L.C. Poon's research while affiliated with Prince of Wales Hospital, Hong Kong and other places

( Acta Obstet Gynecol Scand. 2023;102:1014–1025) The COVID-19 pandemic has profoundly impacted various aspects of life, posing risks not only to physical health but also to mental well-being. Psychological effects such as stress, anxiety, and depression are prevalent, particularly among pregnant women, with potential repercussions for pregnancy outcomes. This study explored the sociodemographic and psychological factors during the COVID pandemic that affected the mood of pregnant Czech women. Conducted through the MindCOVID study, our survey included 1830 pregnant women, utilizing standardized instruments (GAD-7 and PHQ-9) to assess anxiety and depression. The study focused on culturally specific characteristics and risk factors for mental disorders, providing valuable insights for effective multidisciplinary health care planning.

Objectives Well‐established clinical practice to assess progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for women. In this study, our aim is to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, psAOP, HPD and SCD to monitor labor progress in women undergoing induction of labor (IOL). We also aim at determining if ultrasound can reduce women's pain during examinations. Methods Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 ⁺⁰ and 41 ⁺⁶ weeks’ gestation. A baseline combined transabdominal and transperineal scan was performed, including the assessment of fetal biometry, umbilical artery and middle cerebral artery Dopplers, amniotic fluid index (AFI), fetal spine and occiput positions, psAOP, HPD, SCD, and cervical length. Intrapartum scans were performed instead of VEs according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score from 0 – 10 (with 0 representing no pain) during assessment. The repeated measures data were analyzed by mixed effect models to identify the significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery. Results 223 intrapartum ultrasound scans with a median of 2 scans per participant (interquartile range (IQR) = 1 – 3), and 151 VEs were performed with a median of 1 per participant (IQR = 0 – 2). There were no adverse fetal or maternal outcomes. After excluding those with epidural anesthesia during examination, median pain score for intrapartum scan was 0 (IQR = 0 – 1) and 3 for VE (IQR = 0 – 6). Cesarean delivery and epidural anesthesia were significantly associated with slower rate of change in psAOP, HPD and SCD. Maternal height, parity and neonatal birth weight did not affect ultrasound measurements of labor progress. Conclusions Comprehensive transabdominal and transperineal ultrasound assessment can be successfully used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and VE examinations during labor. This article is protected by copyright. All rights reserved.

Objectives To compare longitudinal changes in cervical length (CL) and mean cervical shear wave elastography (CSWE) scores between women with singleton and twin pregnancies who experience spontaneous preterm birth (sPTB) and those who have term births (TB). Methods This was a prospective longitudinal study of 1264 unselected women with singleton (n=1143) and twin (n=121) pregnancy attending a dedicated research clinic for screening of sPTB at 4 timepoints during pregnancy including 11‐15 ⁺⁶ (visit 1), 16‐20 ⁺⁶ (visit 2), 21‐24 ⁺⁶ (visit 3) and 28‐32 ⁺⁶ (visit 4) weeks of gestation. At each visit, a transvaginal ultrasound scan was conducted to measure the CL and the CSWE scores from six regions of interest (ROI) (inner, middle, and external parts of anterior and posterior lips) in the cervix. The mean of CSWE scores from the six ROIs were calculated for data analysis. Log 10 transformation was applied to make the data Gaussian prior to statistical analysis. A multilevel mixed‐effects analysis was performed to compare CL and CSWE longitudinally between sPTB and TB groups. Results A total of 57 (4.99%) singleton pregnancies and 33 (27.27%) twin pregnancies were complicated with sPTB. Women with sPTB had shorter CL across gestation when controlling for history of cervical surgery, number of fetuses, gestational age at cervical assessment (GA), and the interaction between GA and sPTB. CL in the sPTB group was significantly lower than that of the TB group at 21–24 ⁺⁶ weeks (p=0.039) and 28–32 ⁺⁶ weeks (p<0.001). Twin pregnancies had significantly longer CL throughout pregnancy, compared to singleton pregnancies (coefficient=0.01864, p<0.001). Furthermore, after adjusting for maternal age, weight, height, body mass index (BMI), and GA, CSWE scores in sPTB group were significantly lower in the sPTB group across gestation, compared to the TB group (1.28265 vs 1.32832; p=0.013). However, in the individual visit analysis, CSWE scores in the sPTB group were significantly lower than that of the TB group only at 11–15 ⁺⁶ weeks (p=0.013). There was no difference in CSWE scores between singleton and twin pregnancies throughout pregnancy (coefficient=‐0.00128, p=0.937). Conclusion Women with sPTB have shorter CL and softer cervix across gestation when compared to those with TB. In the individual visit analysis, the reduction in CL in the sPTB group occurs from late second trimester onwards, while the reduction in cervical stiffness in the sPTB group is observed primarily in the first trimester. Additionally, our study has found that CL is significantly shorter in singleton pregnancies compared to twin pregnancies, while cervical stiffness does not differ between the two types of pregnancy. Our findings indicate that the cervix tends to undergo a softening process prior to shortening in the sPTB cases This article is protected by copyright. All rights reserved.