Aneuploidy ; Attitude to Health ; Female ; Fetal Diseases ; diagnosis ; Humans ; Informed Consent ; psychology ; Pregnancy ; Prenatal Diagnosis ; psychology

Each of us perceives risk differently, and so do our patients. This perception of risk gets even more complex when multiple individuals and interactions are involved: the doctor, the patient-pregnant mother, the spouse-father and the foetus-unborn child. In this review, we address the relationship between different levels of information gathering, from clinical data to experiential knowledge - data, information, knowledge, perception, attitude, wisdom - and how these would impact the perception of risk and informed consent. We discuss how patients might interpret the risks of the same event differently based upon past experiences, and suggest how risk data could be presented more meaningfully for patients and family to assimilate for informed decision making. Finally, we demonstrate how patients' expectations and risk management can impact scientific research and clinical progress by way of the most topical subject of risk screening in pregnancy - non-invasive prenatal testing using cell-free DNA in maternal plasma.
Aneuploidy ; Attitude to Health ; Female ; Fetal Diseases ; diagnosis ; genetics ; Humans ; Informed Consent ; psychology ; Pregnancy ; Prenatal Diagnosis ; adverse effects ; psychology ; Risk

Chromosome Aberrations ; Chromosome Disorders ; diagnosis ; Female ; Humans ; Practice Patterns, Physicians' ; Pregnancy ; Prenatal Diagnosis ; methods

INTRODUCTIONIntrapartum fetal monitoring is essential for the identification of fetal hypoxia to reduce perinatal morbidity and mortality. Cardiotocography is associated with low specificity for fetal acidosis and poor perinatal outcome leading to unnecessary operative deliveries. ST waveform analysis of the fetal electrocardiogram has been shown to be a promising adjunctive intrapartum assessment tool. We aim to present the pathophysiology, the role of intrapartum monitoring and the practical usage of this relatively new technology in our review.

METHODSAn electronic search of Medline and OVID was carried out, followed by a manual search of the references identified by the electronic search.

RESULTSThe incorporation of ST waveform analysis to cardiotocography has been shown to reduce the rates of neonatal metabolic acidosis, moderate and severe neonatal encephalopathy, thus improving perinatal outcome. The reduction in operative delivery rates due to fetal distress is also significant. The pathophysiology and practical usage of this technology were discussed.

CONCLUSIONSWith more accurate identification of fetal hypoxia and reduction of unnecessary intervention rates, incorporation of ST waveform analysis of fetal electrocardiography into cardiotocography can improve the standard of intrapartum fetal monitoring.

Electrocardiography ; utilization ; Female ; Fetal Hypoxia ; diagnosis ; Fetal Monitoring ; instrumentation ; methods ; Humans ; Pregnancy ; Singapore

: Fetal hydrops is a serious condition which can be caused by immune and non-immune aetiologies. We aimed to review the management of fetal hydrops at our hospital.: A retrospective review of all cases of fetal hydrops diagnosed in our institution from 2006 to 2013 was carried out.: Out of the 30 cases of fetal hydrops diagnosed antenatally, 17 were cases of Bart's hydrops which were all terminated in-utero. Of the remaining 13 cases, 11 cases consisted of non-immune causes of hydrops. Planned antenatal interventions including in-utero blood transfusions (n = 4) and thoracentesis (n = 5) as well as planned caesarean deliveries (n = 11) were performed in the majority of cases. Postnatal neonatal intensive care with interventions including chest drainage and transfusions were also performed. A majority, 92%, of the cases survived the perinatal period following a variable length of hospital stay ranging from a week to 3 months.: Management of fetal hydrops is complex. Close coordination between the obstetric and neonatal teams was the key to good short-term survival of neonates with antenatally diagnosed hydrops, as it allows timely antenatal intervention and anticipation of potential perinatal complications.
Abortion, Induced ; Blood Transfusion ; Cesarean Section ; Disease Management ; Drainage ; Female ; Fetal Therapies ; Hemoglobins, Abnormal ; Humans ; Hydrops Fetalis ; blood ; etiology ; therapy ; Infant, Newborn ; Intensive Care Units, Neonatal ; Pregnancy ; Prenatal Diagnosis ; Retrospective Studies ; Singapore ; Survival Rate ; Tertiary Care Centers ; Thoracentesis ; alpha-Thalassemia ; blood ; complications

INTRODUCTIONThe risk of malignancy index (RMI) is a scoring system used to triage benign from malignant ovarian masses. We compared the specificity and sensitivity of the four indices (RMI 1, RMI 2, RMI 3 and RMI 4) to discriminate a benign ovarian mass from a malignant one in a Southeast Asian population.

METHODSThis was a five-year retrospective study of women who were admitted for surgery due to ovarian masses. RMI scores were calculated based on standardised preoperative cancer antigen (CA)-125 levels, ultrasonography findings, menopausal status and tumour size based on ultrasonography. Postoperative histopathologic diagnosis was regarded as the definite outcome. Data were analysed using the Statistical Package for the Social Sciences, and Mann-Whitney U test was used to compare the individual RMI scores between the benign and malignant cases.

RESULTSOut of the 480 patients reviewed, 228 women aged 10-65 years were included in the study. Of these, 17 (7.5%) had malignant disease and 211 (92.5%) had benign pathology. There was no statistical difference in the RMI 1, 2, 3 and 4 scores between the benign and malignant cases. Individual variables that were analysed showed significant differences in median CA-125 level and tumour size (p = 0.044 and p < 0.0005, respectively) between the benign and malignant cases.

CONCLUSIONOur study shows that RMI is not a valuable triage tool for our Southeast Asian population. Further prospective validation, with regard to standardising results in different patient populations and centres, is required.

Adolescent ; Adult ; Aged ; Area Under Curve ; CA-125 Antigen ; metabolism ; Child ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Models, Statistical ; Ovarian Cysts ; diagnosis ; pathology ; Ovarian Neoplasms ; diagnosis ; pathology ; ROC Curve ; Retrospective Studies ; Risk ; Sensitivity and Specificity ; Singapore ; Young Adult

INTRODUCTIONFirst trimester screening (FTS) is a validated screening tool that has been shown to achieve detection rates of 84%-90% for trisomies 21, 18 and 13. However, its effectiveness for different maternal ages has not been assessed. The present study aimed to assess the performance of FTS in an Asian population, and to compare its effectiveness in older (≥ 35 years) and younger (< 35 years) women. The potential use of noninvasive prenatal test (NIPT) as a contingent screening test is also examined.

METHODSData on cases of FTS performed on singleton pregnancies over a six-year period was collated from two Singapore maternal centres, National University Hospital and Singapore General Hospital. Cases that had a 1:250 risk of trisomy were considered to be screen-positive. Pregnancy outcomes were obtained from birth records or karyotype test results.

RESULTSFrom 10,289 FTS cases, we obtained a sensitivity of 87.8%, a specificity of 97.6%, a false positive rate of 2.4% and a false negative rate of 0.06% for the detection of aneuploidy. The overall detection rate for trisomy 21 was 86.5%-85.7% for older women and 87.5% for younger women. The mean number of invasive tests required per case of trisomy 21 was 9.3 in younger women, 8.6 in older women and 13.5 in women with intermediate risk (1:250-1,000).

CONCLUSIONWhile the performance of FTS was similar in younger and older women, more invasive procedures were required to diagnose trisomy 21 in women with intermediate risk. It may be advantageous to offer contingent NIPT to this group of women to reduce the risk of iatrogenic fetal loss.

Adolescent ; Adult ; Aneuploidy ; Asia ; Cohort Studies ; DNA ; analysis ; Down Syndrome ; diagnosis ; Female ; Humans ; Karyotyping ; Maternal Age ; Maternal Serum Screening Tests ; methods ; Middle Aged ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Prenatal Diagnosis ; methods ; Risk Factors ; Singapore ; Trisomy ; diagnosis

Pregnancy ; Female ; Humans ; Mosaicism ; Prenatal Diagnosis ; Prenatal Care ; Aneuploidy

The aim of this study was to characterize the provesicle formulation of nateglinide (NTG) to facilitate the development of a novel controlled release system of NTG with improved efficacy and oral bioavailability compared to the currently marketed NTG formulation (Glinate™ 60). NTG provesicles were prepared by a slurry method using the non-ionic surfactant, Span 60 (SP), and cholesterol (CH) as vesicle forming agents and maltodextrin as a coated carrier. Multilamellar niosomes with narrow size distribution were shown to be successfully prepared by means of dynamic laser scattering (DLS) and field emission scanning electron microscopy (FESEM). The absence of drug-excipient interactions was confirmed by Fourier transform infrared spectroscopy (FT-IR), differential scanning calorimetry (DSC) and X-ray diffraction (XRD) studies. In vitro release of NTG in different dissolution media was improved compared to pure drug. A goat intestinal permeation study revealed that the provesicular formulation (F4) with an SP:CH ratio of 5:5 gave higher cumulative amount of drug permeated at 48 h compared to Glinate™ 60 and control. A pharmacodynamic study in streptozotocin-induced diabetic rats confirmed that formulation F4 significantly (P<0.05) reduced blood glucose levels in comparison to Glinate 60. Overall the results show that controlled release NTG provesicles offer a useful and promising oral delivery system for the treatment of type II diabetes.

Given the consensus that there is a causal relationship between Zika virus (ZIKV) infection in pregnancy and congenital Zika syndrome (CZS), clinicians must be prepared to manage affected patients despite the numerous gaps in current knowledge. The clinical course in pregnancy appears similar to that in non-pregnant women, although viraemia may be prolonged. ZIKV infection can be diagnosed by serum and urine reverse transcription-polymerase chain reaction, but commercially available serological tests are currently unreliable in dengue-endemic regions. Although vertical transmission can occur at any time during gestation, first- and second-trimester infections have the highest risk of developing central nervous system anomalies. Aberrant fetal growth and pregnancy loss may also occur. Serial ultrasonography should be conducted for infected cases. Without a vaccine, pregnant women should be advised to minimise mosquito bites and reduce sexual transmission risk. Overall, the absolute risk of CZS arising amid a ZIKV outbreak appears relatively low.