Incidence of fetal bradycardia and effect of placental injury on fetal heart rate during second-trimester genetic amniocentesis.

A prospective study was conducted for comparing the incidence of fetal bradycardia and level of fetal heart rate change following a second-trimester genetic amniocentesis with and without placental injury. A total of 257 and 495 participants in injured and non-injured groups were analysed. The incidence of fetal bradycardia following amniocentesis was not statistically different between the two groups (1.17%, [95% CI 0.24, 3.37] and 0.20%, [95% CI 0.005, 1.12]) in injured and non-injured placenta groups, respectively; p = 0.118). The mean change in baseline fetal heart rate before and after amniocentesis was also not significantly different between the two groups (p = 0.844). No fetal death or pregnancy loss occurred within 4 weeks after the procedure. All 4 bradycardia participants were normal and healthy and had an appropriate weight for their gestational age. We conclude that placental injury during a second-trimester genetic amniocentesis due to advanced maternal age poses only a low risk of fetal bradycardia, and there is no evidence of differences between subjects with injured and non-injured placenta in the changes in fetal heart rate.

Frontomaxillary facial angle in chromosomally normal Thai foetuses at 11 to 13 weeks 6 days ' gestation.

Frontomaxillary facial (FMF) angle is the angle between upper part of the anterior end of the maxillary bone and the line along the frontal bone in the midfacial profile view. Based on several previous studies, FMF angle can be useful in screening Down syndrome foetuses, in which FMF angle is significantly larger than that in euploid foetuses. However, racial factors can influence the FMF angle as seen in the different normal ranges among ethnicities. Therefore, before the clinical application of the FMF angle, a reference range for its own population should firstly be developed. In this study, a Thai reference range of FMF angle has been established. The mean FMF angle in euploid foetuses with a 60-mm crown ­ rump length (CRL) was 81.07 °, with 0.23 ° increase for each mm increase in CRL, consistent with those observed in Caucasian and Chinese populations. The measurement of FMF angle has good reproducibility.

Comparison of the five sonographic morphology scoring systems for the diagnosis of malignant ovarian tumors.

OBJECTIVE: To evaluate the accuracy of the 5 sonographic morphology scoring (SMS) systems (Sassone, DePriest, Lerner, Vera and Kawai and Valentin) for prediction of malignant ovarian tumors. METHODS: A diagnostic study was conducted at Songklanagarind Hospital during November 2008 to June 2009. All of the patients scheduled for elective surgery due to ovarian tumors underwent transabdominal or transvaginal sonography within 72 h before the operation. The pictures were recorded. Attention was given to volume, wall and septal thickness, locularity, echogenicity, and papillary and internal surface of the tumor. The 5 SMS systems were applied later by the first author, who was not aware of the clinical data. The final diagnosis was determined by a histopathological report and was categorized into benign or malignant ovarian tumor. Borderline tumors were included in the malignant group. RESULTS: One hundred and forty-six patients were recruited; 82 benign (56.2%), 14 borderline (9.6%), and 50 malignant tumors (34.2%). The sensitivities of the SMS by Sassone, DePriest, Lerner, Vera and Kawai and Valentin were 75, 89.1, 82.8, 79.7 and 82.8% and the specificities were 79.3, 73.2, 68.3, 82.9 and 85.4%, respectively. CONCLUSIONS: Among the 5 systems, the DePriest system is the most sensitive SMS for the prediction of ovarian cancer.

A Thai reference for normal fetal nasal bone length at 11-13(+6) weeks gestation.

AIM: The purpose of this study was to establish a Thai reference for normal fetal nasal bone length (NBL) at 11-13(+6) weeks gestation. METHODS: The fetal nasal bone was measured by sonography in pregnant women at 11-13(+6) weeks gestation. All neonates who showed normal karyotypes were examined after delivery to confirm the absence of congenital abnormalities. RESULTS: A total of 255 pregnant women were recruited. Forty-seven pregnant women were excluded from the analysis because of technically unsatisfactory examination or absent nasal bone and chromosomal abnormalities. The mean ± SD of NBL was 1.79 ± 0.33 mm and increased significantly with crown-rump length (CRL) and gestational age (p < 0.001). The best-fit equation for NBL in euploid fetuses in relation to CRL was: NBL (mm) = (0.030 × CRL (mm)) - 0.016. CONCLUSION: NBL in Thai fetuses at 11-13(+6) weeks was found to be on average shorter than that in Caucasian, African-American and Chinese populations, but similar to those reported in Korean and Latin-American populations.

Comparing complications in intended vaginal and caesarean deliveries.

A hospital-based, prospective cohort study was conducted at the tertiary care university hospital in southern Thailand, between 1 November 2001 and 31 December 2003. The purpose of this study was to compare the various complications found in vaginal and caesarean deliveries based on the original elected intended mode of delivery. There were a total of 1,429 cases, 1,242 intended vaginal deliveries and 187 intended caesarean deliveries. Major and minor complication rates were found to be significantly lower in the intended vaginal delivery group compared with the intended caesarean delivery group (2.3% and 1.3% vs 4.8% and 3.7%; p < 0.05). The most common major complication was haemorrhage, which was found more frequently in the intended caesarean delivery group (OR 7.5, 95% CI 2.6 - 21.5). After statistical adjustment, an intended caesarean delivery was found to be an independent risk factor for complications.

The effect of heavy maternal workload on fetal growth retardation and preterm delivery. A study among southern Thai women.

Heavy maternal workloads are considered to be hazardous to the fetus. The effects of physical activity during pregnancy on low birth weight (LBW), small for gestational age (SGA), and prematurity were assessed from a sample of 1797 women in a follow-up study at the antenatal clinic of two hospitals in southern Thailand. The women were interviewed twice, at 17 and 32 gestational weeks. Outcome data were obtained from medical records and the newborn gestational age determined using Dubowitz's score. The risk of SGA was elevated for women working > 50 hours/week, squatting in work, commuting > 1 hour/day, and having high psychological job demands; the risk of preterm delivery was increased with obstetrical complications. Women who worked long hours and had demanding work conditions had an elevated risk of giving birth to SGA infants but not of preterm delivery.

Are long working hours and shiftwork risk factors for subfecundity? A study among couples from southern Thailand.

OBJECTIVE: To estimate the effect of long working hours and shift work on time to pregnancy. METHODS: Cross sectional samples with retrospective data collection from two 700 bed hospitals at secondary to tertiary care level in Hatyai district, Songkhla Province, Thailand. The study was conducted from March 1995 to November 1995 among 1496 pregnant women attending the antenatal clinics. Subfecundity was defined as time to pregnancy longer than 7.8, 9.5, or 12 months (time to pregnancy was calculated from the date at which the couples started having sexual relations without any contraception until last menstrual date). RESULTS: The descriptive analyses were restricted to 1201 planned pregnancies and the analytical part to 907 working women. Separate analyses on primigravid women were also done. Logistic regressions adjusted for age, education, body mass index, menstrual regularity, obstetric and medical history, coital frequency, and potential exposure to reproductive toxic agents, showed an odds ratio (OR) associated with female exposure to long working hours of 2.3 (95% confidence interval (95% CI) 1.0 to 5.1) in primigravid and 1.6 (1.0 to 2.7) in all pregnant women. Male exposure to long working hours and shiftwork showed no association with subfecundity. The OR of subfecundity was highest when both partners worked > 70 hours a week irrespective of the cut off point used (OR 4.1 (95% CI 1.3 to 13.4) in primigravid women; OR 2.0 (95% CI 1.1 to 3.8) in all pregnant women). CONCLUSIONS: Long working hours is a risk factor for subfecundity especially for women. Shiftwork was not associated with subfecundity in this study.

Prenatal diagnosis of thalassemia in Songklanagarind Hospital in southern Thailand.

A thalassemia screening program for pregnant women has been established in Songklanagarind Hospital since 1992. After genetic counseling, a total of 5078 pregnant women accepted entry into a screening program for thalassemia. Couples at risk who should receive prenatal diagnosis were 2.8%. Total cases who accepted prenatal diagnosis were 135. Total clinical cases were 40 (29.6%) with achievement by prenatal diagnosis of 33 cases (82.5%). Genetic amniocentesis is the most acceptable method for prenatal diagnosis. Five cases (12.5%) were misdiagnosed due to contamination of maternal blood cells in amniotic fluid cases. Questionable results were reported in 2 cases (5%). Abortion occurred in one case (0.7%). Improvement of surgical technic in prenatal diagnosis reduced the complications and contamination of maternal cells. This program shows the feasibility of prevention and control of thalassemia disease in southern Thailand.