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.

The correlation of lactating women's breast size and breast milk production.

Objective: To evaluate the correlation between lactating womenûs breast size and breast milk production. Methods: 53 normal primiparous women with neither breastfeeding problems nor having drugs that affected milk production who delivered vaginally at Siriraj Hospital, Bangkok, Thailand were enrolled. On the 3rd day after delivery, breast size and breast milk volume were recorded by the same investigator at 3 hr after the last breastfeeding. Results: The means of breast size and breast milk volume in this study were 13.5 ± 3.7 cm and 47.8 ± 18.3 ml, respectively. Regarding to the Pearson correlation test, breast milk volume had no significant correlation with breast size (rs= -0.112, p > 0.05), but showed a negative correlation with the maternal age (rs= -0.27, p < 0.05). Conclusion: There is no significant correlation between breast milk volume and breast size. The small breast size woman should be counseled and reassured to get more confidence in breast feeding.

Three–dimensional prenatal ultrasonography of thanatophoric dysplasia: Initial experience at Siriraj Hospital.

Objective: To initially report the prenatal diagnosis of thanatophoric dysplasia (TD) by using both 2 dimensional (2D-US) and 3 dimensional (3D-US) ultrasonography. Methods: During January 2004 to December 2006, 10 pregnant women who were referred to our Maternal Fetal Medicine Unit due to abnormal skeletal sonographic findings have been extensively investigated by 2D-US and 3D-US. Results: 3 cases of TD (30%) have been identified with an average gestational age of 26 weeks. Sonographic findings demonstrated short limbs, severe micromelia, telephone receiver like femoral bone, bell shaped small thorax, platyspondyly of vertebrae and normal shaped skull in all cases. Prenatal diagnosis was made earlier by 2D-US analysis and then was confirmed by 3D-US. Conclusion: 3D-US provides additional findings and increases interpreter confidence, It provides additional information in the evaluation of fetal skeletal dysplasia, including thanatophoric dysphasia, compared with 2D-US.

Comparison of the manual stimulation test and the nonstress test: a randomized controlled trial.

OBJECTIVE: To evaluate manual fetal stimulation (MST) through the maternal abdomen in comparison to standard nonstress test (NST) in terms of nonreactive rates and testing time. MATERIAL AND METHOD: Five hundred and forty high-risk singleton pregnancies at 28 gestational weeks or more were assigned to have either NST or MST using blocked randomization (270 each). All fetal heart rate (FHR) tracings were analyzed blindly using standard NST criteria by one perinatologist. RESULTS: The MST group provided a significantly higher reactive rate than that of the NST group, 98.9% and 84.4% respectively, p < 0.001. Mean testing time of the reactive results of the MST group was also significantly shorter than that of the NST group, 7.94 +/- 6.27 min and 13.91 +/- 9.58 min respectively, p < 0.001. CONCLUSION: This is the first randomized controlled trial (RCT) to demonstrate the distinctive benefit of the simple and less expensive MST. MST significantly reduces the time to reactivity and increases the frequency of reactivity when compared to NST alone.

Experience of the first 50 cases of cordocentesis after training with model.

OBJECTIVE: To describe the experience of the first 50 cases of cordocentesis after practicing with cordocentesis model. MATERIAL AND METHOD: Cordocentesis model consisted of a water-filled transparent glass box covered with a rubber latex sheet with or without piece of pork skin. A 30-cm umbilical cord filled with mercurochrome, hung inside the container, was the target for the puncture. As in real practice, the trainee had to try to aspirate the red mercurochrome from the umbilical cord using a spinal needle under ultrasonographic guidance. After practicing with the model for 300 procedures, the trainee was allowed to perform cordocentesis on pregnant women at gestational age of 18-22 weeks by herself under expert supervision with time limit of 30 minutes. The procedure not successful in 30 minutes was considered failure. Duration of procedures, placental site, puncture site, and related complications were recorded for subsequent analysis. RESULTS: After practicing with model for 300 procedures, real cordocentesis was performed by the trainee on 50 pregnant women. The success rate in obtaining fetal blood within 30 minutes was 100%. Most of them (92%) took less than 10 minutes to complete the procedure. Puncture site bleeding and fetal bradycardia were the most common immediate complications, found in 30% and 8% respectively, and spontaneously resolved within few minutes. CONCLUSION: Without any fetal and maternal jeopardy, cordocentesis model is simple, inexpensive but highly effective for the beginner to gain their experience, skill and prepare themselves for cordocentesis with confidence. However, the reduction of fetal loss rate with the training program remains to be further tested.

Feto-maternal hemorrhage after cordocentesis at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To evaluate the incidence and volume of feto-maternal hemorrhage following cordocentesis. STUDY DESIGN: Descriptive study. MATERIAL AND METHOD: One hundred and sixteen asymptomatic non-anemic pregnant women with an indication for cordocentesis at 18-22 weeks of gestation between January and June 2004 were recruited. Maternal blood samples were obtained immediately before and 30 minutes after cordocentesis. Fetal cells in the maternal blood were counted using Kleihauer Betke test. About 25,000 maternal cells per slide were scanned by the same examiner. Feto-maternal hemorrhage was considered significant if the fetal bleeding was more than 0.25 ml. RESULTS: There was a significant increase in fetal blood volume in maternal circulation after cordocentesis (Paired Students t test, p < 0.001). A significant hemorrhage (> 0.25 ml) occurred in 63 from 116 women (54. 7%). Only one had marked hemorrhage of more than 5.0 ml and none had massive hemorrhage (> 15 ml). CONCLUSION: Cordocentesis at 18-22 weeks of gestation can be associated with feto-maternal hemorrhage in more than half of the cases but nearly all cases had only minimal hemorrhage and none had massive hemorrhage.

Prevalence of gestational diabetes mellitus (GDM) in women screened by glucose challenge test (GCT) at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To assess the prevalence of GDM in GCT screened women at Maharaj Nakorn Chiang Mai Hospital. STUDY DESIGN: Retrospective descriptive study. SETTING: Department of Obstetric and Gynecology, Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: One thousand pregnant women who attended the antenatal care clinic and delivered at Maharaj Nakorn Chiang Mai Hospital from October 2001 to December 2002 were recruited into the study. Glucose challenge test (GCT), 50-g glucose oral load with 1-hr plasma glucose measurement, was performed in GDM high-risk pregnancies. If GCT was positive, oral glucose tolerance test (OGTT), 100-g glucose orally, was done to confirm the final diagnosis. All relevant data including demographic information, previous obstetric history, risk factors for GDM, GCT and OGTT results and pregnancy outcomes were collected for further statistical analysis. MAIN OUTCOME MEASUREs: Prevalence of GDM in GCT screened women, obstetric complications and pregnancy outcomes. RESULTS: There were totally 1000 pregnancies enrolled into the study. Despite 451 pregnant women being eligible for GCT only 411 cases were tested with 164 positive results. 29 cases of GDM were detected with the prevalence of 7.05%. (CI 95% = 0.048, 0.099). As a result, the sensitivity, specificity, positive predictive value, and negative predictive value of GCT were 100%, 64.66%, 17.68% and 0%, respectively. In the GDM group, the common indications for GCT screening were advanced maternal age (75.4%), familial diabetic history (22.1%) and glycosuria (6.8%). Furthermore, only I case of pregnancy-induced hypertension was found with cesarean section, preterm birth, LGA and SGA of 27. 6%, 10.3%, 3.45% and 13.79%, respectively. There were 2 cases of pregestational diabetes mellitus (PGD; 0.2%) with 40 high-risk pregnancies (4%) without screening. CONCLUSION: The selective GCT screening strategy was highly effective and revealed 7.05% of GDM prevalence. Its impact on obstetric complication and pregnancy outcome was inconclusive due to the small number of studied population. Careful history reviewing plays an important role in identifying GDM risk factor for GCT screening.

Validity of antenatal diagnosis of intrauterine growth restriction by umbilical Doppler waveform index.

OBJECTIVE: To evaluate the validity of systolic/diastolic (S/D) ratio of the umbilical artery in predicting intrauterine growth restriction (IUGR). STUDY DESIGN: Diagnostic test study. SETTING: Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. SUBJECTS: Two hundred and twelve singleton pregnancies between 30 and 42 weeks' gestation with clinical suspicion of IUGR were recruited and followed-up between December 1st 1995 and June 30th 1998. They were sonographically examined for routine fetal biometry and S/D ratio of umbilical artery Doppler waveform measurement within 14 days of delivery. All of them had an accurate date of last menstrual period and were between 30-42 weeks' gestation. MATERIAL AND METHOD: The umbilical artery S/D ratio was obtained by the same experienced sonographer, using the same ultrasound machine, Aloka 680EX, (Tokyo, Japan). The S/D ratio of 3 or greater was considered abnormal, predicting IUGR prenatally for every gestational week. IUGR was defined as low birth weight of less than the 10th percentile of the standard birth weight curve of Maharaj Nakorn Chiang Mai Hospital. MAIN OUTCOME MEASURES: Sensitivity specificity positive predictive value and negative predictive value. RESULTS: The prevalence of IUGR among the study group was 50.9%. The S/D ratio of 3 or greater for predicting of IUGR gave the sensitivity, specificity, positive predictive value, and negative predictive value of 52.96%, 78.85%, 74.42% and 65.08%, respectively. CONCLUSION: The umbilical artery S/D ratio has relatively low sensitivity and is not a suitable test for IUGR screening. However, the specificity is rather high and it may be helpful in combination with other parameters.

Prenatal diagnosis of alpha-thalassemia-1 (SEA type) by chorionic villus sampling.

OBJECTIVE: To describe the experience of prenatal diagnosis for Hb Bart's disease, by chorionic villus sampling (CVS) with DNA analysis. DESIGN: Descriptive study SETTINGS: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: Sixteen high risk pregnancies at risk of Hb Bart's disease who were eligible for CVS criteria between 1 January, 1999 and May 31, 2000. MATERIAL AND METHOD: Fetal villi were obtained by either transcervical (TC) or transabdominal (TA) CVS route to extract DNA and detect for alpha-thal-1 gene deletion (SEA type) with modified Chang's method. The CVS results were confirmed by either serial ultrasound or cordocentesis or diagnosis after pregnancy termination. MAIN OUTCOME MEASURES: The efficacy, safety and pregnancy outcomes. RESULTS: CVS was successfully done in all of 16 cases (5 with TC and 11 with TA), The mean gestational age was 13.25 +/- 2.9 weeks. The procedure time for TA was shorter than that of TC (4.64 +/- 5.4 vs 10.4 +/- 11.3 min). The CVS result showed as follows: 3 normal fetuses, 7 alpha-thal-1 carriers, 4 fetal Hb Bart's, 1 misdiagnosis and 1 failure to diagnosis due to technical error. The sensitivity and specificity were 100 per cent (4/4) and 90.91 per cent (10/11), respectively. One case of Hb Bart's misdiagnosis and one failure case were later confirmed for alpha-thal-1 trait and alpha-thal-1/ Hb E trait by cordocentesis, respectively. The pregnancy outcomes included 11 livebirths, 4 terminated cases and 1 fetal loss of continuing pregnancies. No serious complications occurred. CONCLUSION: This preliminary experience suggests that CVS is an effective method for early prenatal diagnosis of fetal Hb Bart's.