To evaluate the psychometric properties of the traditional Chinese version of the Childbirth Experience Questionnaire (CEQ 2.0) and assess the childbirth experiences of Chinese women.
A ...cross-sectional survey was conducted in Hong Kong from July 2020 to February 2021. In total, 975 mothers, who could read traditional Chinese and gave birth in 2020 or 2021, were included in the analysis. Data were fitted into the model proposed by the original developers using the confirmatory factor analysis. The data were then randomly split into training and validation sets for exploratory and confirmatory factor analyses. Childbirth experiences were assessed. Factor structure, internal construct validity, internal consistency, and known-group validity were assessed.
The originally proposed CEQ2.0 model showed a poor fit. An exploratory factor analysis identified a revised four-factor model (CEQ2.0-R) on a randomly split sample, which showed a satisfactory fit (CFI=0.912; TLI=0.884; SRMR=.053; RMSEA=0.072) on the other split sample. The revised scale comprised 13 items and four domains: (1)"Own capacity" (6 items), (2) "General support" (3 items), (3) "Perceived safety" (2 items), and (4) "Professional support" (2 items). CEQ2.0-R showed high internal construct validity and reliability. It can differentiate between participants with different characteristics, including parity, oxytocin augmentation, and companionship during labour. The childbirth experiences of the participants were merely positive, and participants reported that more support from midwives is needed.
CEQ2.0-R can adequately describe the childbirth experiences of women in Hong Kong. The questionnaire is easy to be administer and can be used to assess several domains of the childbirth experiences. It may be useful to evaluate the aspects of support needed during childbirth.
In recent decades, there has been a rising tide in CS worldwide with a wide variation in CS rate among various countries from approximately 16% to more than 60%.3 The reasons for the increase in CS ...rates are multiple and complex, but have been attributed to the increasing prevalence of older mothers, rising rates of maternal obesity and medical co-morbidities, and changing medical practice including a relative increased safety of CS itself.4 5 6 7 In addition, there is substantial evidence that this increase is more prevalent among women with privately funded deliveries.8 9 Nevertheless, the dramatic rise in CS rate has not been shown to be accompanied by any substantial decrease in maternal or perinatal morbidity or mortality.10 Malpractice litigation pressure has been suggested as one of the attributes for the rise because associations have been demonstrated between CS rates and malpractice premiums.11 In Hong Kong, the annual CS rate rose steadily from 16.6% to 27.4% from 1987 to 1999, with the rate in private institutions of 27.4% higher than the public sector.9 Published in this issue of the Hong Kong Medical Journal, a retrospective review of CS rates from 1995 to 2014 at a local public hospital by Chung et al12 shows that the overall rate increased modestly from 15.4% to 24.6%. The territory-wide audit conducted by the Hong Kong College of Obstetricians and Gynaecologists has documented an increase in overall CS rates in Hong Kong from 27.1% in 1999 to 30.4% in 2004 and 42.1% in 2009.13 The latest annual obstetric report of the Hospital Authority in 2015 showed CS rates in the eight public hospitals in Hong Kong varying from 21.7% to 30.4%.14 The WHO recently adopted the Robson's classification system as a global standard for assessing, monitoring, and comparing CS rates.2Robson's system classifies women into 10 groups based on five obstetric characteristics that are routinely documented: parity, onset of labour, gestational age, fetal presentation, and number of fetuses. A local cross-sectional survey of 660 Chinese pregnant women in a government-funded obstetric unit in Hong Kong found that previous CS and conception by in-vitro fertilisation were significant determinants of a preference for elective CS.17 In another local retrospective cohort study of twin pregnancies, conception by assisted reproduction was also a statistically significant factor that affected maternal preference for elective CS.18Non-cephalic presentation of the second twin was another statistically significant factor in the study, indicating women's concern for their babies when considering mode of delivery. Obstetric management protocols, skills, and clinical audits can be targeted at reducing first birth by CS, eg external cephalic version in term-breech pregnancies, safe vaginal twin delivery techniques, standardised fetal heart rate tracing interpretation and management, and increasing women's access to non-medical interventions during labour such as labour and delivery support.
Diabetes insipidus is a condition characterised by polyuria and polydipsia with excretion of diluted urine. Transient diabetes insipidus has been reported in pregnancy and is often associated with ...acute fatty liver of pregnancy, pre-eclampsia, HELLP syndrome and multiple pregnancy. Presenting symptoms can be vague. In our case, a primigravida with spontaneous monochorionic diamniotic twin pregnancy presented at 36+3 weeks in early labour. Severe hypernatremia was found in the patient and in both twins after a caesarean section was performed. Transient diabetes insipidus was diagnosed based on paired serum and urine osmolality. The hypernatremia was corrected gradually and 1-deamino-8D-arginine vasopressin was given. A high index of suspicion and early involvement of physicians and paediatricians are needed to avoid catastrophic consequences.
Abstract
We present the prenatal detection of a 1p32.1p31.3 microdeletion (3.46 Mb) by array comparative genomic hybridization (CGH) associated with fetal agenesis of the corpus callosum (ACC) and ...cerebellar vermian hypoplasia. Analysis of cultured amniocytes showed a normal karyotype. Our observations strengthen the association between this locus and central nervous system development. In addition, the fetus reported herein underscores the importance of array CGH analysis when ACC is detected prenatally, especially when there are additional central nervous system anomalies, to search for submicroscopic imbalances which can facilitate further management and parental counselling. Moreover, the presence of urinary tract anomalies should alert the clinician to the possibility of a 1p interstitial deletion, although the absence of such does not exclude it. Further reports will help to provide more information on the long-term outcomes of individuals with such microdeletion as there are only limited data.
We present the prenatal detection of a 1p32.1p31.3 microdeletion (3.46 Mb) by array comparative genomic hybridization (CGH) associated with fetal agenesis of the corpus callosum (ACC) and cerebellar ...vermian hypoplasia. Analysis of cultured amniocytes showed a normal karyotype. Our observations strengthen the association between this locus and central nervous system development. In addition, the fetus reported herein underscores the importance of array CGH analysis when ACC is detected prenatally, especially when there are additional central nervous system anomalies, to search for submicroscopic imbalances which can facilitate further management and parental counselling. Moreover, the presence of urinary tract anomalies should alert the clinician to the possibility of a 1p interstitial deletion, although the absence of such does not exclude it. Further reports will help to provide more information on the long-term outcomes of individuals with such microdeletion as there are only limited data.
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