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.

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.

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.

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%.

Natural history of Southeast Asian Ovalocytosis during the first 3 years of life.

Southeast Asian Ovalocytosis (SAO), the most common red cell membrane disorder found in the Far-East and Pacific rim, appears to be innocuous in man since it has been identified mostly in non-anemic healthy individuals. To further substantiate our previous observation that this condition might be symptomatic particularly in the neonatal period, we studied 1567 newborns from Southern Thailand where SAO is prevalent. Thirty-one babies (1: 50 with allele frequency of 0.01) have been identified with SAO and confirmed molecularly to carry a single defective AE-1 (band 3) allele. These babies had significant anemia at birth due to hemolysis with 51.6% of them developing neonatal hyperbilirubinemia. Co-inheritance of common UGT1A1 variants in such cases was not associated with their degree of jaundice. Interestingly, hematology data of these SAO babies became "normalized" in the first 3 years of life without further evidence of on-going and/or even "compensated" hemolysis.

A survey of the knowledge and attitudes of pregnant Thai women towards Down syndrome screening.

AIM: To determine the knowledge and attitudes of pregnant Thai women towards Down syndrome screening. METHODS: A total of 714 pregnant women were recruited attending antenatal clinics in Songklanagarind Hospital from February through June 2007. Their knowledge and attitudes concerning Down syndrome screening were evaluated through self-administered questionnaires. The data were analyzed using SPSS version 12.0. RESULTS: The mean age of the respondents was 29.9 +/- 6.4 years. Regarding their knowledge of Down syndrome and its screening test, the mean scores were 43.6% and 20.6%, respectively. Most pregnant women (77.6%) had a positive attitude to Down syndrome screening. In addition, 92.2% of cases would accept a Down syndrome screening test. Multivariate logistic regression analysis showed that levels of education and types of health insurance were factors associated with knowledge of Down syndrome screening. Maternal age was the only factor affecting attitudes. CONCLUSION: Most pregnant women had inadequate knowledge of Down syndrome and the screening test. However, they did have a positive attitude and were willing to accept the test. Providing knowledge on Down syndrome and the screening test for pregnant women should be implemented in our antenatal care services and community.

Outcome of second trimester amniocentesis in twin pregnancies at Songklanagarind Hospital.

OBJECTIVE: To evaluate the outcome of genetic amniocentesis in twin gestations at Songklanagarind Hospital. MATERIAL AND METHOD: This was a descriptive study that included all women with twin pregnancies who had a second trimester amniocentesis for chromosome study at the Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Songklanagarind Hospital from January 1998 through June 2006 to assess the outcome including risk of fetal loss in such cases. RESULTS: Advanced maternal age was the most common indication for amniocentesis. The success rate of cell culture was 100%. The fetal loss within 14 days after the procedure was 1.4%. CONCLUSION: The tendency of fetal loss after amniocentesis in twin pregnancies was higher than in singletons. Pre-procedure counseling personnel should be aware of this potential outcome, and be sure to inform the involved parents prior to the procedure.

WT1 gene expression as a prognostic marker in advanced serous epithelial ovarian carcinoma: an immunohistochemical study.

BACKGROUND: WT1 is a tumor suppressor gene responsible for Wilms' tumor. WT1 reactivity is limited to ovarian serous carcinomas. Recent studies have shown that WT1 plays an important role in the progression of disease and indicates a poorer prognosis of human malignancies such as acute myeloid leukemia and breast cancer. The aims of this study were to determine the survival and recurrence-free survival of women with advanced serous epithelial ovarian carcinoma in relation to WT1 gene expression. METHODS: The study accrued women over an 18-year period, from 1987-2004. During the study period, 163 patients were diagnosed with advanced serous epithelial ovarian carcinoma and had undergone complete post-operative chemotherapy, but the final study group comprised 99 patients. The records of these women were reviewed and the paraffin-embedded tissue of these women stained with WT1 immunostaining. Survival analysis was performed using Kaplan-Meier and Cox regression methods. RESULTS: Fifty patients showed WT1 staining and forty-nine did not. Five-year survival of non-staining and staining groups were 39.4% and 10.7% (p < 0.00005); five-year recurrence-free survival of these groups were 29.8% and < or = 7.5% (p < 0.00005), respectively. For survival the HR of WT1 staining, adjusted for residual tumor and chemotherapy response, was 1.98 (95% CI 1.28-3.79), and for recurrence-free survival the HR was 3.36 (95% CI 1.60-7.03). The HR for recurrence-free survival was not confounded by any other variables. CONCLUSION: This study suggests that expression of WT1 gene may be indicative of an unfavorable prognosis in patients with advanced serous epithelial ovarian carcinoma.

Outcomes of multifetal pregnancies.

AIM: To determine the outcomes of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. METHODS: A retrospective analysis was conducted of the information from medical records relating to all multifetal pregnancies. The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. RESULTS: There were 387 multifetal pregnancies during the study period, which was 1.3% of all the deliveries; 334 cases (86.3%) were spontaneous conceptions and 53 cases (13.7%) were the result of assisted reproductive therapy. Higher-order fetuses (> or =3) represented 8% of all multifetal pregnancies, 13% in the spontaneous group and 87% in the assisted group. The overall cesarean delivery rate was 73.9%. The assisted reproductive therapy group had a cesarean rate of 90.6% compared with 71.3% in the spontaneous group (P = 0.008). The assisted multifetal pregnancy group had more preterm labors and a longer maternal hospital stay than the spontaneous group. One maternal death occurred in the assisted group. The main causes of early neonatal death were prematurity, infection and congenital malformation. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, infection and longer hospital stay (6 days vs 15 days, P < 0.001). More complications occurred in higher-order fetuses than with twins. CONCLUSIONS: Assisted multifetal pregnancies were more likely to be delivered by cesarean section and had a higher rate of higher-order fetuses, preterm birth and neonatal prematurity-related complications with a longer hospital stay in both mothers and newborns, than spontaneous multifetal pregnancies.

Etiology and outcome of non-immune hydrops fetalis in southern Thailand.

OBJECTIVE: To study the etiology and outcome of non-immune hydrops fetalis in southern Thailand. METHODS: The medical records and videotape recordings of all pregnant women diagnosed with non-immune fetal hydrops, from January 1993 to December 2002 were reviewed. RESULTS: Non-immune hydrops fetalis was documented in 71 cases. The causes of fetal hydrops were identified in 87.3%. Homozygous alpha-thalassemia-1 dominated as the cause of non-immune fetal hydrops (28.2%), followed by structural abnormalities (15.5%) and infection (12.7%). The underlying etiology remained unknown in 9 cases (12.7%). The overall survival rate of non-immune hydrops fetalis cases was 4.2%. Spontaneous regression occurred in 2 cases. Two cases were lost to follow up after initial evaluation. Termination of pregnancy was performed in 47 cases. There were 12 dead fetuses in utero, 2 stillbirths, 5 early neonatal deaths and only 3 cases survived. CONCLUSIONS: Homozygous alpha-thalassemia-1 is the most common cause of non-immune hydrops fetalis in southern Thailand, and the overall prognosis of non-immune hydrops fetalis is poor. We suggest that an effective thalassemia-screening program for prevention and control of homozygous alpha-thalassemia-1 be established in all areas where the alpha-thalassemia-1 gene is prevalent.

Variability of nuchal translucency measurement: a multicenter study in Thailand.

OBJECTIVES: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurements and study the duration of measurements. SUBJECTS: One hundred and forty-seven singleton pregnant women with 10-14 weeks of gestation who had attended antenatal clinic during January 1st, 2000-August 31st, 2001 were included. METHODS: Crown-rump length and NT were measured three times for each woman. Then, another examiner who was unaware of the previous results did the other three measurements. The duration of measurements was recorded. Intra-observer and inter-observer variations were analyzed by repeated ANOVA and paired t test, respectively. The correlation of NT measurements within each observer and between paired observers was evaluated by intraclass correlation coefficients (ICC). Kappa statistic was calculated for agreement. RESULTS: Intra-observer variation of all 10 examiners at three institutes was varied from 0.20 +/- 0.27 to 0.33 +/- 0.41 mm. Inter-observer variation at Chiang Mai University was 0.40 +/- 0.37 mm which was the highest value compared with those at Prince of Songkla and Khon Kaen University (p < 0.05). The mean duration of measurements was in range of 8-12 min. The intra-observer repeatability of the first two measurements showed ICCs varying from 0.61 to 0.94. The inter-observer repeatability of paired examiners showed a variation in ICC from 0.28-0.90. The kappa value expressing the intra- and inter-observer repeatability as being >95th or < or = 95th percentile was 0.73 and 0.72, respectively. CONCLUSIONS: NT measurement was reproducible for small variation and good agreement. The duration of measurements was acceptable.