Short-term outcomes after second-trimester genetic amniocentesis in Siriraj Hospital.

OBJECTIVE: To determine the short-term outcomes of second-trimester genetic amniocentesis at Siriraj Hospital, Bangkok, Thailand. METHODS: In a retrospective descriptive study, data were assessed from women with a singleton pregnancy who underwent genetic amniocentesis between 16 and 21 gestational weeks at the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Siriraj Hospital, from May 2007 to June 2012. The amniocentesis records and medical data of all women were analyzed statistically. RESULTS: During the 5-year period, complete data were collected for 3307 pregnant women. The rate of total pregnancy loss within 4 weeks of testing was 7 out of 3307 (0.2%; 95% confidence interval, 0.1%-0.4%). Advanced maternal age (≥35 years) was the most common indication for amniocentesis (94.6%). The culture failure rate was 0.2%. Chromosomal abnormalities were detected in 109 pregnancies (3.3%); trisomy 21 was the most prevalent abnormality (0.8%). The possible risk factors of fetal loss were early amniocentesis (gestational age, <18 weeks) (P=0.013), abnormal fetal sonography (P=0.004), culture failure (P=0.015), and old-blood- or murky-stained amniotic fluid (P=0.036). CONCLUSION: Second-trimester genetic amniocentesis resulted in 0.2% of total pregnancy loss within 4 weeks of testing. This information is essential for patient counseling before amniocentesis.

Influence of water intake on the waiting time prior to gynecologic transabdominal ultrasound.

OBJECTIVE: To investigate the effect of volume of water intake on the length of time before the bladder is sufficiently full prior to undergoing transabdominal ultrasound. METHODS: Ninety-three patients scheduled for transabdominal ultrasound were enrolled between November 2007 and April 2008 and randomly allocated to 3 study groups by volume of water intake: 300, 400, and 500 mL. The total waiting time was recorded when the bladder was sufficiently full to undergo transabdominal ultrasound. The final bladder volume was measured using three-dimensional ultrasound. RESULTS: Mean waiting times were 68.65+/-30.12 min, 64.2+/-26.18 min, and 54.38+/-12.75 min for patients ingesting 300, 400, and 500 mL of water, respectively (P=0.060). The final bladder volumes for the 3 groups were not statistically different (263.06+/-99.21 mL, 275.37+/-113.05 ml, and 316.17+/-101.31 mL; P=0.113). CONCLUSION: Differences in the volume of water ingested in the range of 300-500 mL did not affect the waiting time before undergoing transabdominal ultrasound.

Prevalence and associate factors for striae gravidarum.

OBJECTIVE: To determine the prevalence and associate factors for striae gravidarum in Thai pregnant women. STUDY DESIGN: Cross-sectional study. MATERIAL AND METHOD: Two hundred and eighty women who gave first birth and were admitted to the postpartum wards in Siriraj Hospital were recruited. All of them were assessed during the immediate postpartum period for having striae gravidarum or not by the physician. The questionnaire was used to interview the participants for all of the information needed in the present study. The participants with striae gravidarum and the other without striae gravidarum were compared to characteristics of women using unpaired student t test and Chi-square tests. RESULTS: Seventy-seven percent of the study participants had developed striae gravidarum. Women who developed striae gravidarum were significantly younger (22.8 yr +/- 4.0 yr vs. 26.6 yr +/- 6.0 yr; p < 0.05), higher pre-pregnancy BMI (21.2 kg/m2 +/- 4.1 kg/m2 vs. 19.8 kg/m2 +/- 4.8 kg/m2; p < 0.05), higher maternal BMI at pregnancy (27.3 kg/m2 +/- 4.7 kg/m2 vs. 25.6 kg/m2 +/- 6.0 kg/m2; p < 0.05), higher gestational age at delivery (39.1 wk +/- 1.3 wk vs. 38.6 wk +/- 1.1 wk; p < 0.05), higher birth weight of baby (3,078.8 g +/- 411.4 g vs. 2,895.8 g +/- 339.2 g; p < 0.05), alcoholic drinker (91.4% vs. 8.6%; p < 0.05), had a little water intake (7.4 glasses +/- 2.7 glasses vs. 8.3 glasses +/- 3.1 glasses; p < 0.05), and had a family history of striae gravidarum (82.8% vs. 17.2%; p < 0.05) were associated with striae gravidarum. CONCLUSION: Maternal age, pre-pregnancy BMI, maternal BMI at delivery, gestational age at delivery, birth weight of baby, alcoholic drinking, water intake and family history were associated with striae gravidarum.

Effect of halogen light in fetal stimulation for fetal well-being assessment.

OBJECTIVE: To evaluate the shortening of the time of nonstress test (NST) by using transabdominal fetal stimulation with halogen light. STUDY DESIGN: Experimental research. MATERIAL AND METHOD: The authors enrolled 176 pregnant women between 32 and 42 weeks of gestation indicated for NST at the Division of Maternal Fetal Medicine, Siriraj Hospital, Mahidol University. They were randomly assigned to receive either NST (control) or halogen light stimulation test (LST). The stimulation was performed at the beginning of the test and repeated every 10 minutes until reassuring fetal heart rate (FHR) acceleration was achieved, or up to 3 times. All tracings were interpreted blindly by one investigator at the end of the tests. RESULTS: The mean (+/- SD) duration from starting the test to the first FHR acceleration was not significantly different between the control group and the LST group (5.6 +/- 7.2 and 5.4 +/- 5.2 minutes, respectively). The average testing time (+/- SD) to achieved reactivity was 10.5 +/- 8.8 minutes in the controls and 9.6 +/- 6.7 minutes in the LST group. This was not statistically different. The incidence of nonreactive tests was not significantly different between the LST and the controls (15.9% and 11.4%, respectively). Among the LST subjects, term fetuses and women with BMI < 27 kg/m2 required less time to reach reactivity, 2.4 and 2.3 minutes respectively. CONCLUSION: Transabdominal halogen light stimulation did not shorten the duration of NST in the presented population. However, the presented data suggests that the fetus at term could respond to visual stimulation, especially when the gestational age is more advanced.

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.