Transabdominal chorionic villus sampling: experience at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To describe the experience of transabdominal chorionic villus sampling (CVS) at Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: Between January 2004 and July 2006, 185 pregnant women chose to have CVS for prenatal diagnosis after counseling. Transabdominal CVS under ultrasound guidance was performed in all cases under local anesthesia using spinal needle 20-gauge with back and forth movement technique. The sample was immediately examined under a microscope to determine if the villi were obtained and to remove the decidua (maternal cells) from the villi. RESULTS: The mean gestational age was 12.25 +/- 1.05 weeks (range 10-20 weeks). The procedure was successful in all cases, 168 cases (90.9%) with one attempt. The indications for prenatal diagnosis included fetal risk for chromosomal abnormalities (110 cases; 59.46%), severe thalassemia syndrome (57 cases; 30.81%), both of them (17 cases; 9.19%) and for HLA typing in one case. The results could not be obtained in 11 cases (5.95%) due to laboratory failure. In the present study, abnormal chromosomes were detected in chorionic villi from 12 fetuses, including 45,X (3), trisomy 18 (3), trisomy 21 (2), trisomy 7 (1) and mosaicism (3). Additionally, 18 fetuses with severe thalassemia syndrome were identified; five homozygous beta-thalassemia, 11 beta-thalassemia/Hb E disease, and two homozygous alpha-thalassemia (Hb Bart's). The complications found in the present study included one case (0.54%) of fetal loss following the procedure and one case (0.54%) of vaginal bleeding. No case with limb reduction defect, infection, or rupture of membranes following the procedure was seen. CONCLUSIONS: Transabdominal CVS is a rather safe and reliable prenatal diagnostic technique. The fetal loss rate following the procedure in the present study was 0.54%. However operator' experience and skill in ultrasound-directed needle guidance procedure are essential.

The prevalence and causes of anemia during pregnancy in Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To determine the prevalence and causes of anemia during pregnancy in Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: The pregnant women were screened with hemoglobin, hematocrit, osmotic fragility test, hemoglobin E test and serology for hepatitis B, syphilis and HIV at first antenatal visit. In anemic cases, serum ferritin, serum iron/total iron binding capacity, or therapeutic trial with iron supplementation were performed to assess the iron status. The cases of abnormal thalassemia screening were followed by hemoglobin A2 level, PCR for alpha-1 (SEA type) and hemoglobin electrophoresis. Additional tests were stool exam, stool occult blood and red blood cell indices. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first and third trimester or less than 10.5 g/dl in the second trimester of pregnancy. The data was presented as mean, standard deviation and percentage. RESULTS: Six hundred and forty eight pregnant women were recruited. The prevalence of anemia was 20.1 percent (128 cases). Classified in each trimester the prevalence was 17.3%, 23.8% and 50.0% in the first, second and third trimester, respectively. Thalassemia carriers and diseases were detected in 56 from 102 anemic pregnant women (54.9%). Iron status was assessed in 58 cases and iron deficiency anemia was found in 25 cases (43.1%). Other causes of anemia were parasitic infection (8.7%) and anemia of chronic disease (2.7%). In 37 anemic pregnant women (33.0%), the causes of anemia were not found. CONCLUSION: The prevalence of anemia in pregnant women who first attended at the antenatal clinic was 20.1%. The main causes of anemia were thalassemia carriers/diseases and iron deficiency anemia.

Experience of the first 50 cases of cordocentesis after training with model.

OBJECTIVE: To describe the experience of the first 50 cases of cordocentesis after practicing with cordocentesis model. MATERIAL AND METHOD: Cordocentesis model consisted of a water-filled transparent glass box covered with a rubber latex sheet with or without piece of pork skin. A 30-cm umbilical cord filled with mercurochrome, hung inside the container, was the target for the puncture. As in real practice, the trainee had to try to aspirate the red mercurochrome from the umbilical cord using a spinal needle under ultrasonographic guidance. After practicing with the model for 300 procedures, the trainee was allowed to perform cordocentesis on pregnant women at gestational age of 18-22 weeks by herself under expert supervision with time limit of 30 minutes. The procedure not successful in 30 minutes was considered failure. Duration of procedures, placental site, puncture site, and related complications were recorded for subsequent analysis. RESULTS: After practicing with model for 300 procedures, real cordocentesis was performed by the trainee on 50 pregnant women. The success rate in obtaining fetal blood within 30 minutes was 100%. Most of them (92%) took less than 10 minutes to complete the procedure. Puncture site bleeding and fetal bradycardia were the most common immediate complications, found in 30% and 8% respectively, and spontaneously resolved within few minutes. CONCLUSION: Without any fetal and maternal jeopardy, cordocentesis model is simple, inexpensive but highly effective for the beginner to gain their experience, skill and prepare themselves for cordocentesis with confidence. However, the reduction of fetal loss rate with the training program remains to be further tested.

Feto-maternal hemorrhage after cordocentesis at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To evaluate the incidence and volume of feto-maternal hemorrhage following cordocentesis. STUDY DESIGN: Descriptive study. MATERIAL AND METHOD: One hundred and sixteen asymptomatic non-anemic pregnant women with an indication for cordocentesis at 18-22 weeks of gestation between January and June 2004 were recruited. Maternal blood samples were obtained immediately before and 30 minutes after cordocentesis. Fetal cells in the maternal blood were counted using Kleihauer Betke test. About 25,000 maternal cells per slide were scanned by the same examiner. Feto-maternal hemorrhage was considered significant if the fetal bleeding was more than 0.25 ml. RESULTS: There was a significant increase in fetal blood volume in maternal circulation after cordocentesis (Paired Students t test, p < 0.001). A significant hemorrhage (> 0.25 ml) occurred in 63 from 116 women (54. 7%). Only one had marked hemorrhage of more than 5.0 ml and none had massive hemorrhage (> 15 ml). CONCLUSION: Cordocentesis at 18-22 weeks of gestation can be associated with feto-maternal hemorrhage in more than half of the cases but nearly all cases had only minimal hemorrhage and none had massive hemorrhage.