Perinatal asphyxia: multivariate analysis of risk factors.

Perinatal asphyxia contributes greatly to neonatal mortality and morbidity. In developing countries, the need for risk assessment in perinatal asphyxia is obvious because of the high birth rate and limited perinatal resources. OBJECTIVE: To determine the incidence and risk factors of perinatal asphyxia in infants who were delivered from mothers with high-risk conditions. STUDY DESIGN: A prospective study over a 5-year period from 1993 to 1997 was performed at a tertiary level, referral hospital. PATIENTS AND METHOD: Nine hundred and sixty-one infants who were delivered from 878 high-risk mothers were recruited. All of the risk factors that might have contributed to asphyxia were identified and recorded. Univariate and stepwise multiple logistic regression analysis was performed to identify significant factors that might have contributed to asphyxia, the odds ratios and 95 per cent confidence interval were computed. RESULTS: Abnormal fetal heart rate pattern, thick meconium stained amniotic fluid, and premature delivery, were three common risk factors for asphyxia. The mean gestational age was 37.6 +/- 3.5 weeks, 10.5 per cent (101/961) were infants less than 33 weeks. The incidence of asphyxia was 9.7 per cent and was highest (26.7%) in infants less than 1000 g. By univariate analysis, significant relationships between perinatal factors and asphyxia were found among birth weight, gestational age, premature and breech delivery but stepwise multiple logistic regression analysis revealed that only birth weight was significantly associated with perinatal asphyxia. CONCLUSION: In countries where resources are limited, a neonatal resuscitation team should be available for very low birth weight infants, premature and breech delivery.

Charts of Thai fetal biometries: 1. Methodology.

A cross-sectional study was conducted in order to construct new reference charts for Thai fetal biometries that are commonly used in obstetric ultrasound practice. We discussed and illustrated a sound appropriate study design and statistical analysis which lead to more valid results. A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were recruited. Each fetus was measured once at a randomly assigned gestational age specifically for the purpose of this study only. Stepwise linear regression technique was used to model the mean and its standard deviation as functions of gestational age. Goodness of fit and normality of the data were checked before the final models were chosen. Reference centiles were derived, taking into account the increasing variation as pregnancy proceeds. We demonstrated the stated technique with humerus data from the same study. Reference charts for other fetal biometries have been derived and are presented in subsequent papers.

The screening for gestational diabetes employing 50 g glucose test.

A 50 g 1-h glucose test was studied in pregnant Thai women in order to find out the cut-off level for diagnosis of gestational diabetes. The gold standard for diagnosis of gestational diabetes. The gold standard for diagnosis of gestational diabetes was the standard OGTT. Among 23 patients diagnosed as having gestational diabetes following employing a standard test the cut-off value of 144 mg/dl accounted for the appropriate level for screening of gestational diabetes.

Diagnosis of ectopic pregnancy by ultrasound in Siriraj Hospital.

The study of the diagnosis of ectopic pregnancy was carried out during the whole year of 1988 in the Department of Obstetrics & Gynaecology, Siriraj Hospital, in order to find out the characteristics of ultrasonographic findings by using real time ultrasound. Real time ultrasound examination was carried out on 121 patients with suspicion of ectopic pregnancy. The final diagnosis among these patients was ectopic pregnancy, ruptured corpus luteum, ruptured appendicitis, normal pregnancy, abortion, adnexal mass and no gynecologic abnormality encountered in 21 (17.35%), 3 (2.48%), 1 (0.83%), 27 (22.31%), 4 (3.3%), 43 (35.54%) and 22 (18.18%) respectively. Of 21 patients with ectopic pregnancy 17 (80.95%) cases were between 15-30 years of age with the gestational age ranging from 6 to 12 weeks in 16 patients (76.19%). The majority of the patients 18 (85.7%) were para 0-3. The ultrasonographic findings were pelvic mass and fluid in the cul de sac, pelvic mass and fluid in the cul de sac, pelvic mass only and the presence of free fluid alone encountered in 17 (80.95%), 3 (14.28%) and 1 (4.76%) cases respectively.

Percutaneous umbilical cord blood sampling.

Percutaneous umbilical cord blood sampling is a newer, safer, and more convenient technique and can be performed in the second and third trimester of pregnancy by direct puncture of the umbilical vein near its placental insertion, using a needle guided by ultrasound. Between 2-4 ml of pure fetal blood were obtained from 10 pregnancies at between 19 and 39 weeks' gestation. This new procedure offers access to the fetal circulation for diagnosis and therapeutic purposes.

Amniocentesis guided by ultrasound.

Abdominal amniocentesis was performed on 252 pregnant women at Siriraj Hospital during the period from August 1984 to July 1985, 227 cases for fetal lung maturity and 25 cases for genetic study in second trimester. Failure to obtain amniotic fluid encountered in 11 cases (4.36 percent) was directly associated with placental site, fetal position, amount of amniotic fluid and some technical error. Among the complication occurred in 4 cases (1.76 percent).There were premature rupture of membranes, chorioamnionitis, fetal trauma and one case of abortion in second trimester amniocentesis for chromosome study. The results of this study show that failure rate, bloody taped amniotic taped amniotic fluid and major complication can be reduced by using ultrasound guidance.

Chromosome study of partial hydatidiform mole: A case report.

A case of partial hydatidiform mole was admitted with hyperemesis gravidarum, human chorionic gonadotrophine was at high level. Ultrasonographic study showed the empty gestational sac with enlarged placenta which had cystic change in some area. The histologic study showed only hydatidiform mole but chromosome study confirmed classical partial hydatidiform mole which had a triploid (69 XXY) constitution. The clinical findings, ultrasound study and HCG level can emphasize this condition. Histologic and genetic study will confirm the diagnosis.

Partial hydatidiform mole: Report of 1 case.

A case of partial hydatidiform mole admitted with pre-eclampsia delivery of a living baby at 34 weeks was reported. Ultrasonographic study showed foetus with intrauterine growth retardation and cystic change of the placenta. The final diagnosis was made by pathologic histology. We suggested the clinical findings and ultrasonographic findings reminded the physician that some of this foetus has chromosome abnormalities. Correct diagnosis prenatally, will make the opportunity for the physician to manage such cases properly.