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.

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.

Normal offset of the tricuspid septal leaflet in Thai fetuses.

OBJECTIVE: To quantify the correlation between gestational age and the normal distance between the insertion of the medial leaflets of the mitral valve and tricuspid valve in Thai fetuses. MATERIAL AND METHOD: A prospective study was constructed using an apical 4-chamber view at end diastole to measure the mitral valve-tricuspid valve distance (MTD) in 169 confirmed-dated singleton normal fetuses between 18 and 40 weeks of gestation at King Chulalongkorn Memorial Hospital from August 2005 to July 2006. The recorded distances were plotted against gestational ages. The 5th, 50th, and 95th centile of MTD were calculated and the relationship between MTD and gestational age was determined with regression model. One hundred and forty-seven measurements were validated for analyses. RESULTS: Regression analysis demonstrated a linear correlation of MTD with gestational age with each increase of 1 week in gestational age, there was an increase of 0.12 mm of MTD (p <. 001). The linear regression curve that correlated MTD with gestational age showed a gradual slope (r = 0.84; p < 0.001). The MTD range from 1.3 to 5.1 mm (mean +/- SD = 2.6 +/- 0.9). A significant difference in MTD was noted on comparing to the data in Western study. Intra-observer reliability was 0.92. CONCLUSION: The present findings support the positive correlation between MTD and advancing gestational age. However, clinically significant differences of MTD between the presented population and Caucasian fetuses underline the need for employing a locally derived data on assigning the fetal cardiac abnormality.

Diagnostic evaluation of Karman endometrial aspiration in patients with abnormal uterine bleeding.

AIM: To assess sensitivity and specificity of Karman aspiration in the diagnosis of abnormal endometrium compared with the final diagnosis and evaluate tissue adequacy obtained by Karman aspiration. METHODS: The study group were women who presented with abnormal uterine bleeding to Songklanagarind Hospital between August 2003 and July 2004 and who underwent Karman aspiration prior to conventional curettage. The final diagnosis was defined as the most severe histopathology from either Karman aspiration or conventional curettage. Abnormal endometrium included inflammation, polyp, hyperplasia and malignant changes. RESULTS: Two hundred and twenty-six women were assessed. Endometrial aspiration showed a sensitivity of 89.6% and specificity 100.0% in diagnosis of abnormal endometrium. Abnormal endometrium was detected in 58 women. Of 11 women diagnosed with endometrial cancer, only one case was undetected by Karman aspiration due to a failure to create negative pressure in the uterus. Endometrial aspiration yielded adequate tissue in 86.7%. CONCLUSION: Karman endometrial aspiration is an accurate and easy procedure, and should be considered in the initial evaluation of abnormal uterine bleeding.