Urine Congo red test for the detection of preeclampsia in pregnant women presenting with suspected preeclampsia.

OBJECTIVES: To determine the predictive performance of the urine Congo red point-of-care test for the identification of preeclampsia in women presenting with suspected preeclampsia. METHODS: A prospective multi-center cohort study was conducted to include women with suspected preeclampsia (n = 244). The urine Congo red test was determined (score range 1-8). The diagnosis of preeclampsia was based on criteria proposed by The American College of Obstetricians and Gynecologists. The primary outcome was the predictive performance (sensitivity, specificity, negative and positive predictive values, as well as likelihood ratios) of the Congo red kit test for the diagnosis of preeclampsia. RESULTS: Fifty-four percent (131/244) of women with suspected preeclampsia subsequently developed preeclampsia. The sensitivity and specificity of the urine Congo red test were 49.6% and 94.7%, respectively, when using a cutoff for Congo red ≥4. The test had a significant positive correlation with the level of urine protein (Pearson correlation 0.61, p-value <.01). Intra- and inter-observer reliabilities were good (intra-class correlation coefficient and Cohen's kappa coefficient of 0.88 and 0.75, respectively; p < .01). CONCLUSION: The urine Congo red kit test has a high positive predictive performance for the identification of preeclampsia with high reproducibility. This test may be used as a bed side test to rule-in the diagnosis of preeclampsia in women presenting with suspected preeclampsia.

Survey on knowledge, attitude, acceptance and related factors among pregnant women in Thailand regarding antenatal thalassaemia screening.

Thalassaemia is a common haematologic health condition in Southeast Asian countries (SEA) including Thailand. Reducing the birth of new thalassaemia cases is an effective method to control disease. The background level of knowledge and attitude of pregnant women on the disease influences their decision to perform antenatal screening. Unfortunately, the information about pregnant women's knowledge and attitude on antenatal thalassaemia screening in a developing country such as Thailand is lacking. We therefore conducted this cross-sectional study to examine patients' knowledge and to evaluate the factors which influence the patient's knowledge and attitude on antenatal thalassaemia screening. 1006 pregnant women who attended antenatal care at the Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand were enrolled. We found that women's knowledge on antenatal thalassaemia screening is low. A maternal age of ≥35 years was associated with a higher level of knowledge. A higher level of education and multigravidity, a family history of thalassaemia and a positive level of attitude were found more likely to have higher scores for knowledge. A higher level of education and level of knowledge score were also more likely to have a positive attitude score, but multigravidity negatively affected the attitude score. Effective counselling should be monitored among women with a lower levels of education, those with no family history of thalassaemia, and in primigravidas. Lastly, a concurrent Down syndrome screening or foetal sex determination may be useful incentives to encourage the decision to undergo screening. Impact statement What is already known about this subject? Screening for the paternal and maternal thalassaemia carrier status is important for reducing the incidence of severely thalassaemia-affected children. Poorer education and receiving genetic counselling for the first time were the predictive factors for the low post-counselling knowledge in genetic counselling before second trimester genetic amniocentesis. What do the results of this study add? Pregnant women's knowledge of antenatal thalassaemia screening was low. We found that pregnant women aged ≥35 years had a higher level of knowledge. Women with a higher level of education, multigravidity, the presence of a family history of thalassaemia and a positive attitude were more likely to have higher scores for knowledge. A higher level of education and level of knowledge score were also more likely to have a positive attitude score but multigravidity negatively affected the attitude score. The encouraging factors, such as an adjunctive Down syndrome screening or foetal structural screening or foetal sex determination may be useful as the incentive tools. What are the implications of these finding for clinical practice and/or further research? The awareness of a possible incorrect understanding is important for the antenatal counselling in the developing countries. Intensive monitoring of effective counselling using a post-counselling test should be scheduled. The methods of effective counselling for antenatal thalassaemia in developing countries should be evaluated.

Comparison of Breastfeeding Outcomes Between Using the Laid-Back and Side-Lying Breastfeeding Positions in Mothers Delivering by Cesarean Section: A Randomized Controlled Trial.

BACKGROUND: The breastfeeding position routinely used following a cesarean section is the side-lying position. However, there have been few studies about the effect of breastfeeding positions, including laid-back position on breastfeeding outcomes. OBJECTIVE: To compare the breastfeeding outcomes between using laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section. MATERIALS AND METHODS: A randomized controlled trial was conducted. The postpartum mothers delivering by cesarean section who delivered term newborns were randomly assigned to learn the use of a laid-back or side-lying breastfeeding position. The breastfeeding outcomes were assessed by LATCH scores at the second day postpartum and exclusive breastfeeding rates during the 6-week postpartum period. The mother's satisfaction of each breastfeeding position was collected before discharge from the hospital. RESULTS: The data from 152 postpartum mothers delivering by cesarean section were available for analysis, 76 from the laid-back position group and 76 from side-lying position group. The baseline characteristics of both groups were similar. There were no statistically significant differences of the breastfeeding outcomes, LATCH scores at the second day postpartum and the exclusive breastfeeding rates during the 6-week postpartum period. But the mothers had expressed more satisfaction from the side-lying than the laid-back position. CONCLUSIONS: Among the mothers who delivered by cesarean section, the use of the laid-back breastfeeding position had not shown different breastfeeding outcomes from the side-lying breastfeeding position. It might be an alternative breastfeeding position, which can be taught for mothers delivering by cesarean section along with the side-lying position.

Effect of Obesity and Early Breastfeeding Initiation on Exclusive Breastfeeding Rates.

Objective: To compare the 6-week postpartum, exclusive breastfeeding rates between obese mothers and mothers with a normal body mass index (BMI), with early breastfeeding initiation. Material and Method: The subjects were 415 singleton, postpartum, obese mothers who delivered without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok province between the years of 2013 through 2015 and the same number of matched normal body mass index mothers. The early breastfeeding initiation of both the obese mothers and the normal BMI mothers was recorded. The exclusive breastfeeding rates were collected at the second day postpartum. Following discharge, telephone follow-ups were used for the collection of breastfeeding data at the 7th, 14th day and six weeks postpartum. The exclusive breastfeeding rates of the obese mothers were analyzed and compared with the exclusive breastfeeding rates of normal BMI mothers at the 2nd, 7th, 14th day and 6 weeks postpartum. The data was analyzed by Chi-square, relative risk and 95% confidence interval. Results: At the 2nd, 7th, 14th day and 6th week postpartum; the exclusive breastfeeding rates of the obese mothers' group were 94.5, 71.1, 64.8 and 51.3%, respectively. The exclusive breastfeeding rates of the normal BMI mothers' group for the same periods were 95.7, 79.3, 75.4 and 63.1%, respectively. There are statistically significant differences between the exclusive breastfeeding rates of the obese mothers' group and the normal BMI groups at the 7th day, 14th day and 6th week postpartum. In the situation of early breastfeeding initiation, the exclusive breastfeeding rates of the obese mothers at the 2nd, 7th, 14th day and 6th week postpartum were 96.3, 77.0, 71.2 and 58.4%, respectively. The exclusive breastfeeding rates of the normal BMI mothers who had early breastfeeding initiation were 96.2, 81.3, 77.4 and 67.2% at the 2nd, 7th, 14th day and 6th week postpartum, respectively. No significant differences were seen between the two groups in the exclusive breastfeeding rates at the 2nd, 7th and 14th day postpartum. Conclusion: The obesity had negative effect on exclusive breastfeeding rates during six weeks postpartum after mothers' discharge. But the exclusive breastfeeding rates of both the obese and normal BMI mothers were not significantly different during two weeks postpartum in early breastfeeding initiation situation. The obese mothers could be advised about early breastfeeding initiation.

The Number of Infant Feeding Positions and the 6-Month Exclusive Breastfeeding Rates.

BACKGROUND: Appropriate infant feeding positions will help with latching. Good latching will help decrease cracked nipple and complication leading to early breastfeeding cessation. OBJECTIVE: To investigate the association of the number of infant feeding positions on exclusive breastfeeding during the first six months postpartum period. MATERIAL AND METHOD: The subjects were primiparous women who delivered without complications and intended to breastfeed their newborns at least six months at the HRH Princess Maha Chakri Sririndhorn Medical Center in Nakhon Nayok Province, Thailand, between May 2012 and April 2013. On the first day postpartum, the mothers had received instructions on four infant feeding positions. These included the cradle, cross cradle, football carry, and side-lying positions, and all were practiced. The mothers were assessed on their use of the numbers of infant feeding positions at the second day postpartum prior to their discharge. Telephone follow-ups at the second, fourth, and sixth month postpartum periods were collected and used for exclusive breastfeeding data collection following discharge. Demographic data and exclusive breastfeeding rates were analyzed by Chi-square test, one-way ANOVA test, and relative risk with a 95% confidence interval (CI). RESULTS: Five hundred forty five primiparous women were enrolled in the present study. The data showed that the 6-month exclusive breastfeeding rates of the studied group who could breastfeed by one, two, three, and four positions, had statistically signifcant differences (p-value < 0.05). The relative risks for exclusive breastfeeding rates between the mothers who used two infant breastfeeding positions or more and the mothers who used only one position were 1.68 (95% CI 1.45-1.95) at the 2-month, 1.69 (95% CI 1.38-2.09) at the 4-month, and 1.51 (95% CI 1.18-1.94) at the 6-month postpartum periods. CONCLUSION: The number of infant breastfeeding positions had an association with the exclusive breastfeeding rates during the six months postpartum period.

Comparisons of Latching on between Newborns Fed with Feeding Tubes and Cup Feedings.

BACKGROUND: Feeding tubes and cup feedings were used as alternative feedings. There is scant data regarding the facilitation of latching on by newborns with the use of these alternative supporting techniques. OBJECTIVE: The comparison of the latching on of newborns when fed with the additional support of feeding tubes or cup feedings. MATERIAL AND METHOD: The subjects were 120 normal, postpartum women, who delivered without complications at the HRH Princess Maha Chakri Sririndhorn Medical Center in the Nakhon Nayok Province between October 2012 and September 2013. No breast milk was expressed by the mothers at day 2, postpartum. They were divided into two groups by simple randomization. In the first group, the newborns were fed with a feeding tube in support of breastfeeding. In the second group, the newborns were fed by cup feedings. Latch scores were assessed at the end of postpartum day 3. Demographic data and latch scores were collected and analyzed by Chi-square, t-test and Mann-Whitney U test. RESULTS: No differences in the demographic data of mothers and newborns between the two groups were found. Latch scores for the feeding tube group were significantly higher than the latch scores in the cup feeding group (p < 0.05). CONCLUSION: Latching of newborn after feeding tube method is better than latching of newborn after cup feeding.

Teenage pregnancy and exclusive breastfeeding rates.

BACKGROUND: Teenage pregnancy is an important health issue globally and in Thailand Younger age mothers decide on the breastfeeding practices ofthe first 6-month. OBJECTIVE: To find the rates of 6-month exclusive breastfeeding practices of teenage mothers and compare them with the rates of 6-month exclusive breastfeeding practices in mothers who are 20 years of age or more. MATERIAL AND METHOD: Three thousand five hundred sixty three normal, postpartum women, who delivered without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok Province between 2010 and2013 were included in this study. At the second daypostpartum, the data of latch scores and the data of the practice of exclusive breastfeeding were collected Telephone follow-ups on the seventh, fourteenth, and forty-fifth postpartum days and at the second, fourth, and sixth month postpartum month were collected and used for exclusive breastfeeding data following discharge. Demographic data included the maternal age, parity, gestational age, marital status, occupation, religion, route ofdelivery, estimated blood loss, body mass index, nipple length, and the childs birth weight. The collected data was analyzed by the t-test, Chi-square, and odds ratio with 95% confidence interval. RESULTS: The percentage of teenage pregnancies was at 14.8% (527 cases). On postpartum day 2, the percentage of latch scores of 8 or less was 66.4%. At the seventh, fourteenth, and forty-fifth day and at the second, fourth, and sixth months postpartum, the exclusive breastfeeding rates were 88.5, 78.5, 57.6, 43.1, 32.9, and27.0%, respectively. Comparison of the 6-month exclusive breastfeeding rates between teenage mothers and mothers 20 years ofage or older were not statistically significant (p<0.05). CONCLUSION: The 6-month exclusive breastfeeding rate of teenage mothers was at 27.0% and had no significant differences from the rates of mothers 20 years of age or more.

Comparisons of the latching on between newborns with tongue-tie and normal newborns.

BACKGROUND: Breastfeeding is recommended as the exclusive feeding for the first six months of the newborns life. Difficulty in latching and breastfeeding resulting from tongue-tie are believed to be a problem. OBJECTIVE: To compare the latching on between newborns with tongue-tie (ankyloglossia) and normal newborns. MATERIAL AND METHOD: The subjects were 833 normal, postpartum women who delivered without complications at HRH Princess Maha Chakri Sririndhorn Medical Center in Nakhon Nayok Province between January and June 2013. Their newborns oral cavities' were checked for tongue-tie screening and diagnoses using Kotlow's criteria. Latch scores were used for latch-on assessment at the second day postpartum. Demographic data and latch scores were collected and analyzed by the t-test, Chi-square test, Odds ratio with 95% confidence interval and One-way of ANOVA test. RESULTS: The data shows that the incidence of tongue-tie was 13.4% (6.2% with mild tongue-tie, 5.5% with moderate tongue-tie, and 1.7% with severe tongue-tie). The mean of latch scores in the tongue-tied groups were significantly lower than that in the normal group, especially in the moderate and severe tongue-tie subgroups. The odds ratios for latch scores were < or = 8 compared between the moderate and severe tongue-tied subgroups and the score in the normal and mild tongue-tied subgroups was 1.4. CONCLUSION: The latch scores in tongue-tied newborns were significantly lower than those in normal newborns.

The influence of MR imaging on changes in patient counseling in obstetric patients with suspected fetal anomalies by ultrasound.

OBJECTIVE: To determine the frequency of additional information provided by magnetic resonance (MR) imaging in supplement to ultrasound (US) in patients with fetal anomaly and to determine the influence of MR imaging findings on patient counseling. MATERIAL AND METHOD: MR imaging offetus was performed in 26 patients who have abnormal ultrasound results. Referring obstetricians were asked about how the additional information provided by MR imaging have effect on their decision marking, patient counseling, and case management. RESULTS: MR imaging in 23 of 26 fetuses was technically successful. MR imaging provided additional information in 14/23 (60.9%) cases. In the other nine (39.1%) cases, MR imaging confirmed US diagnosis but did not give supplementary information. Additional information from MR imaging affected patient counseling in five (21.7%) cases and did not affect patient counseling in the other nine (39.1%) cases. In 14 cases with additional information from MR imaging, there were isolated CNS involvement in five (35.7%) cases, isolated extra-CNS involvement in two (14.3%) cases, multisystem involvement in five (35.7%) cases, and other-category in two (14.3%) case. CONCLUSION: MR imaging can provide additional information that have influence on patient counseling and patient care, particularly in cases with CNS and multisystem anomaly.

Nipple length and its relation to success in breastfeeding.

OBJECTIVE: To find the critical cut-off point of nipple length that facilitates success in breastfeeding. MATERIAL AND METHOD: The subjects were 449 postpartum women, who delivered at HRH Princess Maha Chakri Sirindhorn medical center in Nakhon Nayok province between October, 2010 and March, 2011. Data regarding nipple length and its relation to success in breastfeeding were collected and analyzed by a receiver operating characteristic curve (ROC curve). This is a graphical method of assessing the characteristics of a diagnostic test. RESULTS: The data shows that 7-millimeters in nipple length had been shown to be the cut-off point that facilitates successful breastfeeding. Sensitivity was at 72.5%. Specificity was at 46.2%. The positive predictive value was at 97.8% and the negative predictive value was at 4.9%. CONCLUSION: The cut-off point for nipple length that facilitates successful breastfeeding has been measured at 7 millimeters. Nurses and health personnel may use 7 millimeters of nipple length as a criteria for a successful breastfeeding screening test and give close breastfeeding support if postpartum women have less than 7 millimeters in nipple length.

Middle cerebral artery peak systolic velocity in fetuses with homozygous alpha-thalassemia-1: case series.

OBJECTIVES: The objective of this study is to evaluate the potential usefulness of middle cerebral artery peak systolic velocity (MCA-PSV) as a non-invasive means of detecting an anemic fetus from homozygous alpha-thalassemia-1. MATERIAL AND METHOD: We observed four cases of referrals with complicated pregnancies in which the fetuses were suspected with homozygous alpha-thalassemia-1. Three out of four cases involved hydrop fetalis, detected through previous ultrasounds, while the remaining case was referred for prenatal diagnosis. Subsequently, we performed a detailed ultrasound and fetal MCA-PSV in all cases, and to confirm the diagnosis, we also performed cordocentesis. RESULTS: With all the four cases having the gestational age range from 18 to 27 weeks, three showed hydrop fetalis. The remaining case, the 18-week gestational age fetus referred for prenatal diagnosis, showed an increase in the cardiothoracic ratio without other signs of hydrop fetalis. MCA-PSV suggested the presence of fetal anemia in all cases (with the velocity ranging from 37.3 to 62.2 cm/sec). The results obtained from cordocentesis confirmed fetal anemia and homozygous alpha-thalassemia-1 in all cases. CONCLUSION: Peak systolic velocity of fetal middle cerebral artery can predict anemia in fetus affected with homozygous alpha-thalassemia-1 disease.

Low cost combination of DCIP and MCV was better than that of DCIP and OF in the screening for hemoglobin E.

OBJECTIVE: To evaluate hemoglobin E screening tests in a large scale of cases. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted Whole blood obtained from subjects was evaluated for CBC, OF, DCIP, and hemoglobin typing. RESULTS: Five hundred twenty seven hemoglobin E and 280 reference subjects participated. DCIP's sensitivity, specificity, positive predictive value, and negative predictive value were 97.16%, 98.93%, 99.42%, and 95.19%, respectively. These values of OF were 69.12%, 80.00%, 86.67%, and 57.88%, respectively. In the combination of DCIP and OF gave rise to these values of 99.43%, 79.29%, 90.03%, and 96.67%, respectively. Finally the combination of DCIP and MCV < 80 fL resulted in these values to be 99.43%, 98.93%, 99.43%, and 98.93%, respectively. False positive and false negative rate were 1.07% and 0.57%, respectively. CONCLUSION: Combination of DCIP and MCVwas better than that of DCIP and OF in hemoglobin E screening.

Correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography.

OBJECTIVE: To investigate the feasibility of transperineal ultrasonography for uterine cervical assessment by determining the correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography and comparing discomfort arising from each technique. MATERIAL AND METHOD: Fifty pregnant women of 37 weeks' gestation or later who gave consent participated in this research. They had no exclusion criteria, which were listed as the following: preterm premature rupture of membranes, previous cervical surgery, undiagnosed vaginal bleeding, and true labor pain. They all underwent transabdominal (3.5-MHz curvilinear transducer), transperineal (3.5-MHz curvilinear transducer) and transvaginal ultrasonography (7.5-MHz curvilinear endovaginal transducer). The uterine cervical length was measured from the straight line between the external and internal os. If either of the external or internal os was not clearly demonstrated, the authors would justify the cervical length as non-measurable. Measurement in each technique was performed twice and the mean cervical length was used for data analysis. Discomfort arising from each technique was evaluated by visual analog scale. RESULTS: Uterine cervical length was measurable in 23 (46%), 49 (98%) and in all cases by transabdominal, transperineal and transvaginal ultrasonography respectively. In the transabdominal technique, no significant differences in woman's age, weight, body-mass index and parity were observed between measurable and non-measurable cases. Significant correlation was demonstrated between transperineal and transvaginal ultrasound (r = 0.73, p < 0.01). A significantly higher discomfort score was demonstrated in transvaginal ultrasonography, but no significant difference in discomfort score was found between transabdominal and transperineal ultrasonography. CONCLUSION: Transperineal ultrasonography is feasible for acceptable uterine cervical visualization with only slight discomfort to the patients.