Distribution of uterocervical angles in the second trimester of pregnant women at low risk for preterm delivery.

The uterocervical angle (UCA) has recently been studied as a parameter to identify women at risk for spontaneous preterm birth (sPTB). This study aimed to investigate the distribution of UCA values by transvaginal sonography (TVS) in the second trimester of women at low risk for sPTB. TVS was performed in 450 low-risk pregnant women at gestational age (GA) 160/7-240/7 weeks. The UCA distribution by GA was visualised using a scatter plot. The range of UCA values and their relationship with GA were assessed using quantile regression analysis. p < .05 was considered statistically significant. A total of 242 participants with anteflexed uterus, no history of caesarean section and term delivery were analysed. The normal range of UCA (5th and 95th percentiles) was from 63.0 degrees (95% CI, 53.1-72.9) to 148.8 degrees (95% CI, 139.5-158.0) with no significant changes during this GA period (-0.3 degrees per week, p = .757).Impact statementWhat is already known on this subject? Spontaneous preterm birth (sPTB) is a major problem in obstetrics. A screening strategy using history of sPTB and cervical length (CL) measurement is the current standard to identify women at risk for sPTB and provide adequate prevention. However, a third of women who are identified as low risk go on to have sPTB, so a better means needs to be found to more reliably identify women at risk. Various studies have found that a wide uterocervical angle (UCA) was associated with sPTB, and thus the UCA has been proposed as a potential sPTB screening parameter. However, to date there is a lack of prospective studies evaluating this proposal, and no consensus about the proper gestational age to perform UCA measurements to identify women at risk of sPTB.What do the results of this study add? This study reports the distribution of UCA at the GA of 160/7-240/7 weeks of low-risk singleton pregnancy women who delivered at term. The mid-90% values ranged from 63.0 degrees to 148.8 degrees with no significant differences in this GA period.What are the implications of these findings for clinical practice and/or further research? Because of the wide range of UCA values at GA 160/7-240/7 weeks, more studies regarding UCA values in various gestational ages are required to fully understand the trend of UCA values along pregnancy and confirm whether or not the UCA would be a useful parameter for sPTB prediction and if so at what gestational age it would have to be assessed.

Time Interval Measurements of the Ductus Venosus During the Early Second Trimester of Pregnancy: Reference Ranges and Clinical Application.

OBJECTIVES: The aims of this study were to construct reference ranges for the time interval parameters of the ductus venosus during the early second trimester of pregnancy and to demonstrate the clinical utility in various fetal disorders. METHODS: The ductus venosus Doppler measurements of 331 healthy fetuses between 15 and 22 weeks' gestation were analyzed. The systolic time and diastolic time were subdivided into the systolic acceleration time, systolic deceleration time, diastolic acceleration time, and diastolic deceleration time. The median, 5th, and 95th regression lines for each variable were determined according to gestational age. The ductus venosus time interval parameters in cases of fetoplacental abnormalities were calculated and plotted against the reference ranges. RESULTS: With advancing gestation, the systolic acceleration time and total systolic time increased significantly (P < .001). In contrast to the systolic phase, the diastolic deceleration time decreased significantly during the early second trimester of pregnancy (P = .023). The systolic deceleration time, diastolic acceleration time, and diastolic time were relatively constant. Fetuses with tricuspid insufficiency, twin-twin transfusion syndrome, intrauterine fetal growth restriction, and anemia had abnormal ductus venosus times with different patterns. CONCLUSIONS: Predicted normal reference ranges for time interval variables in relation to gestational age were established. These could be helpful for assessing fetal cardiovascular function during the early second trimester of pregnancy.

Comparison of transabdominal and transvaginal sonography in the diagnosis of placenta previa.

PURPOSE: To compare the accuracies of transabdominal sonography (TAS) and transvaginal sonography (TVS) in the diagnosis of placenta previa. METHODS: A prospective, cross-sectional study was conducted at a university hospital. Both TAS and TVS were performed on 81 pregnant women with a suspicion of placenta previa in the third trimester. The final diagnosis was confirmed at delivery. The agreement between the two ultrasound methods and the parameters of each method were calculated. RESULTS: Fifty-eight percent of the women had a placenta previa. The sensitivities of TAS and TVS were 86% (95% CI 78-94%) and 95% (95% CI 91-100%), respectively (p= 0.2). The specificity of both methods was 93% (95 CI 88-99%), and the overall accuracies of TAS and TVS were 89% (95% CI 82-96%) and 94% (95% CI 89-100%), respectively. When TAS was followed by TVS, 23% of the previous diagnoses were changed. The agreement between both methods was good (Kappa value = 0.7, 95%CI 0.55-0.86). CONCLUSIONS: For the diagnosis of placenta previa, TAS showed a high sensitivity and specificity, which were comparable to those of TVS.

Agreement of three interpretation systems of intrapartum foetal heart rate monitoring by different levels of physicians.

A prospective study was conducted in centre in Southern Thailand, to evaluate agreement in EFM interpretation among various physicians in order to find out the most practical system for daily use. We found strong agreement of very normal FHR tracings among the FIGO, NICHD 3-tier and 5-tier systems. The NICHD 3-tier was more compatible with the FIGO system than 5-tier system. Overall inter-observer agreement was moderate for the NICHD 3-tier system while inter-observer agreement of 5-tier system was fair also the intra-observer agreement was higher in the NICHD 3-tier system. So the 3-tier systems are more suitable than the 5-tier system in general obstetric practice. Impact statement What is already known on this subject: The 3-tier and 5-tier systems were widely used in general obstetrics practice. What the results of this study add: The inter- and intra-observer agreement of NICHD 3-tier system was higher than the 5-tier system. What the implications are of these findings for clinical practice and/or further research: The 3-tier systems were more suitable than the 5-tier systems in general obstetrics practice.

Subsequent gestational diabetes mellitus prediction in advanced maternal age using amniotic fluid glucose concentration during second trimester genetic amniocentesis.

This prospective study aimed to present the reference range of amniotic fluid glucose (AFglu) among second trimester pregnant women in southern Thailand, to evaluate the possibility of predicting subsequent gestational diabetes mellitus (GDM) using AFglu, and to estimate AFglu cut-off levels for identifying pregnancies at high or low risk for subsequent GDM in singleton pregnancies undergoing genetic amniocentesis due to advanced maternal age. A total of 438 eligible pregnant women were analysed, among whom 58 were subsequently diagnosed as having GDM. The reference range that included the central 95% of AFglu values at 16, 17 and 18 weeks of gestation in women not subsequently developing GDM was determined from a linear regression model. Logistic regression was used to identify predictors of subsequent GDM. Odds ratio of subsequent diagnosed GDM participant increased by 7% for each 1 mg/dl increase in AFglu. Risk of subsequent GDM was also increased in women aged over 36 years and in 17-18 weeks compared to 16 weeks of gestation. Depending on gestational and maternal age, AFglu levels above 51 to 75 mg/dl were at elevated risk of subsequent GDM (likelihood ratio 2.38). We conclude that AFglu tended to decrease with increasing of gestational age. Gestational age and maternal age accompanied with elevated AFglu are predictive factors for subsequent GDM.

Accuracy of Ultrasonography Performed by Thai Maternal Fetal Medicine Fellowship at Songklanagarind Hospital for Fetal Sex Determination during Second Trimester Genetic Amniocentesis

Objective: To evaluate the accuracy of fetal sex determination using ultrasonography performed by Thai Maternal Fetal Medicine fellowships during second trimester genetic amniocentesis and also identify the possible factors of inaccurate determination. Material and Method: A prospective non-random study was conducted to evaluate the accuracy of fetal sex determination using ultrasonography performed by Thai Maternal Fetal Medicine fellows at Songklanagarind Hospital during second trimester genetic amniocentesis and also identify the possible factors of inaccurate determination. Results: Five hundred and sixty singleton pregnant women were enrolled. Eight cases were excluded due to abnormal fetal karyotype. No pregnancy loss or fetal ambiguous genitalia presented. The sex of 11/552 (1.99%) fetuses could not be adequately determined by ultrasonography. Overall, 491 of the 541 diagnose were correct ­ an accuracy of 90.8% (CI 88.0- 93.1) given an ultrasonographic diagnosis could be made. Among phenotypic females, the accuracy was 226/246, (91.9%; 95% CI 87.7-95.0) and among phenotypic males, the accuracy was 265/295 (89.8%; 95% CI 85.2-92.4). The ultrasonographic diagnosis of female sex was correct in 226/256, (88.3%; 95% CI 84.0-92.0), and the ultrasonographic diagnosis of male sex was correct in 265/285, (93.0%; 95% CI 89.4-95.7). For both sexes combined and for female fetuses, year of fellowship was only significant variable associated with correct sex determination by ultrasonography [2nd year vs. 1st year: overall ORS 2.55, (95% CI 1.44-4.61); female fetuses ORS 6.54, (95% CI 2.48-17.26)]. Conclusion: Fetal sex determination using ultrasonography by Thai Maternal Fetal Medicine Fellows at Songklanagarind Hospital during second trimester genetic amniocentesis is possible. Less experienced physicians should be had increased awareness especially in case of female external genitalia diagnosis.

Music Listening to Decrease Pain during Second Trimester Genetic Amniocentesis: A Randomized Trial.

Objective: To evaluate whether music listening decreased pain perception during second trimester genetic amniocentesis. Material and Method: We conducted a prospective randomized study to compare the pain perception using a visual analogue scale (VAS), pain rating, future decision to repeat the procedure, and pain perception compared to a venipuncture before and after the second trimester genetic amniocentesis between groups of pregnant women who underwent amniocentesis with and without music listening. Results: Three hundred thirty two pregnant women were enrolled; 161 listened and 171 did not listen to the music. The pre-procedure anxiety, the anticipated pain, post-procedure pain/ anxiety median VAS scores, pain rating, future decision and level of pain compare to a venipuncture in the music-listening and non-music-listening groups did not show statistically significant difference. The pre-procedure anxiety median VAS scores were 1.3 and 0.5 in the music-listening and non-musiclistening groups, respectively and the anticipated pain median VAS scores were 4.8 and 4.5 in the music-listening and non-music-listening groups, respectively. The post-procedure median VAS pain/anxiety scores were 2.7 and 2.5 in the music-listening and non-music-listening groups, respectively. Conclusion: Music listening was not significantly effective in reducing pain during second trimester genetic amniocentesis.

Reducing Pain and Anxiety during Second Trimester Genetic Amniocentesis Using Aromatic Therapy: A Randomized Trial.

OBJECTIVE: To evaluate the benefit of aromatic therapy using menthol for decrease pain perception during amniocentesis. MATERIAL AND METHOD: A prospective randomized study was conducted to compare pain level between groups ofpregnant women who underwent amniocentesis with and without aromatic therapy using menthol. Visual analogue scale (VAS) was usedfor pain assessment. The participants were askedfor their anticipated pain and anxiety level and level ofpain before and immediately after the procedure. RESULTS: Three hundred seventeen pregnant women were recruited into the present study, 158 in the menthol group and 159 in the non-menthol group. Mean VAS score of the post-procedure pain and anxiety did not differ significantly between the two groups. Mean VAS score of the anticipated pain influenced the mean VAS score of the pre-procedure anxiety and post-procedure pain and anxiety irrespective of the group. Mean VAS score of the pre-procedure anxiety and post-procedure pain and anxiety increased about 0.3 cm for each 1 cm of increasing mean VAS score of anticipated pain. CONCLUSION: Aromatic therapy using menthol was not significantly effective in reducing pain and anxiety during second trimester genetic amniocentesis.

Prevalence of neural tube defect in southern Thailand: a population-based survey during 2009-2012.

BACKGROUND: Neural tube defects (NTDs) are a group of congenital malformation of the central nervous system that leads to permanent physical disability and requires lifelong treatment. In Thailand, there have been three published articles on NTDs, all hospital-based studies, which found prevalence of NTDs of 4.8-6.7 per 10,000 live births. OBJECTIVE: It was our purpose with this study to determine the prevalence and type of NTDs in southern Thailand through a population-based survey. METHOD: Data were obtained through the population-based surveillance during 2009-2012 in three provinces (Songkhla, Phatthalung, Trang) in southern Thailand. Entries in the birth defects registry included all live births, all stillbirths after 24-week gestational age, and termination of pregnancy following the prenatal diagnosis at any gestational age of all congenital anomalies. RESULTS: During 2009-2012, 148,759 births were registered in the three provinces. Twenty-eight NTD cases were identified, giving an average of 1.88 per 10,000 births (95 % CI 1.20-2.51): 12 cases with anencephaly (42.8 %), 5 with occipital encephalocele (17.9 %), and 11 with myelomeningocele (39.3 %). The birth prevalence per 10,000 births of anencephaly, encephalocele, and myelomeningocele were 0.81, 0.33, and 0.74, respectively. Sixteen (57 %) were detected in live births, and 12 (43 %) were detected by prenatal diagnosis which later resulted in termination of pregnancy. CONCLUSIONS: The prevalence of NTDs based on the population-based study in southern Thailand was low. About 40 % of NTD cases were detected prenatally and later terminated. Hence, examining only registry live births will result in an inaccurately low NTD prevalence rate.

A reference for ductus venosus blood flow at 11-13+6 weeks of gestation.

OBJECTIVE: To establish reference ranges for ductus venosus (DV) blood flow assessment obtained transabdominally at 11-13(+6) weeks of gestation. METHODS: A cross-sectional study was conducted on singleton pregnancies with a crown-rump length (CRL) ranging from 45 to 84 mm, normal fetus, and subsequent newborn birth weight appropriate for gestational age. Measurements of DV Doppler variables were performed by experienced sonographers: peak velocity during ventricular systole (S-wave) and diastole (D-wave), nadir during atrial contraction (A-wave), time-averaged maximum velocity (TAmax), pulsatility index for veins (PIV), and peak velocity index for veins (PVIV). RESULTS: A total of 304 fetuses were included. The mean CRL was 60.7 ± 7.2 mm (range: 45.9-75.5). The mean nuchal translucency measurement was 1.4 ± 0.4 mm. The S-wave, D-wave, A-wave, and TAmax values varied significantly with gestational age (p < 0.05) and regression models were constructed for each variable. The remaining variables, systolic/atrial wave ratio, preload index, PVIV, and PIV, did not vary significantly with gestational age within this CRL range. CONCLUSION: Reference ranges for DV Doppler assessment were established in normal fetuses. These ranges may be a useful tool for evaluation of anueploidy and fetal cardiac function.

Comparison of the effectiveness of different counseling methods before second trimester genetic amniocentesis in Thailand.

OBJECTIVE: The objective of this study is to compare the effectiveness of counseling methods before second trimester genetic amniocentesis. STUDY DESIGN: The design of this study is a randomized controlled study comparing the improvement in patients' knowledge satisfaction anxiety and perceived pain between computer-assisted instruction (CAI) and leaflet self-reading (LSR) and subsequent individual counseling among pregnant women scheduled for second trimester genetic amniocentesis in a developing country. RESULTS: There were 164 and 157 participants in the LSR and CAI groups, respectively. In both groups, knowledge improved significantly after LSR/CAI (p < 0.001) and increased further after individual counseling (p < 0.001). After combined counseling, knowledge was significantly higher in the LSR than in the CAI group (p = 0.032). Knowledge was associated with higher level of education and previous exposure to genetic counseling. Pain decreased more in the CAI than in the LSR group after completion of counseling (p = 0.021). Reduction in anxiety and increase in satisfaction did not differ between the groups. Counseling method did not affect the final decision of patients to accept amniocentesis. CONCLUSION: Both counseling methods improved patients' knowledge and satisfaction and reduced pain and anxiety. In combination with individual counseling, LSR was more effective than CAI in improving patients' knowledge before second trimester genetic amniocentesis.

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.

Reliability of fetal nasal bone length measurement at 11-14 weeks of gestation.

BACKGROUND: Nasal bone assessment has been incorporated into Down syndrome screening in first trimester. Several studies have established the normal reference values for fetal nasal bone length in the first trimester, which were found to be varied by population. However, the study on reliability of nasal bone length measurement was limited with contradictory results. This study aimed to investigate the reliability of fetal nasal bone length measurement at 11-14 weeks of gestation in the Thai population. METHODS: A total of 111 pregnant women at 11-14 weeks of gestation attending for the routine first-trimester ultrasound examination were recruited. Each case was measured separately by two examiners. Examiner 1 performed the first measurement in all cases; any of the other 5 examiners consecutively performed the second measurement. Three independent measurements were performed by each examiner and they were blinded to the results of the others. Intraobserver and interobserver variabilities were evaluated with the intraclass correlation coefficient (ICC). RESULTS: Nasal bone measurement was successfully performed in 106/111 cases (95.5%) by at least one examiner; 89 cases were performed by two examiners. The intraobserver variability was excellent for all examiners (ICC, 0.840-0.939). The interobserver variability between different pairs of examiners varied from moderate to excellent (ICC, 0.467-0.962). The interobserver variability between examiner 1 and any other examiner was good (ICC, 0.749). The Bland-Altman plot of the interobserver differences of nasal bone length measurements between examiner 1 and any other examiner showed good agreement. CONCLUSIONS: The reliability of the fetal nasal bone length measurement at 11-14 weeks of gestation was good. The nasal bone length measurement was reproducible. Ethnicity has an effect on fetal nasal bone length, but reliability of nasal bone length measurement is critical to accuracy of screening and should be audited on an ongoing basis.

Pregnancy outcomes amongst thalassemia traits.

OBJECTIVE: To compare the pregnancy outcome between pregnancies affected and not affected by thalassemia trait. METHODS: A retrospective case-control cohort study was conducted on singleton pregnant women who attended antenatal care and delivered at Songklanagarind Hospital. All of the participating thalassemia trait pregnant women were diagnosed based on hemoglobin typing and/or DNA analysis. A ratio of around 1-1 was used to compare their pregnancy outcomes with normal pregnant women. RESULTS: Seven hundred thirty-nine thalassemia trait and 799 normal pregnant women were included in the study. All of the women were Thai nationals living in the Southern Region of Thailand and nearly all of them had spontaneously conceived. Maternal complication rates of gestational diabetes, preterm birth, antepartum bleeding, postpartum bleeding, shoulder dystocia and puerperal morbidity, and the rates of neonatal complications: macrosomia, fetal weight <2,000 g, intrauterine growth restriction (IUGR), stillbirth, low Apgar score (<7) at 1 and 5 min and NICU admission, were not significantly different between the two groups. The rate of pre-eclampsia, however, was significantly different, with RRs of 1.73 (CI 1.01-3.00). CONCLUSION: The thalassemia trait condition did not affect the risk of gestational diabetes, postpartum hemorrhage, stillbirth, preterm birth and puerperal morbidity. However, pre-eclampsia should be warranted especially among nulliparous and high-BMI pregnant women.

The knowledge and attitudes of Thai obstetrics and gynaecology residents towards Down syndrome screening.

OBJECTIVE: To survey the knowledge and attitudes towards Down syndrome screening in the final year of training of Thai obstetrics and gynaecology residents. MATERIAL AND METHOD: A self-administered structured questionnaire of knowledge and attitudes towards Down syndrome screening was developed One hundred thirty six residents were asked to respond to the questionnaire on their last day of the Thai board examination in the year 2006 and 2007. The data was analyzed using SPSS for windows version 15.0. RESULTS: Eighty-two completed questionnaires surveys were returned (60% response rate). The mean total score of knowledge of Down syndrome and its screening test was 81%. Eighty percent of respondents (65/82) had positive attitudes towards counseling for screening Down syndrome for all pregnant women. Fifty-four percent (44/82) had negative attitudes towards Down syndrome screening for all pregnant women. Sixty percent (49/82) favored nuchal translucency measurement by ultrasonography for screening in the first trimester Training institutes, age, sex, and the counseling experience of residents did not affect the attitudes. CONCLUSION: The final-year Thai Obstetrics and Gynaecology residents had good knowledge and positive attitudes towards Down syndrome screening. More than half of the residents had negative attitudes towards the screening of all pregnant women. Educational programs and training are needed to address these deficiencies before screening programs are widely implemented.

Efficacy of cryoanalgesia in decreasing pain during second trimester genetic amniocentesis: a randomized trial.

OBJECTIVE: To evaluate the effectiveness of cryoanalgesia in decreasing the degree of pain sensation during second trimester genetic amniocentesis. MATERIALS AND METHODS: We performed a prospective randomized study comparing the anticipated and actual pain before and after second trimester genetic amniocentesis between pregnant women who received and did not receive cryoanalgesia. The pain was measured using the visual analog score (VAS), ranging from 0 to 10. RESULTS: Three hundred and seventy-two pregnant women participated in our study. One hundred and eighty-four and 188 pregnant women were randomized to cryoanalgesia received and non-cryoanalgesia received groups, respectively. The pre-procedure anxiety mean VAS scores and the anticipated pain mean VAS scores between the groups were not significantly different (P = 0.25 and 0.18, respectively). The pre-procedure anxiety and the anticipated pain mean ± SD VAS scores in the cryoanalgesia and non-cryoanalgesia groups were 5.7 ± 0.37 vs. 8.0 ± 0.82 and 5.4 ± 1.34 vs. 5.6 ± 1.42, respectively. The post-procedure pain and anxiety mean VAS scores in the cryoanalgesia group were statistically less significant than those from the non-cryoanalgesia group (mean ± SD = 3.2 ± 1.60 and 3.8 ± 1.58, respectively, P = 0.004). Most pregnant women claimed to have experienced moderate pain and accepted to undergo a second trimester genetic amniocentesis again if indicated. CONCLUSION: Cryoanalgesia is effective in decreasing the pain sensation and could be routinely applied to all pregnant women before the second trimester genetic amniocentesis.

Distribution of normal nuchal translucency thickness: a multicenter study in Thailand.

AIMS: To establish the normative data distribution of nuchal translucency (NT) thickness in Thai fetuses. METHODS: A cross-sectional multicenter study was conducted among 6,455 women with singleton pregnancies and gestational age between 10 and 14 weeks. For each case, the fetal crown-rump length (CRL) and NT were measured by transabdominal ultrasound. Transvaginal ultrasounds were used in poorly visualized cases. The distribution values of the NT thicknesses and their corresponding 10-mm CRL intervals between 45 and 84 mm were examined to obtain the median and 95th percentiles. Quantile regression modeling across the CRLs was performed to obtain the reference values. RESULTS: Transabdominal ultrasound measurements were successfully done on 6,347 fetuses with 39 cases by the transvaginal route. Fetuses with CRL between 45 and 84 mm and normal outcomes made up a total of 4,352 cases. The mean (SD) gestational age, CRL and NT thickness were 12.5 (0.7) weeks, 60.2 (9.7) mm, and 1.15 (0.38) mm, respectively. The mean normal NT increased linearly with CRL. The quantile regression equation to predict the 95th percentile of the NT thickness (mm) was 0.727 + [0.017 × CRL (mm)]. CONCLUSIONS: The NT thickness in normal Thai fetuses was found to be thinner than in both Caucasian and other Asian populations.

Outcome of second trimester amniocentesis in singleton pregnancy at Songklanagarind Hospital.

OBJECTIVE: To evaluate the outcome of genetic amniocentesis in singleton gestation at Songklanagarind Hospital. MATERIAL AND METHOD: This was a descriptive study that included all singleton pregnant women who had a second trimester amniocentesis for chromosome studies at the Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Songklanagarind Hospital between January 1998 and 2006 to assess the outcome including risk of fetal loss in such cases. RESULTS: Advanced maternal age was the most common indication for amniocentesis. Amniocentesis after positive screening aneuploidy test increased. The fetal loss within 14 days after the procedure was 0.12% (10/8,073). Leakage of amniotic fluid occurred 0.1% (5/8,073) but only one case aborted. Fever occurred in two cases and a case of chorioamnionitis was diagnosed. CONCLUSION: The rate of fetal loss within 14 days after amniocentesis in singleton pregnant women was lower than the authors' previous 10 years. The anxiety of the family and difficulty of counseling to the family will be reduced because of a lower complication rate. Moreover the pregnant women who have a high degree of anxiety for genetic abnormalities are a likely choice for genetic amniocentesis if the risk rate regarding the patient's age, ultrasonographic finding, or maternal serum screening is around 0.1%.

Calcium Consumption During Pregnancy: A Multicenter Study in a Middle-Income Country in Southeast Asia.

OBJECTIVE: To perform a cross-sectional observational study of calcium consumption among pregnant women from multicenter tertiary care hospitals in the middle-income country in Southeast Asia. STUDY DESIGN: A cross-sectional observational study. SETTING: The study was conducted in four geographical regions (northern, northeastern, southern, and central) of Thailand. Five participating hospitals consisted of one university hospital in each region and one additional tertiary care hospital in the central region. MATERIALS AND METHODS: A cross-sectional study was performed nationwide from 1st November 2017 to 31st January 2019. All singleton aged 19-40 years were included. Exclusion criteria were any conditions that influenced calcium-containing food consumption. Dietary intake self-records immediately after eating for two working days and one holiday were analyzed via INMUCAL-NV3.0 dietary program. RESULTS: The 1549 records were obtained. The mean age was 29 ± 5.7 years. Most participants were primigravida (48.6%). The average gestational age was 20.6 ± 8.8 weeks. Mean calcium consumption was 602.4 mg/day (95% CI; 589.2615.6 mg/day) mg/dL. Inadequate calcium consumption prevalence based on the Thai dietary reference intake (less than 800 mg/day) and US Institute of Medicine (less than 1000 mg/day) were 82.0% and 93.4%, respectively. CONCLUSION: The mean calcium consumption among pregnant women in the middle-income country in Southeast Asia was 602.4 mg/day (95% CI 589.2-615.6 mg/day). Inadequate calcium consumption of Thai pregnant women prevalence was 82.0% and 93.4% according to Thai dietary reference intake in pregnancy and the US Institute of Medicine.