Mother-role development program and postpartum health-service utilization by adolescent mothers: A randomized, controlled trial.

AIM: To evaluate the impact of a mother-role development program on postpartum health-service utilization by adolescent mothers. METHODS: A single center, parallel, randomized, controlled, open-label trial using a computer-generated sequence was conducted at Siriraj Hospital. In all, 120 teenage mothers who delivered February 2015-December 2016 were randomized into experimental and control groups. The experimental group participated in a 2-year, mother-role development program at the Young Family Clinic. The two groups' characteristics, pregnancy outcomes and postpartum follow-up details over the 2-year period were compared. The main outcome measure was the utilization of maternal healthcare services (MHS). RESULTS: The teenage mothers were randomized into two groups of 60 participants each. Many were progressively lost to follow-up, leaving only 37 (experimental group, 19; control group, 18) for the intention-to-treat analysis. The results demonstrated a higher MHS utilization by the experimental group, but only at the 6-week postpartum follow-up. The usage of long-acting, reversible contraception (birth control implants and intrauterine devices) rose from 53.3% (immediate postpartum) to 95.5% (2 years postpartum). The two groups also had identical repeat pregnancy rates (6.67%; four participants in each), a marked decrease from 20% in a prior study. The breastfeeding rate was consistently higher among the mothers undertaking the mother-role development program. CONCLUSION: The program increased both MHS utilization during the initial postpartum period and the breastfeeding duration. Access to immediate postpartum contraception and long-acting, reversible contraception was associated with a reduction in repeat teen pregnancies. Having a multidisciplinary team was key to the health-service improvements.

Additional benefits of three-dimensional ultrasound for prenatal assessment of twins.

Three-dimensional ultrasound (3DUS) may provide additional information for prenatal assessment of twins. It may improve the diagnostic confidence of dating, nuchal translucency (NT) and chorionicity assignment in twin pregnancies. The "virtual 3DUS placentoscopy" can guide selective fetoscopic laser photocoagulation (SFLP) to treat twin-twin transfusion syndrome (TTTS). Volumetric assessment of the dysmorphic acardiac twin with the Virtual Organ Computer-aided Analysis (VOCAL) software is more accurate than the conventional ultrasound measurement. Twin anemia polycythemia (TAP) sequence and selective intrauterine growth restriction (sIUGR) may be clinically monitored with 3DUS placental volume (PV) and power Doppler vascular indices. Congenital anomalies are more common in twins. Evaluation of fetal anomalies with 3DUS could assist perinatal management. The 3DUS power Doppler can provide a better understanding of true and false umbilical cord knots, which are commonly found in monoamniotic (MA) twins. Single demise in monochorionic (MC) twin pregnancies can cause severe neurologic morbidity in the surviving co-twin. Prenatal prediction of brain injury in the surviving co-twin with unremarkable neurosonographic examination is difficult. The 3DUS power Doppler may aid in prenatal detection of subtle abnormal cerebral perfusion. Prenatal assessment of conjoined twins with 3DUS is important if emergency postnatal surgical separation is anticipated. There is no significant additional advantage in using real-time 3DUS to guide prenatal interventions. Assessment of the cervix and pelvic floor during twin pregnancies is enhanced with 3DUS. Due to lack of high-quality studies, routine prenatal 3DUS in twin pregnancies needs to be balanced with risks of excessive ultrasound exposure.

Prenatal diagnosis and management of fetal discordant alpha-thalassaemia in dichorionic diamniotic (DCDA) twins.

A 29-year-old nulliparous woman with a dichorionic diamniotic (DCDA) twin pregnancy was referred to our hospital at 16 weeks' gestation for prenatal diagnosis. She was diagnosed of Haemoglobin H Constant Spring (Hb H CS; --SEA/αCSα) and her husband of alpha thalassemia-1 trait (--SEA/αα). Detailed ultrasound showed that left twin had fetal anaemia and early signs of hydrops while the right one was normal. Both twins were female. Amniocentesis in each sac was performed for prenatal diagnosis of thalassemia after a proper counselling with the couple. DNA analysis confirmed that the left fetus was affected with haemoglobin Bart's hydrops fetalis (--SEA/--SEA) while the right one was alpha thalassemia-1 trait (--SEA/αα). Selective feticide with intracardiac injection of KCl was successfully performed on the hydropic fetus. Identification of the affected fetus is crucial for selective termination. Family counselling about the procedure and complications is also necessary.

Generation of a human induced pluripotent stem cell line (MUSIi001-A) from caesarean section scar fibroblasts using Sendai viral vectors.

We generated a human induced pluripotent stem cell (iPSC) line from caesarean section scar fibroblasts of a 33-year-old healthy woman using transgene-free Sendai viral vectors under feeder-free condition. The established iPSC line, designated as MUSIi001-A, exhibited a normal karyotype, expressed pluripotent markers, differentiated into cells of three embryonic germ layers. Further analyses showed that the Sendai viral genome was absent at passage 25. The MUSIi001-A line can serve as a control for studying developmental biology and phenotypic comparison with disease-specific iPSCs.