The Effect of Early Versus Late Amniotomy on The Course of Labor.

Objective: Comparison effect of early versus late amniotomy on the duration time of first and second stage of labor, the cesarean section rate and analgesic use during labor. Study design: Randomized control trial study. Setting: Labor unit, Department of Obstetrics and Gynecology, Phramongkutklao Hospital. Subjects: 120 term singletons, nulliparous with cephalic presentation pregnant women who had spontaneous labor and came to labor room from June 1st, 2013 to October 31th, 2013. Material and Method: After signed the consent form, the selected pregnant women were divided into two groups by random number table. The early amniotomy which performed when patients entered the active phase of labor (cervical dilatation 3-5 cm., n=60), and the late amniotomy which membrane was left intact and amniotomy was reserved for specific indications (n=60). The outcome of labor was recorded by the attending physicians. Main outcome measures: Compare the duration of labor between two groups. Results: The time of first stage of labor was not different between early and late amniotomy groups (560.0 vs. 637.5 min; p<1.0; time difference 77.5 minutes). There was statistically significant difference between women in the early amniotomy and control groups in cesarean section rate (43.3% vs. 20%; p = 0.006). Conclusion: The amniotomy should not be introduced routinely as the standard labor management, because it was not proven to shorten the course of labor. The authors recommend that the women be informed about the results of the amniotomy, then the decisions were made between the women and their caregivers.

Effectiveness of the model for prenatal control of severe thalassemia.

OBJECTIVE: The aim of the research was to determine effectiveness of the model for prenatal control in reducing new cases of severe thalassemia. METHODS: Pregnant women at six tertiary centers were recruited to follow the model, consisting of (1) carrier screening using mean corpuscular volume (for alpha-thal-1 and beta-thal) and CMU-E screen (for HbE trait), (2) carrier diagnosis, (3) the couples at risk were counseled and offered prenatal diagnosis, and (4) termination of affected pregnancy. All neonates were evaluated for thalassemia. RESULTS: Of the 12,874 recruited pregnancies, 7008 were valid for analysis. Of them, 281 couples were identified to be at risk, Of the 281, 58 affected fetuses were identified and 55 pregnancies were terminated, whereas three did not accept pregnancy termination. All 6727 neonates at no risk were proven to be unaffected. The model had sensitivity and positive predictive value of 100% and 20%, respectively. The model could detect all of affected fetuses. CONCLUSION: The model could prenatally identify affected fetuses with a detection rate and negative predictive value of 100%. The model was highly effective to prenatally detect affected fetuses with an acceptable false positive rate.

Causes and attitude of husbands toward thalassemic carrier screening test when their partners have abnormal screening tests.

OBJECTIVE: To assess the attitude of husbands toward the thalassemic carrier screening test and to explore the causes of non-participation of having a blood test. STUDY DESIGN: Descriptive study. MATERIAL AND METHOD: During 2007-2008, 100 husbands of pregnant women with screening-positive test for thalassemia who refused to have blood test were enrolled by voluntariness. They would fill out a structured questionnaire designed for the present study which was divided into 3 parts; (1) participant's personal characteristics (2) their attitudes toward thalassemic carrier screening test with the score ranging from 1-5, and (3) reasons for their refusal of having a blood test. RESULTS: The husbands had a favorable attitude toward testing for thalassemia, with overall mean score and standard deviation of 3.57 and 0.38. Commonly expressed reasons against testing were the self-belief of having a non-affected child and the inconvenience of coming to the hospital. CONCLUSION: Husbands had a favorable attitude toward test for thalassemia.

Effectiveness of paracervical block versus intravenous morphine during uterine curettage: a randomized controlled trial.

BACKGROUND: Abnormal uterine bleeding is a common gynecologic problem. Fractional curettage, evacuation and curettage, and dilatation curettage are common gynecologic procedures for investigation and treatment of abnormal uterine bleeding. To perform all these procedures, anesthesia is needed but technique varies among hospitals. The standard procedure of uterine curettage was performed after paracervical block or intravenous morphine injection. OBJECTIVE: To compare pain scores during and after uterine curettage using intravenous morphine versus paracervical block MATERIAL AND METHOD: A randomized controlled trial study was performed. Sixty-four patients with abnormal uterine bleeding and indication for curettage were enrolled in the present study. Simple randomized procedure was used to distribute the patients into two groups. Intravenous morphine was carried out in 32 patients as the group A while paracervical block was used in the other 32 patients of the group B before uterine curettage. The main outcome measurement was pain score, which assessed by Numerical rating scale ranging from 0-10. RESULTS: The median pain score during uterine curettage were 7.5 and 6 (p = 0.103), immediately after uterine curettage were 3 and 3 (p = 0.822) and 30 minutes after uterine curettage were 1 and 1 (p = 0.206) in the control and treatment group, respectively. CONCLUSION: Pain scores in patients who received paracervical block were not statistically different from those who received intravenous morphine. Paracervical block could be used as another choice for pain relief during uterine curettage.

The Xp contiguous deletion syndrome and autism.

Xp22 nullisomy in males causes a phenotype consistent with the loss of one or more of the genes located in this chromosomal region. Females with similar Xp deletions rarely manifest the same phenotype. Here we describe a 10-year-old girl with a de novo interstitial deletion encompassing Xp22.2p22.32 who presented with autism, moderate mental retardation, and some dysmorphic features. The deletion was delineated by FISH and STR analyses, and the breakpoints were determined using the Agilent 244 K oligonucleotide array. We found that the 5.5 Mb deletion is located on the paternal X chromosome and encompasses 18 genes. Further molecular and cytogenetic analyses showed unfavorable skewing of X-inactivation of the maternal (intact) chromosome. The phenotype of our patient was compared with previously reported female patients with deletions encompassing the same chromosomal region. We discuss the potential role of the genes in the deleted region and X chromosome inactivation in the pathogenesis of the phenotypic abnormalities seen in our patient. Our findings suggest that the severity and the variability of the clinical findings are determined by the size and the parental origin of the deletions as well as the X-inactivation status.

The association between meconium-stained amniotic fluid and chorioamnionitis or endometritis.

OBJECTIVE: Assess the association between meconium-stained amniotic fluid and chorioamnionitis or endometritis in term pregnant women. MATERIAL AND METHOD: A five-year retrospective study was undertaken between January 1, 1999 and December 31, 2003. One thousand seventy-nine pregnant women who delivered at the Department of Obstetrics & Gynecology, Phramongkutklao Hospital were included in the present study. RESULTS: Five hundred andfifty-three pregnant women (51.25%) had meconium-stained amniotic fluid (group 1) and 526 (48.75%) pregnant women were clear of amniotic fluid (group 2). Two pregnant woman in group 1 (0.36%) and eight pregnant women in group 2 (1.52%) were found to have chorioamnionitis (OR = 0.235). Postpartum endometritis was detected in only one (0.18%) pregnant women in group 1 and nine (1.71%) pregnant women in group 2 (OR = 0.104). CONCLUSION: No association was found between meconium-stained amniotic fluids and chorioamnionitis or endometritis.

Cost-effectiveness analysis of various screening methods for osteoporosis in perimenopausal Thai women.

OBJECTIVE: To perform a health economics analysis of 5 screening programs for osteoporosis in perimenopausal Thai women comparing two alternatives; without intervention and universal treatment without screening. DESIGN: A decision analysis was performed to evaluate five screening strategies: Dual energy X-ray absorptiometry (DXA), Quantitative ultrasound sonography (QUS), risk index (clinical risk factors), two-step screening with QUS followed by DXA, and screening with risk index followed by DXA, comparing outcomes without intervention and universal treatment without screening. RESULTS: The costs for universal treatment, screening by DXA with treatment, screening by QUS with treatment, screening by Risk index with treatment, screening by QUS and DXA with treatment, and screening by Risk index and DXA with treatment strategies to prevent one fracture were 207.82, 88.42, 147.05, 127.67, 71.33, and 60.30 USD, respectively. The cost for no intervention to prevent one fracture is 8.49 USD (1 USD = 40 Thai baht). CONCLUSION: At present, no intervention is the most cost effective strategy. However, screening with risk index and DXA with treatment became the most cost effective when the patients reached the postmenopausal period and had a high risk index, for which the prevalence of osteoporosis will increase. Cost effective screening guidelines still cannot be explicitly established until further data addressing the association between bone mass measurements in the hip and hip fracture risk, are available.

Recurrent biparental hydatidiform mole: additional evidence for a 1.1-Mb locus in 19q13.4 and candidate gene analysis.

OBJECTIVES: A maternal autosomal recessive mutation causing recurrent biparentally inherited complete hydatidiform moles (BiCHM) in affected women was previously mapped to a 12.4-cM interval in 19q13.4, which was recently further narrowed to a smaller 1.1-Mb region at the centromeric end. It is believed that the mutant gene in this condition is a major contributor to the regulation of imprinting in the maternal germline. To confirm and possibly narrow the critical interval we studied additional rare familial and recurrent cases. METHODS: Using polymorphic marker analysis, we first confirmed biparental inheritance on the studied molar tissues. We then performed targeted homozygosity mapping with markers in 19q13.4 on DNA from affected women of a new large consanguineous pedigree, an additional potentially familial case, and three cases with sporadic recurrent CHM. Direct sequencing of coding exons and Southern analysis with a coding-region probe for one candidate gene (NALP5) was also performed. RESULTS: Biparental inheritance was confirmed for those molar tissues available for analysis. All women, except for one of the isolated cases, were homozygous for markers in the identified 1.1-Mb region in 19q13.4. No mutations or large genomic rearrangements were found in NALP5 (MATER), a gene with oocyte-specific expression. Heterozygosity for a single-nucleotide polymorphism in exon 13 of NALP5 in one patient may refine the candidate region to 1.0 Mb. CONCLUSIONS: The reported candidate region for BiCHM in 19q13.4 was confirmed in additional families, further establishing it as the major locus that harbors a gene mutated in this condition.

Presence of filamin in the astrocytic inclusions of Aicardi syndrome.

Aicardi syndrome affects only females and has been hypothesized to be an X-linked dominant male-lethal disorder. Because no familial cases can be studied for genetic linkage analysis, the mutated gene has remained elusive. With the goal of selecting genes for mutation analysis by a functional candidate approach, a detailed pathologic analysis of two brains from deceased Aicardi syndrome patients was performed. The presence of micrencephaly, absent or hypoplastic corpus callosum, polymicrogyria, heterotopia, ventriculomegaly, intracerebral cyst, and intracytoplasmic eosinophilic inclusions was confirmed in glial fibrillary acidic protein-positive astrocytes in the cortex and heterotopias, but not in white matter. The inclusions demonstrated strong immunolabeling with antibodies to filamin and vimentin but weak labeling with antibodies to proteins S100 and microtubule-associated protein 1. These findings suggested that an underlying defect in the cytoskeleton, which involves filamin, may cause this condition. Because the filamin A gene in Xq28 is mutated in another disorder with heterotopia, familial bilateral periventricular heterotopia, mutation analysis of filamin A in Aicardi syndrome patients was pursued. No mutations were found, and the full-length protein was expressed in both brain samples. Future studies will focus on investigation of X-linked genes that may affect function of filamin or other cytoskeletal proteins.