A qualitative study of pregnant women's perceptions and decision-making regarding COVID-19 vaccination in Thailand

To identify pregnant women's attitudes towards, and acceptance and rejection of, COVID-19 vaccination. This prospective, descriptive, implementation study was conducted in the Antenatal clinic of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 pregnant women were interviewed. Phase II consisted of questionnaire development and data validation. In Phase III, the questionnaire was administered to 400 participants. Pregnant women's attitudes towards and acceptance and rejection of COVID-19 vaccination. Most pregnant women were uncertain about the potential harm of vaccination to themselves or their unborn child, including risks such as miscarriage or premature birth (59-66/101 [58.4%-65.3%]; OR 2.53-8.33; 95% CI 1.23-3.60, 5.17-19.30; P < 0.001) compared to those who disagreed with vaccination. Their vaccination decisions were significantly influenced by social media information regarding vaccination complications in pregnant women (74/101 [73.3%]; OR 15.95; 95% CI 2.15-118.55; P = 0.001) compared to those who disagreed with vaccination. Most pregnant women opined that they should not receive a COVID-19 vaccination during pregnancy (adjusted odds ratio [AOR] 6.57; 95% CI 2.44-17.70; P = 0.001). Most also rejected vaccination despite being aware of its benefits (AOR 17.14; 95% CI 6.89-42.62; P < 0.001). Social media messages and obligatory vaccination certifications influence maternal vaccination decisions. Pregnant women believe vaccination helps prevent COVID-19 infection and reduces its severity. Nevertheless, the primary reason for their refusal was concern about potential harm to their unborn child or themselves during pregnancy.The Thai clinical trials registry: TCTR20211126006.

Maternal complications and risk factors associated with assisted vaginal delivery

OBJECTIVE

This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.

METHODS

We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered.

RESULTS

The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016).

CONCLUSIONS

The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%).

CLINICAL TRIAL REGISTRATION

Thai Clinical Trials Registry: 20220126004.

Identifying the Barriers to Universal Cervical Length Screening for Preterm Birth Prevention at a Tertiary Hospital in Thailand (Physician Perspectives): Implementation Research

Objective: To identify physicians’ views on the barriers to measuring cervical length for preventing preterm deliveries. Materials and methods: This prospective, descriptive implementation study had three phases. In Phase I, 20 physicians were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was distributed to 120 Phase III participants. Results and discussion: All 120 participants responded. In 44 cases, the physicians received support from their local Maternal and Child Health Boards for preterm-birth-prevention programs; the other 76 physicians did not. The doctors tended to believe that cervical length screening plays no role in preventing preterm births (4/44 (9.1%) and 24/76 (31.6%); OR, 4.615; 95% CI, 1.482–14.373; p = 0.005). They were unsure about the correct measurement procedures (13/44 (29.5%) and 37/76 (48.7%); OR, 2.262; 95% CI, 1.028–4.977; p = 0.040). A lack of cost-free drug support (progesterone) for women with short cervices was identified as a barrier to preventing preterm births (30/44 (68.2%) and 32/76 (42.1%); OR, 0.339; 95% CI, 0.155–0.741; p = 0.006). Conclusions: Many physicians are unconvinced that measuring cervical length prevents premature births, and are unsure about the correct measurement procedures. There is a lack of government funding for hormone-usage programs.

Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination: Implementation research

OBJECTIVE

There are few data on lactating women's concerns about receiving COVID-19 vaccination during breastfeeding. This research investigated breastfeeding women's attitudes towards and acceptance or rejection of vaccination.

MATERIALS AND METHODS

This prospective, descriptive, implementation study was conducted in the postpartum ward of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 breastfeeding women in the postpartum ward at Siriraj Hospital who were willing to participate in the study were interviewed. Phase II comprised questionnaire development and data validation. The combined multiple choice and scaling questionnaires designed based on the results from comprehensive interviews of phase I were used in the study. The questionnaire was administered to 400 participants in Phase III.

MAIN OUTCOME MEASURES

Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination.

RESULTS

The vast majority of participants (372/400 [93.0 %]) were vaccinated predelivery. Most of the subgroup of women rejecting vaccination while breastfeeding were unsure whether too frequent vaccination would harm their unborn child (52/99 [52.5 %]; crude odds ratio [cOR], 6.50; 95 % CI, 1.47-28.68; P < 0.001). The level of immunity to the COVID-19 virus did not influence their vaccination decisions (19/99 [19.2 %]; cOR, 2.38; 95 % CI, 1.26-4.47; P < 0.001). Multivariable analysis found a significant association for women agreeing with the proposition that vaccination during pregnancy should not be performed (adjusted odds ratio [aOR], 4.83; 95 % CI, 1.41-16.57; P = 0.043). Most women who rejected vaccination knew its benefits (aOR, 31.84; 95 % CI, 7.16-141.65; P < 0.001).

CONCLUSIONS

Breastfeeding women generally believed that vaccines reduce infection and disease severity. The women's COVID-19 immunity levels did not affect their acceptance or rejection of vaccination. Some mothers rejected vaccination because of concerns about possible harm to them or their newborns.

Neonatal complication of caesarean sections at tertiary center: Siriraj hospital, Bangkok, Thailand

To study the complications of newborns related to caesarean sections, through a review of indications and details of complications occurring in newborns. This was a retrospective and descriptive study. A search of hospital records identified 3500 cases that underwent caesarean sections during 2017-2018. Newborn complications arising from the caesarean sections, and other relevant details were recorded. Neonatal complications were 49.23% (1723/3500). Bruises (a region of injured tissue or skin in which blood capillaries have been ruptured) (11.65%), jaundice (18.29%) and hypoglycaemia (11.91%) were the most common complications of the neonates. In summary, foetal complications were jaundice, transient tachypnea, hypoglycaemia and bruises. As the rate of caesarean sections continues to increase and is difficult to control, unnecessary caesarean section should be reduced and obstetricians must be well trained in performing caesarean sections to reduce neonatal complications.

Prevalence of asymptomatic bacteriuria among Thai diabetic pregnant women

Diabetic pregnant women are susceptible to urinary tract infection, which can result in preterm labor and a low birth weight of the neonate. This was a prospective observational study. In total, 110 diabetic pregnant women between 12-20 weeks of gestation were recruited. Asymptomatic bacteriuria (ASB) was diagnosed when the urinalysis presented a white blood cell (WBC) count ≥ 5 WBCs per high power field (HPF). Urine culture was later performed. Most of the diabetic pregnant women were classified as GDM A1. The prevalence of ASB was 7.2% (8/110 cases). Klebsiella aerogenes was found in only one case from urine culture. ASB was commonly found in the pregnant women with a high BMI, with statistical significance. The prevalence of ASB in the diabetic pregnant women was 7.2%. Urinalysis should be considered for diabetic pregnant women with a high body mass index.

Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor

Background

Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery.

Objective

To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length.

Methods

We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 200/7 and 366/7 weeks' gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated.

Results

Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70).

Conclusions

Cervical length ranging 15-30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice.

Identifying the barriers to universal cervical length screening for preterm birth prevention at a tertiary hospital in Thailand (patient's perspectives): implementation research

PURPOSE

To identify patient perspectives of barriers to cervical length screening to prevent preterm births.

METHODS

In Phase I of this prospective descriptive implementation study, 40 pregnant women of up to 24 week gestation were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was subsequently administered to 400 participants in Phase III.

RESULTS

Most participants (74.3%) realised preterm babies have complications and high care costs (53%). They recognised that premature-birth risk identification enables appropriate pregnancy care (93.8%), but they were unaware that cervical length measurements indicate the risk (59.5%). The participants who were aware wanted to be examined (63.5%) because of concern about preterm birth (95.8%). Husbands were reported to influence decision-making about screening (81.3%) and subsequent treatment (42.5%). If the associated costs were subsidised, the majority of participants (67.3%) would undergo screening.

CONCLUSION

Physicians do not explain ways to prevent preterm births. Government policy on preventing preterm births is not well established. Screening and treatment costs are major barriers.

TRIAL REGISTRATION

Thai Clinical Trials Registry (TCTR) number: TCTR20190813003.

A Randomized Controlled Trial of the Effect of Music During Cesarean Sections and the Early Postpartum Period on Breastfeeding Rates

Objective: The objective of this research was to study the role of music listening by mothers during a cesarean section and the postpartum period to achieve exclusive breastfeeding in the first 6 months. Methods and Study Design: This was a prospective, observational, randomized controlled trial study. A total of 185 singleton pregnant women, in at least 37 weeks of gestation, who were appointed for elective cesarean sections, were recruited. They were randomized into three groups, including pregnant women who did not listen to music (Group 1), listened to music during cesarean section (Group 2), and listened to music during cesarean section and the postpartum room for the first 2 days (Group 3). The breastfeeding results of all three groups were followed up at 7 days, 14 days, and then at months 1, 2, 3, and 6. Results: Success in exclusive breastfeeding among Groups 1, 2, and 3 and Groups 1 and 2 + 3 was not different in every lactating period (7 days-6 months). From subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Mothers who listened to music and had an income of <20,000 baht, an educational level lower than university, planned the pregnancy, had their first pregnancy, and stayed in a private ward had more successful exclusive breastfeeding in a 6-month period than those mothers who did not listen to music, and the difference was statistically significant. Conclusions: Music listening by mothers during a cesarean section and in the postpartum ward did not enhance exclusive breastfeeding during the first 6 months of the postpartum period. However, from subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Thai Clinical Trials Registry number was TCTR20180712001.

Alternative Magnesium Sulfate Dosing Regimens for Women With Preeclampsia: A Population Pharmacokinetic Exposure-Response Modeling and Simulation Study

Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be administered only by skilled health professionals. The objectives of this study were to develop a robust exposure‐response model for the relationship between serum magnesium exposure and eclampsia using data from large studies of women with preeclampsia who received magnesium sulfate, and to predict eclampsia probabilities for standard and alternative (shorter treatment duration and/or fewer intramuscular injections) regimens. Exposure‐response modeling and simulation were applied to existing data. A total of 10 280 women with preeclampsia who received magnesium sulfate or placebo were evaluated. An existing population pharmacokinetic model was used to estimate individual serum magnesium exposure. Logistic regression was applied to quantify the serum magnesium area under the curve‐eclampsia rate relationship. Our exposure‐response model‐estimated eclampsia rates were comparable to observed rates. Several alternative regimens predicted magnesium peak concentration < 3.5 mmol/L (empiric safety threshold) and eclampsia rate ≤ 0.7% (observed response threshold), including 4 g intravenously plus 10 g intramuscularly followed by either 8 g intramuscularly every 6 hours × 3 doses or 10 g intramuscularly every 8 hours × 2 doses and 10 g intramuscularly every 8 hours × 3 doses. Several alternative magnesium sulfate regimens with comparable model‐predicted efficacy and safety were identified that merit evaluation in confirmatory clinical trials.

Associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies

INTRODUCTION

This study aimed to evaluate associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies.

METHODS

A case-control study was conducted among 405 pregnant women with placenta praevia who underwent Caesarean delivery between August 2004 and December 2013. 135 of the women received blood transfusions. Another 270 women who did not receive any blood transfusion were randomly selected and served as controls. Maternal demographic data, reproductive history, antepartum profiles and obstetric outcomes were compared between the two groups.

RESULTS

Women in the case group were significantly more likely to be multiparous, deliver at a gestational age of less than 37 weeks, have a prior Caesarean delivery, experience preoperative bleeding and anaemia, and have major and anterior placenta praevia (p < 0.05). Multivariate analysis demonstrated that significant, independently associated factors of blood transfusion were: previous Caesarean section (adjusted odds ratio [OR] 2.30, 95% confidence interval [CI] 1.36-3.90), anterior placenta praevia (adjusted OR 2.30, 95% CI 1.15-4.60), major placenta praevia (adjusted OR 2.39, 95% CI 1.34-4.22), preoperative bleeding of more than 250 mL (adjusted OR 6.11, 95% CI 2.35-15.90), preoperative anaemia (adjusted OR 2.31, 95% CI 1.34-4.00) and emergency Caesarean section (adjusted OR 2.14, 95% CI 1.08-4.22).

CONCLUSION

Previous Caesarean section, anterior placentation, major placenta praevia, preoperative bleeding of more than 250 mL, preoperative anaemia and emergency Caesarean section were independent factors that increased the risk of blood transfusion for Caesarean section in pure placenta praevia pregnancies.

Population Pharmacokinetic Modeling to Evaluate Standard Magnesium Sulfate Treatments and Alternative Dosing Regimens for Women With Preeclampsia

Magnesium sulfate is the standard therapy for prevention and treatment of eclampsia. Two standard dosing regimens require either continuous intravenous infusion or frequent, large-volume intramuscular injections, which may preclude patients from receiving optimal care. This project sought to identify alternative, potentially more convenient, but similarly effective dosing regimens that could be used in restrictive clinical settings. A 2-compartment population pharmacokinetic (PK) model was developed to characterize serial PK data from 92 pregnant women with preeclampsia who received magnesium sulfate. Body weight and serum creatinine concentration had a significant impact on magnesium PK. The final PK model was used to simulate magnesium concentration profiles for the 2 standard regimens and several simplified alternative dosing regimens. The simulations suggest that intravenous regimens with loading doses of 8 g over 60 minutes followed by 2 g/h for 10 hours and 12 g over 120 minutes followed by 2 g/h for 8 hours (same total dose as the standard intravenous regimen but shorter treatment duration) would result in magnesium concentrations below the toxic range. For the intramuscular regimens, higher maintenance doses given less frequently (4 g intravenously + 10-g intramuscular loading doses with maintenance doses of 8 g every 6 hours or 10 g every 8 hours for 24 hours) or removal of the intravenous loading dose (eg, 10 g intramusculary every 8 hours for 24 hours) may be reasonable alternatives. In addition, individualized dose adjustments based on body weight and serum creatinine were proposed for the standard regimens.

Retrospective analysis of 113 consecutive cases of placenta accreta spectrum from a single tertiary care center

Objective: Placenta accreta spectrum (PAS) remains a major cause of maternal morbidity. We sought to assess the characteristics and treatment outcomes of PAS managed at a tertiary care center with high volume of PAS.Study design: Electronic medical records of all patients with diagnosis of PAS from June 2010 to October 2016 were reviewed. Details of obstetric backgrounds, predelivery diagnosis, peripartum management, and outcomes were analyzed.Results: One hundred thirteen women with PAS were identified from 50,448 deliveries during the study period. Vaginal delivery, emergency, and elective cesarean section were accomplished in 41.6, 30.1, and 28.3%, respectively. There was no maternal mortality. Approximately 41.6% of women with PAS had peripartum hysterectomy. There was a fair inverse correlation between intraoperative blood loss and gestational weeks at delivery (r = -0.311; p=.001), but not gestational weeks at diagnosis (p = .249). Cases with predelivery diagnosis (n = 29) had higher intraoperative blood loss than those diagnosed postdelivery (n = 84) (p<.001). Anterior PAS (n = 58) is associated with attachment to previous uterine scar, antepartum bleeding, and intraoperative blood loss compared to posterior PAS (n = 44) (p<.05). The PAS patients with previous uterine surgery had the highest chance of peripartum hysterectomy (p<.001).Conclusions: Contradictory to previous reports, our data suggest a more severe spectrum of PAS in those with predelivery detection earlier gestational weeks at delivery. Peripartum hysterectomy was highest in anterior PAS that attached to the previous uterine scar.

Psychological effects of fetal diagnoses of non-lethal congenital anomalies on the experience of pregnant women during the remainder of their pregnancy

AIM

The aim of this study was to explore the effects of prenatal fetal diagnoses of non-lethal anomalies on the psychological well-being of pregnant women throughout their pregnancy.

MATERIALS AND METHODS

Fifty-five pregnant women were asked to complete a questionnaire (the Spielberger State-Trait Anxiety Inventory) to assess their anxiety levels at multiple follow-up visits. In-depth interviews were conducted with 20 pregnant women after completion of the questionnaire.

RESULTS

We identified three stages of psychological distress. The intense negative psychological reaction stage was characterized by an intense psychological distress in response to the loss of an ideal child. The psychological healing stage was characterized by the emergence of coping mechanisms and a concomitant decrease in psychological distress. Finally, the intense negative psychological reaction re-emergence stage was characterized by an increase in psychological distress related to uncertainty regarding the future of the baby.

CONCLUSIONS

Following a prenatal diagnosis of a non-lethal anomaly, both the nature and the intensity of the psychological distress experienced by pregnant women change throughout the remainder of their pregnancy. Throughout the remainder of their pregnancy, these women should be offered effective psychological support that accounts for each of the distinct psychological response stages identified in this study.

Predictors for complications in pregnant women with heart disease, a retrospective study

OBJECTIVE

Evaluate the CARPREG score in predicting cardiac, obstetric, and neonatal complications in pregnant women with heart disease.

MATERIAL AND METHOD

This was a retrospective study between 2002 and 2011 at a tertiary care center and included 175 pregnant women with heart disease. Maternal and neonatal outcomes were assessed using Cardiac in Pregnancy Score (CARPREG), which included NYHA-class, systolic ejection fraction, left ventricular obstruction, and history of cardiac events.

RESULTS

Rheumatic heart disease (n = 116, 66.3%) was the predominant cardiac problem. CARPREG score was 0, 1, > 1 in 65.1%, 24.6%, and 10.3% pregnancies, respectively. Maternal cardiac events occurred in 27.4%. CARPREG score > or = 1 was associated with an increased rate of cardiac events [odds ratio (OR) 6.76, 95% confidence interval (CI) 3.26 to 14.01]. Fetal complications occurred 24.4%. Neonatal birth weight < 2,500 g was associated with CARPREG score > or = 1 (OR 2.57, 95% CI 1.29 to 5.11).

CONCLUSION

Maternal cardiac events can be predicted using CARPREG risk index. In Thai population, rheumatic heart disease was the most frequent form of cardiac problems in pregnant women.

Nomogram of placental thickness, placental volume and placental vascular indices in healthy pregnant women between 12 and 20 weeks of gestation

OBJECTIVE

To generate the nomogram of placental thickness, volume, and vascular indices in healthy pregnant women between 12 to 20 weeks of gestation.

MATERIAL AND METHOD

An experimental cross sectional study of pregnant women, which were categorized into nine groups according to their gestational age ranging from 12 to 20 weeks of gestation, was done. Placental parameters that included placental thickness, volume, and vascular indices were measured using a Voluson E8 ultrasound machine. The measurements were correlated with gestational age.

RESULTS

Two hundred ninety four subject were included in this study. The study indicated that the placental thickness and volume significantly increased with gestational age (r = 0.481, p < 0.001 and r = 0.837, p < 0.001). The correlation between the placental volume and gestational age can be formulated according to this equation: Placental volume (cm3) = e7.584-42.45(1/GA); R2 = 0.76. Nonetheless, there is a very low correlation between the vascularization index (VI), vascularization flow index (VFI), and the gestational age (r = 0.162, p = 0.005 and r = 0.158, p = 0.007). The flow index (FI) was shown to have no correlation with gestational age (r(p) = -0.067, p = 0.254).

CONCLUSION

From the present study, the placental thickness and placental volume significantly increased with gestational age. The VI and VFI showed poor correlation with gestational age while the FI had no correlation with the gestational age.

Is the U.S. Institute of Medicine recommendation for gestational weight gain suitable for Thai singleton pregnant women?

OBJECTIVE

To compare the gestational weight gain of healthy Thai singleton pregnant women with the U.S. Institute of Medicine (IOM) recommendation.

MATERIAL AND METHOD

One thousand eight hundredforty nine medical records ofuncomplicated singleton pregnant women who delivered at Siriraj Hospital between January 2007 and November 2010 were reviewed. All subjects were divided into four subgroups according to their pre-pregnancy body mass index (BMI): underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese group (> or =30 kg/m2). Their baseline characteristics and gestational weight gain were collected and reported One-way analysis of variance test was used to compare continuous data and Chi-squared test was used to compare discrete data among groups.

RESULTS

Mean gestational weight gain of normal weight, underweight, overweight, and obese women were 14.2+/-4.7 kg, 14.1+/-4.3 kg, 12.4+/-4.7 kg, and 10.8+/-4.3 kg and gestational weight gain between 25th to 75th percentile were 11.0 to 17.0 kg, 11.0 to 16.5 kg, 10.0 to 15.0 kg, and 8.0 to 13.0 kg for pregnant women with pre-pregnancy normal weight, underweight, overweight and obesity respectively. Significant difference of maternal age, gestational weight gain, neonatal birth weight, and parity were found among groups (p<0.05). About one-thirdofpre-pregnancy normal BMI (39.2%), overweight (36.6%), and obese (31.9%) as well as nearly halfofpre-pregnancy underweight group (47.6%) gained the appropriate weight based on the US.IOM recommendation. About one-third of pre-pregnancy underweight (37.9%) and normal BMI group (30.6%) gained less than the recommendation. Majority of pre-pregnancy overweight (52.3%) and obese (63.8%) group gained more weight than the recommendation.

CONCLUSION

Although pregnancy outcomes were normal, less than half of Thai pregnant women gained the appropriate weight based on the U.S. IOM recommendation.

Effectiveness of cefoxitin on preventing endometritis after uterine curettage for spontaneous incomplete abortion: a randomized controlled trial study

BACKGROUND

There are only few studies concerning the usage of antibiotics in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion and no conclusion can be demonstrated

OBJECTIVE

To investigate the effectiveness of prophylactic cefoxitin in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion.

MATERIAL AND METHOD

Eighty-four women with spontaneous first trimester incomplete abortion were randomly allocated into two groups using a computer-generated random number list and the allocation concealment was maintained using a sealed opaque envelope. The patients in the study group were given 1 g of cefoxitin while the patients in the control group were given 0.1 ml of vitamin B complex intravenously 20 minutes prior to curettage. Uterine curettage was performed after intravenous sedation and analgesic drugs were administered. The patients were evaluated on the first, third and seventh day after uterine curettage.

RESULTS

Seventy-nine cases had completed the study protocol. There were no statistically significant differences in demographic data and details of uterine curettage between both groups. Two cases of endometritis were found in the control group but none in the study group. However the difference did not reach the statistical significance (p = 0.241).

CONCLUSION

Prophylactic cefoxitin is not effective in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion.

Does gestational weight gain in normal pre-pregnancy BMI pregnant women reflect fetal weight gain?

OBJECTIVE

To identify the correlation between gestational weight gain in pregnant women with normal pre-pregnancy body mass index (BMI) and fetal weight gain.

MATERIAL AND METHOD

Uncomplicated normal pre-pregnancy BMI Thai singleton pregnant women with less than 16 weeks' gestation participated in this study between June 2008 and September 2009. Serial measurements of maternal and fetal weight using ultrasound examination were recorded every four weeks from 16 to 36 weeks' gestation.

RESULTS

Two hundred seventy four uncomplicated pregnant women were included in this study of which 166 met inclusion criteria during a period of the study. There was a significant correlation between gestational weight gain and both estimated fetal weight gain and actual infant birth weight (p < 0.05). Using the multiple regression analysis, gestational weight gain between 16 to 28 weeks' gestation, multiparity, and male infants were independent factors and were significantly correlated with both fetal weight gain and actual infant birth weight (p < 0.05).

CONCLUSION

For pregnant women with normal pre-pregnancy BM, gestational weight gain can predict intrauterine fetal weight as well as infant birth weight.

A novel method to derive amniotic fluid stem cells for therapeutic purposes

Background

Human amniotic fluid stem (hAFS) cells have become an attractive stem cell source for medical therapy due to both their ability to propagate as stem cells and the lack of ethical debate that comes with the use of embryonic stem cells. Although techniques to derive stem cells from amniotic fluid are available, the techniques have limitations for clinical uses, including a requirement of long periods of time for stem cell production, population heterogeneity and xeno-contamination from using animal antibody-coated magnetic beads. Herein we describe a novel isolation method that fits for hAFS derivation for cell-based therapy.

Methods and Results

With our method, single hAFS cells generate colonies in a primary culture of amniotic fluid cells. Individual hAFS colonies are then expanded by subculturing in order to make a clonal hAFS cell line. This method allows derivation of a substantial amount of a pure stem cell population within a short period of time. Indeed, 10⁸ cells from a clonal hAFS line can be derived in two weeks using our method, while previous techniques require two months. The resultant hAFS cells show a 2-5 times greater proliferative ability than with previous techniques and a population doubling time of 0.8 days. The hAFS cells exhibit typical hAFS cell characteristics including the ability to differentiate into adipogenic-, osteogenic- and neurogenic lineages, expression of specific stem cell markers including Oct4, SSEA4, CD29, CD44, CD73, CD90, CD105 and CD133, and maintenance of a normal karyotype over long culture periods.

Conclusions

We have created a novel hAFS cell derivation method that can produce a vast amount of high quality stem cells within a short period of time. Our technique makes possibility for providing autogenic fetal stem cells and allogeneic cells for future cell-based therapy.

Maternal body mass index at term does not predict the severity of preeclampsia

OBJECTIVE

Maternal pre-pregnancy weight is a risk of developing preeclampsia. Whether it is also associated with the disease severity is still elusive. This retrospective cohort was to determine the association between body mass index (BMI) at term and severity of preeclampsia.

MATERIAL AND METHOD

BMIs on the delivery date of 229 patients were analyzed with various indicators of the disease severity. The corrected BMI (cBMI), calculated by an exclusion of feto-placental unit, was additionally analyzed.

RESULTS

Neither maternal BMI nor cBMI correlated with the disease severity (p = 0.15 and 0.36). Patients who did and did not require MgSO4 do not have different BMI or cBMI (p = 0.12 and 0.23). Neonatal weight from severe disease arm does not differ from those with mild disease (p = 0.51). Counter-intuitively the correlations between birth weight and maternal BMI were stronger in the severe compared to the mild group (p = 0.0 and 0. 03).

CONCLUSION

Neither BMI nor cBMI at the time of delivery predict the severity of preeclampsia or the need for seizure prophylaxis. Birth weight of the baby born from preeclamptic mother might be affected by multiple factors.

Relieving perineal pain after perineorrhaphy by diclofenac rectal suppositories: a randomized double-blinded placebo controlled trial

BACKGROUND

Perineal pain after episiotomy is a common problem following vaginal birth. The pain affects either physical or mental function negatively. There are many methods in perineal pain relief such as local ice pack and a bath, ultrasound, oral anesthesia, and intravenous anesthesia. Analgesic rectal suppository is one of various methods in pain relief especially in drowsy patients, or when oral preparation causes gastric discomfort, nausea or vomiting.

OBJECTIVE

To assess the effectiveness of diclofenac rectal suppositories for relief perineal pain after perineorrhaphy.

DESIGN

A randomized double-blinded placebo controlled trial.

MATERIAL AND METHOD

Seventy-two term, singleton, pregnant women who gave vaginal birth with second to third degree episiotomy tears were randomized with envelop concealment to either diclofenac or placebo rectal suppositories group. Each group received two tablets of 50 mg diclofenac or two tablets of look-alike placebo rectal suppositories. Visual analogue scale was used for scaling pain score before administration of the medications, and at 30 minutes, 1, 2, 12, and 24 hours after administration.

RESULTS

No differences were found in the median pain scores before administration of medications and at 30 min, 1 hour and 2 hour after administration (p > 0.05), while the median pain scores were significantly reduced in the diclofenac group at 12 and 24 hours after administration compared to the control group (4.5 vs. 0.0; p < 0.001 and 2.0 vs. 0.0; p = 0.02 for 12 hours and 24 hours, consecutively).

CONCLUSION

The present study suggested that diclofenac suppository was effective on reducing perineal pain after episiotomy, especially at 12 and 24 hours after administration.

Prevalence and associate factors for striae gravidarum

OBJECTIVE

To determine the prevalence and associate factors for striae gravidarum in Thai pregnant women.

STUDY DESIGN

Cross-sectional study.

MATERIAL AND METHOD

Two hundred and eighty women who gave first birth and were admitted to the postpartum wards in Siriraj Hospital were recruited. All of them were assessed during the immediate postpartum period for having striae gravidarum or not by the physician. The questionnaire was used to interview the participants for all of the information needed in the present study. The participants with striae gravidarum and the other without striae gravidarum were compared to characteristics of women using unpaired student t test and Chi-square tests.

RESULTS

Seventy-seven percent of the study participants had developed striae gravidarum. Women who developed striae gravidarum were significantly younger (22.8 yr +/- 4.0 yr vs. 26.6 yr +/- 6.0 yr; p < 0.05), higher pre-pregnancy BMI (21.2 kg/m2 +/- 4.1 kg/m2 vs. 19.8 kg/m2 +/- 4.8 kg/m2; p < 0.05), higher maternal BMI at pregnancy (27.3 kg/m2 +/- 4.7 kg/m2 vs. 25.6 kg/m2 +/- 6.0 kg/m2; p < 0.05), higher gestational age at delivery (39.1 wk +/- 1.3 wk vs. 38.6 wk +/- 1.1 wk; p < 0.05), higher birth weight of baby (3,078.8 g +/- 411.4 g vs. 2,895.8 g +/- 339.2 g; p < 0.05), alcoholic drinker (91.4% vs. 8.6%; p < 0.05), had a little water intake (7.4 glasses +/- 2.7 glasses vs. 8.3 glasses +/- 3.1 glasses; p < 0.05), and had a family history of striae gravidarum (82.8% vs. 17.2%; p < 0.05) were associated with striae gravidarum.

CONCLUSION

Maternal age, pre-pregnancy BMI, maternal BMI at delivery, gestational age at delivery, birth weight of baby, alcoholic drinking, water intake and family history were associated with striae gravidarum.

Satisfaction of healthy pregnant women receiving short message service via mobile phone for prenatal support: A randomized controlled trial

OBJECTIVE

The main objective was to compare the satisfaction levels of antenatal care between healthy pregnant women who received short message service (SMS) via mobile phone for prenatal support, and those who did not. The second objective was to compare the confidence, anxiety levels and also pregnancy outcomes.

DESIGN

A randomized controlled trial.

MATERIAL AND METHOD

68 healthy pregnant women who attended the antenatal clinic and delivered at Siriraj Hospital, who met the inclusion criterias between May 2007 and October 2007, were enrolled and randomly allocated into two random groups. The study group received two SMS messages per week from 28 weeks of gestation until giving birth. The other group was pregnant women who did not receive SMS. Both groups had the same antenatal and perinatal care. The satisfaction, confidence and anxiety scores were evaluated using a questionnaire at the postpartum ward. The pregnancy outcomes were also compared in these two groups.

RESULTS

The satisfaction levels of the women who received prenatal support in SMS messages, were significantly higher than those of who did not receive the messages both in the antenatal period (9.25 vs. 8.00, p < 0.001) and during labor (9.09 vs. 7.90, p = 0.007). In the SMS using group, the confidence level was'higher (8.91 vs. 7.79, p = 0.001) and the anxiety level was lower (2.78 vs. 4.93, p = 0.002) than the control group n the antenatal period, however no diference in pregnancy outcomes were found.

CONCLUSION

The present study shows the higher satisfaction level of pregnant women who received SMS via mobile phone during their antenatal service when compared with the general antenatal care group. The study also show the higher confidence level and lower anxiety level in the antenatal period but no difference in pregnancy outcomes.

The effect of pre-pregnancy weight on delivery outcome and birth weight in potential diabetic patients with normal screening for gestational diabetes mellitus in Siriraj Hospital

OBJECTIVE

To investigate the influence of pre-pregnancy weight on delivery outcome and birth weight in potential diabetic women with normal glucose tolerance.

DESIGN

Retrospective Cohort study.

MATERIAL AND METHOD

The medical records of 660 pregnant women, who attended the antenatal clinic and delivered at Siriraj Hospital between January 2003 and December 2005, were reviewed and analyzed. They all had the known pre-pregnancy weight and were at risk of gestational diabetes with the normal glucose tolerance. Any pregnant women without pre-pregnancy weight recorded were excluded from the present study. They were classified into two groups according to the pre-pregnancy BMI, one was the overweight group (BMI > or = 27 kg/m2) and the other was the normal weight group (BMI 20-25 kg/m2). Information of the complications of pregnancy, the route of delivery, birth weight, and neonatal outcomes were collected and analyzed.

RESULTS

The risks of adverse pregnancy outcomes in overweight women, after adjusting for the confounding factors, were significantly increased, including pre-eclampsia (OR 3.87, 95% CI 2.09-7.25, p < 0.001), cesarean delivery (OR 2.22, 95% CI 1.45-3.39, p < 0.001), cephalopelvic disproportion (OR 2.15, 95% CI 1.35-3.42, p = 0.001), and macrosomia (OR 7.59, 95% CI 1.98-29.09, p < 0.001).

CONCLUSION

Even though the screening test for gestational diabetes mellitus is normal, the overweight women still have several adverse pregnancy outcomes.

Predicting fetal anemia by using reference centile charts for liver length, spleen perimeter and umbilical vein maximum flow velocity in Thai fetuses throughout gestation

AIM

To create reference centile charts for liver length, spleen perimeter and umbilical vein maximum flow velocity (UVVmax) in Thai fetuses in order to predict fetal anemia in Thai fetuses.

METHODS

The study was a prospective, cross-sectional study, carried out at the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University. A total of 780 pregnant women between 13 and 40 weeks' gestation, who attended the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited. Each fetus was measured only once for the purpose of this study. The mean and standard deviation (SD) were estimated at each week of gestation using linear regression modeling. A total of 752 fetuses were measured for fetal liver length, spleen perimeter and UVVmax. Linear regression models were fitted to estimate the mean 95% confidence interval for liver length, spleen perimeter and UVVmax at each gestational age. The centile charts of those parameters were also presented.

CONCLUSION

Reference centile charts for fetal liver length, spleen perimeter and UVVmax of Thai fetuses were created.

Menopausal symptoms and knowledge towards daily life and hormone replacement therapy among menopausal women in Bangkok

OBJECTIVE

To evaluate prevalence and intensity of menopausal symptoms, knowledge towards daily life and hormone replacement therapy (HRT) among natural menopause women in Bangkok.

DESIGN

Cross-sectional, descriptive study.

MATERIAL AND METHOD

One hundred and sixty two natural menopause women who attended the health seminars or exhibitions except topics about menopause and HRT in Siriraj Hospital from March - June 2005. Targeting women were asked to fill out the structured questionnaires. Data concerning personal history, menopausal symptoms, knowledge of menopause, HRT and daily life in menopause were collected.

RESULTS

A total of 148 questionnaires (91.4%) were completed for the analyses. Of 148 women, 141 (95.3%) had menopausal symptoms. The most common and most severe menopausal symptom was muscle and joint pains (84.5% and 23.0%, respectively). The majority of the women understood correctly regarding knowledge about menopause issue and daily life during menopause (80.6% and 89.2%, respectively). Although 51.1% of the women showed their knowledge about HRT correctly, only 8.1% were currently using HRT. The main reasons for this low percentage of HRT use were ability to tolerate the menopausal symptoms (49.0%) and lack of correct knowledge about HRT (48.9%).

CONCLUSION

The most common and also the most severe menopausal symptom in natural menopause women was muscle and joint pains. Most of them demonstrated their correct understandings about menopause issue and daily life in menopause and half of them demonstrated their correct understandings about HRT.

Dysmenorrhea in Thai adolescents: prevalence, impact and knowledge of treatment

OBJECTIVE

To determine the prevalence of dysmenorrhea, impact on school attendance, academic performance, social activities and knowledge of treatment in Thai adolescents.

DESIGN

Cross-sectional, descriptive study.

SETTING

Nakhorn Pathom Ratjabhat University, Nakorn Patom, Thailand.

SUBJECTS

A total of 789 women who were 1st and 2nd year students from Nakhorn Pathom Ratjabhat University, Nakorn Patom, Thailand.

MATERIAL AND METHOD

Subjects were asked to complete the 35 items anonymous questionnaire handed out by the researchers. The questionnaire included data regarding the social data, menstrual pattern, severity and duration of menstrual pain, impact of dysmenorrhea on school attendance, academic performance and social activities. The methods, knowledge of pain relief and medications used to treat dysmenorrhea were also asked.

RESULTS

The prevalence of dysmenorrhea were 84.2%. The most common symptoms were stomach cramp (78.0%), backache (58.9%) and mood change (56.9%). Only 31 (4.7%) had severe dysmenorrhea. The factors associated with dysmenorrhea were age at menarche (p < 0.05) and body mass index (p < 0.05). More than 60% of dysmenorrheic women reported that their class concentration was affected, Paracetamol was the drug known to 98.8% of participants with dysmenorrhea that help to relief their dysmenorrhea.

CONCLUSION

Dysmenorrhea is a significant public health problem. It has an impact on academic activities. Most of the subjects know that Paracetamol is the drug that help to relief their symptoms.

Reference centile charts for ratio of fetal transverse cerebellar diameter to abdominal circumference in a Thai population

OBJECTIVE

To establish the centile chart for the ratio of transverse cerebeller diameter to abdominal circumference throughout pregnancy from 13-40 weeks.

DESIGN

Cross-sectional study.

SETTING

Department of Maternal - Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University.

SUBJECTS

The participants are women with gestational age between 13 and 40 weeks who attend Antenatal Clinic, Siriraj Hospital.

MATERIAL AND METHOD

A total of 643 pregnant women were recruited in this study. The exclusion criteria were uncertained date of last menstrual period, multiple pregnancies, fetal abnormalities and maternal conditions which could affect fetal growth. Transverse cerebellar diameter and abdominal circumference of all the subjects were measured out by gestational age. The approximately equal numbers of fetuses were measured at each week of gestation. The mean and standard deviation of TCD/AC ratio is estimated at each week of gestation. In addition the 5th, 10th, 50th, 90th and 95th percentiles were calculated at each week of gestation.

RESULTS

Of 643 pregnant women, 149 (23.1%) were scanned before 20 weeks of gestation and 286 (44.5%) were scanned between 20 and 30 weeks of gestation. The last group was intervened after 30 weeks of gestation. TCD/AC ratio slowly declined from early pregnancy until about 20 weeks then remained stable. After 30 weeks of gestation it started to decline again.

CONCLUSION

The normal reference value of TCD/AC ratio in Thai fetus were shown in this study. This ratio can be used to calculate gestational age in intrauterine growth restriction fetus.

Double-blind randomized comparison of xylocaine and saline in paracervical block for diagnostic fractional curettage

Comparative study of the level of the reported pain between patients who received xylocaine and normal saline for paracervical block during fractional curettage was carried out in 70 patients in a double blind randomized controlled trial. One group of patients received xylocaine for paracervical block just before the procedure was performed while the other group received normal saline in the same manner. Self-reported pain intensity using visual analog scale was assessed at four time points including the first time point when Allis tissue forceps was applied on the cervix, the second and third time points when curettage was done on the endocervix and in the endometrial cavity respectively. The last time point was evaluated at 30 minutes after the procedure. The results of the study revealed pain occurring in patients in the normal saline group was more severe than those in the xylocaine group with statistically significant difference at the second time point (visual analog scale 4.80 +/- 2.7 in the normal saline group compared to 3.20 +/- 2.4 in the xylocaine group, p < 0.05) and third time point (visual analog scale 8.17 +/- 2.0 in the normal saline group compared to 4.94 +/- 3.1 in the xylocaine group, p < 0.05 ). On the contrary, pain occurring in patients in the normal saline group and xylocaine group was not statistically significantly different at the first time point (visual analog scale 3.62 +/- 2.7 in the normal saline group compared to 3.97 +/- 2.8 in the xylocaine group, p > 0.05) and the fourth time point (visual analog scale 1.34 +/- 2.0 in the normal saline group compared to 1.57 +/- 2.6 in the xylocaine group, p > 0.05). Before this study, there was an idea that normal saline solution could be considered for the paracervical injection solution. The explanation for this was the local anesthetic mechanism may be from distension of nerve capsules rather than blockage of specific autonomic nerves. However, this study showed that nerve capsule distension is not the only factor for pain control in paracervical block. An analgesic agent is still an important factor.

Risk factors for birth before arrival at Siriraj Hospital

OBJECTIVE

To assess the potential risk factors for birth before arrival at Siriraj Hospital.

STUDY DESIGN

Prospective case-control study.

SETTING

Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University.

SUBJECTS

The subjects were 320 patients who had delivered at Siriraj Hospital and were divided into two groups. One hundred and sixty patients, who gave birth before admission to the labor room of Siriraj Hospital, were assigned as the study group. The control group consisted of 160 patients who had normal deliveries in the labor room of Siriraj Hospital at the same period of time.

INTERVENTION

Information was obtained by interviewing the patients. Both the interviewer and the subjects were blinded to each other. The data were analyzed by using logistic regression model and EpiInfo program.

MAIN OUTCOME MEASURE

Information of antenatal care, socio-economic data, past obstetric history and present data of delivery.

RESULTS

The six significant risk factors were identified; education level of the patients (odds ratio 6.11), past history of previous delivery (odds ratio 6.18), past history of preterm delivery (odds ratio 4.03), no antenatal care (odds ratio 8.55), unawareness of true labor symptoms (odds ratio 1.89) and present preterm delivery (odds ratio 2.99).

CONCLUSION

The risk factors identified from this study were low education level, past history of previous delivery, past history of preterm delivery, no antenatal care, unawareness of symptoms of true labor and present preterm delivery. The risk factors from this study should have further study to get more information that can apply to control birth before arrival.

Morbidity and mortality from birth before arrival at Siriraj Hospital

OBJECTIVE

To identify maternal and infant morbidity and mortality from birth before arrival at Siriraj Hospital.

STUDY DESIGN

Prospective case-control study.

SETTING

Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University.

SUBJECTS

Three hundred and twenty patients, who had delivered at Siriraj Hospital, were divided into two groups. The study group consisted of 160 patients, who gave birth before admission to the labour room of Siriraj Hospital. The control group consisted of 160 patients, who had normal deliveries in the labour room of Siriraj Hospital at the same period of time.

INTERVENTION

Interviewing the patients and reviewing the medical records of the mothers and infants from both groups. The data were analyzed by using the EpiInfo program.

MAIN OUTCOME MEASURE

Maternal and infant characteristics after delivery, maternal and infant outcomes including puerperal morbidity, low birth weight, perinatal death and infant morbidity.

RESULTS

The study showed that the mothers in the study group had to stay in the hospital longer than the control group (3.9 +/- 2.5 days and 3.6 +/- 1.3 days respectively, p < 0.05). The infants in the study group also had to stay in the hospital longer than the control group (5.1. +/- 6.5 days and 3.3 +/- 1.7 days respectively, p < 0.001). The birth weights of infants in the study group were significantly lower than in the control group (2,753.4 +/- 594.1 grams and 3,016.6 +/- 405.0. grams respectively, p < 0.001). The body temperature of the newborns in the study group were also lower than in the control group (36.2 +/- 0.6 degree Celsius and 37.0 +/- 0.4 degree Celsius respectively, p < 0.05). Concerning maternal and infant outcomes, all variables including low birth weight,perinatal death and infant morbidity were better in the control group significantly (p < 0.05) except for puerperal morbidity that had no significant difference (p = 0.77).

CONCLUSION

From the present study, the authors confirmed the higher mortality and morbidity rate of infants who were born unexpectedly before hospital admission. However, there was no difference in morbidity between the mothers of both groups.

Increasing trend of illicit drug abuse in Thai parturient at Siriraj Hospital

OBJECTIVE

To report the magnitude of the problem and to evaluate the outcome of maternal illicit drug use in Thai parturients.

DESIGN

Retrospective case-control study.

SETTING

Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University.

SUBJECT

The subjects were 44,640 parturients who had deliveries at Siriraj Hospital from January 1998 to December 2001 and were divided into two groups. The study group consisted of 66 parturients with a history of illicit drug use and the control group consisted of 44,574 parturients without a history of illicit drug use.

INTERVENTION

Medical records of 66 parturients with a history of illicit drug use were reviewed. Obstetric statistics of the department were retrieved from the computerized database in the Division of Obstetric and Gynecologic Registry. The data were analyzed using descriptive statistics.

MAIN OUTCOME MEASURE

Characteristics of parturients, pregnancy outcome, type and incidence of illicit drug.

RESULTS

Within the study period, 66 cases of maternal illicit drug use were identifiable during the intrapartum period; 65 cases used amphetamine or derivatives and 1 case used an opioid derivative. The number had risen from 1 case in 1998 to 58 cases in 2001. Mean age of the patients was 23.30 +/- 6.04 years. Compared to the control group which included 44,574 parturients, the patients had a lower incidence of antenatal care (ANC rate = 21.21% vs 94.35%; RR = 0.23, 95% CI = 0.14-0.26), a higher incidence of HIV infection (10% vs 2%; RR = 6.09, 95% CI = 2.83-13.12), a higher incidence of birth before arrival (BBA rate = 9.09% vs 1.06%; RR = 8.59, 95% CI = 3.98-18.51), and a lower cesarean section rate (10.60% vs 26.36%; RR = 0.40, 95% CI = 0.20-0.81). There were no serious intrapartum, immediate postpartum and neonatal complication. Fetal outcome included a higher incidence of low birth weight infants (22.73% vs 10.23%; RR = 2.22, 95% CI = 1.42-3.46) and a smaller head circumference than the normal range of Thai fetal biometry (31.85 +/- 1.47 cm).

CONCLUSION

There is an increasing trend of illicit drug use in Thai parturients. Although the present case series of drug abuse in Thai parturients cannot give the whole picture of maternal drug abuse in the Thai population, the dramatic increase in the identifiable cases during the past 4 years is very alarming. Currently, the outcome of pregnancy in case detected during intrapartum is not much different from that in the general population. However, there are potential risks for the patients and their babies. All medical staffs should be aware of this condition. Careful clinical data gathering and laboratory testing are suggested for prevention of complications and the potential hazards of this problem.

Placental ratio and fetal growth pattern

INTRODUCTION

Placental hypertrophy and reduced fetal growth have been postulated to be an adaptation to maintain placental function in pregnant women with complications such as malnutrition. If this is true, a pregnancy with impaired fetal growth, resulting in a small for gestational age (SGA) infant, should have an increased placental weight to birthweight ratio (placental ratio) compared to those with appropriate for gestational age (AGA) or large for gestational age (LGA) infants.

OBJECTIVES

To determine the relationship between placental ratio and fetal growth pattern.

MATERIAL AND METHOD

Labour and delivery data of 1000 deliveries in the Department of Obstetrics & Gynecology, Siriraj Hospital from January 2001 to June 2001 were retrospectively studied to compare the placental ratios among pregnancies with SGA, appropriate for gestational age (AGA) and large for gestational age (LGA) infants.

RESULTS

From 96 SGA, 804 AGA and 100 LGA cases, a higher placental ratio was found in the SGA group compared to AGA (0.2074 and 0.1985 respectively, p = 0.013). However, actual placental hypertrophy was not found as demonstrated by a lower placental weight in SGA compared with AGA pregnancies of the same birthweight range. There was no significant difference in placental ratio between the LGA and AGA group, the ratios being 0.2020 and 0.1985 respectively (p = 0.260). Although a positive correlation between placental weight and birthweight was observed in the AGA and LGA groups, it was not demonstrated in the SGA infants. This might influence the placental ratio in the SGA group.

CONCLUSION

SGA pregnancies are associated with an increased placental ratio which appears not to be due to placental hypertrophy. As reduced birthweight has been shown to be correlated to diseases in adult life, whether this association between SGA and an increased placental ratio will have an implication in future obstetric care and prediction of diseases in adult life remains to be elucidated.

Trihydroxyethylrutosides in the treatment of hemorrhoids of pregnancy: a double-blind placebo-controlled trial

The safety and efficacy of Trihydroxyethylrutosides (HR) in the treatment of 53 patients with 1st-2nd degree hemorrhoids of pregnancy (16th-34th week) was investigated in a double-blind randomised, placebo controlled trial. The dosage of Trihydroxyethylrutosides was 1 tablet of 300 milligrams twice daily for the first 2 weeks. If the treatment was successful, the treatment was stopped. If the clinical signs or symptoms still persisted, the treatment was continued for another two weeks using the same dosage and re-evaluated at the end of the fourth week after initial treatment. The parameters for efficacy were symptoms (pain, bleeding, exudation and pruritus) and the objective signs on proctoscopy (bleeding, inflammation and dilatation of the hemorrhoidal venous plexus). The study revealed improvement of symptoms in the study group which was better than in the control group after 2 weeks of treatment but the clinical signs were not different. After a further 2 weeks of treatment, the result showed improvement of both clinical signs and symptoms in this study. Only one mild transient side effect was reported in the HR group and there were no drug-related problems in the pregnancies, delivery or the babies.

A comparison of clinical and ultrasound estimation of fetal weight

The accuracy of clinical and ultrasound estimation of fetal weight was compared by an analytical cross sectional study. 266 pregnant women who were admitted to the labour room, Siriraj Hospital during the period from February 1, 1999 to March 1, 1999 were included in this study. Fetal weight was estimated in all pregnant women clinically by 2nd year resident physicians and 6th year medical students, followed by ultrasound estimation within 24 hours before delivery. Every estimation was blinded from each other. From the study, clinical estimation by 2nd year resident physicians was comparable with ultrasound estimation and both were significantly more accurate than estimation by 6th year medical students. The proportions of accuracy were 66.7 per cent, 63.3 per cent and 55.3 per cent respectively. Clinical estimation by 2nd year resident physicians tended to have equally over- and underestimation. On the contrary, ultrasound estimation tended to underestimate when the method was inaccurate. Among infants with a birth weight less than 2,500 grams, ultrasound estimation performed slightly better than clinical estimation. However, every method underestimated the fetal weight when an infant weighed more than 4,000 grams. In conclusion, accuracy of clinical estimation of fetal weight by 2nd year resident physicians was comparable to that of ultrasound estimation and may be used as an alternative to ultrasound estimation for pregnant women. However, when the clinical estimate of fetal weight is less than 2,500 grams, ultrasound estimation should be performed for more accurate results and also for assessment of other abnormalities. Careful attention should be paid to infants with a birth weight of more than 4,000 grams since no method can correctly estimate the fetal weight and physicians should be aware of birth trauma.

Charts of Thai fetal biometries: 3. Femur length

A cross-sectional study was conducted in order to construct a new reference chart for Thai fetal femur length (FL). A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were enrolled. Measurements were made once at a randomly assigned gestational age specifically for the purpose of this study only. Femur length data were available in 608 measurements due to unfavorable fetal position in some cases. Linear regression technique was used to model separately the mean and standard deviation as functions of gestational age. Reference centiles were constructed from a combination of both models, assuming the data were normally distributed. A new reference centiles chart for FL is presented and compared with previously published data. While our derived centiles were clearly lower than those from Western studies, they were found comparable with those from a Thai study. This demonstrated the important effect of racial differences between populations on fetal biometries and elucidates the need to develop fetal biometries charts specifically for each region.

Charts of Thai fetal biometries: 4. Abdominal circumference

A cross-sectional study was conducted in order to construct a new reference chart for Thai fetal abdominal circumference (AC). A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were recruited. Measurements were made once at a randomly assigned gestational age specifically for the purpose of this study only. Due to unfavorable fetal position in some cases, AC data were available in 615 measurements. Linear regression models were fitted separately to estimate the mean and standard deviation as functions of gestational age. Reference centiles were constructed from both equations, assuming the data were normally distributed. A new reference centiles for AC is presented and compared with previously published data. Our derived centiles were lower than those from Western studies which may partly be due to racial differences. This emphasizes the need to develop fetal biometries charts specifically for each region.

Charts of Thai fetal biometries: 2. Biparietal diameter

A cross-sectional study was conducted in order to construct a new reference chart for Thai fetal biparietal diameter (BPD). A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were recruited. Measurements were made once at a randomly assigned gestational age specifically for the purpose of this study only. Due to unfavorable fetal position in some cases, BPD data were available in 613 measurements. Linear regression models were fitted separately to estimate the mean and standard deviation as functions of gestational age. Reference centiles were constructed from both equations, assuming the data were normally distributed. A new reference centiles chart for BPD is presented and compared with previously published data. Our derived centiles were clearly lower than those from Western studies showing the importance of racial differences between populations. This elucidates the need to develop fetal biometries charts specifically for each region.