Plasma HIV-1 RNA viral load and serum vitamin A and E levels in HIV-1 infected pregnant women.

The aim of this study was to assess the correlation between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio in HIV-1 infected pregnant women not receiving antiretroviral therapy There were no significant correlations between plasma HIV-1 RNA viral load and serum vitamin A and E concentrations and vitamin E/cholesterol ratio. However, the presence of underlying vitamin A deficiency in these pregnant women was common.

The relationship of fetal heart rate at 10-14 weeks and birthweight at term.

The purpose of this study was to examine the correlation between the fetal heart rate at 10-14 weeks and birthweight at term. At the fetal medicine unit, Ramathibodi Hospital, the screening for Down's syndrome at 10-14 weeks' gestation by ultrasound has been ongoing since January 1997. Transabdominal ultrasound examination is routinely performed for the crown-rump length, nuchal translucency thickness and fetal heart rate. The fetal heart rate is measured over four to six cardiac cycles by using the pulsed Doppler technique. One thousand and fourteen term singleton pregnancies that resulted in phenotypically normal live births were studied. The study was done was carried out at 10-14 weeks of gestation (mean 12.27 weeks) from January 1997 to November 1997. The mean patient age was 26.78 years old. The mean gestational age and birthweight were 38.83 weeks and 3,097.83 grams respectively. The incidence of low birthweight (less than 2,500 grams) was 14.2 per cent. Regression analysis demonstrated no significant relation between fetal heart rate at 10-14 weeks and birthweight at term. In conclusion, the result of this study revealed that there was no correlation of the fetal heart rate at 10-14 weeks' gestation and birthweight at term.

Prevention and control of thalassemia in Ramathibodi Hospital, Thailand.

Eight thousand seven hundred and thirty-six pregnant women were screened for thalassemia and hemoglobinopathies by mean corpuscular volume less than 80 femtolitres (fl). Three thousand six hundred and seventy women (42%) were MCV less than 80 fl. In this group there were 2,390 women (70%) who had positive Hb typing by high performance liquid chromatography (HPLC) such as beta-thalassemia major, beta-thalassemia hemoglobin E disease, beta-thalassemia trait, heterozygous and homozygous hemoglobin E, alpha-thalassemia-1 trait and hemoglobin H disease and 77% of their partners came and had hemoglobin typing done. Seventy-five couples at risk for having severely affected thalassemia fetuses were detected from this screening program. Prenatal diagnosis was performed in 58 couples (77.3%). Eight affected fetuses were detected. All pregnancies with affected fetuses except one with beta-thalassemia/HbE were terminated. There were 3 fetal losses (6%) as the result of prenatal diagnosis procedure.

Maternal viral load and vertical transmission of HIV-1 in mid-trimester gestation.

BACKGROUND: It is now accepted that the majority of HIV-1 vertical transmissions occur in late gestation and at the time of delivery. However, there is wide variation in the prevalence rate of mid-trimester vertical transmission. We assessed the maternal HIV-1 RNA viral load and in utero transmission during mid-trimester gestation. METHODS: Patients were enrolled when they decided to have their pregnancies terminated between 17 and 24 weeks of gestation. Prostaglandin-induced abortion with PGE1 analogue vaginal administration was carried out in all patients. Maternal plasma HIV-1 RNA viral load and plasma HIV-1 RNA (qualitative) from abortus heart blood were assessed. RESULTS: Amongst 41 HIV-1 seropositive pregnant women not receiving antiretroviral therapy plasma HIV-1 RNA was detected in the abortus heart blood from two women (4.9%; 95% confidence interval (CI), 0.6-16.5). Transmission occurred in one out of nine (11.1%; 95% CI, 0.3-48.2) with maternal viral load > or =100000 copies/ml versus one out of 32 (3.1%; 95% CI, 0.1-16.2) of those with <100000 copies/ml (P = 0.39). CONCLUSIONS: The frequency of HIV-1 vertical transmission during mid-trimester was approximately 5% as detected by plasma HIV-1 RNA (qualitative) method in the fetuses aborted from the prostaglandin termination of pregnancy. During mid-trimester gestation there was no correlation between high maternal viral load and vertical transmission.

Serum vitamin A and E in pregnant women with hemoglobinopathies.

OBJECTIVE: To evaluate the relationship between the status of serum vitamin A, E and hemoglobinopathies among Thai pregnant women. METHODS: This was a cross-sectional study in which serum vitamin A and E were assessed in 323 pregnant women with normal hemoglobin and 73 with hemoglobinopathies (47 with hemoglobin E and 26 with thalassemia) during the first trimester. RESULTS: There were no significant differences in the mean serum vitamin A, E concentrations and vitamin E/cholesterol ratio between pregnant women with normal hemoglobin and hemoglobinopathies, while confounding variables that might affect serum vitamin levels i.e. maternal age, gravida, BMI, gestational age, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration and blood group were not different. CONCLUSION: The results of this study suggest that antenatal care in terms of micronutrients-vitamin A, E in Thai pregnant women with hemoglobinopathies should not be different from normal pregnant women.

External cephalic version: first report from Thailand.

This prospective study was to preliminary report the safety and success rate of external cephalic version (ECV) in patients with breech presentation or transverse lie at 36 weeks of gestation or more. The aim of this procedure was to reduce the cesarean section rate from indication of breech presentation and transverse lie. This procedure was first started in the Obstetrics and Gynecology Department, Ramathibodi Hospital in June 1998. Thirty two patients were enrolled in this study. ECV was 65 per cent successful with the reversion rate of five per cent. There was no maternal or fetal complication related to this procedure. Factors associated with successful outcome in this study were the location of placenta, the position of fetal spine and the amount of amniotic fluid. A larger study is needed before the true success rate and the efficacy of this procedure can be apparent.

Maternal mortality in Ramathibodi Hospital: a 28-year comparative study.

A comparative review of maternal mortality rates at Ramathibodi Hospital from 1969 through 1996 including 176, 161 live births is presented. The data are divided into two time periods, both of 14 years, for comparison. A significant decrease in direct obstetric deaths secondary to infection and toxemia (P < 0.05). The rate of deaths due to indirect causes in unchanged. Deaths due to malignancies have increased. This study of maternal mortality demonstrates the need for increased contraceptive services, voluntary sterilization, patient education and preconceptional identification of high-risk patients for further reduction of the maternal mortality rate.

Study of hematopoietic progenitor cells, hematological values and lymphocyte subsets in cord blood: application for cord blood transplantation.

Hematological values, lymphocyte subsets and hematopoietic progenitor cells from normal term cord blood samples were studied, compared with normal adult blood, and analysed to determine whether a single collection of cord blood is sufficient for transplantation in adults. The parameters were assayed by automatic cells counter, flow cytometry and semisolid cell culture. All of the hematological values except RBC and MCHC were higher than in normal adult blood. Sex had an influence on RBC, Hb, Hct, Plt and reticulocyte counts. For lymphocyte subsets, all of the absolute CD3+, CD4+, CD8+ counts and T helper: suppressor ratio were higher than those of adult blood. All of the hematopoietic progenitor cells in cord blood were also higher than in adult blood. The mean volume of cord blood for each collection was 80.75 +/- 4.81 ml and the mean numbers of nucleated cells, CFU-GM and CD34+ were 13.51 +/- 0.38 x 10(8) cells, 4.33 +/- 0.66 x 10(5) colonies and 42.65 +/- 7.00 x 10(5) cells respectively. This 80 ml of cord blood would contain sufficient marrow repopulating cells for a recipient weighing about 20 kg. Recently developed technology, including ex vivo expansion may even permit transplants in adults.

Vasa previa in Ramathibodi Hospital: a 10 years review.

Vasa previa is presented when fetal vessels cross the internal os as a velamentous insertion of the umbilical cord. This retrospective study is to review the diagnosis, the management, and the outcome of this condition over the 10 years period in Ramathibodi Hospital, Bangkok, Thailand. Five cases were diagnosed after the rupture of membranes with only one case diagnosed prior to the rupture of membranes. The fetal mortality was 50 per cent. Despite continued advances in diagnostic procedures, vasa previa still presents considerable risk to the fetus.