Factors affecting Thai pregnant women's decisions concerning prenatal diagnosis and termination of pregnancy for ß-thalassemia.

AIM: To investigate the factors influencing decisions concerning prenatal diagnosis (PND) and termination of pregnancy for ß-thalassemia in Thai pregnant women. METHODS: A total of 142 Thai Buddhist pregnant women waiting for PND were asked to undertake semi-structured interviews regarding their reasons for PND and their decisions and reasoning concerning pregnancy if the fetus was found to be affected. The interviews were analyzed using a thematic content approach. RESULTS: Thai pregnant women accepted PND for three reasons: to know whether their pregnancies were affected, to confirm that their pregnancies were unaffected and to terminate if their pregnancies were affected. Three decisions identified among the women were to terminate the pregnancy, to continue the pregnancy and undecided. The interview analysis identified five themes and nine sub-themes affecting pregnancy-related decision-making: (i) quality of life (suffering or no disability); (ii) burden (difficulty or acceptability); (iii) sense of motherhood (the best way for the child or I cannot hurt my child); (iv) significant others (support to terminate, support to continue or support to wait for the test result) and (v) conflict in deciding. CONCLUSION: An acceptance of PND in Thai pregnant women was not always associated with pregnancy termination. Multiple factors influenced the decision to terminate, but not their religious affiliation.

Correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women.

BACKGROUND: Preterm labor is one of major obstetric challenges and can be predicted by cervical length at mid-trimester. In some settings, transvaginal ultrasound is not available and the screening and prevention of preterm labor will be suboptimal. We hope to find a correlation between other marker i.e. lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women during 16-32 weeks of gestation. METHODS: This study was a cross-sectional study. 166 singleton pregnant women were invited to participate in the study between June 2015 and December 2015. Transabdominal ultrasonography was performed to measure the lower uterine wall thickness and transvaginal ultrasonography was performed to measure the cervical length. The Spearman's rank correlation was used to evaluate the correlation between the two parameters. The inter-observer variation was assessed by using Bland-Altman plot. The outcomes of all pregnancies were followed and only those who delivered at term were included for the calculation of normal value of lower uterine wall thickness. RESULTS: There was a highly positive correlation between lower uterine wall thickness and cervical length (rs = 0.767, n = 166, p < 0.001). For those who had short cervical length (defined as less than 30 mm) at GA 16-24 weeks (n = 10), the mean corresponding lower uterine wall thickness was 4.4 mm (SD 0.50). The inter-observer variation of the measurement of lower uterine wall thickness and cervical length were small. The lower uterine wall thickness tended to be slightly thinner when the gestation advanced. (mean 5.4 mm at 16-20 weeks and 5.1 mm at 28-32 weeks). CONCLUSION: There was a highly positive correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women.

Correlation Between Third Trimester Glycemic Variability in Non-Insulin-Dependent Gestational Diabetes Mellitus and Adverse Pregnancy and Fetal Outcomes.

BACKGROUND: Gestational diabetes mellitus (GDM) is a pregnancy-related metabolic complication. Despite optimal glycemic control from self-monitoring blood glucose (SMBG) in non-insulin-dependent GDM, variations in pregnancy outcomes persist. Glycemic variability is believed to be a factor that causes adverse pregnancy outcomes. Continuous glucose monitoring system (CGMS) detects interstitial glucose values every 5 minutes, and glycemic variability data from CGMS during the third trimester may be a predictor of fetal birth weight and pregnancy outcomes. The aim of this study was to investigate correlation between third trimester glycemic variability in non-insulin-dependent GDM and fetal birth weight. METHOD: This prospective study was conducted in 55 pregnant volunteers with non-insulin-dependent GDM that were recruited at 28 to 32 weeks' gestation from the outpatient clinic of the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital during the study period of August 1 to December 31, 2016. Patients had CGMS installed for at least 72 hours and glycemic variability data were analyzed. RESULTS: Of 55 enrolled volunteers, the data from 47 women were included in the analysis. Mean CGMS duration was 85.5 ± 12.83 hours. No statistically significant correlation was identified between glycemic variability in third trimester and birth weight percentiles, or between third trimester CGMS parameters and pregnancy outcomes in the study. CONCLUSION: Based on these findings, third trimester glycemic variability data from CGMS are not a predictor of fetal birth weight percentile, and no significant association was found between CGMS parameters and adverse pregnancy outcomes; thus, CGMS is not necessary in non-insulin-dependent GDM.

Serum-free placental growth factor isoform 1 at 11-13-week gestation: effects of maternal factors, mean arterial pressure, placental volume, and uterine artery pulsatility index.

INTRODUCTION: To define the effects of maternal factors, mean arterial pressure (MAP), placental volume (PV), and uterine artery Doppler pulsatility index (UtAPI) to serum level of free form of placental growth factor isoform 1 (free PlGF-1) measured with a novel automated assay. METHODS: We enrolled 200 Thai women singleton pregnancy from 11+0 to 13+6 weeks gestation with low prior risk maternal factors (age, parity, tobacco use, assisted reproductive technology, and body mass index). MAP was measured. Serum-free PlGF-1, PV, and UtAPI were measured with a new assay, transabdominal three-dimensional, and color Doppler ultrasounds, respectively. Effects of these variables to serum-free PlGF-1 level were assessed. RESULTS: Data from 195 eligible subjects showed an elevation of serum-free PlGF-1 from 11, 12, and 13 weeks (mean ± SD; 36.89 ± 24.92, 38.71 ± 17.44, and 49.68 ± 22.30 pg/mL, respectively (p < .05)). Serum-free PlGF-1 level showed positive correlation with PV (r = 0.290, p < .01), and negative correlation with right and left UtAPI (r = -0.717, p = .05 and r = -0.221, p < .05, respectively). PV showed negative correlation with right and left UtAPI (r = -0.243, p < .05 and r = -0.372, p < .05, respectively). Serum-free PlGF-1 level had no significant correlation with maternal factors or MAP (p > .05). There was no preeclampsia at <34 weeks in 161 subjects (82.6%) with known pregnancy outcomes. CONCLUSIONS: There was modest correlation of serum-free PlGF-1, PV, and UtAPI, but not with maternal factors or MAP. Adjustment of serum-free PlGF-1 in early preeclampsia screening algorithm should be considered.

Effect of Supportive Information on Anxiety Levels in Pregnant Women Awaiting Amniocentesis Results: A Randomized Controlled Trial.

Objective: To evaluate the effect of supportive information on anxiety levels in women awaiting amniocentesis results. Material and Method: Women underwent amniocentesis were randomized into two groups according to whether they did (group A) or did not (group B) receive supportive information. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory at four time points, (1) after amniocentesis, (2) before phoning for test result appointment confirmation, (3) after phoning, during which supportive information was given to group A, and (4) before receiving the test results. Semistructured interviews were conducted after the last anxiety measurement. Results: There were no significant differences in the state anxiety scores between the two groups after amniocentesis and before phoning to confirm that the amniocentesis results were available. The state anxiety scores after telephoning and before receiving the test results in group A were significantly lower than those in group B (36.69 vs. 42.50, p<0.001, and 39.16 vs. 42.82, p<0.05, respectively). We identified three stages of psychological distress, uncertainty of fetal safety, uncertainty of the test results, and hopefulness concerning the test results. Women in group B experienced only the two early stages of distress, whereas after receiving supportive information, the psychological state of women in group A further progressed to the hopefulness concerning the test result Conclusion: Supportive information could alleviate the anxiety level of women awaiting amniocentesis results. Providing appropriate supportive information for each psychological stage should be considered for women underwent amniocentesis.

Circulating free soluble fms-like tyrosine kinase-1 during late first trimester in relation with placental volume as a surrogate for trophoblastic production: a physiology study in low-risk cohort.

BACKGROUND: Data on first-trimester circulating soluble fms-like tyrosine kinase-1 (sFlt-1) and ischemic placental disease is limited and conflicting. This study aimed to study its physiology in relation to trophoblastic mass as the source of production. METHODS: Low-risk (representing normal placentation) women from 11 0/7 to 13 6/7 weeks' gestation were prospectively enrolled. Selective measurement of serum free sFlt-1 using a new automated assay from 100 eligible subjects was analyzed with gestational age, maternal weight, fetal crown-rump length (CRL), and mean uterine artery Doppler pulsatility index (PI). Placental volume (surrogate for trophoblastic mass) was estimated using 3-dimensional ultrasound and was assessed for its association with serum free sFlt-1. RESULTS: There was no significant association between serum free sFlt-1 and placental volume in either arithmetic (r = 0.053, p = 0.600), logarithmic (r = 0.005, p = 0.963), or quartile (p = 0.703) scale. There was a significant negative correlation between free sFlt-1 level and maternal weight (r=-0.213, p = 0.033). No significant correlation was found between free sFlt-1 level and gestational age (r = 0.007, p = 0.947), CRL (r = 0.027, p = 0.788), and uterine artery Doppler mean PI (r = 0.020, p = 0.828). CONCLUSIONS: Lack of correlation between circulating free sFlt-1 level and placental volume suggests that trophoblasts are not its major source during first trimester with presumably physiologic placentation.