A comparison of the rate of premature rupture of membranes between twin versus singleton pregnancy.

OBJECTIVE: To compare the rate of pregnancy complicated with premature rupture of membranes (PROM) and obstetric outcomes of twin pregnancies and singleton pregnancies. MATERIAL AND METHOD: A retrospective cohort study was conducted on twin and singleton pregnancies that delivered at Rajavithi Hospital, Tertiary public hospital, Bangkok, Thailand between January 1, 2008 and July 31, 2012. Singleton pregnancies as a control group were matched with twin pregnancies based on date ofdelivery, with a ratio of]:1. The main outcome of measure was the prevalence ofpreterm rupture of membranes. RESULTS: The prevalence of PROM among twin pregnancies had a tendency to be lower than that in singleton pregnancies, 5.4% vs. 9%, but the difference was not statistically significant (p = 0.053). The mean gestational age at delivery for twin pregnancies was significantly lower than singleton, 34.8±3.1 weeks vs. 38.1±2.1 weeks (p<0.001). The rates of cesarean delivery, low birth weight baby, and APGAR scores less than 7at 5 minutes were also significantly higher in twin pregnancies. CONCLUSION: The prevalence of PROM in twin pregnancies had a tendency to be lower than that in singleton, but not statistically significant. The reason may be associated with a high rate ofpre-labor cesarean section due to other obstetric complications.

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.

Takayasu disease in twin pregnancy: a case report.

Takayasu arteritis is a rare chronic inflammatory vascular disease involving the aorta and its major branches. During pregnancy, the disease can be life-threatening. This report describes a successful management of twin pregnancy complicated with Takayasu disease, rarely described elsewhere. A 33-year-old pregnant woman had been diagnosed with Takayasu disease since the age of 15 during a typical history and investigation. The patient underwent abdominal aortic aneurysmectomy with graft and revascularization of renal artery with saphenous vein graft before pregnancy. This pregnancy was a monochorion-diamnion twin. She was closely followed up and taken care of by a multidisciplinary approach at the high-risk antenatal clinic. A single fetal demise was detected at 20 weeks and the live fetus was diagnosed with intrauterine growth restriction at 25 weeks. Cesarean delivery was performed at 30 weeks due to severe IUGR, abnormal umbilical artery Doppler, and maternal superimposedpreeclampsia, giving birth to a healthy female baby weighing 960 gm. The case presented here implies that a successful outcome of twin pregnancy complicated with Takayasu disease is possible with multidisciplinary approach and extreme cautions.

The influence of MR imaging on changes in patient counseling in obstetric patients with suspected fetal anomalies by ultrasound.

OBJECTIVE: To determine the frequency of additional information provided by magnetic resonance (MR) imaging in supplement to ultrasound (US) in patients with fetal anomaly and to determine the influence of MR imaging findings on patient counseling. MATERIAL AND METHOD: MR imaging offetus was performed in 26 patients who have abnormal ultrasound results. Referring obstetricians were asked about how the additional information provided by MR imaging have effect on their decision marking, patient counseling, and case management. RESULTS: MR imaging in 23 of 26 fetuses was technically successful. MR imaging provided additional information in 14/23 (60.9%) cases. In the other nine (39.1%) cases, MR imaging confirmed US diagnosis but did not give supplementary information. Additional information from MR imaging affected patient counseling in five (21.7%) cases and did not affect patient counseling in the other nine (39.1%) cases. In 14 cases with additional information from MR imaging, there were isolated CNS involvement in five (35.7%) cases, isolated extra-CNS involvement in two (14.3%) cases, multisystem involvement in five (35.7%) cases, and other-category in two (14.3%) case. CONCLUSION: MR imaging can provide additional information that have influence on patient counseling and patient care, particularly in cases with CNS and multisystem anomaly.

Pregnancy outcomes of Southeast Asian immigrant pregnant women compared with Thai pregnant women in Rajavithi Hospital.

OBJECTIVE: To determine the pregnancy outcomes of Southeast Asian immigrant women compared to native Thai women in Rajavithi Hospital. MATERIAL AND METHOD: A retrospective cohort study was conducted on singleton Southeast Asian immigrant pregnant women in Thailand between January 2007 and December 2008. RESULTS: One thousand two hundred sixty immigrant pregnant women and 5040 controls were included. After adjusting the odds ratio, the cesarean section rate, postpartum hemorrhage, preterm birth, and neonatal intensive care unit admission of immigrant women are not different from native-born women. The incidence of low Apgar score at 5 minutes and perinatal death were significantly lower in the study group with an odds ratio of 0.506 (95% CI 0.29-0.89) and 0.295 (95% CI 0.10-0.83), respectively. Low birth weight was higher in the study group with an odds ratio of 1.707 (95% CI 1.45-2.01). CONCLUSION: In Thailand, the cesarean section rate, postpartum hemorrhage, preterm birth, and neonatal intensive care unit admission of immigrant women are not different from native-born women. Foreign-born status confers a protective effect for low Apgar score at 5 minutes and perinatal death. However, the incidence of low birth weight in foreign-born women is higher than native-born women.

Feto-maternal hemorrhage after cordocentesis at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To evaluate the incidence and volume of feto-maternal hemorrhage following cordocentesis. STUDY DESIGN: Descriptive study. MATERIAL AND METHOD: One hundred and sixteen asymptomatic non-anemic pregnant women with an indication for cordocentesis at 18-22 weeks of gestation between January and June 2004 were recruited. Maternal blood samples were obtained immediately before and 30 minutes after cordocentesis. Fetal cells in the maternal blood were counted using Kleihauer Betke test. About 25,000 maternal cells per slide were scanned by the same examiner. Feto-maternal hemorrhage was considered significant if the fetal bleeding was more than 0.25 ml. RESULTS: There was a significant increase in fetal blood volume in maternal circulation after cordocentesis (Paired Students t test, p < 0.001). A significant hemorrhage (> 0.25 ml) occurred in 63 from 116 women (54. 7%). Only one had marked hemorrhage of more than 5.0 ml and none had massive hemorrhage (> 15 ml). CONCLUSION: Cordocentesis at 18-22 weeks of gestation can be associated with feto-maternal hemorrhage in more than half of the cases but nearly all cases had only minimal hemorrhage and none had massive hemorrhage.

Doppler waveform indices of the Middle Cerebral Artery of normal fetuses in the first half of pregnancy in the Thai population.

OBJECTIVE: To establish the reference ranges of middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV) of the Thai fetuses at gestational age of 11-20 weeks. METHODS: A descriptive cross-sectional study was conducted at Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Normal singleton pregnancies between 11 and 20 weeks of gestation were recruited into the study for measurements of MCA Doppler indices between November 2005 and August 2006. The trans-abdominal ultrasound, Aloka Model Prosound 5000 (Tokyo) was used. The MCA Doppler data were analyzed for median, 5th, and 95th percentile for each gestational week. The best-fit mathematical model was derived. RESULTS: A total of 300 measurements, with average of 30 +/- 7.35 per gestational week (mean +/- SD) and range 23-45 per gestational week, were obtained from 149 patients. Regression analysis yielded the best-fitted equation of quadratic function as follows: PI = 8.421 - 0.705(GA) + 0.018(GA(2)) (r (2) = 0.452), RI = 1.54 - 0.073(GA) + 0.002(GA(2)) (r (2) = 0.309), PSV = -63.456 + 9.425(GA) - 0.262(GA(2)) (r (2) = 0.504). CONCLUSION: A nomogram for MCA Doppler indices, including PI, RI and PSV ratio for each gestational age during 11-20 weeks was constructed. This may be a useful aid in the early detection of abnormalities in fetal cerebral blood flow, especially in fetal anemia secondary to hemoglobin Bart's disease.