Oral dydrogesterone for prevention of miscarriage in threatened miscarriage: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To determine the effectiveness of oral dydrogesterone in preventing miscarriage in threatened miscarriage. METHODS: A randomized, controlled trial study was conducted among pregnant Thai women at the gestational age of six to less than 20 weeks who visited King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand with threatened miscarriage from August 2021 to August 2022. These pregnant women were randomized to receive oral dydrogesterone 20 mg per day or placebo twice a day until one week after vaginal bleeding stopped or otherwise for a maximum of six weeks. RESULTS: A total of 100 pregnancies were recruited. Fifty of them were assigned to receive oral dydrogesterone and 50 were assigned to receive placebo. The rate of continuing pregnancy beyond 20 weeks of gestational age was 90.0% (45 out of 50 women) in the dydrogesterone group and 86.0% (43 out of 50 women) in the placebo group (p = 0.538). The incidence of adverse events did not differ significantly between the groups. CONCLUSION: Oral dydrogesterone 20 mg/day could not prevent miscarriages in women with threatened miscarriage.

Serum fatty acid binding protein 4 and Doppler of uterine artery ultrasound in the first trimester for the prediction of preeclampsia.

The objective of this study was to determine the predictive value of serum fatty acid binding protein 4 (FABP4) combined with Doppler of the uterine artery in singleton pregnancy at gestational age (GA) 11-13+6 weeks for prediction of preeclampsia. A prospective observational study included singleton pregnant women at GA 11-13+6 weeks and was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, between December 2020 and April 2022. Serum FABP4 levels and Doppler of the uterine artery were performed. Pregnancy outcomes were recorded. The predictive values of these combined tests at the optimal cut-off values were determined to predict preeclampsia. A total of 330 participants with 15 cases of preeclampsia (4.5%) and 6 cases of them had preterm preeclampsia (GA < 37 weeks) (1.8%) were analyzed. Women with preeclampsia had significantly higher serum FABP4 levels than normal pregnant women (12.9 ± 6.5 ng/ml vs 10.1 ± 4.8 ng/ml, p = 0.034) but no difference in the mean pulsatility index (PI) of the uterine artery and the presence of an early diastolic notch. When using serum FABP4 levels greater than 1.0 multiple of the median of GA as a cut-off value to predict preeclampsia, combined with abnormal Doppler PI of the uterine artery, the sensitivity, specificity, positive predictive value, and negative predictive value were 73.3%, 47.3%, 6.2%, and 97.4%, respectively. This study demonstrated that serum FABP4 levels combined with Doppler of the uterine artery at GA 11-13+6 weeks were effective in predicting preeclampsia.

First trimester SHARP1 and second-trimester uterine artery Doppler to predict preeclampsia.

OBJECTIVES: The objective of this study was to identify the predictive value of the first-trimester serum SHARP1 level and the second-trimester uterine artery Doppler in singleton pregnancy for the prediction of preeclampsia. METHODS: A prospective study including singleton pregnancy presenting at an antenatal clinic, King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University from 2019-March 2020 was conducted. Serum SHARP1 was collected at the gestational age (GA) of 11-13+6 weeks, and transabdominal uterine artery Doppler ultrasound was performed at GA of 18-24 weeks. Serum SHARP1 level and uterine artery pulsatility index (PI) were combined to calculate the predictive value for preeclampsia detection. RESULTS: 288 pregnant women were enrolled in the first trimester, but only 249 participants completed the study. Thirteen patients had preeclampsia (5.2%), which three cases (1.2%) had early-onset preeclampsia. The median serum SHARP1 level in the first trimester of pregnant women with preeclampsia was lower than the normal pregnancy group (1392 pg/ml vs. 1941 pg/ml, p = 0.046). The second-trimester uterine artery PI and prevalence of early diastolic notching were higher in the preeclampsia group than in the normal pregnancy group (p = 0.029 and p = 0.001, respectively). When the first-trimester serum SHARP1 level is combined with the second-trimester uterine artery PI, the sensitivity, specificity, PPV, and NPV for preeclampsia prediction were 84.6%, 47.5%, 8.2%, and 98.3%, respectively. CONCLUSIONS: This study demonstrated that serum SHARP1 level in the first trimester combined with the uterine artery PI in the second trimester had good sensitivity to predict preeclampsia.

The first-trimester serum high-temperature requirement protease A4 and uterine artery Doppler for the prediction of preeclampsia.

The objective of this study was to investigate the predictive value of serum high-temperature requirement protease A4 (HtrA4) and the first-trimester uterine artery in predicting preeclampsia in singleton pregnancy. Pregnant women at gestational age 11-13+6 weeks, who visited the antenatal clinic at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University during April 2020-July 2021 were included. Serum HtrA4 levels and transabdominal uterine artery Doppler ultrasound were performed to evaluate this combination for calculating the predictive value of preeclampsia. While 371 singleton pregnant women enrolled in this study, 366 completed it. Thirty-four (9.3%) women had preeclampsia. Mean serum HtrA4 levels were higher in the preeclampsia group than in the control group (9.4 ± 3.9 vs 4.6 ± 2.2 ng/ml, p < 0.001). The mean uterine artery pulsatility index (UtA-PI) was higher in the group with early onset preeclampsia than in the control group (2.3 ± 0.5 vs 1.7 ± 0.5, p = 0.002). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 76.5%, 90.7%, 45.6%, and 97.4%, respectively, when using serum HtrA4 levels above 1.8 multiples of the median for the gestational age as a cut-off value for predicting preeclampsia. A combination of serum HtrA4 levels and UtA-PI > 95th percentile yielded sensitivity, specificity, PPV, and NPV of 79.4%, 86.1%, 37% and 97.6%, respectively, for the prediction of preeclampsia. A combination of serum HtrA4 levels and uterine artery Doppler in the first trimester had good sensitivity for predicting preeclampsia.

The effect of Moringa oleifera capsule in increasing breast milk volume in early postpartum patients: A double-blind, randomized controlled trial.

Objectives: Moringa oleifera is an herbal galactagogue that is used to increase the volume of breast milk. The objective of this study was to evaluate the efficacy of Moringa oleifera leaves in increasing the volume of breast milk in early postpartum mothers. Methods: A randomized, double-blinded, placebo-controlled trial was conducted. Eighty-eight postpartum women were randomized to either the study group receiving oral Moringa oleifera capsules or to the control group receiving oral placebo capsules. Results: There was no difference in median breast milk volume on the third day of postpartum between the Moringa oleifera leaf group and the control group (73.5 vs 50 ml, p = 0.19). However, the amount of breast milk in the Moringa oleifera group was 47% more than the one in the control group. The exclusive breastfeeding rate at 6 months in this study was 52.3% in the Moringa oleifera group, which met the goals set by the World Health Organization. Conclusions: Even 900 mg/day of the Moringa oleifera leaf could not significantly increase breast milk volume in early postpartum mothers, but the amount of breast milk in the Moringa oleifera group was 47% more than the one in the control group. The exclusive breastfeeding rate at 6 months in the Moringa oleifera group achieved the goals set by the WHO. Therefore, Moringa oleifera leaf may be used as a galactagogue herb to increase the volume of breast milk.

Second-trimester serum high mobility group box-1 and uterine artery Doppler to predict preeclampsia.

The objective of this study was to identify the predictive value for preeclampsia of second-trimester serum high mobility group box-1 (HMGB1) and uterine artery Doppler in singleton pregnancies. Between April 2020 and April 2021, a prospective study was conducted on singleton pregnancies with a gestational age of 16-20+6 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Maternal characteristics, uterine artery Doppler, and serum HMGB1 were collected. Serum HMGB1 levels and mean uterine artery pulsatility index (UAPI) were combined to calculate the predictive value for preeclampsia. A total of 393 pregnant women were analyzed, with 25 cases (6.4%) developing preeclampsia and 5 cases (1.3%) developing early-onset preeclampsia. Baseline characteristics of preeclampsia and normal pregnant women were comparable. Preeclamptic pregnant women had significantly higher mean serum HMGB1 levels than normal pregnant women (1112.8 ± 363.1 ng/mL vs 910.8 ± 486.1 ng/mL, p = 0.013). There was no difference in the mean UAPI. Any early-diastolic notching was found more frequently in the preeclampsia group (32.0% vs 12.5%, p = 0.013). The cut-off value for serum HMGB1 levels above 1.04 MoM as abnormal value to predict preeclampsia had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88.0%, 53.5%, 11.4% and 98.5%, respectively. When using abnormal serum HMGB1 levels combined with mean UAPI above 95th percentile, the sensitivity, specificity, PPV and NPV to predict preeclampsia were 88.0%, 50.8%, 10.8% and 98.4%, respectively. This study showed that serum HMGB1 at 16-20+6 weeks of gestation were effective in predicting preeclampsia. The addition of UAPI did not improve the prediction performance.

MicroRNA Expression Profiling in Hydatidiform Mole for the Prediction of Postmolar GTN : MicroRNA Profile in Postmolar GTN.

Objectives: The primary aim of the study was to identify miRNAs that were differentially expressed between complete hydatidiform moles (CHMs) that turned out to be gestational trophoblastic neoplasia (GTN) [GTN moles] and CHMs that regressed spontaneously after evacuation [remission moles]. The secondary aim was to study the profiles of miRNA expressions in CHMs. Methods: A case-control study was conducted on GTN moles and remission moles. We quantitatively assessed the expression of 800 human miRNAs from molar tissues using Nanostring nCounter. Results: From a pilot study, 21 miRNAs were significantly downregulated in GTN moles compared to the remission moles. Five of them (miR-566, miR-608, miR-1226-3p, miR-548ar-3p and miR-514a-3p) were downregulated for >4 folds. MiR-608 was selected as a candidate for further analysis on 18 CHMs (9 remission moles and 9 GTN moles) due to its striking association with malignant formation. MiR-608 expression was slightly lower in GTN moles compared to the remission moles, that is, 2.22 folds change [p = 0.063]. Conclusion: We identified 21 miRNAs that were differentially expressed between GTN moles and remission moles suggesting that miRNA profiles can distinguish between the two groups. Although not reaching statistically significant, miR-608 expression was slightly lower in GTN moles compared to remission moles.

Prediction of preeclampsia using first trimester placental protein 13 and uterine artery Doppler.

OBJECTIVE: To determine the predictive value for preeclampsia by using serum placental protein 13 (PP13) levels and uterine artery pulsatility index (PI) in the first trimester. METHODS: This is a prospective observational study that was conducted in pregnant women with gestational age 11-13+6 weeks. Transabdominal uterine artery Doppler and serum PP13 level were performed at the first trimester aneuploidy screening visit. The predictive values of these tests were calculated. RESULTS: Data from 353 pregnant women were analyzed. Twenty-nine cases developed preeclampsia. The sensitivity, specificity, positive predictive value and negative predictive value of serum PP13 levels in predicting preeclampsia were 51.7, 65.7, 11.9, and 93.8%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the uterine artery PI in predicting preeclampsia were 10.3, 95.7, 17.7, and 92.3%, respectively. When a combination of serum PP13 levels and uterine artery PI were used to predict preeclampsia, the sensitivity, specificity, positive predictive value and negative predictive value were 58.6, 62.9, 12.4 and 94.4%, respectively. CONCLUSION: This study demonstrated that the combination of serum PP13 level and uterine artery Doppler in the first trimester was increased the sensitivity for predicting preeclampsia.

Maternal serum split and hairy-related protein 1 in preeclampsia versus normal pregnancy.

OBJECTIVE: The primary objective was to compare maternal serum split and hairy related protein-1 (SHARP1) in preeclamptic women versus normal pregnant women. The secondary objectives were to compare maternal and neonatal outcomes between preeclampsia and normal pregnant women. METHODS: This cross-sectional analytic study included 75 preeclamptic pregnant women and 75 normal pregnant women at Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital between March 2018 and May 2019. Blood was collected into nonheparinized tubes. Blood samples were centrifuged and stored at -80 °C until assayed. Maternal serum SHARP1 levels were measured by enzyme-linked immunosorbent assays. Maternal and neonatal outcomes were recorded. RESULTS: Median serum SHARP1 level in preeclampsia was significantly higher than in normal pregnancy (5.2 vs. 3.7 ng/mL, p = .007). Preeclamptic women had a higher rate of cesarean section than normal pregnant women (68% vs. 32%, p < .001). Preeclamptic women had lower neonatal birth weight than normal pregnant women (2,546.1 ± 766.3 vs 2,884.5 ± 479.9, p = .001). Neonatal complications were higher in preeclamptic women than normal pregnant women (40% vs. 17.3%, p = .002). CONCLUSIONS: Serum SHARP1 in preeclampsia was significantly higher than in normal pregnancy.

Prediction of preeclampsia using a combination of serum micro RNA-210 and uterine artery Doppler ultrasound.

The objective was to determine whether a combination of serum micro RNA-210 level and uterine artery Doppler can predict preeclampsia in pregnant women at 16-24 weeks gestation. A prospective observational study conducted in singleton pregnant women at 16-24 weeks of gestation who had prenatal care at the King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand between 2017 and 2018. Uterine artery Doppler ultrasound and blood testing for serum micro RNA-210 were performed. Pregnancy outcomes were recorded. Optimal cut-off for uterine artery pulsatility index (PI) and serum micro RNA-210 were obtained to calculate the predictive values for preeclampsia. Data from 443 participants were analyzed. Twenty-two cases developed preeclampsia (5.0%) and seven of these preeclamptic cases had early-onset preeclampsia (1.6%). Pregnant women with preeclampsia had higher mean PI of the uterine artery (1.34 ± 0.52 vs 0.98 ± 0.28, p = 0.004), higher detection rates of diastolic notching (45.5% vs 11.2%, p < 0.001), and lower median serum micro RNA-210 level (22.86 vs 795.78, p < 0.001) than pregnant women without preeclampsia. Using abnormal serum micro RNA-210 level, abnormal mean PI or uterine artery diastolic notches to predict for preeclampsia, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.5%, 54.9%, 10.0%, and 99.6%, respectively. For early-onset preeclampsia prediction, the sensitivity, specificity, PPV, and NPV were 100.0%, 53.2%, 3.3%, and 100.0%, respectively. This study demonstrated that a combination of serum micro RNA-210 and uterine artery Doppler is effective in predicting preeclampsia in the second trimester.

Clinical risk factors for preeclampsia in twin pregnancies.

BACKGROUND: Preeclampsia is a common obstetric complication. The rate of preeclampsia is increased in twin pregnancies. The aim of this study was to assess the clinical risk factors for developing preeclampsia in twin pregnancies. METHODS: A case-control study was carried out among women with twin pregnancies who delivered at gestational age more than 23 weeks at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, from 2003 to 2019. The data were retrieved from electronic medical records. Multivariate logistic regression analysis was used to find the risk factors. RESULTS: A total of 1,568 twin pregnancies were delivered during the study period and 182 cases (11.6%) developed preeclampsia. 172 cases with preeclampsia and 516 controls were selected for analysis. After certain variables were adjusted in the multivariate logistic regression analysis, the clinical factors associated with preeclampsia in twin pregnancies were nulliparity (adjusted odds ratio (OR) 1.57, 95% confidence interval (CI) 1.02-2.41) and chronic hypertension (adjusted OR 6.22, 95%CI 1.98-19.57). Low gestational weight gain was a significant protective factor against the development of preeclampsia (adjusted OR 0.50; 95%CI 0.32-0.77). CONCLUSION: The clinical risk factors for developing preeclampsia in twin pregnancies were nulliparity and chronic hypertension. These risk factors are of value to identify twin pregnant women at risk for preeclampsia and in implementing primary prevention.

Fetal cystic hygroma in the first trimester led to diagnosis of partial trisomy 22.

Partial trisomy 22 is a rare condition that is found in live birth. In most cases, diagnosis of partial trisomy 22 was made after birth. Herein, we report a prenatal diagnosis of fetal partial trisomy 22 in a 28-year-old pregnant woman presented with fetal cystic hygroma. Structural abnormalities were detected at 16 weeks of gestation: left cleft lip and ventricular septal defect. The G-banding karyotype analysis and fluorescence in situ hybridization showed partial trisomy 22. It is recommended that pregnant women with fetal anomalies should have prenatal genetic diagnosis to ascertain whether the fetus has partial trisomy 22 or other rare chromosomal abnormalities.

Vaginal Progesterone Supplementation in the Management of Preterm Labor: A Randomized Controlled Trial.

OBJECTIVES: The primary objective in this study was to evaluate the effects of vaginal progesterone supplementation for the prolongation of the latency period in preterm labor. The secondary objectives were to evaluate gestational age at delivery, rates of preterm birth less than 34 and 37 weeks, obstetric outcomes, maternal compliance with medication use, and side effects. METHODS: A randomized controlled, unblinded trial was performed. Ninety women with preterm labor occurring at 24 to 34 weeks were either randomized to a vaginal progesterone group (44 women) receiving tocolytic and antenatal corticosteroids treatment combined with vaginal micronized progesterone (400 mg everyday) or to the no-progesterone group (46 women) receiving tocolytic and antenatal corticosteroids treatment only. RESULTS: Latency periods were more prolonged in the vaginal progesterone group than in the no-progesterone group (32.8 ± 18.7 vs. 25.8 ± 22.7 days, p = 0.045). Gestational age at delivery in the vaginal progesterone group was also higher than in the no-progesterone group (37 vs. 35 weeks, p = 0.027). There were significant reduction rates of preterm birth less than 34 weeks (13.6% vs. 39.1%, p = 0.012), low birth weight (29.5% vs. 50%, p = 0.048), neonatal respiratory distress syndrome (13.6% vs. 37%, p = 0.021), and neonatal intensive care unit admission (6.8% vs. 28.3%, p = 0.017). CONCLUSIONS: Combined treatment with vaginal progesterone 400 mg could prolong the latency period in preterm labor when compared with no progesterone.

The effect of Moringa oleifera capsule in increasing breastmilk volume in early postpartum patients: A double-blind, randomized controlled trial.

Moringa oleifera is an herbal galactagogue that has been used to increase the volume of breastmilk. Few studies have evaluated the effect of Moringa oleifera in breastfeeding. There are conflicting data whether it can increase the volume of breastmilk or not. Thus, the objective of this study is to evaluate the efficacy of Moringa oleifera leaves in increasing the volume of breastmilk in early postpartum mothers. A randomized, double-blind, placebo-controlled trial will be conducted. The outcomes of this study will provide the data of Moringa oleifera as an herbal medication to increase the volume of breastmilk. This information will be used to increase the rate of exclusive breastfeeding for the first 6 months as recommended by the World Health Organization. Clinical trial registration This clinical trial was registered at ClinicalTrials.gov (Clinical trials registration: NCT04487613).

Serum hypoxia-inducible factor-1α and uterine artery Doppler ultrasound during the first trimester for prediction of preeclampsia.

The objective of this study was to determine the predictive value of serum hypoxia-inducible factor-1α (HIF-1α) combined with uterine artery Doppler in singleton pregnancy during 11-13+6 weeks of gestation for preeclampsia. This prospective observational study was conducted in singleton pregnant women at 11-13+6 weeks of gestation who visited the King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University for antenatal care between February 2019 and May 2020. Serum HIF-1α levels and uterine artery Doppler ultrasound were performed. Pregnancy outcomes were recorded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these tests at the optimal cut-off values were determined to predict preeclampsia. A total of 385 participants were analyzed. Of these, 31 cases had preeclampsia (8.1%), and 6 cases of them had early-onset preeclampsia (1.6%). Preeclamptic women had significantly higher serum HIF-1α levels than normal pregnant women (median 1315.2 pg/ml vs. 699.5 pg/ml, p < 0.001). There was no difference in the mean pulsatility (PI) of the uterine artery. Serum HIF-1α levels were higher than 1.45 multiple of median for the gestational age as a cut-off value for predicting preeclampsia; the sensitivity, specificity, PPV, and NPV were 66.7%, 71.5%, 17.2%, and 96.2%, respectively. When a combination of abnormal serum HIF-1α levels and abnormal uterine artery Doppler PI (above the 95th percentile) were used as a predictive value to predict preeclampsia, the sensitivity, specificity, PPV, and NPV were 74.2%, 67.2%, 16.6%, and 96.8%, respectively. This study showed that the serum HIF-1α levels with or without uterine artery Doppler at 11-13+6 weeks of gestation were effective in predicting preeclampsia.

Oral dydrogesterone as an adjunctive therapy in the management of preterm labor: a randomized, double blinded, placebo-controlled trial.

BACKGROUND: Preterm birth is a major challenge in obstetric and perinatal care. It is the leading cause of neonatal death. The primary aim of this study was to evaluate the efficacy of oral dydrogesterone on latency period in managing preterm labor. The secondary aims were to evaluate the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, time to recurrent uterine contraction, pregnancy outcomes, neonatal outcomes, compliance and side effects. METHODS: This was a randomized, double blinded, placebo-controlled trial. Forty-eight pregnant women with preterm labor, singleton pregnancy, and gestational age of 24-34 weeks were enrolled into the study. The study group received 10 mg of oral dydrogesterone three times per day and the control group received placebo. All pregnant women received standard treatment with tocolytic and antenatal corticosteroids. RESULTS: The median latency periods were not significantly different between the dydrogesterone group (27.5 days) and placebo group (34 days, p = 0.45). Additionally, there were no differences in the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, pregnancy outcomes, neonatal outcomes, compliance and side effects. However, the time to the recurrence of uterine contractions in participants that had recurrent preterm labor was longer in the dydrogesterone group than in the placebo group (30.6 ± 12.3 vs 13.7 ± 5.0 days, p = 0.01). CONCLUSIONS: Adjunctive treatment with 30 mg of oral dydrogesterone could not prolong latency period in preterm labor when compared to placebo. TRIAL REGISTRATION: ClinicalTrials.gov (Clinical trials registration: NCT03935152 , registered on May 2,2019).

Determination of morphologic and immunohistochemical stain (p57 kip2) discrepancy of complete and partial hydatidiform mole by using microsatellite genotyping.

OBJECTIVE: to evaluate the role of microsatellite genotyping in discordant results between morphologic examination and p57Kip2 staining in hydatidiform mole. MATERIALS AND METHODS: 127 cases of hydatidiform mole who had morphologic examination and p57Kip2immunohistochemical staining were evaluated. Six discrepant cases between morphologic examination and p57Kip2 staining were recruited. DNA was extracted from chorionic villi and paired maternal decidual tissue in Formalin fixed paraffin embedded tissue sections. The STR DNA genotyping was performed by Applied Biosystems 3500 Genetic Analyzer. Genetic data analysis was performed by Gene mapper ID-X software. Three concordant cases were used as control. Results were compared to histopathology, p57Kip2 stain and development of post-molar GTN. RESULTS: All controlled cases were confirmed PHM. Two cases of histologic CHM with positive p57Kip2and 2 cases of PHM with negative p57Kip2 were reported as PHM from microsatellite. Other 2 cases of histologic diagnosis PHM with negative p57Kip2 reported as CHM from microsatellite test and both of them developed post-molar GTN. CONCLUSION: Microsatellite genotyping is a high accuracy method for differential diagnosis from complete and partial hydatidiform moles. However, cost of microsatellite genotyping is still too high to use routinely. Therefore, selected use in discrepancy cases may be suitable.

Soluble fms-like tyrosine kinase 1 and placental growth factor ratio for predicting preeclampsia in elderly gravida.

Objective: To determine the predictive value of plasma soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) ratio for detection of preeclampsia in elderly gravida at 16-18 weeks of gestation and to identify whether abnormalities of this ratio are associated with any other pregnancy complications or not.Methods: Blood samples of 300 cases were collected. Plasma sFlt-1 and PlGF levels were measured using an automated immunoassay.Results: Sensitivity and specificity for plasma sFlt-1/PlGF ratio above 9.8 for preeclampsia prediction were 85.7% and 61.2%, respectively. The sensitivity and specificity to predict early onset preeclampsia were 100% and 61.1%, respectively. Women with abnormal plasma sFlt-1/PlGF ratio were not associated with any other pregnancy complications.Conclusion:  sFlt-1/PlGF ratio at 16-18 weeks of gestation in elderly gravida has a high sensitivity for predicting preeclampsia, especially early onset preeclampsia.

Diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus.

Objective: To investigate the diagnostic value of glycated hemoglobin A1c (HbA1c) in detecting gestational diabetes mellitus (GDM).Methods: Pregnant women at gestational age 24 weeks or more, who had abnormal GDM screening test, were enrolled in this prospective study. A HbA1c assessment was performed at the same time of 3-h 100 g oral glucose tolerance test (OGTT). GDM was diagnosed according to the National Diabetes Data Group for a 3-h 100 g OGTT. Sensitivity and specificity of HbA1c were evaluated and pregnancy outcome were recorded in aspects of gestational age at delivery, preeclampsia, primary cesarean section rate, birth weight, fetal macrosomia, and neonatal intensive care unit admission.Results: One hundred fourteen women were enrolled. There were 35 women with GDM using NDDG criteria. The area under the curve of the receiver operating characteristic curve for HbA1c detection of GDM was 0.725 (95% confidence interval 0.621-0.829). Cut-off value of HbA1c was 5.8%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 17.1, 100, 100, 73.2, and 74.6%, respectively. Pregnancy outcome in both groups in this study has no statistical significance.Conclusions: HbA1c values cannot replace OGTT for the diagnosis of GDM. However, HbA1c might be a useful tool to reduce the number of OGTT, associated costs and patient inconvenience.

Serum SHARP1 and uterine artery Doppler for the prediction of preeclampsia.

The aim of this study was to identify the value of serum SHARP1 levels and Doppler of the uterine artery in singleton pregnancy at 11-13+6 weeks for predicting preeclampsia. A prospective observational study was conducted in pregnant women at 11-13+6 weeks of pregnancy who had antenatal care at King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand, between January 2017 and January 2018. Serum SHARP1 measurement and transabdominal Doppler of the uterine artery were performed. The predictive values of these tests were determined. Data were obtained from 405 pregnant women. Thirty-five women had preeclampsia (8.6%), and six of these had early-onset preeclampsia (1.5%). Preeclamptic women had significantly lower serum SHARP1 levels than pregnant women without preeclampsia (3.6 ng/ml vs 4.7 ng/ml, p < 0.01). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of serum SHARP1 levels of less than 3.89 ng/ml for predicting preeclampsia were 77.1%, 72.7%, 21.1% and 97.1%, respectively. For uterine artery Doppler, the sensitivity, specificity, PPV and NPV of the mean pulsatility index (PI) > 95th percentile for predicting preeclampsia were 5.7%, 95.4%, 10.5% and 91.5%, respectively. For the combination of serum SHARP1 levels with a cutoff value of less than 3.89 ng/ml and a mean PI > 95th percentile, the sensitivity, specificity, PPV and NPV were 77.1%, 70.3%, 19.7% and 97.0%, respectively. This study demonstrated that serum SHARP1 is a promising biomarker for predicting preeclampsia in the first trimester.