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Biomedical subjects

T T Lao

Publications and source records attributed to T T Lao.

At least 37 records · Page 2Linked to original sources
PubMed2000

Placental size and large-for-gestational-age infants in women with abnormal glucose tolerance in pregnancy.

AIMS: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance. METHODS: A retrospective study was performed on 568 consecutive singleton pregnancies complicated by gestational impaired glucose tolerance controlled with diet and who delivered within a 15-month period. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (< 10th percentile), appropriate-for-gestational age (10th to 90th percentile) and large-for-gestational age (> 90th percentile). Maternal and infant anthropometric data, glycaemic status, and placental weight-to-birthweight ratio were compared among the three groups. RESULTS: The infant body mass index and placental weight showed a significantly increasing trend from the small-for-gestational age to the large-for-gestational age groups, but there was no significant difference in the placental weight-to-birthweight ratio, values of the oral glucose tolerance test, or haemoglobin A1c among the three groups. On the other hand, the maternal body mass index before pregnancy and at delivery were significantly higher in the large-for-gestational age group. The placental weight, but not the ratio, was significantly correlated with the maternal body mass index before pregnancy and at delivery (P < 0.001). CONCLUSIONS: The results indicate that the placenta is not disproportionately bigger, and therefore unlikely to be the cause, in large-for-gestational age infants. Maternal size appeared to be the major determinant of birthweight percentile ranking in pregnancies with gestational impaired glucose tolerance.

Adult↗
PubMed2000

Relationship between preterm delivery and maternal height in teenage pregnancies.

A retrospective study was performed in 613 singleton pregnancies born to mothers aged < or =19 years over a 4-year period to determine the relationship between maternal height and preterm delivery (<37 weeks). The pregnancies were grouped according to maternal height quartiles for comparison of maternal and infant characteristics, obstetric complications and pregnancy outcome. The incidences of preterm delivery and labour decreased from 17.5% and 15.6% respectively in the lowest quartile, to 8.5% and 7.1% respectively in the highest quartile, without any difference in the risk factors or major complications. In the pregnancies without major complications, which included 73.3% of the cases of preterm labour, the rate of preterm labour was significantly and inversely correlated with the height quartiles. In the newborns, gestational age, birthweight and crown-heel length increased with the higher quartiles, but the ratio between infant crown-heel length and maternal height (height ratio) decreased with the higher quartiles. Unlike birthweight and crown-heel length, the height ratio was not correlated with gestational age. Our findings suggested that the inherent risk of preterm delivery in teenagers was related to their immature physical development at the time of pregnancy, as reflected by the maternal height.

Abortion, Induced↗
PubMed2000

Impaired glucose tolerance and pregnancy outcome in Chinese women with high body mass index.

To determine if impaired glucose tolerance (IGT) impacts on the outcome of singleton pregnancies in Chinese women with a high (>26 kg/m(2)) body mass index (BMI), a retrospective case-control study was performed on 128 women with IGT and 128 controls with normal oral glucose tolerance test results, who were matched for pre-pregnancy BMI (within 0.1 kg/m(2)) and delivered within the same 3 year period. The IGT group was older, with more multiparae, a higher incidence of previous gestational diabetes mellitus, higher booking haemoglobin and fasting glucose concentrations, but no difference in the pre-pregnancy weight, gestational weight gain, or weight or BMI at delivery. There was no difference in the obstetric complications, mode of delivery, or the gestational age or mean infant birthweight. However, the birthweight ratio (relative to mean birthweight for gestation), incidence of large-for-gestational-age (birthweight >90th percentile) and macrosomic (birthweight > or =4000 g) infants, and treatment for neonatal jaundice, were significantly higher in the IGT group. The results suggest that some of the complications attributed to gestational diabetes mellitus are probably related to maternal weight excess/obesity in the affected subjects, but IGT could still affect infant birthweight outcome despite diet treatment which has normalized gestational weight gain.

Adult↗
PubMed2000

Third trimester iron status and pregnancy outcome in non-anaemic women; pregnancy unfavourably affected by maternal iron excess.

A prospective observational study was performed on 488 women with haemoglobin >/=10 g/dl at booking to examine the relationship between serum ferritin concentration quartiles at 28-30 weeks gestation with maternal characteristics, pregnancy complications and infant outcome. While there was no difference in the maternal characteristics or gestational age, the infant size decreased significantly and progressively from the lowest to the highest quartile. Despite a significant difference in the incidence of multiparous women, there was no difference in the incidence of most complications except for prelabour rupture of the membranes and infant admission to the neonatal unit. Compared with the other three quartiles, the highest quartile was associated with increased risk for preterm delivery and neonatal asphyxia, while the lowest quartile was associated with decreased risk of pre-eclampsia, prelabour rupture of the membranes, and infant admission to the neonatal unit. Overall, ferritin quartiles were correlated with other parameters of iron status and red cell indices, and ferritin concentration was inversely correlated with infant birthweight. Our findings suggested that maternal ferritin concentration is primarily a reflection of maternal iron status, and a high level is associated with unfavourable outcome. The rationale of routine iron supplementation in non-anaemic women needs to be re-examined.

Adult↗
PubMed2000

Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of the membranes.

OBJECTIVE: To compare the labour pattern and uterine activity of oral misoprostol with oxytocin for labour induction in women presenting with prelabour rupture of membranes at term. DESIGN: Prospective randomised study. SETTING: Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong. PARTICIPANTS: Eighty women presenting with prelabour rupture of membranes at term. METHODS: The women were randomised to receive either 100 microg misoprostol orally every 4 hours to a maximum of three doses, or intravenous oxytocin infusion according to the hospital protocol. Intrauterine pressure transducers were inserted one hour before induction of labour in both groups of women. We compared the pattern of uterine activity, the induction-to-delivery interval, duration of labour, mode of delivery and neonatal outcome between the two groups. RESULTS: Both oxytocin and oral misoprostol caused an increase in uterine activity within one hour of labour induction. Peak uterine activity was reached 6-8 h after oral misoprostol, with persistent effects, and 8-10 h after oxytocin, requiring continuous titration of medication. The duration of labour was significantly reduced in nulliparous women, but not in those who were multiparous in the misoprostol group. The induction-to-delivery interval, the mode of delivery and the perinatal outcome were similar for the two groups. CONCLUSION: Oral misoprostol caused earlier peak uterine activity, compared with oxytocin (6-8 h vs 8-10 h). Oral misoprostol was not only as effective as oxytocin in inducing labour in women at term with prelabour rupture of the membranes, but it reduced significantly the duration of labour in nulliparous women.

Administration, Oral↗
PubMed2000

Predicting the success of external cephalic version with a scoring system. A prospective, two-phase study.

OBJECTIVE: To develop a noninvasive and quantifiable scoring system based on clinical parameters to predict the success of external cephalic version (ECV) in women with breech presentation at term. STUDY DESIGN: This was a prospective, two-phase, clinical study. Phase 1 was to develop a scoring system from 53 versions with singleton pregnancy in breech presentation at term using a standard protocol with fetal monitoring, ultrasound assessment and tocolysis. Phase 2 was to verify this scoring system by application to 88 versions using the same standard protocol as in phase 1. RESULTS: The success rates for ECV in phases 1 and 2 were 64.2% and 61.4%, respectively, making the overall success rate 62.4%. The results of phase 1 showed that there were significant differences in the following parameters: head palpable, breech unengagement, symphysisfundal height and uterine relaxation. A scoring system based on these four clinical parameters was developed. When applied to 88 versions in the second phase, the likelihood ratio of successful ECV was > 30 if the version score was > or = 3 and < 1.8 if the version score was < or = 2. CONCLUSION: Using our scoring system, prediction of successful ECV was possible without ultrasound scan or vaginal examination, and counseling could be given once breech presentation was diagnosed.

Adult↗
PubMed2000

Placental ratio and anemia in third-trimester pregnancy.

OBJECTIVE: To perform a prospective, observational study in a tertiary center to determine whether anemia (hemoglobin level < 10 g/dL) developing in the third trimester was associated with an increased placental weight/birth weight ratio (placental ratio) and whether the placental ratio correlated with the hemoglobin level at different periods and with other factors, such as gestational age and parity. STUDY DESIGN: A total of 476 nonanemic women with low-risk singleton pregnancies were recruited at their 28-30-week antenatal visit over a three-month period. Excluded from the final analysis were 20 women who delivered elsewhere and 19 found to be carriers of thalassemia traits due to their low mean cell volume. All women received standard obstetric care, and ferrous sulphate was prescribed for those who developed anemia. RESULTS: Anemia developed in 45 (10.3%) of the remaining 437 women. This group had significantly decreased red cell indices, gestational age (38.3 +/- 2.0 vs. 39.2 +/- 1.3 weeks, P = .004) and birth weight (3,082 +/- 416 vs. 3,220 +/- 411 g, P = .035) but no difference in placental weight (609 +/- 102 vs. 594 +/- 108 g), so the placental ratio was increased as compared with that in the control group (0.196 +/- 0.026 vs. 0.185 +/- 0.026, P = .002). Multiple regression analysis confirmed that the placental ratio correlated only with the last hemoglobin level (P = .041). CONCLUSION: Our results indicate that placental size increased relative to infant size in pregnancies complicated by anemia, but whether this phenomenon reflected actual placental hypertrophy or failure of fetal growth to keep up with placental growth remains to be determined.

Adult↗
PubMed1999

Hemoglobin and red cell indices correlated with serum ferritin concentration in late pregnancy.

OBJECTIVE: To study the correlation between third-trimester serum ferritin concentration and hemoglobin and red cell indices to select the best hematologic characteristic to identify women who need iron therapy. METHODS: In a prospective study, blood was drawn from pregnant women with hemoglobin above 10 g/dL, and thalassemia trait excluded at booking, at 28-30 weeks' gestation to study the correlation (Spearman p value) between serum ferritin concentration and hemoglobin level, mean corpuscular volume, mean cell hemoglobin, mean cell hemoglobin concentration, and hematocrit. The best relationship was identified using receiver operating characteristic (ROC) curves. RESULTS: Serum ferritin concentration correlated significantly with hemoglobin (p = .211), mean corpuscular volume (p = .332), mean cell hemoglobin (p = .304), and hematocrit (p = .199). The area under the ROC curve was largest for hemoglobin. CONCLUSION: Serum ferritin concentration at the early third trimester correlated best with hemoglobin level. If a hemoglobin level of 11 g/dL or below (25% of all patients) was used as the cutoff, 64% of women who needed iron therapy were identified.

Adult↗
PubMed1999

The neonatal implications of a high placental ratio in small-for-gestational age infants.

An increased placental ratio has been associated with small-for-gestational age (SGA) infants. A retrospective study on 252 singleton SGA infants without major anomalies born within a 1-year period was performed to determine the relationship between placental ratio and maternal/infant characteristics, and perinatal complications. The cases were categorized into three groups according to the placental ratio (<1 sd below the mean, within 1 sd of the mean, >1 sd above the mean) based on our previous data. There were more infants with a high ratio (32.9 per cent) than with a low ratio (15.5 per cent). While there was no difference in the maternal characteristics or antenatal complications, there was a significant trend in decreasing birthweight and an increasing placental weight in relation to an increasing placental ratio. The infants with a high ratio had increased incidence of meconium stained liquor, hypocalcaemia, hypomagnesaemia and phototherapy, a trend that was consistent even after exclusion of the preterm infants. Our data indicated that a high placental ratio in SGA infants was due to both increased placental size and decreased birthweight, and this was associated with increased neonatal morbidity.

Adult↗
PubMed1999

Influence of parity on the obstetric performance of mothers aged 40 years and above.

We reviewed the delivery records of 205 mothers aged 40 years and above who delivered from 1st January 1994 to 31st December 1996 to examine the influence of parity on their obstetric performance. There were 51 (24.9%) primiparous mothers. The incidences of antenatal complications (antepartum haemorrhage, hypertensive disorder, glucose intolerance, prematurity), labour performance (type of labour, mode of delivery) and neonatal outcome (birth weight, Apgar scores, neonatal intensive care unit admission, perinatal mortality) were compared between the 51 (24.9%) primiparous and the 154 (75.1%) multiparous mothers. Higher incidences of antepartum haemorrhage (17.6 versus 5.8%, P = 0.0188), hypertensive disorder (17.6 versus 5.2%, P = 0.015), labour induction (33.3 versus 14.3%, P = 0.004) and Caesarean section delivery (58.8 versus 20.8%, P < 0.0001) were found among the primiparous mothers than the multiparous group. Neonatal outcome, however, was similar in both groups. We conclude that the primiparous mothers aged 40 years and above had more complicated antenatal and labour courses than multiparous mothers. On the other hand, the neonatal outcomes of two groups were comparable.

Adult↗
PubMed1999

Colon cancer in pregnancy. A case report.

BACKGROUND: Carcinoma of the colon diagnosed during pregnancy is very rare. Delayed diagnosis is common because of the similarity between early signs and symptoms of colon cancer and gastrointestinal complaints often experienced by pregnant women. We report a case of early-stage colon cancer in pregnancy with a good outcome. CASE: A 35-year-old woman presented with rectal bleeding at 26 weeks of gestation. Initial assessment with digital examination and proctoscopy revealed only a mild degree of hemorrhoids. Colonoscopy and biopsy at 30 weeks of gestation showed sigmoid colon cancer. Cesarean section was performed after steroid therapy. Subtotal colectomy and ileosigmoid anastomosis were then performed at the same setting. Postoperative adjuvant chemotherapy was given. There was no evidence of recurrence at this writing, 28 months after surgery. CONCLUSION: Colon cancer is a rare complication of pregnancy. The associated poor prognosis is usually due to delay in diagnosis. A high index of suspicion is essential, and it is important not to underestimate the patient's symptoms. Early diagnosis is the key to longer survival.

Adult↗
PubMed1999

Gastric adenocarcinoma presenting with persistent, mild gastrointestinal symptoms in pregnancy. A case report.

BACKGROUND: Mild gastrointestinal symptoms are common during pregnancy but can also be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor to delayed diagnosis and poor outcome. We report a case of maternal death to alert clinicians to this rare possibility. CASE: A 36-year-old woman had persistent, mild epigastric discomfort, nausea, vomiting and frequent episodes of dark stools since the second trimester of pregnancy. These were attributed to peptic ulcer and an iron supplement given, without investigation. Gastroscopy was performed only at 32 weeks of gestation, when the patient had heavy hematemesis. Biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach. Cesarean section was performed after steroid therapy. Advanced stomach cancer with stomach perforation was found. Curative surgery was not possible. The patient died four weeks after delivery. CONCLUSION: Stomach cancer is a rare complication of pregnancy. Delay in diagnosis is commonly due to clinicians' reluctance to request diagnostic studies and the nonspecific symptoms of the disease. Early recognition and diagnosis are the only possibilities for a better outcome. Clinicians must be alert to this possibility and include this in the differential diagnosis of minor gastrointestinal discomfort during pregnancy.

Adenocarcinoma↗
PubMed1998

Gestational 'impaired glucose tolerance': should the cut-off be raised to 9 mmol l(-1)?

It has been suggested that the diagnostic criterion for the 2-h value of the 75 g oral glucose tolerance test in pregnancy be raised to 9 mmol l(-1). In order to determine whether patients with a 2-h value of between 8 and 8.9 mmol l(-1) should be classified as normal, we performed a retrospective study on patients with gestational diabetes mellitus treated with diet only who delivered within 1 year, and categorized them into three groups according to the 2-h value as follows: group A (8-8.9 mmol l(-1)), group B (9-10.9 mmol l(-1)), and group C (> or =11.0 mmol l(-1)). These groups were compared with a control group with normal oral glucose tolerance test results and who delivered within the same 1-year period. Group A patients were significantly different from the control group in maternal age, parity, fasting value in the oral glucose tolerance test, maternal body mass index, gestational age at delivery, incidence of large for dates infants, and placental weight, but were similar to group B for most of these parameters. Group C was significantly different from both the control group and group A for most of the above parameters. Our results suggest that the current World Health Organization criterion for the diagnosis of gestational diabetes mellitus should be maintained.

Adult↗
PubMed1998

Gestational diabetes mellitus in teenage pregnancy: a case-control study.

In a retrospective study, teenage Asian pregnancies with gestational diabetes managed over a 4-year period were compared with a group of age and parity matched controls (2 for each study case) to determine the incidence of gestational diabetes and its impact on the pregnancy outcome. The incidence of gestational diabetes in teenage pregnancy was 5.4% (33/611), and accounted for 1.4% of all the cases of gestational diabetes. There was no difference in the maternal anthropometric parameters or antenatal complications, but the study group had a higher incidence of postpartum haemorrhage (p = 0.010), greater amount of estimated blood loss at delivery (p = 0.016), a trend towards a higher incidence of large-for-gestational age infants, a higher incidence of admission to the neonatal unit (p = 0.024), mostly due to meconium-stained liquor for observation (p = 0.014), and a lower first minute Apgar score (p = 0.012). Our findings support the recommendation that in ethnic groups with a high prevalence of diabetes, universal as opposed to age-limited screening for gestational diabetes should be undertaken.

Adolescent↗