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.

Clinical practice guideline for cesarean section due to cephalopelvic disproportion.

OBJECTIVES: To evaluate the effect of the Clinical Practice Guideline (CPG) for cesarean section due to Cephalopelvic Disproportion (CPD) on physician compliance, pregnancy outcomes and cesarean section rate. The study also wants to identify factors associated with physician non-compliance. MATERIAL AND METHOD: 455 medical records of women undergoing a cesarean section due to CPD from January 1, 2002 to December 31, 2003 were reviewed The CPG was implemented on January 1, 2003. The pregnant outcomes of women who delivered from January 1, 2002 to December 31, 2002 were used for comparison. The outcome measurements were physician compliance, pregnancy outcomes and cesarean section rates. Multivariate logistic regression analysis was used to identify factors associated with physician non-compliance. Independent variables included private care, parity, maternal height, Bishop score, maternal age and estimated fetal weight. RESULTS: The compliance rate was 83%. Physician compliance in private practice was lower than in non-private practice (76.6% VS 92.4%). Pregnancy outcomes were not different between the two periods. The cesarean section rates before and after implementation of the CPG were 8.4% and 8.5%, respectively. Private practice, poor Bishop score and estimated fetal weight < or = 3500 g were significant predictors of physician non-compliance. CONCLUSION: The compliance rate was high, but the cesarean section rate due to CPD did not significantly change within a one year period There was no adverse outcome. Physician non-compliance was more common in private practice. Poor Bishop score and high estimated fetal weight were significant predictors.