Prediction of perinatal outcomes in patient with pre-eclampsia: maternal hyperoxygenation test on fetal Doppler flow.

OBJECTIVE: Investigate if the maternal hyperoxygenation test in pregnancy with pre-eclampsia could be used for prediction of perinatal outcomes. MATERIAL AND METHOD: Fifty-four singleton pre-eclampsia pregnant women were enrolled in the present study. Positive hyperoxygenation test was defined as an increase of the middle cerebral artery (MCA) or the ductus venosus (DV) pulsatility index (PI), or a decrease of the uterine artery or the umbilical artery (UA) PI by at least 20%. Results of hyperoxygenation test were analyzed for the correlation with perinatal outcomes. RESULTS: Fetuses with positive hyperoxygenation test of the MCA had a birth weight less than the negative group significantly. Furthermore, there was a significantly higher rate ofsmall for gestational age (SGA) neonates and admission to the neonatal intensive care unit (NICU) in cases with positive test of the MCA. CONCLUSION: The present study shows the correlation of positive hyperoxygenation test of the MCA and low birth weight, SGA, and NICU admission.

Nomograms of the fetal heart between 16 and 39 weeks of gestation.

OBJECTIVE: To establish the normal fetal cardiac measurement from 16 to 39 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Four hundred and eighty normal singleton pregnant women were recruited into the present study. The sonographic measurements were obtained from axial scans at the level of the four-chamber view. RESULTS: The regression model for cardiac circumference (CC), thoracic circumference (TC), thickness of left ventricular wall during diastole (LVW), diameter of left ventricle during diastole (LVD) and systole (LVS) and thickness of interventricular septum during diastole (IVS) were best fit by allowing a polynomial for gestational age. The cardiothoracic ratio (CTR) and shortening fraction of left ventricle (SFLV) were not statistically different with advancing gestation. CONCLUSION: The normal values of fetal CC, TC, CTR, LVW, LVD, LVS, IVS and SFLV during gestation were established These data could serve as a standard to investigate cardiac change in pregnancies with fetuses at risk.

Fetal ductus venosus pulsatility index and diameter during 20-30 weeks gestation.

OBJECTIVE: To present normal range of the pulsatility index and the smallest diameter in the ductus venosus in normal fetuses throughout gestation. MATERIAL AND METHOD: This was a prospectively cross-sectional study. Three measurements were made for the ductus venosus diameter and the pulsatility index in each fetus during fetal quiescence. Statistical Package for the Social Sciences 14.0 software was used to create nomograms for the ductus venosus pulsatility index and diameter against gestational age. Four hundred and sixty normal fetuses aged seventeenth to thirty-seventh weeks were evaluated. RESULTS: The median diameter of the ductus venosus was linear across gestation. CONCLUSION: The nomograms for the ductus venosus pulsatility index and diameter are presented. The size of the narrowest portion of the DV grows in a linear relationship through gestation.

The efficacy of lidocaine-prilocaine cream to reduce pain in genetic amniocentesis.

OBJECTIVE: Evaluate whether local anesthesia by lidocaine-prilocaine cream decreases maternal pain during mid-trimester genetic amniocentesis. MATERIAL AND METHOD: This randomized controlled study of mid-trimester genetic amniocentesis was conducted between 1 October 2006 and 30 April 2007. Pregnant women were randomized to receive lidocaine-prilocaine cream or placebo cream 30 minutes prior to amniocentesis. Patients, blinded to allocation, recorded anticipated and actual pain before and after the procedure. The visual analog score (VAS) was evaluated, using a 0-10 scale. RESULTS: One hundred and twenty women participated in the present study. Sixty women were randomized to lidocaine-prilocaine group. The two groups were similar with respect to clinical correlations and procedure characteristics. Anticipated pain was 6.1 +/- 2.0 in the lidocaine-prilocaine group and 6.3 +/- 2.3 in the placebo group (p = 0.61). Actual pain was 2.3 +/- 2.2 in the lidocaine-prilocaine group and 2.9 +/- 2.5 in the placebo group (p = 0. 16). CONCLUSION: Lidocaine-prilocaine cream does not decrease pain during mid-trimester genetic amniocentesis.

Indications for cesarean section at Thammasat University Hospital.

OBJECTIVE: To present the indications associated with the increase in cesarean section rate at Thammasat University Hospital during the past three years. MATERIAL AND METHOD: This was a cross-sectional study. Pregnant women who underwent cesarean section between January 2003 and December 2005 at Thammasat University Hospital were recruited for the present study. Cases of fetal anomaly or intrauterine fetal death were excluded. Demographic and obstetric data including indications of cesarean section and pregnancy outcomes were collected and analyzed RESULTS: Among the 1328, 1402, and 1522 cases of cesarean section (27.31, 27.94, and 29.26%) in 2003, 2004 and 2005 respectively, the major indication was previous cesarean section (29%). Cephalopelvic disproportion (CPD), and elective cesarean section were second, and third most common indication (24.64%, 11.23%) respectively. CONCLUSION: The increasing cesarean section rate was due to rising of elective cesarean section or patient's request. Cesarean section without obstetric indication should be reconsidered to lower the cesarean section rate.

A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy.

OBJECTIVE: To study the efficacy of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. STUDY DESIGN: Double blind randomized controlled trial. SETTING: Department of Obstetrics and Gynecology, Thammasat Hospital, Faculty of Medicine, Thammasat University. MATERIAL AND METHOD: Between January 2005 and December 2005, 170 pregnant women who attended at antenatal clinic Thammasat University Hospital with the symptoms of nausea and vomiting in pregnancy were randomly allocated into group A (n = 85) and group B (n = 85). The patients in group A received one capsule of ginger twice daily (one capsule contained 0.5 gm of ginger powder) while the patients in group B received the identical capsule of 50 mg dimenhydrinate twice daily. The visual analogue nausea scores (VANS) and vomiting times were evaluated at day 0-7 of the treatment. RESULTS: There was no significant difference in the visual analogue nausea scores (VANS) between group A and group B in day 1-7 of the treatment. The vomiting episodes of group A were greater than group B during the first and second day of the treatment with statistically significant difference. No difference in vomiting episodes during the day 3-7 of treatment was found in both groups. There was a statistically significant difference in the side effect of drowsiness after treatment in group B greater (77.64%) than group A (5.88%) (p < 0.01). CONCLUSION: From the presented data, ginger is as effective as dimenhydrinate in the treatment of nausea and vomiting during pregnancy and has fewer side effects.

Blood absorption capacity of various sanitary pads available in Thailand.

Objective: To assess the blood absorption capacity of various sanitary pads available in Thailand. Methods: Forty-eight models of sanitary pads, 10 pads per each model, were tested. Whole blood was poured into the center of each pad. Three volumes were recorded: volume-A, the volume recorded when the seeping blood reached at least one lateral rim of the pad, volume-B, when it reached at least one longitudinal end, and volume-C, when it showed the maximal absorption capacity of the pad. Results: The blood volume absorbed in each model ranged from 2.4+0.5 to 23.5+2.9 mL for volume-A, 4.9+0.9 to 40.7+2.1 mL for volume-B, and 7.9+1.2 to 90.0+16.9 mL for volume-C, respectively. Some models did not allow blood to reach either a lateral rim or a longitudinal end of the pad. Conclusion: The blood absorption capacity of sanitary pads largely varied on model and brand. Therefore, in order to use pad counting for estimating the volume of excess menstrual blood loss, it is necessary to know the exact model of sanitary pad used by the patient.

TRAP sequence in an acardiac twin.

CASE REPORT: The authors present a case of an acardiac twin gestation diagnosed sonographically at 20 weeks with evidence of twin reversed-arterial perfusion (TRAP) sequence. The acardius appeared to be less than half the estimated weight of the pump twin. The acardius was identified as an amorphous mass, without extremities. The parents chose expectant management rather than surgical intervention. Observation by serial sonographic and color Doppler evaluation was performed. At 34 weeks, a healthy infant was delivered by cesarean section after showing signs of fetal congestive heart failure (CHF). The acardius was 2/3 the size of the infant at delivery. CONCLUSION: Expectant management with close antepartum surveillance deserves consideration in cases of monozygotic twins with TRAP sequence. Neonatal mortality of the pump twin diagnosed antenatally may be considerably less than reported.

Acardiac twin.

Acardiac twin is a rare complication of monozygotic twin pregnancies occurring in 1% of monochorionic twin gestations with an incidence of 1 in 35,000 births. Without treatment, the perinatal mortality of the pump twin is about 50-70%. The optimal management of acardiac twin pregnancies is controversial. Management options include elective termination, observation with close antepartum surveillance (serial cardiotocography, ultrasonography and echocardiography) and surgical interventions

Prevalence and management of abnormal pap smear in antenatal care clinic at Thammasat University Hospital.

OBJECTIVE: To investigate the prevalence of abnormal Papanicolaou smear in pregnant patients who attend the Antenatal Care Clinic at Thammasat University Hospital. MATERIAL AND METHOD: Pregnant patients who attended the antenatal care clinic at Thammasat University Hospital from August 2003 to December 2003 were recruited for Papanicolaou test. Patients who had abnormal results of equally or over "abnormal squamous/glandular cells of undetermined significance" were assigned for colposcopy and colposcopic biopsy to confirm the result. RESULTS: From 500 Papanicolaou smear performed, there were only four patients who had abnormal Pap tests, which were: 2 ASC-US and 2 LSIL. The prevalence of abnormal Pap smear in pregnant patients who attended the antenatal clinic at Thammasat University Hospital was 0.8 percent. CONCLUSION: The prevalence of abnormal Papanicolaou smear in pregnant patients attending antenatal care clinic at Thammasat University Hospital was quite low in compares with other literature.