Intrapartum and neonatal zidovudine treatment in reduction of perinatal HIV-1 transmission in Bangkok.

OBJECTIVE: To evaluate the efficacy of zidovudine (ZDV) administered during labor and to the infants in the first 6 weeks of life in reduction of perinatal HIV-1 transmission. DESIGN: Open label clinical trial. SITE: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. MATERIAL AND METHOD: One hundred asymptomatic, antiretroviral naive HIV-1 infected pregnant women who had either late or no prenatal care were recruited from the obstetric service of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. They were given ZDV 300 mg orally every 3 hours during the intrapartum period until delivery. ZDV syrup 2 mg/kg orally every 6 hours were given to the infants immediately after birth for 6 weeks. Breast feeding was not allowed. Infant's blood for HIV-1 PCR test was obtained at age 1 day, and 1, 3 and 6 months. HIV-antibody test was determined at age 18 months. Infants with at least one positive HIV-1 PCR test performed at or after 1 month of age or positive HIV-antibody test at age 18 months were classified as HIV-1 infected infants. RESULTS: There were 100 healthy infants delivered without complication. Fourteen infants were excluded due to; 13 lost to follow-up and 1 drug intolerance. Of the remaining 86 infants who were followed-up, 27 infants (31.4%) did not receive intrapartum ZDV treatment and 9 infants were HIV-1 infected. The perinatal transmission rate was 10.5 per cent, (95% CI 3.9, 17.1). CONCLUSION: The result of this study suggests that intrapartum oral ZDV treatment in asymptomatic HIV-1 infected mothers together with ZDV treatment in the neonates for 6 weeks can reduce the rate of perinatal HIV-1 transmission. This regimen may be an alternative treatment for prevention of HIV-1 infection in infants born to HIV-1 seropositive mothers who have had either late or no prenatal care.

Serum human chorionic gonadotropin regression pattern in persistent trophoblastic disease during chemotherapy.

The objective of this study was to identify the regression pattern of serum beta-hCG in persistent trophoblastic disease patients after initiating chemotherapy. Eighty-nine women who were diagnosed as persistent trophoblastic disease in King Chulalongkorn Memorial Hospital between January 1985 and December 1998, and received single agent chemotherapy were included. The incidence was 20.2 per cent of total gestational trophoblastic disease patients. Seventy-two (80.9%) from 89 patients were recruited in our study. Sixty-four (88.9%) patients responded to first-line chemotherapy and 8 patients (11.1%) resisted. Suction curettage was done as initial treatment in 61 (84.7%) cases. Most of them (95.8%) received actinomycin-D as first line treatment. Total courses of chemotherapy averaged 4 courses, but increased to 8.5 courses in the resistant group. Mean time of serum beta-hCG to remission was 16.7 and 21.5 weeks in the chemo-sensitive and chemo-resistant group, respectively. Average time to start chemotherapy was in the tenth week, and in the resistant group it was started in the sixth week. Chemotherapy regimen was changed in the fifteenth week. Initial serum beta-hCG levels were not significantly different between the two groups. The reduction rates of beta-hCG were significantly different from the third to the seventh week in the chemo-sensitive and chemo-resistant groups, which was during the second and third course of chemotherapy (P<0.05). In conclusion, by using the reduction rate, the regression pattern of serum beta-hCG level in persistent trophoblastic disease patients was significantly different between the chemosensitive and chemoresistant group from the third to the seventh week after starting chemotherapy.

The role of maternal serum C-reactive protein and white blood cell count in the prediction of chorioamnionitis in women with premature rupture of membranes.

This study was performed to evaluate the diagnostic performance of maternal serum C-reactive protein, maternal white blood cell (WBC), and neutrophil counts in the detection of histologic chorioamnionitis. One hundred and twenty six pregnant women after at least 28 weeks of gestation with premature rupture of membranes (PROM) were studied. Blood samples for C-reactive protein, WBC and neutrophil counts were taken at delivery. Placental histology was evaluated for histologic chorioamnionitis. Maternal and neonatal complications were observed. Among women with and without histologic chorioamnionitis, the maternal WBC and neutrophil counts were different (P<0.05) but the maternal serum C-reactive protein was not. Cutoff values for C-reactive protein, WBC, and neutrophil counts were 0.5 mg/dL, 15,000 cell/mm3, and 80 per cent, respectively. Sensitivity and specificity were 56 per cent and 58 per cent for C-reactive protein, 60 per cent and 63 per cent for WBC count, and 62 per cent and 54 per cent for neutrophil count, respectively. In conclusion, the maternal serum C-reactive protein, WBC, and neutrophil counts have poor diagnostic performance for histologic chorioamnionitis.

Short course zidovudine maternal treatment in HIV-1 vertical transmission: randomized controlled multicenter trial.

A multicenter randomized, double blind, placebo-controlled clinical trial was conducted to evaluate the effectiveness of a short course of oral zidovudine (ZDV) treatment in HIV-1 infected pregnant women, starting at 38 weeks of gestation plus ZDV infusion during labor until delivery, to reduce HIV-1 vertical transmission in non-breast fed infants. One hundred and eighty two asymptomatic antiretroviral naïve HIV-1 infected pregnant women were enrolled. Each patient was randomly allocated into either the ZDV or placebo group. The ZDV group received 250 mg ZDV orally twice a day initiated at 38 weeks' gestation until the onset of labor. During the intrapartum period, ZDV infusion at the rate of 2 mg/kg was administered within the first hour and then continuously infused at the rate of 1 mg/kg/h until delivery. The placebo group received an identical capsule during pregnancy and normal saline infusion during labor until delivery. HIV-1 transmission was documented by nested polymerase chain reaction in infants at birth and at 1, 3 and, 6 months of age. The estimated HIV-1 vertical transmission rate was 14.9 per cent (95% CI = 11.1 to 18.7) and 16.3 per cent (95% CI = 12.3 to 20.9) in ZDV and placebo group, respectively (p > 0.05). The short course ZDV in antiretroviral naïve pregnant women initiated at 38 weeks' gestation plus intrapartum ZDV infusion without treatment in the infants was not effective to prevent HIV-1 vertical transmission.

Intrapartum zidovudine infusion alone failed to reduce both maternal HIV-1 viral load and HIV-1 infection in infant.

A pilot clinical trial to assess the efficacy of intrapartum zidovudine (ZDV) infusion alone in the reduction of maternal viral load and its potential role in preventing vertical transmission of HIV-1. Twenty six, asymptomatic antiretroviral naïve HIV-1 infected pregnant women who had no prior antenatal care and were in labor were enrolled. Each patient received ZDV infusion at the rate of 2 mg/kg within the first hour. ZDV was then continuously infused at 1 mg/kg/h until delivery. Maternal plasma HIV-1 RNA prior to the commencement of ZDV infusion and within an hour after delivery were measured. HIV-1 transmission was documented by nested polymerase chain reaction in infants at six months of age. Median maternal plasma HIV-1 RNA prior to the ZDV infusion and after delivery was 29,401 and 32,555 copies/ml respectively, (p>0.05). The estimated HIV-1 transmission rate was 19.2 per cent (95% CI = 4-34). This result suggested that in asymptomatic HIV-1 infected pregnant women who were antiretroviral naïve and had no prior antenatal care, intrapartum ZDV infusion alone failed to reduce maternal HIV-1 viremia and the transmission rate of HIV-1.

Pregnancy in amniotic band scarred woman.

Amniotic band syndrome is an uncommon syndrome. The incidence is 1:1,200-1:15,000 live births. This syndrome is variable malformation. Amniotic band scar of the abdomen seen in adulthood is rare. We managed a case of a 23 year-old pregnant woman who had suspected amniotic band scar of the abdomen since birth. The uterus could expand until term pregnancy despite no intervention. The healthy female baby was delivered by cesarean section because of obstetric indication. Both mother and baby were in good condition. She and her baby were well at six weeks follow-up. We know of no other reported case of maternal abdominal amniotic band scar who could continue pregnancy until term with good outcome.

Maternal risk factors for low birth weight newborn in Thailand.

The present study assesses the risk approach for maternal risk factors for LBW newborn in Thailand. This study can be considered as a managerial tool for developing local strategies and is particularly useful in the field of maternal and child health care. A summary of maternal risk factors for LBW newborn as listed in Table 7 and can be used as a health educational tool for pregnant women and as basic data for marital counseling. It can also be used to keep the public informed about the maternal risk factors for LBW newborn which will help Thai women of reproductive age avoid the chance of having such babies.

Decreased suppressor T-lymphocytes in women who received progestogen injections.

Decreased levels of suppressor T-cells (CD8+) were found in 17 normal women who received progestogen (Depoprovera) injection, 150 mg intramuscularly every three months for contraceptive purposes, for more than 30 months. The helper: suppressor T-cells (CD4+ : CD8+ ratio) was significantly elevated in this group compared to 30 normal female controls. No significant change of T-lymphocyte was found in 53 normal women who received the injection for less than 30 months or who received combined oral contraceptive pills. In conclusion, long term progestogen injection induced a lowering of suppressor T-cell levels, which is the same immunological change found in several autoimmune diseases.

Prevalence of Chlamydia trachomatis among women attending an antenatal clinic in Bangkok.

Cervical swabs from 140 Thai pregnant women were cultured for Chlamydia trachomatis twice during the first and the third trimester. Serum samples for antichlamydial antibodies was also studied from 126 women; 12 of women were culture positive on both occasions. Chlamydia was isolated from 24% of women aged 20-24 years, compared to only 9% of women 25-30 years. Antibody were detected to the genital serotypes (D-K) in 31 (25%) of 126 women who were tested. 70% of women who were culture positive had antibody titer greater than or equal to 1:64 compared to 7% of women who were culture negative.