Maternal complications and risk factors associated with assisted vaginal delivery.

OBJECTIVE: This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery. METHODS: We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered. RESULTS: The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016). CONCLUSIONS: The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%). CLINICAL TRIAL REGISTRATION: Thai Clinical Trials Registry: 20220126004.

Neonatal complication of caesarean sections at tertiary center: Siriraj hospital, Bangkok, Thailand.

To study the complications of newborns related to caesarean sections, through a review of indications and details of complications occurring in newborns. This was a retrospective and descriptive study. A search of hospital records identified 3500 cases that underwent caesarean sections during 2017-2018. Newborn complications arising from the caesarean sections, and other relevant details were recorded. Neonatal complications were 49.23% (1723/3500). Bruises (a region of injured tissue or skin in which blood capillaries have been ruptured) (11.65%), jaundice (18.29%) and hypoglycaemia (11.91%) were the most common complications of the neonates. In summary, foetal complications were jaundice, transient tachypnea, hypoglycaemia and bruises. As the rate of caesarean sections continues to increase and is difficult to control, unnecessary caesarean section should be reduced and obstetricians must be well trained in performing caesarean sections to reduce neonatal complications.

Identifying the barriers to universal cervical length screening for preterm birth prevention at a tertiary hospital in Thailand (patient's perspectives): implementation research.

PURPOSE: To identify patient perspectives of barriers to cervical length screening to prevent preterm births. METHODS: In Phase I of this prospective descriptive implementation study, 40 pregnant women of up to 24 week gestation were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was subsequently administered to 400 participants in Phase III. RESULTS: Most participants (74.3%) realised preterm babies have complications and high care costs (53%). They recognised that premature-birth risk identification enables appropriate pregnancy care (93.8%), but they were unaware that cervical length measurements indicate the risk (59.5%). The participants who were aware wanted to be examined (63.5%) because of concern about preterm birth (95.8%). Husbands were reported to influence decision-making about screening (81.3%) and subsequent treatment (42.5%). If the associated costs were subsidised, the majority of participants (67.3%) would undergo screening. CONCLUSION: Physicians do not explain ways to prevent preterm births. Government policy on preventing preterm births is not well established. Screening and treatment costs are major barriers. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR) number: TCTR20190813003.

Prevalence of asymptomatic bacteriuria among Thai diabetic pregnant women.

Diabetic pregnant women are susceptible to urinary tract infection, which can result in preterm labor and a low birth weight of the neonate. This was a prospective observational study. In total, 110 diabetic pregnant women between 12-20 weeks of gestation were recruited. Asymptomatic bacteriuria (ASB) was diagnosed when the urinalysis presented a white blood cell (WBC) count ≥ 5 WBCs per high power field (HPF). Urine culture was later performed. Most of the diabetic pregnant women were classified as GDM A1. The prevalence of ASB was 7.2% (8/110 cases). Klebsiella aerogenes was found in only one case from urine culture. ASB was commonly found in the pregnant women with a high BMI, with statistical significance. The prevalence of ASB in the diabetic pregnant women was 7.2%. Urinalysis should be considered for diabetic pregnant women with a high body mass index.

Dyspareunia and sexual dysfunction after vaginal delivery in Thai primiparous women with episiotomy.

INTRODUCTION: Episiotomy remains commonly practiced in Thailand. There are limited data on its impacts on sexuality among Asian women during the first postdelivery year. AIMS: The aim was to study dyspareunia and sexual function at 3-12 months after vaginal delivery in Thai primiparous women with episiotomy. METHODS: A total of 190 participants were approached on Day 2 postpartum. Of these, 93 sexually active women were evaluated for dyspareunia and sexual function at 3 months by using 10-cm visual analog scale and the validated Thai version of Female Sexual Function Index (TFSFI). TFSFI < 26.5 was defined as having potential sexual dysfunction. At 6 and 12 months, sexual function was evaluated by telephone interview. MAIN OUTCOME MEASURES: The prevalence of dyspareunia at 3 months and the changes of TFSFI scores during the first postdelivery year were the main outcome measures. RESULTS: The average age of the participants, over 90% of whom were high school finishers, was 24. Their partners were around 3 years older, and the median partnership duration was 3 years. At 3 months, 30.1% of participants reported dyspareunia. There was no association between dyspareunia and the following characteristics: pre-pregnancy dyspareunia, newborn's head circumference and birthweight and breast-feeding (P > 0.05 for all). Sexual dysfunction was demonstrated in 66.7% at 3 months, 31.0% at 6 months, and 14.9% at 12 months. From 3 to 12 months, the median TFSFI scores in all domains increased significantly. There was no difference of the scores in all domains at 3 and 12 months between women with and without dyspareunia at 3 months. However, at 6 months, those without dyspareunia had better scores in pain, orgasm, satisfaction, and total scores (P < 0.05 for all). CONCLUSION: Dyspareunia at 3 months is common in Thai primiparous women with episiotomy. Those with dyspareunia have a slower resumption of normal sexual function.

Psychological effects of fetal diagnoses of non-lethal congenital anomalies on the experience of pregnant women during the remainder of their pregnancy.

AIM: The aim of this study was to explore the effects of prenatal fetal diagnoses of non-lethal anomalies on the psychological well-being of pregnant women throughout their pregnancy. MATERIALS AND METHODS: Fifty-five pregnant women were asked to complete a questionnaire (the Spielberger State-Trait Anxiety Inventory) to assess their anxiety levels at multiple follow-up visits. In-depth interviews were conducted with 20 pregnant women after completion of the questionnaire. RESULTS: We identified three stages of psychological distress. The intense negative psychological reaction stage was characterized by an intense psychological distress in response to the loss of an ideal child. The psychological healing stage was characterized by the emergence of coping mechanisms and a concomitant decrease in psychological distress. Finally, the intense negative psychological reaction re-emergence stage was characterized by an increase in psychological distress related to uncertainty regarding the future of the baby. CONCLUSIONS: Following a prenatal diagnosis of a non-lethal anomaly, both the nature and the intensity of the psychological distress experienced by pregnant women change throughout the remainder of their pregnancy. Throughout the remainder of their pregnancy, these women should be offered effective psychological support that accounts for each of the distinct psychological response stages identified in this study.

Relation between gestational weight gain and pregnancy outcomes.

AIM: The aim of this study was to evaluate the effects of gestational weight gain on pregnancy outcomes in pregnant Thai women with different pre-pregnancy body mass indexes (BMI). MATERIALS AND METHODS: A retrospective study was carried out by reviewing 5200 medical records of pregnant women who delivered at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital during 1 September 2011-1 August 2012. Inclusion criteria were singleton pregnancy with available pre-pregnant weight and maternal height. Pre-pregnancy BMI were categorized according to World Health Organization criteria. Pregnancy outcomes of interest were appropriate-for-gestational-age infants. The optimal gestational weight gain for each BMI group was proposed to achieve a high proportion of appropriate-for-gestational age infants. RESULTS: Patients were divided into four groups according to their pre-pregnancy BMI: underweight (21.3%), normal weight (64.1%), overweight (11.5%), and obese (3.1%). Optimal gestational weight gain ranges for each group were 10-18, 8-16, 6-14 and 4-8 kg, respectively. Our proposed criteria seem to be realistic, with 60% of pregnant Thai women able to adhere to the recommendation, compared to 40.5% adherence to the 2009 Institute of Medicine recommendation. There were no significant complications when following either of the recommendations. Adverse pregnancy outcomes, including large for gestational age, cesarean section, and severe pre-eclampsia, were significantly decreased in women who complied with our recommendation. CONCLUSION: To achieve a high proportion of appropriate-for-gestational-age infants, Thai pregnant women could follow our gestational weight gain recommendation.

Nomogram of placental thickness, placental volume and placental vascular indices in healthy pregnant women between 12 and 20 weeks of gestation.

OBJECTIVE: To generate the nomogram of placental thickness, volume, and vascular indices in healthy pregnant women between 12 to 20 weeks of gestation. MATERIAL AND METHOD: An experimental cross sectional study of pregnant women, which were categorized into nine groups according to their gestational age ranging from 12 to 20 weeks of gestation, was done. Placental parameters that included placental thickness, volume, and vascular indices were measured using a Voluson E8 ultrasound machine. The measurements were correlated with gestational age. RESULTS: Two hundred ninety four subject were included in this study. The study indicated that the placental thickness and volume significantly increased with gestational age (r = 0.481, p < 0.001 and r = 0.837, p < 0.001). The correlation between the placental volume and gestational age can be formulated according to this equation: Placental volume (cm3) = e7.584-42.45(1/GA); R2 = 0.76. Nonetheless, there is a very low correlation between the vascularization index (VI), vascularization flow index (VFI), and the gestational age (r = 0.162, p = 0.005 and r = 0.158, p = 0.007). The flow index (FI) was shown to have no correlation with gestational age (r(p) = -0.067, p = 0.254). CONCLUSION: From the present study, the placental thickness and placental volume significantly increased with gestational age. The VI and VFI showed poor correlation with gestational age while the FI had no correlation with the gestational age.

Predictors for complications in pregnant women with heart disease, a retrospective study.

OBJECTIVE: Evaluate the CARPREG score in predicting cardiac, obstetric, and neonatal complications in pregnant women with heart disease. MATERIAL AND METHOD: This was a retrospective study between 2002 and 2011 at a tertiary care center and included 175 pregnant women with heart disease. Maternal and neonatal outcomes were assessed using Cardiac in Pregnancy Score (CARPREG), which included NYHA-class, systolic ejection fraction, left ventricular obstruction, and history of cardiac events. RESULTS: Rheumatic heart disease (n = 116, 66.3%) was the predominant cardiac problem. CARPREG score was 0, 1, > 1 in 65.1%, 24.6%, and 10.3% pregnancies, respectively. Maternal cardiac events occurred in 27.4%. CARPREG score > or = 1 was associated with an increased rate of cardiac events [odds ratio (OR) 6.76, 95% confidence interval (CI) 3.26 to 14.01]. Fetal complications occurred 24.4%. Neonatal birth weight < 2,500 g was associated with CARPREG score > or = 1 (OR 2.57, 95% CI 1.29 to 5.11). CONCLUSION: Maternal cardiac events can be predicted using CARPREG risk index. In Thai population, rheumatic heart disease was the most frequent form of cardiac problems in pregnant women.

Neonatal complications and risk factors associated with assisted vaginal delivery.

To investigate neonatal injuries, morbidities and risk factors related to vaginal deliveries. This retrospective, descriptive study identified 3500 patients who underwent vaginal delivery between 2020 and 2022. Demographic data, neonatal injuries, complications arising from vaginal delivery and pertinent risk factors were documented. Neonatal injuries and morbidities were prevalent in cases of assisted vacuum delivery, gestational diabetes mellitus class A2 (GDMA2) and pre-eclampsia with severe features. Caput succedaneum and petechiae were observed in 291/3500 cases (8.31%) and 108/3500 cases (3.09%), respectively. Caput succedaneum was associated with multiparity (adjusted odds ratio [AOR] 0.36, 95% confidence interval [CI] 0.22-0.57, P < 0.001) and assisted vacuum delivery (AOR 5.18, 95% CI 2.60-10.3, P < 0.001). Cephalohaematoma was linked to GDMA2 (AOR 11.3, 95% CI 2.96-43.2, P < 0.001) and assisted vacuum delivery (AOR 16.5, 95% CI 6.71-40.5, P < 0.001). Scalp lacerations correlated with assisted vacuum and forceps deliveries (AOR 6.94, 95% CI 1.85-26.1, P < 0.004; and AOR 10.5, 95% CI 1.08-102.2, P < 0.042, respectively). Neonatal morbidities were associated with preterm delivery (AOR 3.49, 95% CI 1.39-8.72, P = 0.008), night-time delivery (AOR 1.32, 95% CI 1.07-1.63, P = 0.009) and low birth weight (AOR 7.52, 95% CI 3.79-14.9, P < 0.001). Neonatal injuries and morbidities were common in assisted vacuum delivery, maternal GDMA2, pre-eclampsia with severe features, preterm delivery and low birth weight. Cephalohaematoma and scalp lacerations were prevalent in assisted vaginal deliveries. Most morbidities occurred at night.Clinical trial registration: Thai Clinical Trials Registry 20220126004.

A qualitative study of pregnant women's perceptions and decision-making regarding COVID-19 vaccination in Thailand.

To identify pregnant women's attitudes towards, and acceptance and rejection of, COVID-19 vaccination. This prospective, descriptive, implementation study was conducted in the Antenatal clinic of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 pregnant women were interviewed. Phase II consisted of questionnaire development and data validation. In Phase III, the questionnaire was administered to 400 participants. Pregnant women's attitudes towards and acceptance and rejection of COVID-19 vaccination. Most pregnant women were uncertain about the potential harm of vaccination to themselves or their unborn child, including risks such as miscarriage or premature birth (59-66/101 [58.4%-65.3%]; OR 2.53-8.33; 95% CI 1.23-3.60, 5.17-19.30; P < 0.001) compared to those who disagreed with vaccination. Their vaccination decisions were significantly influenced by social media information regarding vaccination complications in pregnant women (74/101 [73.3%]; OR 15.95; 95% CI 2.15-118.55; P = 0.001) compared to those who disagreed with vaccination. Most pregnant women opined that they should not receive a COVID-19 vaccination during pregnancy (adjusted odds ratio [AOR] 6.57; 95% CI 2.44-17.70; P = 0.001). Most also rejected vaccination despite being aware of its benefits (AOR 17.14; 95% CI 6.89-42.62; P < 0.001). Social media messages and obligatory vaccination certifications influence maternal vaccination decisions. Pregnant women believe vaccination helps prevent COVID-19 infection and reduces its severity. Nevertheless, the primary reason for their refusal was concern about potential harm to their unborn child or themselves during pregnancy.The Thai clinical trials registry: TCTR20211126006.

Economic evaluation of lifestyle interventions in infertility management: A systematic review.

INTRODUCTION: Infertility, a global concern affecting both sexes, is influenced by modifiable and non-modifiable risk factors. While the literature predominantly underscores the clinical- and cost-effectiveness of lifestyle interventions in the realm of infertility treatment, a holistic compilation analysing the economic dimensions of such interventions is lacking. This systematic review aimed to fill this gap by evaluating the economic facets of lifestyle interventions in the management of infertility. METHODS: An exhaustive search was conducted within the PubMed, Embase, and Scopus databases from their inception to February 2024. The aim was to find articles related to the economic aspects of lifestyle interventions in infertility management. These included clinical studies covering economic outcomes and economic evaluations. The Drummond Checklist was used to assess the quality of the included studies. RESULTS: From an initial yield of 7555 articles, five studies were deemed eligible for inclusion, comprising three cost-effectiveness analyses, one prospective cohort study and a randomized controlled trial, all of which were undertaken in high-income countries (the Netherlands, Australia and Japan). These studies included patients receiving infertility treatments for conditions such as unexplained infertility, polycystic ovary syndrome, ovulation disorders, or mild male infertility, inclusive of individuals with and without obesity. The women who participated in these studies were up to 45 years of age. The findings suggested that integrating lifestyle intervention programmes tends to enhance pregnancy and live birth outcomes. These programmes encompass coaching, psychological or behavioural guidance, nutritional adjustments, exercise regimes, weight management, smoking cessation and mindfulness techniques. Moreover, these interventions are likely to be more cost-effective than standard infertility care. CONCLUSION: For couples embarking on infertility treatments, the integration of lifestyle interventions into their management strategy not only fosters clinical benefits but also represents a cost-effective alternative to conventional care, particularly within high-income settings.

Is the U.S. Institute of Medicine recommendation for gestational weight gain suitable for Thai singleton pregnant women?

OBJECTIVE: To compare the gestational weight gain of healthy Thai singleton pregnant women with the U.S. Institute of Medicine (IOM) recommendation. MATERIAL AND METHOD: One thousand eight hundredforty nine medical records ofuncomplicated singleton pregnant women who delivered at Siriraj Hospital between January 2007 and November 2010 were reviewed. All subjects were divided into four subgroups according to their pre-pregnancy body mass index (BMI): underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese group (> or =30 kg/m2). Their baseline characteristics and gestational weight gain were collected and reported One-way analysis of variance test was used to compare continuous data and Chi-squared test was used to compare discrete data among groups. RESULTS: Mean gestational weight gain of normal weight, underweight, overweight, and obese women were 14.2+/-4.7 kg, 14.1+/-4.3 kg, 12.4+/-4.7 kg, and 10.8+/-4.3 kg and gestational weight gain between 25th to 75th percentile were 11.0 to 17.0 kg, 11.0 to 16.5 kg, 10.0 to 15.0 kg, and 8.0 to 13.0 kg for pregnant women with pre-pregnancy normal weight, underweight, overweight and obesity respectively. Significant difference of maternal age, gestational weight gain, neonatal birth weight, and parity were found among groups (p<0.05). About one-thirdofpre-pregnancy normal BMI (39.2%), overweight (36.6%), and obese (31.9%) as well as nearly halfofpre-pregnancy underweight group (47.6%) gained the appropriate weight based on the US.IOM recommendation. About one-third of pre-pregnancy underweight (37.9%) and normal BMI group (30.6%) gained less than the recommendation. Majority of pre-pregnancy overweight (52.3%) and obese (63.8%) group gained more weight than the recommendation. CONCLUSION: Although pregnancy outcomes were normal, less than half of Thai pregnant women gained the appropriate weight based on the U.S. IOM recommendation.

Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination: Implementation research.

OBJECTIVE: There are few data on lactating women's concerns about receiving COVID-19 vaccination during breastfeeding. This research investigated breastfeeding women's attitudes towards and acceptance or rejection of vaccination. MATERIALS AND METHODS: This prospective, descriptive, implementation study was conducted in the postpartum ward of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 breastfeeding women in the postpartum ward at Siriraj Hospital who were willing to participate in the study were interviewed. Phase II comprised questionnaire development and data validation. The combined multiple choice and scaling questionnaires designed based on the results from comprehensive interviews of phase I were used in the study. The questionnaire was administered to 400 participants in Phase III. MAIN OUTCOME MEASURES: Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination. RESULTS: The vast majority of participants (372/400 [93.0 %]) were vaccinated predelivery. Most of the subgroup of women rejecting vaccination while breastfeeding were unsure whether too frequent vaccination would harm their unborn child (52/99 [52.5 %]; crude odds ratio [cOR], 6.50; 95 % CI, 1.47-28.68; P < 0.001). The level of immunity to the COVID-19 virus did not influence their vaccination decisions (19/99 [19.2 %]; cOR, 2.38; 95 % CI, 1.26-4.47; P < 0.001). Multivariable analysis found a significant association for women agreeing with the proposition that vaccination during pregnancy should not be performed (adjusted odds ratio [aOR], 4.83; 95 % CI, 1.41-16.57; P = 0.043). Most women who rejected vaccination knew its benefits (aOR, 31.84; 95 % CI, 7.16-141.65; P < 0.001). CONCLUSIONS: Breastfeeding women generally believed that vaccines reduce infection and disease severity. The women's COVID-19 immunity levels did not affect their acceptance or rejection of vaccination. Some mothers rejected vaccination because of concerns about possible harm to them or their newborns.

Identifying the Barriers to Universal Cervical Length Screening for Preterm Birth Prevention at a Tertiary Hospital in Thailand (Physician Perspectives): Implementation Research.

OBJECTIVE: To identify physicians' views on the barriers to measuring cervical length for preventing preterm deliveries. MATERIALS AND METHODS: This prospective, descriptive implementation study had three phases. In Phase I, 20 physicians were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was distributed to 120 Phase III participants. RESULTS AND DISCUSSION: All 120 participants responded. In 44 cases, the physicians received support from their local Maternal and Child Health Boards for preterm-birth-prevention programs; the other 76 physicians did not. The doctors tended to believe that cervical length screening plays no role in preventing preterm births (4/44 (9.1%) and 24/76 (31.6%); OR, 4.615; 95% CI, 1.482-14.373; p = 0.005). They were unsure about the correct measurement procedures (13/44 (29.5%) and 37/76 (48.7%); OR, 2.262; 95% CI, 1.028-4.977; p = 0.040). A lack of cost-free drug support (progesterone) for women with short cervices was identified as a barrier to preventing preterm births (30/44 (68.2%) and 32/76 (42.1%); OR, 0.339; 95% CI, 0.155-0.741; p = 0.006). CONCLUSIONS: Many physicians are unconvinced that measuring cervical length prevents premature births, and are unsure about the correct measurement procedures. There is a lack of government funding for hormone-usage programs.

Effectiveness of cefoxitin on preventing endometritis after uterine curettage for spontaneous incomplete abortion: a randomized controlled trial study.

BACKGROUND: There are only few studies concerning the usage of antibiotics in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion and no conclusion can be demonstrated OBJECTIVE: To investigate the effectiveness of prophylactic cefoxitin in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion. MATERIAL AND METHOD: Eighty-four women with spontaneous first trimester incomplete abortion were randomly allocated into two groups using a computer-generated random number list and the allocation concealment was maintained using a sealed opaque envelope. The patients in the study group were given 1 g of cefoxitin while the patients in the control group were given 0.1 ml of vitamin B complex intravenously 20 minutes prior to curettage. Uterine curettage was performed after intravenous sedation and analgesic drugs were administered. The patients were evaluated on the first, third and seventh day after uterine curettage. RESULTS: Seventy-nine cases had completed the study protocol. There were no statistically significant differences in demographic data and details of uterine curettage between both groups. Two cases of endometritis were found in the control group but none in the study group. However the difference did not reach the statistical significance (p = 0.241). CONCLUSION: Prophylactic cefoxitin is not effective in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion.

Does gestational weight gain in normal pre-pregnancy BMI pregnant women reflect fetal weight gain?

OBJECTIVE: To identify the correlation between gestational weight gain in pregnant women with normal pre-pregnancy body mass index (BMI) and fetal weight gain. MATERIAL AND METHOD: Uncomplicated normal pre-pregnancy BMI Thai singleton pregnant women with less than 16 weeks' gestation participated in this study between June 2008 and September 2009. Serial measurements of maternal and fetal weight using ultrasound examination were recorded every four weeks from 16 to 36 weeks' gestation. RESULTS: Two hundred seventy four uncomplicated pregnant women were included in this study of which 166 met inclusion criteria during a period of the study. There was a significant correlation between gestational weight gain and both estimated fetal weight gain and actual infant birth weight (p < 0.05). Using the multiple regression analysis, gestational weight gain between 16 to 28 weeks' gestation, multiparity, and male infants were independent factors and were significantly correlated with both fetal weight gain and actual infant birth weight (p < 0.05). CONCLUSION: For pregnant women with normal pre-pregnancy BM, gestational weight gain can predict intrauterine fetal weight as well as infant birth weight.

Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor.

Background: Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery. Objective: To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length. Methods: We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 200/7 and 366/7 weeks' gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated. Results: Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70). Conclusions: Cervical length ranging 15-30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice.

A Randomized Controlled Trial of the Effect of Music During Cesarean Sections and the Early Postpartum Period on Breastfeeding Rates.

Objective: The objective of this research was to study the role of music listening by mothers during a cesarean section and the postpartum period to achieve exclusive breastfeeding in the first 6 months. Methods and Study Design: This was a prospective, observational, randomized controlled trial study. A total of 185 singleton pregnant women, in at least 37 weeks of gestation, who were appointed for elective cesarean sections, were recruited. They were randomized into three groups, including pregnant women who did not listen to music (Group 1), listened to music during cesarean section (Group 2), and listened to music during cesarean section and the postpartum room for the first 2 days (Group 3). The breastfeeding results of all three groups were followed up at 7 days, 14 days, and then at months 1, 2, 3, and 6. Results: Success in exclusive breastfeeding among Groups 1, 2, and 3 and Groups 1 and 2 + 3 was not different in every lactating period (7 days-6 months). From subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Mothers who listened to music and had an income of <20,000 baht, an educational level lower than university, planned the pregnancy, had their first pregnancy, and stayed in a private ward had more successful exclusive breastfeeding in a 6-month period than those mothers who did not listen to music, and the difference was statistically significant. Conclusions: Music listening by mothers during a cesarean section and in the postpartum ward did not enhance exclusive breastfeeding during the first 6 months of the postpartum period. However, from subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Thai Clinical Trials Registry number was TCTR20180712001.