A qualitative study of pregnant women's perceptions and decision-making regarding COVID-19 vaccination in Thailand.

To identify pregnant women's attitudes towards, and acceptance and rejection of, COVID-19 vaccination. This prospective, descriptive, implementation study was conducted in the Antenatal clinic of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 pregnant women were interviewed. Phase II consisted of questionnaire development and data validation. In Phase III, the questionnaire was administered to 400 participants. Pregnant women's attitudes towards and acceptance and rejection of COVID-19 vaccination. Most pregnant women were uncertain about the potential harm of vaccination to themselves or their unborn child, including risks such as miscarriage or premature birth (59-66/101 [58.4%-65.3%]; OR 2.53-8.33; 95% CI 1.23-3.60, 5.17-19.30; P < 0.001) compared to those who disagreed with vaccination. Their vaccination decisions were significantly influenced by social media information regarding vaccination complications in pregnant women (74/101 [73.3%]; OR 15.95; 95% CI 2.15-118.55; P = 0.001) compared to those who disagreed with vaccination. Most pregnant women opined that they should not receive a COVID-19 vaccination during pregnancy (adjusted odds ratio [AOR] 6.57; 95% CI 2.44-17.70; P = 0.001). Most also rejected vaccination despite being aware of its benefits (AOR 17.14; 95% CI 6.89-42.62; P < 0.001). Social media messages and obligatory vaccination certifications influence maternal vaccination decisions. Pregnant women believe vaccination helps prevent COVID-19 infection and reduces its severity. Nevertheless, the primary reason for their refusal was concern about potential harm to their unborn child or themselves during pregnancy.The Thai clinical trials registry: TCTR20211126006.

Maternal complications and risk factors associated with assisted vaginal delivery.

OBJECTIVE: This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery. METHODS: We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered. RESULTS: The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016). CONCLUSIONS: The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%). CLINICAL TRIAL REGISTRATION: Thai Clinical Trials Registry: 20220126004.

Identifying the Barriers to Universal Cervical Length Screening for Preterm Birth Prevention at a Tertiary Hospital in Thailand (Physician Perspectives): Implementation Research.

OBJECTIVE: To identify physicians' views on the barriers to measuring cervical length for preventing preterm deliveries. MATERIALS AND METHODS: This prospective, descriptive implementation study had three phases. In Phase I, 20 physicians were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was distributed to 120 Phase III participants. RESULTS AND DISCUSSION: All 120 participants responded. In 44 cases, the physicians received support from their local Maternal and Child Health Boards for preterm-birth-prevention programs; the other 76 physicians did not. The doctors tended to believe that cervical length screening plays no role in preventing preterm births (4/44 (9.1%) and 24/76 (31.6%); OR, 4.615; 95% CI, 1.482-14.373; p = 0.005). They were unsure about the correct measurement procedures (13/44 (29.5%) and 37/76 (48.7%); OR, 2.262; 95% CI, 1.028-4.977; p = 0.040). A lack of cost-free drug support (progesterone) for women with short cervices was identified as a barrier to preventing preterm births (30/44 (68.2%) and 32/76 (42.1%); OR, 0.339; 95% CI, 0.155-0.741; p = 0.006). CONCLUSIONS: Many physicians are unconvinced that measuring cervical length prevents premature births, and are unsure about the correct measurement procedures. There is a lack of government funding for hormone-usage programs.

Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination: Implementation research.

OBJECTIVE: There are few data on lactating women's concerns about receiving COVID-19 vaccination during breastfeeding. This research investigated breastfeeding women's attitudes towards and acceptance or rejection of vaccination. MATERIALS AND METHODS: This prospective, descriptive, implementation study was conducted in the postpartum ward of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 breastfeeding women in the postpartum ward at Siriraj Hospital who were willing to participate in the study were interviewed. Phase II comprised questionnaire development and data validation. The combined multiple choice and scaling questionnaires designed based on the results from comprehensive interviews of phase I were used in the study. The questionnaire was administered to 400 participants in Phase III. MAIN OUTCOME MEASURES: Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination. RESULTS: The vast majority of participants (372/400 [93.0 %]) were vaccinated predelivery. Most of the subgroup of women rejecting vaccination while breastfeeding were unsure whether too frequent vaccination would harm their unborn child (52/99 [52.5 %]; crude odds ratio [cOR], 6.50; 95 % CI, 1.47-28.68; P < 0.001). The level of immunity to the COVID-19 virus did not influence their vaccination decisions (19/99 [19.2 %]; cOR, 2.38; 95 % CI, 1.26-4.47; P < 0.001). Multivariable analysis found a significant association for women agreeing with the proposition that vaccination during pregnancy should not be performed (adjusted odds ratio [aOR], 4.83; 95 % CI, 1.41-16.57; P = 0.043). Most women who rejected vaccination knew its benefits (aOR, 31.84; 95 % CI, 7.16-141.65; P < 0.001). CONCLUSIONS: Breastfeeding women generally believed that vaccines reduce infection and disease severity. The women's COVID-19 immunity levels did not affect their acceptance or rejection of vaccination. Some mothers rejected vaccination because of concerns about possible harm to them or their newborns.

Neonatal complication of caesarean sections at tertiary center: Siriraj hospital, Bangkok, Thailand.

To study the complications of newborns related to caesarean sections, through a review of indications and details of complications occurring in newborns. This was a retrospective and descriptive study. A search of hospital records identified 3500 cases that underwent caesarean sections during 2017-2018. Newborn complications arising from the caesarean sections, and other relevant details were recorded. Neonatal complications were 49.23% (1723/3500). Bruises (a region of injured tissue or skin in which blood capillaries have been ruptured) (11.65%), jaundice (18.29%) and hypoglycaemia (11.91%) were the most common complications of the neonates. In summary, foetal complications were jaundice, transient tachypnea, hypoglycaemia and bruises. As the rate of caesarean sections continues to increase and is difficult to control, unnecessary caesarean section should be reduced and obstetricians must be well trained in performing caesarean sections to reduce neonatal complications.

Identifying the barriers to universal cervical length screening for preterm birth prevention at a tertiary hospital in Thailand (patient's perspectives): implementation research.

PURPOSE: To identify patient perspectives of barriers to cervical length screening to prevent preterm births. METHODS: In Phase I of this prospective descriptive implementation study, 40 pregnant women of up to 24 week gestation were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was subsequently administered to 400 participants in Phase III. RESULTS: Most participants (74.3%) realised preterm babies have complications and high care costs (53%). They recognised that premature-birth risk identification enables appropriate pregnancy care (93.8%), but they were unaware that cervical length measurements indicate the risk (59.5%). The participants who were aware wanted to be examined (63.5%) because of concern about preterm birth (95.8%). Husbands were reported to influence decision-making about screening (81.3%) and subsequent treatment (42.5%). If the associated costs were subsidised, the majority of participants (67.3%) would undergo screening. CONCLUSION: Physicians do not explain ways to prevent preterm births. Government policy on preventing preterm births is not well established. Screening and treatment costs are major barriers. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR) number: TCTR20190813003.

A Randomized Controlled Trial of the Effect of Music During Cesarean Sections and the Early Postpartum Period on Breastfeeding Rates.

Objective: The objective of this research was to study the role of music listening by mothers during a cesarean section and the postpartum period to achieve exclusive breastfeeding in the first 6 months. Methods and Study Design: This was a prospective, observational, randomized controlled trial study. A total of 185 singleton pregnant women, in at least 37 weeks of gestation, who were appointed for elective cesarean sections, were recruited. They were randomized into three groups, including pregnant women who did not listen to music (Group 1), listened to music during cesarean section (Group 2), and listened to music during cesarean section and the postpartum room for the first 2 days (Group 3). The breastfeeding results of all three groups were followed up at 7 days, 14 days, and then at months 1, 2, 3, and 6. Results: Success in exclusive breastfeeding among Groups 1, 2, and 3 and Groups 1 and 2 + 3 was not different in every lactating period (7 days-6 months). From subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Mothers who listened to music and had an income of <20,000 baht, an educational level lower than university, planned the pregnancy, had their first pregnancy, and stayed in a private ward had more successful exclusive breastfeeding in a 6-month period than those mothers who did not listen to music, and the difference was statistically significant. Conclusions: Music listening by mothers during a cesarean section and in the postpartum ward did not enhance exclusive breastfeeding during the first 6 months of the postpartum period. However, from subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Thai Clinical Trials Registry number was TCTR20180712001.

Placental α-microglobulin-1 in cervicovaginal fluid and cervical length to predict preterm birth by Thai women with symptoms of labor.

Background: Presence of placental α microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery. Objective: To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length. Methods: We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 200/7 and 366/7 weeks' gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated. Results: Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was ≤30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70). Conclusions: Cervical length ranging 15-30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice.

Prevalence of asymptomatic bacteriuria among Thai diabetic pregnant women.

Diabetic pregnant women are susceptible to urinary tract infection, which can result in preterm labor and a low birth weight of the neonate. This was a prospective observational study. In total, 110 diabetic pregnant women between 12-20 weeks of gestation were recruited. Asymptomatic bacteriuria (ASB) was diagnosed when the urinalysis presented a white blood cell (WBC) count ≥ 5 WBCs per high power field (HPF). Urine culture was later performed. Most of the diabetic pregnant women were classified as GDM A1. The prevalence of ASB was 7.2% (8/110 cases). Klebsiella aerogenes was found in only one case from urine culture. ASB was commonly found in the pregnant women with a high BMI, with statistical significance. The prevalence of ASB in the diabetic pregnant women was 7.2%. Urinalysis should be considered for diabetic pregnant women with a high body mass index.

Retrospective analysis of 113 consecutive cases of placenta accreta spectrum from a single tertiary care center.

Objective: Placenta accreta spectrum (PAS) remains a major cause of maternal morbidity. We sought to assess the characteristics and treatment outcomes of PAS managed at a tertiary care center with high volume of PAS.Study design: Electronic medical records of all patients with diagnosis of PAS from June 2010 to October 2016 were reviewed. Details of obstetric backgrounds, predelivery diagnosis, peripartum management, and outcomes were analyzed.Results: One hundred thirteen women with PAS were identified from 50,448 deliveries during the study period. Vaginal delivery, emergency, and elective cesarean section were accomplished in 41.6, 30.1, and 28.3%, respectively. There was no maternal mortality. Approximately 41.6% of women with PAS had peripartum hysterectomy. There was a fair inverse correlation between intraoperative blood loss and gestational weeks at delivery (r = -0.311; p=.001), but not gestational weeks at diagnosis (p = .249). Cases with predelivery diagnosis (n = 29) had higher intraoperative blood loss than those diagnosed postdelivery (n = 84) (p<.001). Anterior PAS (n = 58) is associated with attachment to previous uterine scar, antepartum bleeding, and intraoperative blood loss compared to posterior PAS (n = 44) (p<.05). The PAS patients with previous uterine surgery had the highest chance of peripartum hysterectomy (p<.001).Conclusions: Contradictory to previous reports, our data suggest a more severe spectrum of PAS in those with predelivery detection earlier gestational weeks at delivery. Peripartum hysterectomy was highest in anterior PAS that attached to the previous uterine scar.

Alternative Magnesium Sulfate Dosing Regimens for Women With Preeclampsia: A Population Pharmacokinetic Exposure-Response Modeling and Simulation Study.

Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be administered only by skilled health professionals. The objectives of this study were to develop a robust exposure-response model for the relationship between serum magnesium exposure and eclampsia using data from large studies of women with preeclampsia who received magnesium sulfate, and to predict eclampsia probabilities for standard and alternative (shorter treatment duration and/or fewer intramuscular injections) regimens. Exposure-response modeling and simulation were applied to existing data. A total of 10 280 women with preeclampsia who received magnesium sulfate or placebo were evaluated. An existing population pharmacokinetic model was used to estimate individual serum magnesium exposure. Logistic regression was applied to quantify the serum magnesium area under the curve-eclampsia rate relationship. Our exposure-response model-estimated eclampsia rates were comparable to observed rates. Several alternative regimens predicted magnesium peak concentration < 3.5 mmol/L (empiric safety threshold) and eclampsia rate ≤ 0.7% (observed response threshold), including 4 g intravenously plus 10 g intramuscularly followed by either 8 g intramuscularly every 6 hours × 3 doses or 10 g intramuscularly every 8 hours × 2 doses and 10 g intramuscularly every 8 hours × 3 doses. Several alternative magnesium sulfate regimens with comparable model-predicted efficacy and safety were identified that merit evaluation in confirmatory clinical trials.

Associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies.

INTRODUCTION: This study aimed to evaluate associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies. METHODS: A case-control study was conducted among 405 pregnant women with placenta praevia who underwent Caesarean delivery between August 2004 and December 2013. 135 of the women received blood transfusions. Another 270 women who did not receive any blood transfusion were randomly selected and served as controls. Maternal demographic data, reproductive history, antepartum profiles and obstetric outcomes were compared between the two groups. RESULTS: Women in the case group were significantly more likely to be multiparous, deliver at a gestational age of less than 37 weeks, have a prior Caesarean delivery, experience preoperative bleeding and anaemia, and have major and anterior placenta praevia (p < 0.05). Multivariate analysis demonstrated that significant, independently associated factors of blood transfusion were: previous Caesarean section (adjusted odds ratio [OR] 2.30, 95% confidence interval [CI] 1.36-3.90), anterior placenta praevia (adjusted OR 2.30, 95% CI 1.15-4.60), major placenta praevia (adjusted OR 2.39, 95% CI 1.34-4.22), preoperative bleeding of more than 250 mL (adjusted OR 6.11, 95% CI 2.35-15.90), preoperative anaemia (adjusted OR 2.31, 95% CI 1.34-4.00) and emergency Caesarean section (adjusted OR 2.14, 95% CI 1.08-4.22). CONCLUSION: Previous Caesarean section, anterior placentation, major placenta praevia, preoperative bleeding of more than 250 mL, preoperative anaemia and emergency Caesarean section were independent factors that increased the risk of blood transfusion for Caesarean section in pure placenta praevia pregnancies.

Population Pharmacokinetic Modeling to Evaluate Standard Magnesium Sulfate Treatments and Alternative Dosing Regimens for Women With Preeclampsia.

Magnesium sulfate is the standard therapy for prevention and treatment of eclampsia. Two standard dosing regimens require either continuous intravenous infusion or frequent, large-volume intramuscular injections, which may preclude patients from receiving optimal care. This project sought to identify alternative, potentially more convenient, but similarly effective dosing regimens that could be used in restrictive clinical settings. A 2-compartment population pharmacokinetic (PK) model was developed to characterize serial PK data from 92 pregnant women with preeclampsia who received magnesium sulfate. Body weight and serum creatinine concentration had a significant impact on magnesium PK. The final PK model was used to simulate magnesium concentration profiles for the 2 standard regimens and several simplified alternative dosing regimens. The simulations suggest that intravenous regimens with loading doses of 8 g over 60 minutes followed by 2 g/h for 10 hours and 12 g over 120 minutes followed by 2 g/h for 8 hours (same total dose as the standard intravenous regimen but shorter treatment duration) would result in magnesium concentrations below the toxic range. For the intramuscular regimens, higher maintenance doses given less frequently (4 g intravenously + 10-g intramuscular loading doses with maintenance doses of 8 g every 6 hours or 10 g every 8 hours for 24 hours) or removal of the intravenous loading dose (eg, 10 g intramusculary every 8 hours for 24 hours) may be reasonable alternatives. In addition, individualized dose adjustments based on body weight and serum creatinine were proposed for the standard regimens.

Dyspareunia and sexual dysfunction after vaginal delivery in Thai primiparous women with episiotomy.

INTRODUCTION: Episiotomy remains commonly practiced in Thailand. There are limited data on its impacts on sexuality among Asian women during the first postdelivery year. AIMS: The aim was to study dyspareunia and sexual function at 3-12 months after vaginal delivery in Thai primiparous women with episiotomy. METHODS: A total of 190 participants were approached on Day 2 postpartum. Of these, 93 sexually active women were evaluated for dyspareunia and sexual function at 3 months by using 10-cm visual analog scale and the validated Thai version of Female Sexual Function Index (TFSFI). TFSFI < 26.5 was defined as having potential sexual dysfunction. At 6 and 12 months, sexual function was evaluated by telephone interview. MAIN OUTCOME MEASURES: The prevalence of dyspareunia at 3 months and the changes of TFSFI scores during the first postdelivery year were the main outcome measures. RESULTS: The average age of the participants, over 90% of whom were high school finishers, was 24. Their partners were around 3 years older, and the median partnership duration was 3 years. At 3 months, 30.1% of participants reported dyspareunia. There was no association between dyspareunia and the following characteristics: pre-pregnancy dyspareunia, newborn's head circumference and birthweight and breast-feeding (P > 0.05 for all). Sexual dysfunction was demonstrated in 66.7% at 3 months, 31.0% at 6 months, and 14.9% at 12 months. From 3 to 12 months, the median TFSFI scores in all domains increased significantly. There was no difference of the scores in all domains at 3 and 12 months between women with and without dyspareunia at 3 months. However, at 6 months, those without dyspareunia had better scores in pain, orgasm, satisfaction, and total scores (P < 0.05 for all). CONCLUSION: Dyspareunia at 3 months is common in Thai primiparous women with episiotomy. Those with dyspareunia have a slower resumption of normal sexual function.

Psychological effects of fetal diagnoses of non-lethal congenital anomalies on the experience of pregnant women during the remainder of their pregnancy.

AIM: The aim of this study was to explore the effects of prenatal fetal diagnoses of non-lethal anomalies on the psychological well-being of pregnant women throughout their pregnancy. MATERIALS AND METHODS: Fifty-five pregnant women were asked to complete a questionnaire (the Spielberger State-Trait Anxiety Inventory) to assess their anxiety levels at multiple follow-up visits. In-depth interviews were conducted with 20 pregnant women after completion of the questionnaire. RESULTS: We identified three stages of psychological distress. The intense negative psychological reaction stage was characterized by an intense psychological distress in response to the loss of an ideal child. The psychological healing stage was characterized by the emergence of coping mechanisms and a concomitant decrease in psychological distress. Finally, the intense negative psychological reaction re-emergence stage was characterized by an increase in psychological distress related to uncertainty regarding the future of the baby. CONCLUSIONS: Following a prenatal diagnosis of a non-lethal anomaly, both the nature and the intensity of the psychological distress experienced by pregnant women change throughout the remainder of their pregnancy. Throughout the remainder of their pregnancy, these women should be offered effective psychological support that accounts for each of the distinct psychological response stages identified in this study.

Functional three-dimensional sonographic study of the postpartum uterus.

OBJECTIVE: To demonstrate sequential changes of the postpartum uterus using two- and three-dimensional (2D and 3D) ultrasounds and Doppler studies. METHODS: Eighty-one women who delivered a singleton at term were recruited for this prospective longitudinal study. Manual and ultrasound examinations of the uterus were performed for seven consecutive weeks. Sequential changes in size of the uterus, endometrial thickness and appearances and Doppler indices of the uterine and arcuate arteries were analyzed. RESULTS: Complete follow ups were achieved in 71 women who had an uncomplicated postpartum course. 2D and 3D ultrasound estimations of uterine volume are highly correlated with each other (r > 0.7), but not manual estimations (r < 0.3). Data generated from 497 3D observations demonstrated rapid involution of the uterus in the first two weeks after delivery. Breastfeeding and parity did not affect uterine involution (r < 0.2). Resistance index (RI) of the uterine artery started to elevate at four weeks after delivery (r > 0.7). RI of the arcuate artery was not significantly changed during the study period (r < 0.2). Uterine involution was independent from progressive thinning of the endometrium and elevation of uterine artery RI. (r < 0.1 and 0.2, respectively). CONCLUSION: Longitudinal sonographic study showed independent physiologic reversals of uterine volume, endometrium and vascular supply in the first seven weeks following vaginal delivery. Standardization of measurement techniques is essential to apply this information for an early detection of postpartum uterine complications.

Predictors for complications in pregnant women with heart disease, a retrospective study.

OBJECTIVE: Evaluate the CARPREG score in predicting cardiac, obstetric, and neonatal complications in pregnant women with heart disease. MATERIAL AND METHOD: This was a retrospective study between 2002 and 2011 at a tertiary care center and included 175 pregnant women with heart disease. Maternal and neonatal outcomes were assessed using Cardiac in Pregnancy Score (CARPREG), which included NYHA-class, systolic ejection fraction, left ventricular obstruction, and history of cardiac events. RESULTS: Rheumatic heart disease (n = 116, 66.3%) was the predominant cardiac problem. CARPREG score was 0, 1, > 1 in 65.1%, 24.6%, and 10.3% pregnancies, respectively. Maternal cardiac events occurred in 27.4%. CARPREG score > or = 1 was associated with an increased rate of cardiac events [odds ratio (OR) 6.76, 95% confidence interval (CI) 3.26 to 14.01]. Fetal complications occurred 24.4%. Neonatal birth weight < 2,500 g was associated with CARPREG score > or = 1 (OR 2.57, 95% CI 1.29 to 5.11). CONCLUSION: Maternal cardiac events can be predicted using CARPREG risk index. In Thai population, rheumatic heart disease was the most frequent form of cardiac problems in pregnant women.