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.

Three–dimensional prenatal ultrasonography of thanatophoric dysplasia: Initial experience at Siriraj Hospital.

Objective: To initially report the prenatal diagnosis of thanatophoric dysplasia (TD) by using both 2 dimensional (2D-US) and 3 dimensional (3D-US) ultrasonography. Methods: During January 2004 to December 2006, 10 pregnant women who were referred to our Maternal Fetal Medicine Unit due to abnormal skeletal sonographic findings have been extensively investigated by 2D-US and 3D-US. Results: 3 cases of TD (30%) have been identified with an average gestational age of 26 weeks. Sonographic findings demonstrated short limbs, severe micromelia, telephone receiver like femoral bone, bell shaped small thorax, platyspondyly of vertebrae and normal shaped skull in all cases. Prenatal diagnosis was made earlier by 2D-US analysis and then was confirmed by 3D-US. Conclusion: 3D-US provides additional findings and increases interpreter confidence, It provides additional information in the evaluation of fetal skeletal dysplasia, including thanatophoric dysphasia, compared with 2D-US.

Prenatal diagnosis of thalassemia and hemoglobinopathies: 20 years experience at Siriraj Hospital.

Objective: To show the experience of prenatal diagnosis of Thalassemia and hemoglobinopathies in Siriraj Hospital. Methods: Hb Bart’s hydrops fetalis can be detected by DNA study from polymerase chain reaction (PCR) product in the first trimester of pregnancy either by chorionic villus sampling (CVS) or aminocentesis but in late pregnancy it can be detected unambiguous by ultrasonography at 18-20 weeks gestation, the suspected cases are confirmed by fetal blood sampling and Hb electrophoresis. Prenatal diagnosis (PND) for β-thalassemia diseases can be done at early pregnancy by direct visualization of the PCR products on electrophoresis or by dot blot analysis of amplified DNA with a set of HRP-labeled oligonucleotide probes complementary to the mutations. If the mutation is unknown. The couples have to wait for Hb analysis by HPLC or in vitro globins chain analysis from fetal blood in the second trimester. Results: The results of PND at Siriraj Hospital are summarized as Hb Bart’s Hydrops fetalis 228 cases, Homozygous Beta-Thalassemia 126 cases, and Beta Thalassemia/Hb E disease 550 cases. There are various methods of sampling namely chorionic villous sampling, amniocentesis, fetal blood sampling, ultrasound, or even combined method. There are minimal incidences of fetal loss 9 out 904 cases which comparatively give us one of the best center for prenatal diagnosis in Asia. Conclusion: Of the 904 pregnancies, the diagnosis were obtained in 891 pregnancies in which had 5 fetal loss from dead fetus in utero after fetal blood sampling in the second trimester. The other complication occurred after sampling failure.

Effect of halogen light in fetal stimulation for fetal well-being assessment.

OBJECTIVE: To evaluate the shortening of the time of nonstress test (NST) by using transabdominal fetal stimulation with halogen light. STUDY DESIGN: Experimental research. MATERIAL AND METHOD: The authors enrolled 176 pregnant women between 32 and 42 weeks of gestation indicated for NST at the Division of Maternal Fetal Medicine, Siriraj Hospital, Mahidol University. They were randomly assigned to receive either NST (control) or halogen light stimulation test (LST). The stimulation was performed at the beginning of the test and repeated every 10 minutes until reassuring fetal heart rate (FHR) acceleration was achieved, or up to 3 times. All tracings were interpreted blindly by one investigator at the end of the tests. RESULTS: The mean (+/- SD) duration from starting the test to the first FHR acceleration was not significantly different between the control group and the LST group (5.6 +/- 7.2 and 5.4 +/- 5.2 minutes, respectively). The average testing time (+/- SD) to achieved reactivity was 10.5 +/- 8.8 minutes in the controls and 9.6 +/- 6.7 minutes in the LST group. This was not statistically different. The incidence of nonreactive tests was not significantly different between the LST and the controls (15.9% and 11.4%, respectively). Among the LST subjects, term fetuses and women with BMI < 27 kg/m2 required less time to reach reactivity, 2.4 and 2.3 minutes respectively. CONCLUSION: Transabdominal halogen light stimulation did not shorten the duration of NST in the presented population. However, the presented data suggests that the fetus at term could respond to visual stimulation, especially when the gestational age is more advanced.

Correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography.

OBJECTIVE: To investigate the feasibility of transperineal ultrasonography for uterine cervical assessment by determining the correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography and comparing discomfort arising from each technique. MATERIAL AND METHOD: Fifty pregnant women of 37 weeks' gestation or later who gave consent participated in this research. They had no exclusion criteria, which were listed as the following: preterm premature rupture of membranes, previous cervical surgery, undiagnosed vaginal bleeding, and true labor pain. They all underwent transabdominal (3.5-MHz curvilinear transducer), transperineal (3.5-MHz curvilinear transducer) and transvaginal ultrasonography (7.5-MHz curvilinear endovaginal transducer). The uterine cervical length was measured from the straight line between the external and internal os. If either of the external or internal os was not clearly demonstrated, the authors would justify the cervical length as non-measurable. Measurement in each technique was performed twice and the mean cervical length was used for data analysis. Discomfort arising from each technique was evaluated by visual analog scale. RESULTS: Uterine cervical length was measurable in 23 (46%), 49 (98%) and in all cases by transabdominal, transperineal and transvaginal ultrasonography respectively. In the transabdominal technique, no significant differences in woman's age, weight, body-mass index and parity were observed between measurable and non-measurable cases. Significant correlation was demonstrated between transperineal and transvaginal ultrasound (r = 0.73, p < 0.01). A significantly higher discomfort score was demonstrated in transvaginal ultrasonography, but no significant difference in discomfort score was found between transabdominal and transperineal ultrasonography. CONCLUSION: Transperineal ultrasonography is feasible for acceptable uterine cervical visualization with only slight discomfort to the patients.

Fetal abnormalities in the fetal anomaly clinic at Siriraj Hospital.

In order to reduce perinatal morbidity and mortality rates, a Fetal Anomaly Clinic has been set up at Siriraj Hospital. The aims are to identify abnormal fetuses and manage them in an appropriate way before delivery. From 1st May, 2000 to 30th April, 2002, 142 pregnancies with fetal abnormalities out of 10,386 pregnant women examined were found at the Fetal Anomaly Clinic, Siriraj Hospital. There were 32 fetuses (22.5%) with CNS abnormalities and neural tube defects with a mean gestational age at diagnosis of 18.6 weeks, 12 fetuses (8.5%) with gastrointestinal abnormalities with a mean gestational age at diagnosis of 17.1 weeks, 12 cases (8.5%) with cardiovascular and pulmonary abnormalities with a mean gestational age at diagnosis of 24.8 weeks, 10 cases (7%) with skeletal abnormalities with mean gestational age at diagnosis of 26.7 weeks,15 cases (10.6%) with chromosome abnormalities with a mean gestational age at diagnosis of 21.7 weeks, 18 cases (12.6%) of KUB abnormalities with a mean gestational age at diagnosis of 25.6 weeks and 43 cases (30.3%) of other abnormalities with a mean gestational age at diagnosis of 24.5 weeks. Counsellings was given before making a decision and all abnormalities were confirmed by autopsy, amniocentesis, paediatric neonatologists or paediatric surgeons.

Comparison of three methods for DNA extraction from amniotic fluid for fetal sex determination by multiplex polymerase chain reaction (PCR).

The objective of this study was to compare three methods used for amniotic fluid DNA extraction. These methods were: Proteinase K/Phenol-Chloroform, Proteinase K/7.5M Guanidine-HCl and DNAzolา BD Reagent. Ten samples of uncontaminated amniotic obtained by amniocentesis performed in mothers with advanced maternal age for detection of fetal chromosome abnormality were studied. Each sample was divided into three tubes, 1 ml placed in each, and DNA extraction was performed by all three methods. The quality and quantity of DNA extracted by each method were compared by electrophoresis on 3% agarose gel and spectrophotometric study at 260 & 280 nm. The DNA obtained was subsequently used for fetal sex determination by multiplex PCR method. The primers used for multiplex PCR were specific for X and Y chromosomes. Accuracy of fetal sex determination was compared with the results from amniocyte culture and the sex at birth. The results showed that DNA extracted by DNAzolาBD Reagent was 100% accurate when used to determine fetal sex by PCR; eight samples on 1st PCR and the other two on repeat PCR. DNA extracted by Proteinase K/7.5M Guanidine-HCl also yielded 100% accuracy in fetal sex determination; seven samples on 1st PCR, two samples on 2nd PCR and one sample needed 3rd PCR. The Proteinase K/Phenol-Choroform method yielded only 90% accuracy and one sample failed to determine fetal sex after having repeated PCR three times. The extraction method which gave the maximum amount of DNA was the Proteinase K/Phenol-Chloroform one but the failed to give 100% accuracy in determining fetal sex. The method which produced the least protein contamination was DNAzolฎBD Reagent and gave 100% accuracy in determining fetal sex with smallest number of PCR reactions. In conclusion, DNAzolฎBD reagent method is relatively rapid for amniotic fluid DNA extraction with high accuracy for fetal sex determination but when large amount of DNA is also needed for other purposes, Proteinase K/Phenol-Chlorofrom is recommended as the method of choice.