Risk Factors for the Occurrence of Scalp Hematoma in Term Neonates in King Chulalongkorn Memorial Hospital

Objectives: To determine the incidence and associated factors of neonatal scalp hematoma.Materials and Methods: This prospective case-control study included all term singleton live newborns that delivered in King Chulalongkorn Memorial Hospital during July 2016 to October 2016. All neonates were prospectively evaluated and divided into two groups: cases with scalp hematoma and controls. Diagnoses of neonatal scalp hematoma either cephalhematoma or subgaleal hemorrhage were confirmed by the experienced neonatologist. Medical records of these neonates and their mothers were reviewed to collect demographic data and information regarding their processes of labor and delivery. Logistic regression analysis was used to identify the risk factors associated with presence of neonatal scalp hematoma.Results: A total of 938 term neonates were included in this study. The incidence of neonatal scalp hematoma was 3.19% (30/938). Operative obstetrics (vacuum and forceps extraction) were found to have the highest rate (15.38%) of scalp hematoma when compare with other routes of delivery. Factors associated with neonatal scalp hematoma were primiparity (adjusted OR 4.86, 95% CI 1.61-14.58) and prolonged second stage of labor (adjusted OR 4.31, 95% CI 1.08-17.25). When analysis was done in only vaginally delivered neonates, the significant factors were primiparity (adjusted OR 3.84, 95% CI 1.26-11.71) and artificial rupture of membranes (adjusted OR 2.93, 95% CI 1.24-6.97).Conclusion: Neonatal scalp hematoma was common. Primiparous women significantly increased risk of neonatal scalp hematoma regardless of route of delivery

A synbiotic intervention modulates meta-omics signatures of gut redox potential and acidity in elective caesarean born infants.

Background The compromised gut microbiome that results from C-section birth has been hypothesized as a risk factor for the development of non-communicable diseases (NCD). In a double-blind randomized controlled study, 153 infants born by elective C-section received an infant formula supplemented with either synbiotic, prebiotics, or unsupplemented from birth until 4 months old. Vaginally born infants were included as a reference group. Stool samples were collected from day 3 till week 22. Multi-omics were deployed to investigate the impact of mode of delivery and nutrition on the development of the infant gut microbiome, and uncover putative biological mechanisms underlying the role of a compromised microbiome as a risk factor for NCD. Results As early as day 3, infants born vaginally presented a hypoxic and acidic gut environment characterized by an enrichment of strict anaerobes (Bifidobacteriaceae). Infants born by C-section presented the hallmark of a compromised microbiome driven by an enrichment of Enterobacteriaceae. This was associated with meta-omics signatures characteristic of a microbiome adapted to a more oxygen-rich gut environment, enriched with genes associated with reactive oxygen species metabolism and lipopolysaccharide biosynthesis, and depleted in genes involved in the metabolism of milk carbohydrates. The synbiotic formula modulated expression of microbial genes involved in (oligo)saccharide metabolism, which emulates the eco-physiological gut environment observed in vaginally born infants. The resulting hypoxic and acidic milieu prevented the establishment of a compromised microbiome. Conclusions This study deciphers the putative functional hallmarks of a compromised microbiome acquired during C-section birth, and the impact of nutrition that may counteract disturbed microbiome development. Trial registration The study was registered in the Dutch Trial Register (Number: 2838 ) on 4th April 2011

Neonatal Survival Rate following Premature Rupture of Membranes at Gestational Age 15-30 Weeks

Objectives: To determine neonatal survival rate and associated factors in pregnancies with preterm premature rupture of membranes (PPROM) at gestational age (GA) between 15 and 30 weeks.Materials and Methods: This retrospective descriptive study was conducted by reviewing the medical records of the pregnant women with premature rupture of membranes (PROM) at 15-30 weeks’ gestation admitted at King Chulalongkorn Memorial Hospital between 1st January 2002 and 31stDecember 2013. Logistic regression analysis was used to determine association between factors and neonatal survival. Results: The total number of pregnancies in this study was 99 and neonatal survival rate was 80.8% (95% confidence interval 71.4-87.8%). Women with PPROM at GA between 15 and 19+6 weeks had neonatal survival rate of 16.7% while neonatal survival rates of cases with PPROM at 20-23+6 weeks and 24-30 weeks were 50.0% and 92.2%, respectively. Factors associated with increased neonatal survival from logistic regression analysis included GA at PROM ≥ 24 weeks and tocolytic administration. Conclusion: Neonatal survival in pregnancies with midtrimester PPROM depended on GA when PROM started. Neonates in women with PPROM at ≥ 24 weeks’ gestation had more chances to survive than those with PROM at GA less than 24 weeks. Use of tocolysis was associated with increase neonatal survival

Acceptance of Influenza Vaccination among Pregnant Women attending the Antenatal Care Clinic, King Chulalongkorn Memorial Hospital

Objectives: To determine the acceptance rate and associated factors of influenza vaccination among Thai pregnant women.Materials and Methods:A cross-sectional descriptive study was conducted at King Chulalongkorn Memorial Hospital from November 2014 to March 2015. Pregnant women were asked to complete self-administered questionnaires that collected data on acceptance of vaccination, knowledge, attitude and practice regarding to influenza vaccination during pregnancy. The associated factors were determined by logistic regression analysis.Results: A total of 412 women completed the questionnaires. Acceptance rate of influenza vaccination among the participants was 40.5% (95% CI 35.9-45.3). Most participants (320 women, 77.7%) had good knowledge about influenza and the vaccine. Factors positively associated with the acceptance were ‘advice from physicians’ (adjusted OR 2.61, 95% CI 1.55-4.39), ‘notification about vaccination in current pregnancy’ (adjusted OR 1.84, 95% CI 1.17-2.89), ‘protection of newborn’ (adjusted OR 2.83, 95% CI 1.74-4.62) and ‘cost of vaccination’ (adjusted OR 2.36, 95% CI 1.46-3.82). Negatively associated factors included ‘experience of side effects following past vaccination’ (adjusted OR 0.19, 95% CI 0.05-0.74), ‘belief that vaccination is unnecessary’ (adjusted OR 0.42, 95% CI 0.21-0.86), and ‘unsafe during the first trimester’ (adjusted OR 0.55, 95% CI 0.34-0.90).Conclusion: Acceptance rate of influenza vaccination during pregnancy among women in King Chulalongkorn Memorial Hospital was 40.5%. To increase vaccination rate, health care providers should advise or mention on influenza vaccination and provide information to support that the immunization can protect their newborns and is safe at any trimeste

Factors associated with the use of irreversible contraception and continuous use of reversible contraception in a cohort of HIV-positive women

Effective contraception can be lifesaving by reducing maternal mortality linked to childbirth and unsafe abortion and by reducing vertical and horizontal transmission of HIV, in the case of an HIV-positive woman. This study is a secondary analysis of a prospective cohort study. We assessed factors associated with the use of irreversible contraception and the continuous use of reversible contraception in HIV-positive Thai women. We used descriptive statistics to present baseline characteristics and logistic regression to assess the association between contraceptive use and factors in the study. Of 196 women included in the analysis, 87% self-reported always using male condoms and 56% continuously using another effective contraceptive method during the period of the study (12-18 months). The choice of effective contraceptive methods was suboptimal--42% were sterilized, 14% used hormonal contraception and no participant reported the use of an intrauterine device. Sexual activity and past contraceptive use were factors associated positively with current continuous contraceptive use. Live births and lower levels of education were additional factors associated positively with sterilization. Despite high contraceptive use, there are still uncovered contraceptive needs among HIV-positive women in Thailand. HIV-positive women need established specialized family planning services, offering an optimal variety of contraceptive choices and tailored to their individual needs. As sterilization is an irreversible choice, it cannot be a viable alternative for every woman. Due to the positive trend between current and past contraceptive use, we consider that it may be possible to improve family planning programs if they start as early as possible in a woman's life and are continued throughout her sexually active and reproductive year

Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting

We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes

Effect of Synbiotic on the Gut Microbiota of Cesarean Delivered Infants : A Randomized, Double-blind, Multicenter Study

We determined the effect of short-chain galacto-oligosaccharides (scGOS), long-chain fructo-oligosaccharides (lcFOS) and Bifidobacterium breve M-16V on the gut microbiota of cesarean-born infants. Infants were randomized to receive a standard formula (control), the same with scGOS/lcFOS and B. breve M-16V (synbiotic), or with scGOS/lcFOS (prebiotic) from birth until week 16, 30 subjects born vaginally were included as a reference group. Synbiotic supplementation resulted in a higher bifidobacteria proportion from day 3/5 (P<0.0001) until week 8 (P=0.041), a reduction of Enterobacteriaceae from day 3/5 (P=0.002) till week 12 (P=0.016) compared to controls. This was accompanied with a lower fecal pH and higher acetate. In the synbiotic group, B. breve M-16V was detected 6 weeks postintervention in 38.7% of the infants. This synbiotic concept supported the early modulation of Bifidobacterium in C-section born infants that was associated with the emulation of the gut physiological environment observed in vaginally delivered infants.</p

Thai HIV-1-infected women do not require a dose increase of lopinavir/ritonavir during the third trimester of pregnancy.

Contains fulltext : 97408.pdf (publisher's version ) (Closed access)OBJECTIVES: To investigate whether Thai HIV-1-infected pregnant women require a dose increase of lopinavir/ritonavir (LPV/r) and to assess the safety and efficacy of the generic tablets during pregnancy. DESIGN: Prospective, single-center pharmacokinetic study. METHODS: HIV-infected pregnant, antiretroviral therapy-naive or experienced women started HAART containing generic LPV/r 400/100 mg tablets twice daily. The 12-h pharmacokinetic curves were recorded at gestational age 20 weeks (GA20, optional), 33 weeks (GA33) and 12 weeks postpartum (12PP, optional). RESULTS: Twenty women were included. Median [interquartile range (IQR)] age was 28 (25-33) years and mean (SD) weight at GA33 was 59.9 (4.2) kg. Mean (SD) values for LPV area under the curve(0-12 h), C(max), C(min), and T(half) were 72.9 (19.2) mg/l h, 9.3 (2.2) mg/l, 3.2 (1.3) mg/l and 4.8 (2.4) h, respectively, on GA33 and 98.0 (24.1) mg/l h, 11.7 (2.2) mg/l, 4.7 (2.2) mg/l and 5.9 (2.7) h, respectively on 12PP. Twelve women recorded both GA33 and 12PP curves; mean LPV AUC(0-12) was significantly lower at GA33 [-24.1 (95% confidence interval -44.4 to -3.7) mg/l h]. At GA33, 19 of 20 women had sufficient LPV trough concentrations (>1.0 mg/l) and at 12PP, all had sufficient LPV trough concentrations. None of the women stopped LPV/r before planned discontinuation due to side-effects. At delivery, 19 of 20 women had a viral load below 50 copies/ml. One woman had a viral load of 60 copies/ml, but was undetectable at 12PP. CONCLUSION: Standard dose generic LPV/r (400/100 mg twice daily) in Thai HIV-1-infected pregnant women leads to adequate plasma concentrations during the third trimester. The generic LPV/r tablet is well tolerated and effective for use during pregnancy