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.

Reducing cesarean delivery rates: an active management labor program in a setting with limited resources.

OBJECTIVE: To determine the effect of an active management of a labor program on the rate of cesarean section and labor outcomes in low-risk nulliparous pregnancies in a setting with limited resources. MATERIAL AND METHOD: Nine hundred and seventy-five low risk nulliparous pregnant women were randomized to receive either active management of a labor program (n = 325) or conventional management (n = 650). The rate of cesarean section and labor outcomes were compared between the two groups using Chi-square and t-tests. RESULTS: The subjects in the active management program had significantly shortened first stage of labor and total duration of labor compared with the conventional group (538.0 +/- 242.9 min vs 589.4 +/- 263.8 min, p < 0.05, 539.3 +/- 261.4 min vs 610.3 +/- 264.4 min, p < 0.001, respectively). There was no statistical difference found in the rate of cesarean section and other labor outcomes. CONCLUSION: The active management program shortened the first stage and duration of labor in low-risk nulliparous pregnant women.