Nutrients and hormones in heat-dried human placenta.

This cross-sectional study was to assess the nutrients in terms of protein, fat, minerals, and hormones in heat-dried human placenta. Thirty heat-dried human placentas, 15 from male and 15 from female, were analyzed for protein (amino acids), fiber, fat, moisture, minerals (sodium, potassium, phosphorus, calcium, iron, magnesium, zinc, copper, manganese), hormones (estradiol, progesterone, testosterone, growth hormone). Heat-dried female human placentas had slightly higher fiber content than male, but protein and fat components were not different. Mineral levels in placentas were high especially sodium, potassium and phosphorus. There were no significant differences in the amount of minerals and hormonal profile between female and male placentas. However, hormone levels in heat-dried placenta were low compared to physiologic level in human beings. The results of this study suggest that the amount of nutrients particularly protein and minerals in heat-dried human placentas were enriched.

The effect of parity on lipid profile in normal pregnant women.

A cross sectional study was carried out at Ramathibodi Hospital between June and August 1997. The objective of this study was to determine maternal serum lipid levels at delivery and the effect of parity on maternal lipid profile. Study population was normal term pregnant women aged 20-35 years who delivered normal infants with a birthweight > or = 2,500 grams. Maternal serum lipid levels at delivery were determined from 177 normal term pregnant women. Their mean age was 27.6 +/- 4.5 years. The first parity (P1) was about 52 per cent, whereas, the second and third parity (P2 and P3) were 37 and 11 per cent, respectively. Mean maternal serum total cholesterol (TC) levels in P1, P2 and P3 were 258.3 +/- 46.9, 266.7 +/- 47.1 and 295.7 +/- 61.2 mg/dl, respectively. Serum triglyceride (TG) levels in P1, P2 and P3 were 265.2 +/- 81.1, 280.3 +/- 72.1 and 260.7 +/- 82.8 mg/dl, respectively; serum low density lipoprotein-cholesterol (LDL-C) in P1, P2 and P3 were 136.9 +/- 45.2, 144.9 +/- 43.3 and 173.4 +/- 62.1 mg/dl, respectively; and serum high density lipoprotein-cholesterol (HDL-C) levels were 64.6 +/- 16.6, 65.7 +/- 17.8, 67.2 +/- 16.0 mg/dl, respectively. Serum TC and LDL-C levels increased with parity. There was a significant difference between maternal TC and parity (F = 4.702, p = 0.01) as well as LDL-C and parity (F = 4.883, p < 0.01), especially P1 and P3. There was no significant difference between maternal TG and parity as to HDL-C and parity (p > 0.05).

HIV screening in pregnant women.

Abstract. The following recommendations are made for prenatal screening for HIV infection 1) Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2) Every seropositive result should be repeated for confirmation before coming to a definititve conclusion to avoid a misdiagnosis. 3) Fetal blood sampling in the mid-trimester for PCR and p24 antigen assay seems inappropriate as a diagnostic tool for in utero HIV infection of the HIV seropositive pregnant women as the infection mostly occurs after this time. 4) Routine screening of seronegative pregnant women should be repeated during the third trimester to detect seroconversion since this offers a chance for antiretroviral administration to the seroconverted pregnant women for reduction of perinatal transmission. 5) There should be available the appropriate back up services for seropositive pregnant women. There is sufficient evidence indicating a higher vertical HIV-1 transmission rate in the last trimester and during labour compared with the first and second trimesters. Antiretroviral therapy either single or in combination given to the mother during the last trimester and delivery can reduce the viral load in the maternal circulation. Vertical HIV-1 transmission during delivery can be minimized by appropriate timing and route of delivery. Elective Cesarean section before the onset of labour with an intact bag of forewaters provides the least mother-to-fetus microtransfusion compared to other modes of delivery. Since an effective combination of HIV-1 immunoglobulin and HIV-1 vaccine given to the HIV-1 exposed newborns to prevent HIV-1 transmission similar to the viral hepatitis B model is not firmly established at present, postexposure antiretroviral prophylaxis and nonbreast-feeding are advocated for infants born from the HIV-1 infected mothers. In cases of advanced stage of maternal HIV-1 infection, and in developing areas where malnutrition prevails, an adequate supply of essential micronutrients is proposed as an adjunctive measure to reduce HIV-1 perinatal transmission.

Five-year thyrotropin screening for congenital hypothyroidism in Ramathibodi Hospital.

OBJECTIVES: To detect newborns with congenital hypothyroidism (CH) and to treat the affected infants as early as possible. STUDY DESIGN: Cord blood thyrotropin (TSH) screening for CH in Ramathibodi Hospital began in 1993. From October 1993 to December 1998, 35,390 neonates were screened. The infants with elevated TSH level of greater than 30 mU/L were recalled for verification of CH. Confirmation tests included total thyroxine, free thyroxine and TSH level. Thyroid scan and uptake were performed in some affected infants. RESULTS: Twelve infants with CH were detected resulting in an incidence of one in 2,949 live-births. All affected infants were asymptomatic at birth. Of 12 infants with CH, one premature neonate had a delayed TSH elevation and was diagnosed as having primary hypothyroidism at 2 months of age. The recall rate for validation of CH based on a cut-off value at serum TSH level of greater than 30 mU/L is 1.1 per cent. If the cut-off value of serum TSH level was raised to greater than 40 mU/L, the recall rate would decrease to 0.43 per cent. None of the affected infants had cord blood TSH level of less than 50 mU/L except one premature patient. Therefore, beginning in January 1997, the cut-off value of TSH was raised to 40 mU/L or greater. Pitfalls in this program include incomplete blood-specimen collection and incomplete follow-up. To strengthen the program, improvements were made in the follow-up system from 1996 onward. Therefore, the coverage for blood-specimen collection progressively increased from 84 per cent in 1994 to 96 per cent in 1998. Simultaneously, the patients' return after recalls also increased from 38 per cent to 100 per cent. CONCLUSIONS: The incidence of CH in Ramathibodi Hospital is approximately 1:3,000 live-births. The optimal cord blood TSH level for recall is 40 mU/L or greater. The intensification of follow-up strategy resulted in better response to recall and earlier treatment in the affected infants.

Maternal and umbilical cord serum vitamin A, E levels and mother-to-child transmission in the non-supplemented vitamin A, E HIV-1 infected parturients with short-course zidovudine therapy.

This study was undertaken to assess the maternal and umbilical cord serum vitamin A, E levels at delivery and mother-to-child transmission in nonsupplemented vitamin A, E HIV-1 infected parturients who received short-course zidovudine therapy. Maternal and umbilical cord serum vitamin A, E levels were quantitated by high-performance liquid chromatography in 67 HIV-1 infected parturients who received short-course zidovudine therapy. Mother-to-child transmission occurred in 13.4 per cent of HIV-1 infected parturients. There were no significant differences in the mean concentrations of vitamin A, E and vitamin E/cholesterol ratio between parturients with HIV-1 infected and non-infected infants. While maternal serum vitamin E level was adequate, nearly one-third of the parturients in the study had vitamin A deficiency. In conclusion our study has shown that there was no correlation between maternal serum vitamin A, E levels and mother-to-child HIV transmission in HIV-1 infected parturients who received short-course zidovudine therapy. However, the presence of underlying vitamin A deficiency in these parturients was common, adequate and intensive maternal-infant nutritional support should be emphasized especially in developing countries as an adjunctive measure in the reduction of mother-to-child transmission of HIV as well as the reduction in maternal and perinatal morbidity.

Adolescent pregnancy with HIV-1 positive in Ramathibodi Hospital 1991-1995.

In summary, the level of HIV infection among teenagers will increase in our community because of their risky behaviour. Education and counselling should be the effective strategies to overcome this problem.

Maternal and umbilical cord blood lead levels in Ramathibodi Hospital, 1993.

A prospective cross-sectional study of maternal and umbilical cord blood lead levels was conducted in a total of 500 deliveries at Ramathibodi Hospital. The mean concentrations of lead in maternal and cord blood were 6.2 +/- 2.0, 1.6 +/- 0.5 microgram/dl respectively. There was direct relationship between maternal and umbilical cord blood lead level. Maternal occupation and length of stay in Bangkok were related to maternal blood lead levels. There was no association between adverse pregnancy outcomes and maternal blood lead levels. A large scale study and periodic surveillance of blood lead levels in pregnancy is advocated.

Risk factors for neonatal hyperbilirubinemia.

The purpose of this Historical Prospective Study was to analyze factors associated with neonatal hyperbilirubinemia. Data were collected from summary labour records and individual patients' records at Ramathibodi Hospital between January 1, 1988 and December 31, 1988. Of the 7,644 livebirths, neonatal hyperbilirubinemia (> or = 15 mg/100 ml) occurred in 638 cases. There was a statistically significant positive relationship between hyperbilirubinemia and vacuum extraction (RR 2.7), preterm delivery (relative risk, RR 2.1), low birthweight (RR 2.0), antepartum complication (RR 1.7), intrapartum complications (RR 1.5), forceps delivery (RR 1.4), and oxytocin infusion (RR 1.3). No significant relationship emerged between hyperbilirubinemia and fetal sex, cesarean section, breech delivery and the 5 min Apgar score. From 1984 to 1988 there was a pronounced increase in the incidence of neonatal hyperbilirubinemia in Ramathibodi Hospital. This increase was consistent with the increase in use of oxytocin infusion which reflects changes in obstetric practice. Provision of information, education and communication about this adverse effect to obstetricians and auditing their use are suggested solutions.

Graves' disease complicating pregnancy.

During the 12-yr period from 1981 to 1992, over 85,000 deliveries at Ramathibodi Hospital from 114 pregnancies (prevalence 0.1%) in 110 patients were complicated by Graves' disease. The diagnosis was made following conception in 52 per cent. Medical treatment with propylthiouracil was the main regimen. Maternal and perinatal outcome were related with thyroid status at delivery including thyrotoxic crisis, preeclampsia and preterm deliveries. There was no case of fetal goitre, hyperthyroidism, but fetal hypothyroidism occurred in 12.2 per cent which calls for close monitoring of antithyroid drug dosage and close neonatal-infant follow-up.

Treatment of atonic postpartum hemorrhage with a prostaglandin E2 analogue.

Atonic postpartum hemorrhage constitutes a dramatic clinical situation, with acute danger to the life of the mother. The present report is a 3 yrs prospective study using a Prostaglandin E2 analogue (Sulprostone) in the management of 22 cases with severe postpartum hemorrhage due to uterine atony unresponsive to conventional therapy. Successful control of hemorrhage in cases of blood loss more than 1,500 ml occurred in 83 per cent. Precipitated labour was the most common predisposing factor encountered in this group of atonic postpartum hemorrhage. Side effects of the prostaglandin therapy was tolerable and self-limited. The use of intramuscular administered Sulprostone appears to be an adjunctive treatment in uncontrollable atonic postpartum hemorrhage.

Uterine rupture and labor induction with prostaglandins.

Uterine rupture in patients with labor induction with prostaglandin E2 application though uncommon is a very serious complication and preventable in obstetrics. We reported three cases of spontaneous uterine rupture following induction of labor with intracervical PGE2 gel administration in a dosage of 3-6 mg and two in whom labor was augmented with oxytocin infusion. To avoid such a complication, intracervical PGE2 gel administration should be started with a smaller dose and should augmentation with oxytocin be required careful evaluation and monitoring by a specialist is desirable.

Diabetic ketoacidosis in pregnancy.

Diabetic ketoacidosis, though uncommon, is a very serious complication in obstetrics. We reported 5 cases, which in retrospect could all have been prevented from occurring. Either a strong family of diabetes mellitus or presence of glycosuria were present in 4 cases. In 3 cases, the use of sympathomimetic and corticosteroid was the predisposing factor. Clinicians should have an index of suspicion in patients at risk and it might be prudent to screen for diabetes where the use of sympathomimetic and corticosteroid.

Epidemiology of hypertensive disorders of pregnancy and childbirth: population-based study, Thailand.

A geographically population-based epidemiological study was conducted in Thailand under the WHO International Collaborative Study of Hypertensive Disorders of Pregnancy. Prospectively collected data on blood pressure, proteinuria and edema in pregnancy of 4,126 pregnancies were analyzed correlating with pregnancy outcome. The prevalence of mothers with antenatal diastolic pressures equal to or greater than 90 mmHg was approximately 20 per cent. Hypertension with edema or proteinuria was observed in about 6 per cent of pregnancies and these were associated with a significant increase of low birthweight infants, but did not produce a significant increase in perinatal deaths. Although the incidence of eclampsia during the study period was not high, Hypertensive Disorders of Pregnancy remained the second leading cause of maternal mortality.