Relationship between fetal nuchal thickening and crown-rump length in Thai fetuses during 10-14 weeks of gestation.

Objective: To investigate the relationship between the Nuchal thickening (NT) and crown–rump length (CRL) in normal Thai fetuses during 10-14 weeks of gestation. Methods: A prospective observational study was conducted. Ultrasound measurement of NT and CRL was offered for 1,000 consecutive Thai fetuses between 10-14 weeks of gestation. Regression analysis was used to analyze the relationship between the NT and CRL. Results: The mean maternal age was 28.03 ± 5.8 yr (range 14-47 yr). The mean CRL was 54.7 ± 12.7 mm (range 10.0-82.0 mm), and the mean NT was 1.6 ± 0.60 mm (range 0.3-6.9 mm), respectively. The median gestational age was 12.0 weeks. The regression equation relating median NT to CRL was described as follows: expected Nuchal thickening (mm) = 0.437 + (0.01764 × CRL) (mm) (R2 = 0.134, p <0.001). Conclusion: The present study offers normative data of the fetal NT in Thai fetuses, which may improve the performance of NT measurement during the first-trimester as a screening tool for chromosomal abnormalities or other congenital abnormalities in the first trimester. The present study shows that NT measurements increase with increasing CRL.

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.

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.

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.