Early universal screening of gestational diabetes in a university hospital in Thailand.

A total of 1016 pregnant women attending antenatal clinic before 20 weeks of gestation during September 2018 to February 2019 were included in a cohort study with repeated cross-sectional assessments. The study was aimed to determine prevalence and characteristics of gestational diabetes mellitus (GDM) and pregnancy outcomes by early universal screening approach. GDM screening was performed during first visit and repeated during 24-28 weeks of gestation, as necessary, using a 50-g glucose challenge test followed by a 100-g oral glucose tolerance test for GDM diagnosis. Overall prevalence of GDM was 18.6%. A significantly higher prevalence of GDM was observed among high-risk than low-risk women (21.3% vs. 13.1%, p = 0.002). GDM among low-risk women contributed to 23.3% of all GDM cases. The majority of GDM (76.2%) were diagnosed before 20 weeks of gestation, with 74.5% occurring in high-risk women and 81.8% occurring in low-risk women. When initial screening tests were normal, risk of GDM diagnosed during 24-28 weeks was 6.0% (7.5% among high-risk women and 3.1% among low-risk women). Compared to those without GDM, women with GDM significantly had lower gestational weight gain (p < 0.001), higher prevalence of preeclampsia (p = 0.001), large for gestational age (LGA) (p = 0.034) and macrosomia (p = 0.004). These outcomes were more pronounced among high-risk women with GDM. Impact StatementWhat is already known on this subject? Universal GDM screening is recommended during 24-28 weeks of gestation, either by 1- or 2-step approach. Some also recommend early GDM screening among high-risk women. Prevalence of early-onset GDM varies between studies and benefits of early diagnosis and treatment are still controversial.What do the results of this study add? Early universal GDM screening identified more women with GDM and majority could be diagnosed before 20 weeks of gestation. GDM among low-risk women contributed to 23.3% of all cases. Adverse pregnancy outcomes were more common among high-risk women with GDM. This approach could be useful and can be implemented in other settings, especially those that serve high-risk population or with high GDM prevalence.What are the implications of these findings for clinical practice and/or further research? Early universal GDM screening should be considered in settings with high prevalence of GDM and high-risk women. However, benefits of early detection and treatment of GDM should be determined in more details in the future, especially in terms of cost-effectiveness and improvement in pregnancy outcomes.

Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated infection (COVID-19) is affecting populations worldwide. This statement may serve as guidance for infection prevention and safe ultrasound practices during the COVID-19 pandemic. Ultrasound examination is a fundamental part of obstetric care, yet it is a potential vector for transmission of SARS-CoV-2. Decontamination methods should always be implemented for ultrasound equipment, especially in the presence of suspected or confirmed COVID-19 cases. There must be workflow policies to protect pregnant women and healthcare providers from nosocomial cross transmission of SARS-CoV-2. Cleaning and disinfecting of equipment must be in accordance with their potential of pathogen transmission. Consider using telemedicine and genetic technologies as an adjunctive of obstetric ultrasound to reduce patient crowding. Patient triage and education of healthcare providers of infection prevention are crucial to minimize cross contamination of SARS-CoV-2 during obstetric ultrasound.

Comparison of the efficacy and safety of titrated oral misoprostol and a conventional oral regimen for cervical ripening and labor induction.

OBJECTIVE: To compare the efficacy and safety of titrated oral misoprostol and a conventional oral regimen for cervical ripening and labor induction. METHODS: A randomized double-blind trial of women with term singleton pregnancies with indications for labor induction. Participants were allocated to receive 20 mL of misoprostol solution (1 µg/mL) orally every 1 hour for 4 doses then titrated to 40 µg every 1 hour (titrated group) or 50 µg of misoprostol orally every 4 hours up to 12 hours (conventional group). Primary outcomes were success rate of cervical ripening within 12 hours, interval from first dose until more favorable cervix or active labor occurred, and total dose of misoprostol. RESULTS: Sixty-four participants were included. Mean total dose of misoprostol and incidence of tachysystole were significantly higher in the titrated compared with the conventional group (236.2±110.1 µg vs 103.1 ± 35.7 µg; P=0.001 and 25.0% vs 6.3%; P=0.03), whereas success rate, interval from drug administration to more favorable cervix and delivery, proportion of patients delivered vaginally within 12 hours and 24 hours, need for oxytocin augmentation, cesarean delivery rate, maternal adverse effects and complications, and neonatal outcome were not significantly different (P>0.05). CONCLUSION: Conventional oral misoprostol is as effective as titrated misoprostol for cervical ripening and labor induction, but has a lower incidence of tachysystole and a lower total dose of misoprostol is required. ClinicalTrial.gov: NCT00886860.

The correlation in antepartum fetal test between full fetal biophysical profile (FBP) and rapid biophysical profile (rBPP).

OBJECTIVE: To determine the correlation between the rapid biophysical profile (rBPP), the combination of amniotic fluid index (AFI), and sound-provoked fetal movement (SPFM) detected by ultrasound, and the full biophysical profile (FBP) in terms of abnormal and normal result. MATERIAL AND METHOD: A prospective study was performed in 200 singleton pregnancies with no fetal anomalies between 30-42 weeks of gestation indicated for non-stress test (NST). All participants received both the standard (FBP) and the new rBPP examinations. Abnormal fetal test was defined as having a score of < or = 6 for FBP or < or = 2 for rBPP. The main outcome measurement was Spearman's correlation coefficient (r) between both examinations. RESULTS: The incidences of the abnormal tests were 1.5% and 6.0% in FBP and rBPP, respectively. The data showed a positive correlation between the two tests (r(s) = 0.67; p < 0.01). Regarding the operative time, FBP assessment was 25.56 +/- 8.75 times longer than rBPP. The number of abnormal NST was remarked at 1.5% while oligohydramnios and abnormal SPFM were detected at 5% and 2%, respectively. Compared to the standard NST, rBPP test was significantly superior in terms of correlation with FBP (r(s) = 0.67 vs. 0.33) and shorter duration of test (1.21 +/- 0.32 min. vs. 21.65 +/- 5.47). CONCLUSION: The statistically significant positive correlation between rBPP and FBP has been revealed. Due to its simplicity, rapidity, and no need of expensive equipment or experienced interpreter the rBPP may be alternatively used as a primary antepartum fetal test in the overcrowded obstetric center or when fetal surveillance tests are limited.

Transabdominal ultrasound in the assessment of postvoid residual urine volume in patients after hysterectomy.

OBJECTIVE: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy. MATERIAL AND METHOD: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization. RESULTS: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml. CONCLUSION: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.