Association between breastfeeding success rate and nipple length and diameter in Thai pregnant women.

Objective: To demonstrate the average value of nipple length and diameter during the first and second half of gestation in Thai pregnant women, as well as its association with breastfeeding success rate. Methods: A total of 140 pregnant women attending the ANC unit at Siriraj Hospital were enrolled into this study during April to July 2008. They were divided equally into 2 groups by gestational age of less than 20 weeks and between 20-40 weeks, respectively. Demographic data, nipple length and width, areola width and breastfeeding success rate of each participant was retrieved for statistical analysis. Results: The mean nipple lengths of the first and second half of pregnancy were 0.79 + 0.20 cm and 0.80 + 0.18 cm, respectively, which were not statistically different. There was also no difference between the left and right side. The nipple width was 1.11 + 0.27 cm. by average which did not change between gestations. The areola width increased significantly by gestational age but there was no difference between both sides. Breastfeeding success rate in mothers with nipple length of >0.7 cm of at least one side was greater than those with short nipples at both sides (86.6% and 58.8%, respectively). Forty four neonates (38.60%) with tongue tie were observed with 25 cases undergoing frenulotomy (56.81%). The breastfeeding success rate of newborns, tongue-tied newborns who underwent frenulotomy, and tongue-tied newborns without frenulotony was 84.3%, 84% and 73.7 %, respectively. Conclusion: Both nipple length and width did not increase along with gestation. Mothers with nipple length of 0.7 cm or more of at least one side could succeed in breastfeeding of 4.38 times greater than those with shorter nipple.

Livebirth derived from in vitro matured oocytes.

The authors presented a case report of a woman who suffered from primary infertility due to anovulation. She was diagnosed to have polycystic ovarian syndrome (PCOS) and was treated by ovarian stimulation with conventional technique, such as clomiphene citrate alone, the combination of clomiphene citrate and metformin and the combination of clomiphene citrate with gonadotropins. Nevertheless all of them resulted in no response. Therefore, in vitro maturation of oocyte (IVM) was started and followed by intracytoplasmic sperm injection (ICSI) of 22 oocytes. 14 embryos developed and three of them were transferred back to the uterine cavity. She conceived and the ultrasonography revealed twin pregnancy at the 8-weeks gestation. She gave birth at the 31 weeks’ gestation in Siriraj Hospital. The newborns were admitted in the hospital for 24 days for phototherapy in treating jaundice which was due to prematurity. Then both of them were discharged healthily.

A case report of tubo-ovarian abscess, a complication of saline infusion sonohysterography.

Saline infusion sonohysterography (SIS) is a widely used procedure for intrauterine lesion diagnosis. It has few side effects and complications. The authors present a case report of a middle-aged Thai woman who presented with metrorrhagia. Malignancy had been ruled out with fractional curettage. Despite hormonal treatment, she had persistent metrorrhagia. SIS was performed and a tubo-ovarian abscess developed. Exploratory laparotomy with TAH and BSO were carried out for treatment.

A case of ovarian endodermal sinus tumor diagnosed during pregnancy.

Pregnancy complicated by endodermal sinus tumor of the ovary is extremely rare. The authors present a case report of a pregnant woman with persistent left adnexal mass and subsequently found to have a primary endodermal sinus tumor of the ovary that was diagnosed at 19 weeks of gestation. After left salpingo-oophorectomy had been performed, the patient chose to terminate the pregnancy before the initiation of combination chemotherapy with bleomycin, etoposide, and cisplatin. The response to chemotherapy was not satisfactory. The patient expired after seven cycles of treatment had been completed because of pulmonary fibrosis and the drug toxicity of bleomycin.

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.