ABSTRACT
OBJECTIVE: To compare the obstetric outcomes between pregnant women affected by beta-thalassemia trait and normal controls. METHODS: A retrospective cohort study was conducted on singleton pregnant women complicated by beta-thalassemia trait and normal controls, randomly selected with the controls-to-case ratio of 2:1. All were low-risk pregnancies without underlying medical diseases and fetal anomalies. The pregnancies undergoing invasive prenatal diagnosis were excluded. RESULTS: A total of 597 pregnant women with beta-thalassemia trait and 1194 controls were recruited. Baseline characteristics and maternal outcomes in the two groups were similar, except that hemoglobin levels were slightly lower in the study group. The prevalence of small for gestational age and preterm birth tended to be higher in the study group but not reached the significant levels but the rate of low birth weight was significantly higher in the study group (relative risk 1.25; 95 % CI 1.00-1.57). Additionally, abortion rate was also significantly higher in the study group (relative risk 3.25; 95 % CI 1.35-7.80). CONCLUSION: Beta-thalassemia trait could minimally, but significantly, increase risk of low birth weight but did not increase rates of maternal adverse outcomes.
Subject(s)
Fetal Growth Retardation/epidemiology , Pregnancy Complications, Hematologic/epidemiology , Pregnancy Outcome/epidemiology , beta-Thalassemia/complications , Adult , Case-Control Studies , Female , Fetal Growth Retardation/etiology , Gestational Age , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Pregnancy , Premature Birth/epidemiology , Premature Birth/etiology , Prenatal Diagnosis/adverse effects , Retrospective Studies , Thailand/epidemiology , beta-Thalassemia/blood , beta-Thalassemia/epidemiologyABSTRACT
OBJECTIVE: The objective of this article is to evaluate hemodynamic changes among fetuses with isolated absent ductus venosus (IADV) diagnosed by prenatal ultrasonography. PATIENTS AND METHODS: Fetuses with prenatal diagnosis of IADV were recruited and followed. Hemodynamic assessment was performed in all cases, including measurement of cardiac dimensions, shortening fraction, myocardial performance index, preload index in the inferior vena cava and the presence of venous pulsations in the umbilical vein (UV). RESULTS: Nine fetuses of IADV were assessed, including six cases with extra-hepatic UV drainage and three with intra-hepatic drainage. All fetuses with extra-hepatic UV drainage showed an elevated preload index in the inferior vena cava, venous pulsations in the UV and cardiomegaly. Of them, four had hydrops, two showed poor cardiac function and three resulted in perinatal mortality. Three cases with intra-hepatic drainage had continuous flow in the UV, normal in all hemodynamic parameters and all survived. CONCLUSION: Hemodynamic assessment of fetuses with IADV was helpful in predicting the development of hydrops and perinatal mortality. The poor prognostic factors included cardiac overload, cardiomegaly, poor myocardial performance, increased preload, the presence of venous pulsations and extra-hepatic UV drainage. © 2015 John Wiley & Sons, Ltd.
Subject(s)
Hemodynamics , Ultrasonography, Prenatal , Umbilical Veins/physiopathology , Vascular Malformations/physiopathology , Vena Cava, Inferior/physiopathology , Cardiomegaly/diagnostic imaging , Cardiomegaly/etiology , Female , Follow-Up Studies , Humans , Hydrops Fetalis/diagnostic imaging , Hydrops Fetalis/etiology , Male , Pregnancy , Prospective Studies , Ultrasonography, Doppler, Color , Ultrasonography, Prenatal/methods , Umbilical Veins/diagnostic imaging , Umbilical Veins/embryology , Vascular Malformations/complications , Vascular Malformations/diagnostic imaging , Vascular Malformations/embryology , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/embryologyABSTRACT
OBJECTIVE: To determine a trend of cesarean section rate (CSR) and main contributing factors in a public sector hospital, representing northern part of Thailand. METHODS: A retrospective descriptive analysis was conducted by assessing the database of maternal-fetal medicine unit, which had prospectively been collected for 20 years. Trends were evaluated using data for the years 1992-2011. Private sector patients were excluded. RESULTS: A total of 50,872 public sector patients were available for analysis. The number of deliveries was gradually decreased from 3,802 in 1992 to 1,748 in 2011. Of them, 7,480 underwent cesarean section, CSR of 14.7 %. However, the CSR was significantly increased from 11.3 % in 1992 to 23.6 % in 2011 (p value <0.001). The CSRs indicated by cephalopelvic disproportion (CPD) and previous CSs were mainly responsible for a marked increase over the study period. CSR due to CPD was increased from 3.2 % in 1992 to 7.9 % in 2011 (p value <0.0001). While CSR due to other indications either breech presentation, fetal distress and twin pregnancies were only slightly, but significantly increased in the last decades but they are relatively constant in the recent years. CONCLUSIONS: In our public sector, CSR has gradually increased. The main reasons of such an increase were likely to be associated with over-diagnosis of CPD and subsequent repeated CS, while other indications played only a minimal role. To achieve the appropriate CSR, audit system for diagnosis of CPD must be instituted.
