Impact of COVID-19 pandemic on specialty training in obstetrics and gynaecology in Hong Kong: is there a concern about the future prospect?

Introduction: The COVID-19 pandemic in the past few years led to major adjustments in the provision of healthcare. This study aimed to investigate trainees' perception of impact of the pandemic on specialty training in Obstetrics & Gynaecology (O&G) in Hong Kong.

Methods: A cross-sectional questionnaire survey was performed on all the O&G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG).

Pregnancy and perinatal outcomes of women with SARS-CoV-2 infection during pregnancy.

Introduction: This study aimed to compare the pregnancy and perinatal outcomes of women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy.

Methods: Women who delivered in an obstetric unit from March 2022 to October 2022 were recruited. The history of vaccination and SARS-CoV-2 infection during pregnancy was recorded.

A prospective study on neonatal ophthalmic injuries associated with forceps delivery.

Background: Assisted delivery by forceps is needed to expedite vaginal delivery in certain maternal and fetal conditions. The aim of this study was to evaluate the incidence and the extent of ophthalmological injuries in neonates after forceps delivery.

Methods: Women with cephalic fetuses delivered vaginally by forceps from July 2020 to June 2022 were recruited prospectively.

Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates.

Purpose: To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma.

Methods: All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30 months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal.

Prenatal Diagnosis and Pregnancy Outcomes of Fetuses With Orofacial Cleft: A Retrospective Cohort Study in Two Centres in Hong Kong.

Objective: To evaluate the local incidence of orofacial cleft (OFC) encountered in fetal morphology scan and prenatal diagnosis, genetic etiology of fetuses with or without other structural abnormalities, and their pregnancy outcomes.

Design: Retrospective cohort study.

Setting: Two maternal fetal medicine units, tertiary hospitals, Hong Kong.

Trend and causes of maternal death, stillbirth and neonatal death over seven decades in Hong Kong.

Background: Reducing maternal and perinatal mortality is a global objective. Hong Kong is a city with low maternal and perinatal mortality but little is known about the trend and causes of these deaths in this high-income city. We analyzed the maternal death, stillbirth and neonatal death since 1946 in Hong Kong.

The Discriminant Use of Intrauterine Balloon Tamponade and Compression Sutures for Management of Major Postpartum Hemorrhage: Comparison of Patient Characteristics and Clinical Outcome.

Background: Intrauterine balloon tamponade (IUBT) and compression sutures have been widely used in recent years in the management of postpartum hemorrhage (PPH). However, there is scant literature directly comparing the clinical scenarios that led to the discriminant selection of these management modalities and the direct clinical outcomes. The purpose of this study is to compare the patient characteristics and clinical risk factors that led to the use of IUBT and compression sutures in the management of major PPH as well as the immediate outcome in a retrospective cohort.

Use of balloon tamponade in management of vaginal laceration and its possible complication of urinary stress incontinence: a case report.

Background: Postpartum haemorrhage from vaginal lacerations can occasionally be refractory to suturing and vaginal packing. Bakri uterine balloon has been widely adopted to stop uterine bleeding, but its use to stop bleeding in vaginal lacerations and its possible complications have seldom been reported.

Case Presentation: We report a patient who had vacuum delivery for fetal distress and subsequently had postpartum hemorrhage due to previous caesarean uterine scar rupture and multiple vaginal lacerations.

Risk factors for severe postpartum haemorrhage during caesarean section for placenta praevia.

The objective of this study was to evaluate the value of clinical and ultrasound risk factors in predicting severe postpartum haemorrhage (PPH) (≥1.5 L) in pregnancies undergoing caesarean section for placenta praevia. This cohort consists of all cases of placenta praevia undergoing caesarean delivery over a period of 5 years in a service unit.

Comparison of the accuracy of INTERGROWTH-21 formula with other ultrasound formulae in fetal weight estimation.

Objective: A new ultrasound formula for fetal weight estimation was proposed from the INTERGROWTH-21 project in 2017. There is no comparison of its accuracy with other ultrasound formulae. This study aims to compare the accuracy of INTERGROWTH-21 formula in fetal weight estimation with the traditional Hadlock1 and Shepard formula.

Menstrual and reproductive outcomes after use of balloon tamponade for severe postpartum hemorrhage.

Background: The use of intrauterine balloon tamponade to manage postpartum hemorrhage is increasing. However, there is lack of studies on the menstrual and reproductive outcomes after such treatment. The purpose of this study is to explore the menstrual and reproductive outcomes for patients who had been managed by intrauterine balloon tamponade for severe postpartum hemorrhage in her index pregnancy.

Intraluminal pressure of uterine balloon tamponade in the management of severe post-partum hemorrhage.

Aim: Intrauterine balloon tamponade has been increasingly used for the management of post-partum hemorrhage (PPH) in recent years. However, data on the precise mechanisms and pressure required for the balloon tamponade are scanty in the literature. This study aims to review the intraluminal pressure (ILP) generated by the Bakri intrauterine balloon that is necessary to produce a 'positive tamponade test' during severe PPH.

Outcome of pregnancy with new onset proteinuria and progression to pre-eclampsia: A retrospective analysis.

Objective: To examine maternal and neonatal outcomes of gestational proteinuria, and to identify maternal characteristics for progression to pre-eclampsia.

Study Design: Retrospective cohort. Included all pregnant women who delivered between Jan 2014-Feb 2017 with new onset proteinuria in a single obstetric unit.

Trends in conservative procedures and peripartum hysterectomy rates in severe postpartum haemorrhage.

Objective: The objective of this study is to explore whether increase in use of second-line conservative surgical procedures will alter the rate of peripartum hysterectomies in management of severe postpartum haemorrhage (PPH).

Methods: This is a retrospective cohort. All pregnant patients with gestation > = 28 weeks with severe PPH (> = 1.

The predicting factors and outcomes of caesarean section of the second twin.

The aim of this study was to review the indications for caesarean delivery of second twins after vaginal delivery of a first twin (combined delivery) and the associated foetal outcomes of the second twin. Possible factors that could be employed to predict combined delivery were explored. This was a retrospective review of all twin pregnancies delivered in a tertiary maternity unit between 2000 and 2013.

Impact of nuchal cord on fetal outcomes, mode of delivery, and management: a questionnaire survey of pregnant women.

Objectives: To explore pregnant women's views on the impact of nuchal cord on fetal outcomes, mode of delivery, and management.

Design: Questionnaire survey.

Setting: Antenatal clinic of two regional hospitals in Hong Kong.

Neonatal outcome and mode of delivery in the presence of nuchal cord loops: implications on patient counselling and the mode of delivery.

Purpose: To review and compare the foetal outcomes and mode of delivery in patients with nuchal cord for single loop, double loops, and multiple loops.

Methods: A retrospective study of 4,404 singleton term pregnancies which underwent spontaneous labour was conducted. The patients were classified into five groups: without nuchal cord, nuchal cord of any turns, nuchal cord for 1 turn, nuchal cord for 2 turns and nuchal cord for 3 turns or above.

Uterine compression sutures for management of severe postpartum haemorrhage: five-year audit.

Objectives: To audit the use of compression sutures for the management of massive postpartum haemorrhage and compare outcomes to those documented in the literature.

Design: Retrospective study.

Setting: A regional obstetric unit in Hong Kong.

Optimal delivery for preterm breech fetuses: is there any consensus?

The optimal route for delivery of preterm breech-presenting fetuses remains a clinical dilemma. Available data from the literature are largely based on retrospective cohort studies, and randomised controlled trials are considered impossible to conduct. Consistently however, large population-based surveys have shown that planned caesarean sections for these fetuses were associated with better neonatal outcomes compared with those following vaginal delivery.

A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome.

Study Objective: To evaluate whether there are any differences in bone mineral density (BMD) between normal weight and obese adolescents suffering from polycystic ovary syndrome (PCOS) with oligo/amenorrhea.

Design: Prospective cohort study.

Setting: Adolescent gynecology clinic in a general service hospital.

Prenatal diagnosis and assessment of facial clefts: where are we now?

Orofacial clefts are one of the most common non-syndromic congenital structural abnormalities. Prenatal diagnosis of such defects has traditionally been made by ultrasound examination. With the advent of routine second-trimester ultrasound screening for morphological abnormalities in the recent two decades, the prenatal detection rate of such abnormalities has progressively increased.

Bone mineral density changes during pregnancy in actively exercising women as measured by quantitative ultrasound.

Objective: To evaluate whether bone mineral density (BMD) changes in women engaged in active exercises during pregnancy would be different from non-exercising women.

Methods: Consecutive patients with singleton pregnancies who were engaged in active exercise training during pregnancy were prospectively recruited over a period of 6 months. Quantitative USG measurements of the os calcis BMD were performed at 14-20 weeks and at 36-38 weeks.

Noninvasive prenatal diagnosis of fetal trisomy 18 and trisomy 13 by maternal plasma DNA sequencing.

Massively parallel sequencing of DNA molecules in the plasma of pregnant women has been shown to allow accurate and noninvasive prenatal detection of fetal trisomy 21. However, whether the sequencing approach is as accurate for the noninvasive prenatal diagnosis of trisomy 13 and 18 is unclear due to the lack of data from a large sample set. We studied 392 pregnancies, among which 25 involved a trisomy 13 fetus and 37 involved a trisomy 18 fetus, by massively parallel sequencing.

Training in emergency obstetric skills: is it evidence-based?

In recent years, training in emergency obstetric skills has moved from the traditional clinical teaching in the labour ward to specific, targeted skills and scenario-based courses utilising mannequins and simulators. Such changes have been necessary, largely as a result of the limitations of traditional clinical teaching when it comes to genuine patient encounters in an emergency situation. The range of simulations now available extends from simple pelvic models to sophisticated computer-based birth simulators.