Outcome of second trimester amniocentesis in twin pregnancies at Songklanagarind Hospital.

OBJECTIVE: To evaluate the outcome of genetic amniocentesis in twin gestations at Songklanagarind Hospital. MATERIAL AND METHOD: This was a descriptive study that included all women with twin pregnancies who had a second trimester amniocentesis for chromosome study at the Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Songklanagarind Hospital from January 1998 through June 2006 to assess the outcome including risk of fetal loss in such cases. RESULTS: Advanced maternal age was the most common indication for amniocentesis. The success rate of cell culture was 100%. The fetal loss within 14 days after the procedure was 1.4%. CONCLUSION: The tendency of fetal loss after amniocentesis in twin pregnancies was higher than in singletons. Pre-procedure counseling personnel should be aware of this potential outcome, and be sure to inform the involved parents prior to the procedure.

Overt disseminated intravascular coagulation in obstetric patients.

OBJECTIVE: To determine the incidence, etiology and outcome of treatment in obstetric patients complicated by overt disseminated intravascular coagulation (DIC). MATERIAL AND METHOD: Medical records of 25 obstetric patients with a diagnosis of DIC in Songklanagarind University Hospital from January 1993 to December 2005 were reviewed RESULTS: The incidence of overt DIC was I per 1,355 deliveries. Median maternal age was 30 years (range 17-44 years). Median duration of hospital stay was 10 days (range 0-32 days). The main associated conditions included abruptio placentae in 6 patients (24%), pregnancy-induced hypertension (PIH) in 5 (20%), amniotic fluid embolism in 4 (16%), acute fatty liver of pregnancy (AFLP) in 4 (16%), and HELLP syndrome in 3 (12%). A definite diagnosis ofDIC was made in 8 patients (32%) with a median DIC score of 6 (range 5-7) and the remainder were clinically diagnosed with incomplete work-up. All patients received blood component replacement. Cesarean section was performed in 10 patients (40%) and hysterectomy in 9 patients (36%). Six patients died, giving a case mortality rate of 24%. Three were associated with amniotic fluid embolism and one of each with fulminant hepatitis, ALFP and HELLP syndrome. Thirteen of 24 fetuses (54%) died, most related to abruptio placentae (6/6, 100%), PIH (4/5, 80%), and amniotic fluid embolism (2/4, 50%). CONCLUSION: Various pregnancy-related conditions will predispose to DIC development. Early diagnosis with prompt treatment, including a quick decision for surgical intervention, and eradication of predisposing conditions would minimize maternal morbidity and mortality.

Placental weight and its ratio to birth weight in normal pregnancy at Songkhlanagarind Hospital.

OBJECTIVES: To quantify placental weight and its ratio to birth weight in normal pregnancy; and to determine whether abnormal placental weight and its ratio are associated with poor pregnancy outcomes. DESIGN: Prospective, cross-sectional study. MATERIAL AND METHOD: From January 1st, 2004, to December 31st, 2004, placentae were obtained from 238 normal pregnancies, between the 36th-40th gestational weeks. The trimmed and drained placenta was weighed and the mean placental weight at term was defined Distribution curves for placental weight and their ratios with gestational age were constructed. The outcomes for the intrapartum and perinatal periods were compared with normal placental weight, its ratio to the group above the 90th percentile and below the 10th percentile. Fisher's Exact Test was used to analyze the data. A p value < 0.05 was considered significant. RESULTS: The placental weight increased according to the birth weight (r = 0.450, p < 0.005). The mean placental weight at 36-40 gestational age was 519 g (SD = 89.01g). The mean placental weight to birth weight ratio was 17.08%. This ratio decreased slightly with advancing gestational age. There was an association between placental weight below the 10th percentile and fetal distress (p = 0.003). Placental weight to birth weight ratio below the 10th percentile was also associated with fetal distress (p = 0.02). Placental weight above the 90th percentile was associated with newborns requiring neonatal intensive care admission (p = 0.016). CONCLUSION: The placental weight increased according to the birth weight. The placental weight to birth weight ratio decreased slightly with advancing gestational age. Abnormal placental weight and its ratio were significantly associated with some adverse pregnancy outcomes.