Safety and efficacy of oral nifedipine versus terbutaline injection in preterm labor.

OBJECTIVE: To compare the safety and tocolytic efficacy of oral nifedipine with intravenous terbutaline for the management of threatened preterm labor. MATERIAL AND METHOD: Pregnant women between 24 and 36 completed weeks of single gestation with preterm labor were randomized to either oral nifedipine (n=20) or intravenous terbutaline (n=20) treatment. Nifedipine (immediate released capsule) 10 mg was crushed and swallowed, 10 mg every 20 minutes was allowed if necessary with a maximum 40 mg in the first hour. After that 20 mg nifedipine every 4 hours was given, up to 72 hours. Terbutaline was initially infused with the rate 10 g/min with an increment 5 microg/min every 10 minutes if required, until 25 microg/min was reached. Once the contractions had stopped for 2-6 hours, the patients were switched to subcutaneous injection with 0.25 mg terbutaline every 4 hours for 24 hours. The main safety outcome was the changes in maternal diastolic blood pressure from baseline and 1 hour after starting the treatment (deltaDBP(1hr)). Secondary outcomes were the efficacy to delay delivery > or =48 hours and 7 days, the adverse events and the birth outcomes. RESULTS: deltaDBP(1hr) was greater in the terbutaline group than that in the nifedipine group with no statistically significant difference. Hypotension (defined as BP < or = 90/60 mmHg) was found in one patient of the nifedipine group and two patients of the terbutaline group. Seventeen and 14 patients in the nifedipine group and 15 and 12 patients in the terbutaline group had delayed delivery > or =48 hours and 7 days, respectively. Mothers in the nifedipine group experienced fewer side effects than those in the terbutaline group. Maternal heart rate, at I hour after starting the treatment, increased significantly higher in the terbutaline group than in the nifedipine group. Birth outcomes were measured in all nifedipine group patients, but in only 16 of the terbutaline group patients. Six mothers in each group delivered after 37 weeks. Intraventricular hemorrhage (IVH) occurred in three babies (gestational aged 25, 29 and 37 weeks) born to mothers treated with terbutaline. In one baby, IVH related to trauma resulted from the delivery procedure. CONCLUSION: The safety and efficacy of nifedipine compares with that of terbutaline for treatment of preterm labor.

Excursion index of the septum primum in Thai fetuses of gestational diabetic mothers at 32 to 35 weeks' gestation.

OBJECTIVE: To compare excursion index of the septum primum (EISP) among Thai fetuses of gestational diabetic mothers (FGDMs) with and without septal hypertrophy (SH) and those of nondiabetic mothers from 32 to 35 weeks' gestation. MATERIAL AND METHOD: Fetuses of Thai pregnant women were recruited for prenatal 2-dimensional echocardiographic measurements of the EISP (the ratio between the linear displacement of the flap valve of septum primum and the left atrial diameter) at 32 to 35 weeks' gestation. All had confirmed gestational age and normal structural scanning. The EISP was compared among gestational age--matched 15 FGDMs with SH, 18 FGDMs with normal septal thickness, and 20 fetuses of nondiabetic mothers. The data were presented as mean and standard deviation (SD). Analysis of variance (ANOVA) was used to compare the EISP of the three groups. RESULTS: Fifty-three measurements were obtained. Comparison among the three groups showed that the mean and SD of the EISP were 0.27 +/- 0.04, 0.50 +/- 0.04 and 0.51 +/- 0.05 in FGDMs with SH, normal septal thickness and those of nondiabetic mothers, respectively. The analysis demonstrated that the EISP was significantly less than in FGDMs with SH when compared to the FGDMs with normal septal thickness and those of nondiabetic mothers (p < 0.01). There was no significant difference in the EISP of the FGDMs with normal septal thickness and those of nondiabetic mothers (p = 0.16). CONCLUSION: Mobility of the septum primum in FGDMs with septal hypertrophy is reduced. This may indicate a higher preload compared to FGDMs with normal septal thickness and those of nondiabetic mothers.

Excursion index of the septum primum as a parameter for diastolic function assessment of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal diastolic function by the measurement of the excursion index of the septum primum (EISP) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Fetuses of normal Thai pregnant women were recruited for 2-dimensional echocardiographic measurements of the EISP (the ratio between the linear displacement of the flap valve and the left atrial diameter) from 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning, and negative diabetic screening at 24 to 28 weeks' gestation. The 5th, 50th and 95th percentile of the EISP were demonstrated The relationship between the EISP and gestational age were determined RESULTS: Three hundred twenty-seven measurements were obtained The normal values of the EISP according to gestational age were presented as 5th, 50th, and 95th percentile ranks. The correlation coefficients (r) between the EISP and gestational age were 0.03. The EISP were not statistically different with advancing gestation. The 5th, 50th, and 95th of the EISP were 0.32, 0.45, and 0.59 respectively. The intra-observer variability was 5.5%. CONCLUSION: The normal values of fetal EISP in the Thai population from 32 to 35 weeks' gestation were established This could serve as a baseline data in detection of the alteration of left ventricular diastolic function during fetal life.

Embryonic stem cell bank.

Embryonic stem cell bank is a cornerstone for stem cell research. It is providing essential resources to support advances in research in this challenging field that promises broad-ranging cell and tissue therapy. It is important to make good quality and well characterized embryonic cell lines that will be available for both research and clinical purposes. This article provides a concise summary on embryonic stem cell banking processes from cell line characterization, storage, quality assurance, safety testing, distribution, and post-distribution monitoring. It also states the importance of an international network and collaboration for technology and knowledge transfer Moreover, the Bank should play a substantial role as a national reference and a training center for stem cell research.

Interventricular septal thickness of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal InterVentricular Septal Thickness (IVST) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Thai pregnant women with normal fetuses were recruited for prenatal 2-dimensional M-mode echocardiographic measurements of fetal IVST at 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning and negative diabetic screening at 24 to 28 weeks 'gestation. The IVST was measured from the 4-chamber view during diastole and systole. The 5th, 50th and 95th percentile of the IVST during Diastole (IVSD) and the IVST during Systole (IVSS) were demonstrated The relationship between the IVSD and IVSS and gestational age were determined RESULTS: A total of 410 measurements were obtained. The normal values of the IVSD and IVSS according to gestational age were presented as 5th, 50th and 95th percentile ranks. The correlation coefficients (r) between the IVSD and IVSS and gestational age were 0.11 and 0.12, respectively. The IVSD and IVSS were not statistically different with advancing gestation. The 95th, percentile of the IVSD was 4.51 millimeters (mm) (range = 4.26 to 4.74 mm) and IVSS was 6.23 mm (range = 5.96 to 6.68 mm). The intraobserver variability was 7.6%. CONCLUSION: The normal values of fetal IVSD and IVSS in a Thai population from 32 to 35 weeks' gestation were established. This could be used as a baseline data in detecting the asymmetrical septal hypertrophy during fetal life.

International stem cell research; networking and collaboration.

Stem cell research has obtained more attention during the last decade because of its strong potential as a new tool to cure many chronic diseases. In addition, stem cell knowledge is an important basis for understanding pathophysiology at the cellular level and developing disease models for experimental research. There are different limitations on resources, budget, policy and regulation among countries. As a result, each country has particular advantages and disadvantages in stem cell research. This result in the establishment of international networks and collaborations to coordinate and promote stem cell research aimed at medical applications.

Fetal stem cell: from research to clinical use.

The discovery of new sources of stem cells over the past few years has raised the expectation that stem cells may in the future provide new biological therapies for a number of diseases, the incredible potential for substituting damaged or lacking cells, tissues, and even organs. A number of stem cell types have been identified, including bone marrow stem cells, embryonal stem cells, and fetal stem cell including umbilical cord blood (UCB) stem cells. The UCB contains a rich source of hematopoietic stem cells that can be used to reconstitute the blood system and can easily be extracted and cryopreserved, thus allowing for the establishment of HLA-typed stem cell banks. UCB have also the potential to give rise to non-hematopoietic cells, such as bone, neural and endothelial cells.

Umbilical cord blood transplantation in children with beta-thalassemia diseases.

To evaluate factors affecting the outcome of sibling and unrelated donor umbilical cord blood transplantation (CBT) in Thai children with beta-thalassemia diseases. The case-series study of all children undergoing such transplants in our institute was conducted Six children with thalassemia major were diagnosed at a median age of 1.5 years and CBT was performed at a median age of 5.5 years (range 2-15). Six donors consisted of three HLA-identical siblings, one two-allele, one three-antigen mismatched sibling, and one one-allele mismatched unrelated cord blood. The median number of nucleated cells infused was 2.83 x 10(7)/kg (range 1.49-5.3); the median number of CD34+ cells infused was 1.94 x 10(5)/kg (range 0.2-5.3). In all, two patients had complete donor engraftment; three had mixed chimerism (MC); one patient died of cerebral thrombosis and neutropenic septicemia. Of the two complete donor-engrafted patients, two developed grade 2 acute graft-versus-host disease (GVHD) which responded well to immunosuppressive therapy. Of the three mixed-chimeric patients, two were clinically cured. With a median follow-up of 7 months (range 2-30), five children survived and have done well with transfusion-independent. Umbilical cord blood provides a reasonable option for hematopoietic stem cell source to transplant for beta-thalassemia diseases and the outcome in the present study was good.

The management of acardiac twins at King Chulalongkorn Memorial Hospital: case series.

Acardiac twin is a rare event with high perinatal mortality rate and the management strategies remain controversial. The authors report 4 cases of twin pregnancies associated with one acardiac twin diagnosed at King Chulalongkorn Memorial Hospital during the period 1993 to 2002. Two cases were expectantly managed and intrauterine interventions were performed in order to occlude umbilical artery of the acardiac twin in 2 cases, by using Guglielmi detachable coil (GDC) embolization and absolute alcohol injection. Overall, the perinatal mortality rate for the pump twin was 50% and the survival rate of expectant management in the present series was 100%. GDC embolization was judged to be technically successful since it completely occluded the circulation to the acardiac twin. However, the pump twin was dead which might have resulted from the compromised state due to cardiac failure. At present, it seems that conservative management with close antenatal surveillance is the treatment of choice when the twin-weight ratios are substantially less than 70%. Invasive techniques should be considered when there is ultrasound evidence of hydramnios or congestive heart failure of the pump twin at a previable gestational age.

First trimester umbilical cord and vessel diameters of Thai fetuses.

OBJECTIVE: To establish the reference ranges for first trimester umbilical cord and vessel diameters of Thai fetuses. MATERIAL AND METHOD: A prospective study was performed on normal pregnant women between 10(+0) and 13(+6) weeks of gestation who underwent ultrasound examination. The diameter measurements were obtained by a 7.5 MHz vaginal--or a 3.75 MHz abdominal transducer. Statistics were analyzed using SPSS computer program. RESULTS: Records of 184 pregnancies were analyzed and the outcome demonstrated a strong correlation between umbilical cord diameter and gestational age (r = 0.90; p < 0.001). Umbilical vessel diameters were also correlated with gestational age. CONCLUSION: First trimester umbilical cord and vessel diameters of Thai fetuses are related to gestational age. The presented reference ranges might be useful for further studies, such as prediction of adverse pregnancy outcome or combination with biochemical or other ultrasound markers for fetal aneuploidy screening.

Cord blood collection for the National Cord Blood Bank in Thailand.

Umbilical cord blood is an effective alternative source of hematopoietic stem cells transplantation in children and adolescents. However, the efficacy and safety of cord blood transplantation correlates with the quantity and quality of cord blood. To evaluate the collection systems and processing of cord blood donations, a pilot research program to optimize recruitment, collection and processing of cord blood donations was developed. The present results showed that the quality of the cord blood (volume, total white blood cells (WBC) count, CD34+ and sterility control) collected was satisfactory and discard rate of collecting units (24.2%) were comparable with data reported from other cord blood banks. To find the optimal mode of collection, comparison of 3 cord blood collection methods (Method 1 = Hanging method after delivering the placenta, Method 2 = Aspiration from in utero placenta, Method 3 = Aspiration from in utero placenta and Syringe-assisted aspiration) using the closed system showed that method 3 was the best method but it required more trained personnel and involved a complicated procedure. The National Cord Blood Bank started its activity in 2002 after several years of pre-clinical studies. To date, a number of transplants using cord blood from related and unrelated cord blood (first report in Thailand) donors have been successfully performed.

Reference ranges for Doppler indices of uterine arteries in pregnant women during 22-28 weeks' gestation: a study at King Chulalongkorn Memorial Hospital.

Color pulsed Doppler ultrasound was used to examine the uterine arteries of a total of 265 normal pregnant women during 22-28 weeks' gestation at the Division of Maternal-Fetal Medicine, King Chulalongkorn Memorial Hospital. Reference ranges for pulsatility index (PI) were determined and throughout this gestational range, the mean values were nearly constant and lower than 0.9 and the upper limit of 95 per cent confidence interval (CI) for the PI values were lower than 1.0. In conclusion, the authors have established the reference ranges for PI of uterine arteries in the late second to early third trimester of pregnancy in Thai pregnant women. This could be beneficial for the baseline data in the evaluation of pregnant women complicated with preeclampsia and fetal growth restriction.