for cases of prenatal diagnosis of FIUV varix. The FIUV was considered dilated when the measurements were above 2 SD of the mean for gestational age. Cases reported in the literature were included if they met the diagnostic criteria for FIUV varix.

RESULTS

Between 1994 and 2003, 13 fetuses were diagnosed in our hospital as having FIUV varix. Review of the literature revealed an additional 80 cases. Fetal outcome was available for analysis in 91 cases. Additional sonographic abnormalities were detected prenatally in 29 cases (31.9%), most commonly anomalies of the cardiovascular system (including structural and functional abnormalities), hydropic features and anemia. There were nine (9.9%) cases of chromosomal abnormalities. All except one had associated sonographic abnormalities. There were 12 (13%) perinatal losses. Only 54 cases (59.3%) of fetuses with FIUV varix had a normal obstetric outcome. In the 62 cases with isolated FIUV varix, there were five unexplained intrauterine deaths (8.1%) occurring between 29 and 38 weeks of gestation. The incidence of complications, which included intrauterine death, thrombosis of the umbilical vein and abnormal antenatal cardiotocogram, were significantly higher (P = 0.01, Fisher's exact test) if the diagnosis of FIUV varix was made before 26 weeks.

CONCLUSIONS

FIUV varix is associated with a high incidence of fetal anomalies and obstetric complications. Detailed sonography is necessary to exclude fetal anomalies. Karyotyping should be offered when additional fetal abnormalities are detected. Intensive surveillance including color Doppler ultrasound should be started from the moment of diagnosis until delivery, especially in those cases presenting early in pregnancy.

A validation study of ultrasonic foetal weight estimation models for Hong Kong Chinese singleton pregnancies

OBJECTIVE

To validate the published regression models for ultrasonic foetal weight estimation in Hong Kong Chinese singleton pregnancies.

DESIGN

Prospective cohort study.

SETTING

Regional hospital, Hong Kong.

PARTICIPANTS

One hundred and fourteen Hong Kong Chinese women with singleton pregnancy at term (37-42 weeks).

MAIN OUTCOME MEASURES

The birth weight of the neonate was used to validate the ultrasonic foetal weight estimation models. The ultrasound used to collect the data was performed within 2 days prior to delivery.

RESULTS

Foetal weight estimation models published by Hadlock and Woo have a high intraclass correlation coefficient of 0.86. Woo's regression model has the least mean difference (0.2 g; 95% limits of agreement, -569.4 to 569.8 g) and Hadlock 3 has the smallest limits of agreement (-114.6 g; 95% limits of agreement, -663.4 to 434.2 g) among the models tested.

CONCLUSIONS

Woo's regression model of foetal weight estimation gave the least mean difference and the actual birth weight for our local population were within the acceptable limits of agreement.

Intrapartum Cesarean Delivery After Successful External Cephalic Version

OBJECTIVE

We sought to estimate whether the risk of intrapartum cesarean delivery is higher in pregnancies after successful external cephalic version.

DATA SOURCES

We searched the MEDLINE, PubMed, EMBASE, and Cochrane Library databases to identify relevant studies. Abstracts of the American College of Obstetricians and Gynecologists Annual Clinical Meeting and the Society for Maternal-Fetal Medicine Annual Meeting were searched by hand.

STUDY SELECTION

Studies published between 1980 and 2002 that provided data allowing us to estimate the cesarean rate in both pregnancies after successful version and spontaneous cephalic-presenting pregnancies were selected.

TABULATION, INTEGRATION, AND RESULTS

Relative risks (RRs) and 95% confidence intervals (CIs) between the 2 compared groups were calculated. We used a meta-analysis to assess the heterogeneity of the studies and to combine the results from the included studies. Six eligible studies were identified. The cesarean rate was 27.6% in pregnancies after successful version and 12.5% in cephalic-presenting pregnancies. The combined RR and 95% CI was 2.04 (1.43-2.91). The increased cesarean rate in pregnancies after successful version was accounted for primarily by a higher incidence of emergency cesarean delivery for dystocia and fetal distress; the RR (95% CI) for these 2 events was 2.19 (1.38-3.48) and 2.10 (1.18-3.75), respectively.

CONCLUSION

The intrapartum cesarean delivery rate after successful version is 2 times that in pregnancies where there is spontaneous cephalic presentation. Pregnancies after successful version should not be considered the same as a normal pregnancy.

An in-vitro study of ginsenoside Rb1-induced teratogenicity using a whole rat embryo culture model

BACKGROUND

Ginseng is a commonly used herbal medicine worldwide. However, there is limited information regarding its effects on the developing embryo.

METHODS

The effect of ginsenoside on the developing embryo during the critical period of organogenesis was investigated using a whole rat embryo culture model. Embryos were exposed to various concentrations of ginsenoside Rb(1) and scored for growth and differentiation at the end of the culture period.

RESULTS

Median total morphological scores in embryos exposed to 30 micro g/ml of ginsenoside Rb(1) was significantly lower (P < 0.05) than that in control embryos (35 versus 45). Morphological scores for flexion, forelimb and hindlimb were also significantly reduced. The median total morphological scores further decreased to 28 when the concentration of ginsenoside Rb(1) was increased to 50 micro g/ml. At this concentration, the embryonic crown-rump length and somite number were also significantly reduced compared with control embryos (2.8 versus 3.0 mm and 16.0 versus 21.0, respectively).

CONCLUSIONS

Our study has demonstrated that ginsenoside exerts direct teratogenic effects on rat embryos. Until more is known about the effects of ginsenoside in women of reproductive age, we suggest its use should be treated with caution.

Application of a toxicity identification evaluation for a sample of effluent discharged from a dyeing factory in Hong Kong

A first toxicity identification evaluation (TIE) was conducted in three phases using the Microtox test to identify the major toxicant(s) in effluent discharged from a dyeing plant in Hong Kong. In Phase I toxicity characterization indicated that anions were likely to be the major toxicants for the entire effluent. In Phase II concentrations of sulfite and other anions in the original and the anion exchange resin-treated effluent samples were determined by ion chromatography. Anions, which were found in the effluent at comparatively high concentrations and were suspected of being responsible for the toxicity to luminescent bacteria, were selected for further study in Phase III. Investigation in Phase III using the spiking and mass balance approaches confirmed that the sulfite ion was the major toxicant in the effluent.

Customizing fetal biometric charts

OBJECTIVE

To study the effects of maternal and pregnancy characteristics on fetal biometric size using longitudinal ultrasound measurements and to construct customized models for fetal biometric size charts.

METHODS

A cohort of 533 healthy pregnant women with normal singleton pregnancies were recruited for regular ultrasound examination for fetal biometry between 24 and 40 weeks' gestation. Multilevel modeling was used to construct models of fetal head size, femur length and abdominal circumference. Variables of maternal and pregnancy characteristics including booking weight and height, age, parity and fetal sex were included in the construction of the customized fetal biometric size charts.

RESULTS

Increased fetal head size and abdominal circumference were significantly associated with extremes of maternal age. Maternal height had a statistically significant influence on biparietal diameter. Maternal booking weight had an influence on fetal abdominal circumference and femur length. Fetal sex was found to have a statistically significant influence on the final regression models of biparietal diameter, head circumference and femur length. Parity had an influence on fetal head circumference and abdominal circumference.

CONCLUSIONS

Maternal and pregnancy characteristics have a significant influence on in-utero fetal biometry. We produced models to construct customized fetal biometric size charts. Further validation studies are necessary to evaluate the clinical usefulness of such customized fetal biometric size charts.