Prevalence, Risk Factors, and Pregnancy Outcomes of Early-onset Severe Preeclampsia among Severe Preeclamptic Women in Siriraj Hospital

Objectives:To determine the prevalence, associated factors and outcomes of early-onset severe preeclampsia among severe preeclamptic women in Siriraj Hospital.Materials and Methods:A total of 220 pregnant women diagnosed with severe preeclampsia were enrolled. Relevant data including obstetric data, diagnosis, treatment, route of delivery, maternal and neonatal outcomes were retrieved from medical records. Prevalence of early-onset severe preeclampsia (diagnosed before 34 weeks of gestation) was estimated. Various characteristics were compared between early and late-onset groups to determine associated risk factors.Results:Mean age of pregnant women was 28.6 years, and 59.1% were nulliparous. Mean gestational age (GA) at first antenatal visit was 14.5 weeks and mean GA at delivery was 36.2 weeks. Prevalence of early-onset severe preeclampsia was 15.9%. Only 9.1% received expectant management and 32.7% delivered vaginally. Mean birth weight was 2514.1 g. Stillbirth, small for gestational age (SGA), birth asphyxia and neonatal intensive care unit (NICU) admission was found in 1.8%, 17.7%, 2.7%, and 6.8%, respectively. Mean GA at delivery was 30.6 weeks in early-onset group and 37.2 weeks among late-onset group. Early-onset group was more likely to receive expectant management than late-onset group (34.3% vs. 4.3%; p<0.001). Worse outcomes were more common among neonates of early-onset group and they were significantly more likely to require NICU admission (37.1% vs. 1.1%, p<0.001). Women with previous preeclampsia were significantly more likely to develop early-onset severe preeclampsia. (35.7% vs. 13.2%, p=0.037).Conclusion: Prevalence of early-onset severe preeclampsia among preeclamptic women in Siriraj hospital was 15.9%. Worse neonatal outcomes were more commonly observed among early-onset cases. Previous preeclampsia was the only significant possible associated factors

Incidence of postpartum glucose intolerance among women with gestational diabetes in Siriraj Hospital

Objectives: To determine the incidence of postpartum glucose intolerance among women with gestational diabetes (GDM) and its associated factors. Materials and Methods:A total of 110 GDM women who delivered at Siriraj Hospital were enrolled. A 2-hour 75-gram glucose tolerance test was offered at 6-12 weeks postpartum to determine the incidence of glucose intolerance, which includes impaired glucose tolerance (IGT), and type 2 diabetes (T2DM). Demographic data, GDM risks and diagnosis data, and delivery data were collected. Incidence of glucose intolerance was estimated. Comparison was made between glucose intolerance groups to determine possible associated factors.Results: Mean age was 33.7±5.1 years, and 46% were nulliparous. According to pre-pregnancy BMI, 45.5% were overweight/obese, and 24.5% gained weight greater than recommendation. Majority was GDM A1 (85.5%), and 63.6% were diagnosed before 20 weeks of gestation. Mean postpartum follow up time was at 6.2±0.9 weeks. Incidence of postpartum IGT and T2DM were 35.5% and 10% respectively. No difference was found between groups in terms of pre-pregnancy BMI, gestational weight gain, weight retention, and severity of GDM. However, HbA1c level was significantly greater among women with postpartum T2DM than IGT and normal results (6.1±0.5%, 5.6±0.4%, and 5.4±0.3% respectively, p<0.001). HbA1c level of ≥ 6% significantly increased the chance of T2DM (33.3% vs. 53.4%, p=0.001).Conclusion: Among GDM pregnant women, incidence of postpartum glucose intolerance was 45.5% (35.5% IGT and 10% T2DM). HbA1c level of ≥ 6% significantly increased the chance of postpartum T2DM

Success Rate of Cervical Cerclage at Siriraj Hospital

Objective: To determine the success rate of cervical cerclage at Siriraj Hospital and the associated factors. Methods: The study included 90 pregnant women who received cervical cerclage procedures at Siriraj Hospital during 2007-2016. Clinical information and the cerclage procedures were evaluated. Successful cervical cerclage was defined as delivery at 34 weeks’ gestation or more. Results: The mean maternal age was 31.8 ± 5 years. The most common indication was history of second trimester abortion (76.7%). The mean gestational age (GA) at cervical cerclage was 18.0 ± 4.3 weeks. The mean cervical length was 25.2 ± 12.0 mm. Most of the patients had no cervical dilatation (76.7%). Almost all the cervical cerclage procedures were performed using McDonald’s technique (98.9%). Of the 90 women, 66 (73.3%) delivered at >34 weeks’ gestation, while 59.9% delivered at >37 weeks’ gestation. The mean birth weight was 2404.9 ± 991.7 grams. The success rate of cervical cerclage increased significantly among women with greater cervical length (28.2±10.5 vs. 18.0±14.9 mm., p=0.002), without cervical dilatation (83.3% vs. 58.3%, p=0.046), without bulging of membranes (92.5% vs. 66.7%, p=0.002), and prophylactic operations (89.4% vs. 58.3%, p=0.001). Maternal complications were significantly lower in women with successful cervical cerclage (9.1% vs. 45.8%, p<0.001). Conclusion: The success rate of cervical cerclage at Siriraj Hospital was 73.3%. Possible associated factors included cervical length, cervical dilatation, bulging of membranes, and the prophylactic procedure

Incidence of Intrapartum Abnormal Fetal Heart Rate Pattern in Siriraj Hospital

Objectives: To determine the incidence of intrapartum abnormal fetal heart rate (FHR), possible associated factors and pregnancy outcomes.Materials and Methods: A total of 900 low-risk pregnant women were enrolled in this retrospective cohort study. Obstetric, labor and delivery data were collected. Incidence of intrapartum abnormal FHR pattern was determined, according to the National Institute of Child Health and Human Development (NICHD) classification. Comparisons were made between those with and without abnormal FHR pattern to evaluate possible associated factors and pregnancy outcomes.Results: Mean maternal age was 29.1 years, 55.7% were nulliparous, and mean gestational age at delivery was 38.1 weeks. Incidence of abnormal FHR pattern was 30.7% (30.3% and 0.4% in NICHD category II and III, respectively). Among these, 46.6% and 39.7% occurred in active and deceleration phase of labor, respectively. Univariate analysis showed that rate of abnormal FHR pattern was more common among nulliparous women (RR 1.22, 95% CI 1.003-1.5, p = 0.045). Cesarean delivery was required in 28.9% of cases with abnormal FHR pattern. Birth asphyxia was significantly more common among those with abnormal FHR pattern (7.2% vs. 3.7%, p = 0.016). Multivariate analysis demonstrated that only nulliparity was significantly associated with abnormal FHR pattern (adjusted OR 1.35, 95%CI 1.01-1.82, p = 0.045).Conclusion: Incidence of intrapartum abnormal FHR pattern was 30.7% and nulliparity was the only independent associated factor. The condition significantly increased the risk of birth asphyxia

Cut-off Value of 50-g Glucose Challenge Test for The Diagnosis of Gestational Diabetes Mellitus

Objective: To determine the cut-off value of 50-g glucose challenge test (GCT) for the diagnosis of gestational diabetes mellitus (GDM) among Thai pregnant women.Materials and Methods: A study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. Data of 816 pregnant women who were at risk for GDM with abnormal 50-g GCT results (≥140 mg/dL) before 20 weeks of gestation were included. All women received 100-g oral glucose tolerance test (OGTT) for GDM diagnosis. This approach was repeated during 24-28 weeks of gestation among those with normal 100-g OGTT results. Medical records were reviewed for data collection. Positive predictive values for GDM diagnosis were estimated at different cut-off levels of 50-g GCT, using 10 mg/dL increment interval.Results: Mean age was 32.4±5.1 years, and mean gestational age when 50-g GCT was initially performed was 10.1±5.9 weeks of gestation. GDM was diagnosed in 290 cases (35.5%) and mean gestational age at diagnosis was 19.1±10.3 weeks. The positive predictive values for GDM diagnosis increased with 50-g GCT values. Of 19 and 13 women whose 50-g GCT values were ≥230 and ≥240 mg/dL, 90.5% and 100% were diagnosed with GDM, respectively. Conclusion: 50-g GCT before 20 weeks of gestation could be applied and used for diagnosis of GDM using appropriate cut-off value

Incidence and Risk Factors of HELLP Syndrome in Thai Pregnant Women with Severe Pre-eclampsia

ObjectivesTo determine the incidence and risk factors of HELLP syndrome in pregnant Thai women with severe pre-eclampsia and to compare pregnancy outcome. DesignCross-sectional study. SubjectA total of 255 pregnant women with severe pre-eclampsia, >28 weeks of gestation, who delivered at Siriraj Hospital between January 2005 and June 2007. Materials and Methods The medical records were reviewed to determine the incidence of HELLPsyndrome. Characteristics regarding current pregnancy and delivery and maternal and neonatal outcomes were extracted. ResultsThe incidence of HELLP syndrome was 12.5%. Women with HELLP syndrome were significantly older, more likely to be multiparous and delivered at lower gestational age (p<0.05). Placental abruption and birth asphyxia significantly increased among women with HELLP syndrome (p<0.05). Conclusion HELLP syndrome was found in 12.5% of severe pre-eclampsia pregnant women in our institute. Risk factors were old maternal age and preterm gestation

Nipple Characteristics between Teenage and Adult in Postpartum Period and Success in Breastfeeding at day 3 Postpartum

Objectives: To compare nipple length and diameter between teenage and adult mothers during early postpartum period and their association with success in breastfeeding at day 3 postpartum.Materials and Methods: A total of 315 nulliparous women, who delivered at Siriraj Hospital between March and October 2016 were enrolled. Study group consisted of 105 teenage mothers and 210 adult mothers were served as a comparison group. Baseline characteristics, obstetric data, maternal and neonatal outcomes were extracted from medical records. Nipple length and diameter were measured. LATCH score was used to evaluate success in breastfeeding at day 3 postpartum, using score of ≥ 7 as a cut off. Comparisons of various characteristics were made between groups. Association between nipple characteristics and LATCH score were evaluated.Results: Teenage mothers were significantly more likely to be underweight, working as a housewife, and have lower income. While gestational age at delivery was comparable, teenage mothers were significantly more likely to deliver vaginally. Birth weight were significantly lower among teenage mother. Nipples of teenage mothers were significantly shorter and narrower than adult mothers (7.3 ± 2.8 mm vs. 9.6 ± 2.8 mm, p < 0.001 and 13.5 ± 1.4 mm vs. 14.2 ± 1.8 mm, p = 0.002, respectively). At day 3 postpartum LATCH scores ≥ 7 were comparable between groups (58.1% vs. 55.2%, p = 0.631). Nipple length of ≥ 7 mm was significantly associated with success in breastfeeding at day 3 postpartum (LATCH score of ≥ 7) in both teenage (71% vs. 39.5%, p = 0.002) and adult (60.4% vs. 13%, p < 0.001) mothers.Conclusion: Teenage nipples had significantly shorter and narrower than adult mothers. Pregnant women with nipple length of ≥ 7 mm on at least one side significantly increased the chance of success in breastfeeding at day 3 postpartum regardless of age group

A Correlation between First-void Morning Urinary Protein to Creatinine Ratio (UPCR) and 24 Hours Urinary Protein in Pregnancy with Suspected Preeclampsia

Objective:To evaluate a correlation between first-void morning urinary protein to creatinine ratio (UPCR) and 24-hour urine protein in pregnant women suspected of preeclampsia.Materials and Methods: A total of 40 pregnant women suspected of preeclampsia were enrolled and admitted for 24-hour urine collection. Collected urine was divided into 2 parts, first-void morning urine and the remaining. First-void morning UPCR was determined and 24-hour urine protein was calculated by a combination of protein from both specimens. Significant proteinuria was diagnosed if the total 24-hour urine protein was greater than 300 mg. A correlation between first-void morning UPCR and 24-hour urine protein was estimated using Pearson product-moment correlation coefficient (r).Results: Mean age was 31.0 ± 7.0 years and mean gestational age was 33.2 ± 4.6 weeks. Eight patients (20%) had significant proteinuria and were diagnosed as preeclampsia. A correlation between first-void morning UPCR and 24-hour urine protein showed a significant positive correlation with coefficient (r) of 0.76, p < 0.001. At the cut-off value of 0.3, first-void morning UPCR had sensitivity of 87.5% (95% CI 46.7 – 99.3) specificity of 96.9% (95% CI 82.0 – 99.8) for diagnosis of significant proteinuria.Conclusions: First-void morning UPCR significantly correlated with 24-hour urine protein. It should be considered as an alternative method for detecting significant proteinuria in women suspected of preeclampsia

Relationship between 50-g glucose challenge test and large for gestational age infants among pregnant women without gestational diabetes

The study aimed to compare the incidence of large for gestational age (LGA) infants between women with a false positive and normal glucose challenge test (GCT), and to evaluate the factors associated with LGA. A total of 480 pregnant women at risk for gestational diabetes mellitus (GDM); 160 with a false positive GCT and 320 with normal GCT results were included. The incidence of LGA and other pregnancy outcomes were compared between the two groups. Possible associated factors for LGA were also evaluated. Women with a false positive GCT were significantly older and more likely to be multiparous. The incidence of LGA was comparable between the false positive and normal GCT groups (15.6% vs. 13.1%, p = .456). Other pregnancy outcomes were also comparable. Logistic regression analysis showed that pre-pregnancy underweight significantly reduced the risk of LGA (adjusted OR 0.25, 95% CI 0.07–0.87, p = .029) while a second trimester weight gain >7 kg significantly increased the risk of LGA (adjusted OR 3.13, 95% CI 1.67–5.89, p 7 kg significantly increased the risk of LGA. What the implications are of these findings for clinical practice and/or further research? As a gestational weight gain is modifiable, behavioural and a dietary intervention as well as a close monitoring of the weight gain could help in lowering the risk of LGA, even in the absence of GDM. Further studies which are more widely generalisable are needed to elucidate the relationship between 50 g GCT and the adverse outcomes and to investigate the benefits of a specific intervention among this specific group of women

Relationship between ABO blood groups and preeclampsia

Objective To investigate the relationship between ABO blood group and preeclampsia.Methods: A case-control study was conducted, including 230 and 460 women with and without preeclampsia. ABO blood groups were compared and associated factors for preeclampsia were determined.Results: Blood group O was significantly more common in early-onset and less common in late-onset preeclampsia. Regression analysis showed that blood group O decreased the risk of late-onset preeclampsia (aOR 0.63, 95%CI 0.42-0.93) but increased the risk of early-onset preeclampsia (aOR 1.97 95%CI 1.05-3.69).Conclusion: Blood group O decreased the risk of late-onset preeclampsia while it increased the risk of early-onset preeclampsia