Efficacy of external cephalic version with tocolysis in late pregnancy.

OBJECTIVE: To study the success rate and identify factors influencing the success rate of external cephalic. version (ECV) at Bhumibol Adulyadej Hospital. STUDY DESIGN: Prospective descriptive study. SETTING: Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital. MATERIAL AND METHOD: All parturients attending the obstetrics unit at Bhumibol Adulyadej Hospital between October 1, 1997 and September 30, 2006, having completed 36 or more gestational weeks with singleton non-vertex fetus, who had no exclusion criteria for ECVwere given full information concerning a trial of ECV risk of cesarean section, and risk of emergency breech deliveries. Those who chose to undergo ECV after counseling were recruited and gave signed consent. One hundred and forty singleton, pregnant women with non-vertex presentation participated in this study. RESULTS: The success rate of ECV was 71.43%. Birth weight significantly affected the success rate of ECV Maternal weight, parity, gestational age, and placental site did not have any effect on the outcome. All fetuses in the present study were subsequently delivered without significant morbidity and no cases of perinatal mortality were recorded. CONCLUSION: ECV is a safe procedure with a high success rate in selective cases. ECV thus, is an effective alternative practice for non-vertex presentation, which can also reduce the rate of breech delivery and cesarean section. The major benefits of external cephalic version are reduced maternal morbidity and mortality from surgery.

Chorionic villus sampling for early prenatal diagnosis at Bhumibol Adulyadej Hospital.

OBJECTIVE: To evaluate results of chorionic villus sampling for early prenatal diagnosis at Bhumibol Adulyadej Hospital. DESIGN: Retrospective descriptive study. SETTING: Perinatal unit, Department of Obstetrics and Gynaecology, Bhumibol Adulyadej Hospital. SUBJECTS: Three hundred and eighty three women were enrolled to chorionic villus sampling at the perinatal unit, Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, from November 10,1997 to October 17, 2006. RESULTS: During the present study periods three hundred and eighty three women were recruited, of these chorionic villus sampling for chromosome diagnosis were performed on 355 while 6 were for abnormal Thalassemia screening. Twenty two cases were excluded because ultrasound examination showed anembryonic pregnancy or fetal demise in utero in 13 cases, multiple fibroids in 4 cases, large area of placental hemorrhage in 3 cases, 1 case of multiple pregnancy and in 1 case the placenta was in an inappropriate position. The most common indication was elderly gravidarum (95.84%). Other indications were abnormal Thalassemia screening, abnormal ultrasound findings, family chromosome disorder previous Down syndrome, and severe oligohydramnios. The authors found eleven cases of chromosome abnormalities, four cases of maternal cell contamination and three cases of failed tissue culture (two cases from transcervical chorionic villus sampling and one case from transabdominal chorionic villus sampling) and two cases of mosaicism. There were two fetal losses in the present study and all the babies from the normal chromosome result looked normal. Second trimester amniocentesis following chorionic villus sampling was required due to maternal cell contamination, mosaicism and failed tissue culture. (2.77%) All cases had follow-up ultrasound scan during 18-20 weeks. CONCLUSION: The authors found that chorionic villus sampling is a possible alternative technique for prenatal diagnosis of cytogenetic abnormalities and abnormal Thalassemia screening in Thailand. It probably has a slightly higher rate of failed tissue culture and maternal cell contamination than amniocentesis, but it is generally done earlier in pregnancy than amniocentesis and is particularly advantageous for detecting certain genetic conditions.

50-grams glucose challenge test for screening of gestational diabetes mellitus in high risk pregnancy.

OBJECTIVE: To evaluate the cutoff value of the 1-hr, 50-gram glucose challenge test (GCT) for screening of gestational diabetes mellitus (GDM), in high-risk pregnancy, and to determine the prevalence of GDM in this group. STUDY DESIGN: Descriptive study (Diagnostic test). SUBJECTS: Eight hundred and thirty-eight pregnant women, 24-28 weeks, were identified and recruited based on risk indicators between January and October 2004. MATERIAL AND METHOD: A GCT was performed in this group. All women with plasma glucose value > or = 130 mg/ dl were given a 3-hr, 100-gram glucose tolerance test (OGTT) to diagnose gestational diabetes mellitus using Carpenter and Coustan diagnostic criteria. The receiver-operator characteristic (ROC) curve was used to identify the cut-off value of GCTfor detecting GDM. MAIN OUTCOME MEASURES: The cut-off value of GCTfor detecting GDM by using ROC curve with the sensitivity and specificity of various cut-off values. RESULTS: The ROC curve identified a GCT value of > or = 140 mg/dl as the cut-off value for detecting GDM, which showed the sensitivity and specificity of 95.3% and 48.6% respectively. The prevalence of GDM in high-risk pregnant women was 20.17% (169/838). CONCLUSIONS: Recommended threshold of 140 mg/dl used as the cut-off value of 50-gram, 1-hr GCTfor screening GDM in high-risk pregnancy.