Postpartum Weight Retention in Thai Singleton Pregnant Women with Normal Pre-pregnancy Body Mass Index

Objective:To determine the mean postpartum weight retention in Thai singleton pregnant women with normal pre-pregnancy body mass index (BMI) at sixth week postpartum period. Study design: Descriptive study Materials and Methods: Six weeks after delivery, 185 women who visited postpartum clinic and reached the inclusion criteria (Thai pregnancy with normal pre-pregnancy BMI (18.5-24.9 kg./m2), no medical or obstetric complications during pregnancy with term delivery and normal birth weight infant) were included. The questionnaires including age, parity, height, pre-pregnancy weight, gestational weight gain, body weight at postpartum visit, monthly income and the other factors (breastfeeding, nutritional status, physical activity) were recorded and further statistically analyzed. Results:Mean weight retention at sixth weeks postpartum in Thai singleton pregnancy with normal pre-pregnancy BMI was 4.99 ± 4.03 kg. Nineteenth point four six (36/185) and zero point five four percent (1/185) of these women became overweight and obesity, respectively. Gestational weight gain, breastfeeding behavior and daily dietary composition during postpartum period were the significant factors (P<0.05) which affected the postpartum weight retention. Conclusion: Mean weight retention at sixth weeks postpartum in Thai singleton pregnancy with normal pre-pregnancy BMI was 4.99 ± 4.03 kg. The recommendation for the optimal gestational weight gain, absolute breastfeeding and the appropriate nutrition after delivery and the suggestion of weight reduction at postpartum visit are the important issues which the obstetricians should be concerned

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

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

Serum Adiponectin, Visfatin, and Omentin Compared between Non-pregnant and Pregnant Women in Overall, Non-obese, and Obese subjects

Objective: This study aimed to compare serum adiponectin, visfatin, and omentin between non-pregnant and pregnant women in overall, non-obese, and obese subjects. Methods: There were 40 pregnant and 33 non-pregnant women classified by body mass index (BMI) into non-obese or obese subjects. Fasting blood samples were collected in the morning for the non-pregnant group and before delivery for the pregnant group. Results: Plasma glucose levels were significantly lower, but plasma insulin levels were significantly higher in pregnant when compared to non-pregnant women in overall, non-obese, and obese women (p<0.05 all). The homeostasis model assessment of insulin resistance (HOMA-IR) was significantly higher, but the quantitative insulin sensitivity check index (QUICKI) was significantly lower only in obese pregnant when compared to obese non-pregnant women (p<0.01 all). However, in non-obese women, HOMA-IR and QUICKI were comparable between pregnant and non-pregnant women. Serum adiponectin, visfatin, and omentin were significantly lower in pregnant compared to non-pregnant women in overall, non-obese, and obese groups (p<0.05 all). In pregnant women, serum adiponectin and omentin levels were significantly lower in obese compared to non-obese pregnant women while serum visfatin levels were comparable in both groups. Serum adiponectin levels were highest followed by omentin and visfatin, respectively in both non-obese and obese pregnant groups. These results indicated that lower serum adiponectin, visfatin, and omentin in pregnant women might contribute to higher insulin resistance in pregnancy. Furthermore, serum adiponectin and omentin were reduced in increasing adiposity similarly to non-pregnant women. Conclusion: Lower serum adiponectin, visfatin, and omentin in pregnant women might lead to decreased insulin sensitivity in these women

Serum Neuropeptide Y and Leptin Levels compared between Non-pregnant and Pregnant Women in Overall, Non-obese, and Obese Subjects

Objective: The primary objective of this study was to compare serum NPY and leptin levels between non-pregnant and pregnant women in overall, non-obese, and obese subjects. The secondary objective was to compare these peptides between non-obese and obese pregnant women. Methods: Fasting venous blood was collected from non-pregnant women before open abdominal surgery and from pregnant women when admitted to the delivery room during the latent phase of labor. Results: There were 12 non-obese and 14 obese subjects in the non-pregnant group and 9 non-obese and 30 obese subjects in the pregnant group. Systolic blood pressure (SBP) was comparable, but heart rate (HR) was higher in pregnant compared to non-pregnant women. Mean±S.E.M serum NPY levels were lower in the pregnant than in the non-pregnant group in overall (0.54±0.02 and 1.34±0.08, respectively), non-obese (0.53±0.05 and 1.23±0.14, respectively), and obese (0.54±0.03 and 1.43±0.09, respectively) subjects (p<0.01 for all), but these were comparable between obese and non- obese pregnant subjects. Serum NPY was positively correlated with SBP (R=0.281, p<0.05), but negatively correlated with HR (R=-0.324, p<0.01). Serum leptin levels were not different between pregnant and non-pregnant groups, but were significantly higher in obese than non-obese pregnant subjects (p<0.001). Serum leptin levels were positively correlated with body weight, BMI, waist and hip circumferences in overall and pregnant subjects (p<0.001 all). Conclusion: In pregnancy, decreased NPY levels might be associated with inhibition of SBP rising as well as increased HR. Leptin levels might not be associated with pregnancy, but associated mainly with obesity

Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

<p>Abstract</p> <p>Background</p> <p>Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt.</p> <p>Methods</p> <p>From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ≥ 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors.</p> <p>Results</p> <p>We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases.</p> <p>Conclusions</p> <p>The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.</p

Standardising definitions for the pre-eclampsia core outcome set: A consensus development study

Objectives To develop consensus definitions for the core outcome set for pre-eclampsia. Study design Potential definitions for individual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions were entered into the consensus development meeting. Ten healthcare professionals and three researchers, including six participants who had experience of conducting research in low- and middle-income countries, participated in the consensus development process. The final core outcome set was approved by an international steering group. Results Consensus definitions were developed for all core outcomes. When considering stroke, pulmonary oedema, acute kidney injury, raised liver enzymes, low platelets, birth weight, and neonatal seizures, consensus definitions were developed specifically for low- and middle-income countries because of the limited availability of diagnostic interventions including computerised tomography, chest x-ray, laboratory tests, equipment, and electroencephalogram monitoring. Conclusions Consensus on measurements for the pre-eclampsia core outcome set will help to ensure consistency across future randomised trials and systematic reviews. Such standardization should make research evidence more accessible and facilitate the translation of research into clinical practice

The Incidence of Needlestick Injuries During Perineorrhaphy and Attitudes Toward Occurrence Reports Among Medical Students

Background: Medical students are at risk of needlestick injuries (NSIs) while performing obstetrical procedures especially perineorrhaphy, because of their less experience. This study aims to determine the incidence and causes of NSIs during perineorrhaphy and medical students’ attitudes toward occurrence reports. Methods: A cross-sectional study was conducted. After completion of Obstetrics & Gynaecology rotation, the data from final year medical students were collected using a self-administered questionnaire. Results: Of 390 medical students, 290 (74.4%) returned questionnaires with complete data. The annual NSIs incidence during perineorrhaphy was 26.9%. The most common site of injury was the index finger of the non- dominant hand (66.2%). Common causes of NSIs were time pressure (52.1%) and lack of surgical skills (50.7%). Nearly half of students (41%) did not report their occurrence, and 81.3% of injured students believed that NSIs were harmless. Conclusion: The incidence of NSIs during perineorrhaphy and the non-reporting occurrence were quite high among medical students. Structural clinical supervision by medical staffs, HBV vaccination for all medical students, and instruction on standard pre-exposure precaution should be applied. We advocate a strategy plan for increasing students’ awareness and having a simple occurrence reporting system for NSIs, with clear guidelines on post-exposure protocols in all medical schools and teaching hospitals

Improving surgical skills with feedback: directly-observed versus video-recorded practice

Abstract Objective This study aimed to compare two methods of feedback: verbal face-to-face feedback after direct observation (F2F-feedback) versus electronic-written feedback after observation of recorded-VDO of student’s performance (VDO-feedback), in terms of effectiveness in improving skill, effects on motivation and satisfaction. Background Medical schools are responsible for teaching and ensuring proficiency of basic surgical skills. Feedback is effective in developing psychomotor skills; by providing information of learner’s current performance, how to improve, and enhancing motivation. Materials and method Fifty-eight medical students (3rd– 4th year) were trained to perform vertical mattress suture in small groups. Then, during 6-week period of self-directed practice, students were randomized into group1 VDO-feedback (male:female = 21:8) and group 2 F2F-feedback (male:female = 20:9). Feedbacks were provided once every 2 weeks (Week2, Week4). End-of-rotation OSCE was at Week6, and retention tested was at Week8. Performance checklist (Cronbach’s Alpha 0.72) was used to assess skill at 4 timepoints; pre- and post- small group learning, OSCE, and retention phase. Questionnaire was used to assess motivation, learning strategies and satisfaction (Cronbach’s Alpha 0.83). Result After in-class learning, further significant improvement of skills could be gained by both F2F- and VDO- feedbacks (p < 0.0001). Both could similarly retain skill for at least 4 weeks later without additional practice. Self-efficacy, test anxiety, and cognitive strategies scores were significantly increased in both groups (p < 0.05). Extrinsic motivation was increased in VDO-feedback group. No difference in satisfaction between groups was observed. Discussion and conclusion VDO-feedback could be alternative to F2F-feedbacks for basic surgical skill training when limitation for simultaneous meeting of teacher and students occurs. Trial registration This study has been registered to Thai Clinical Trial Registry (WHO International Clinical Trial Registry Platform) on 11/07/2023 (TCTR20230711005)

Prevalence of Repeat Pregnancy Including Pregnancy Outcome of Teenage Women

Objective: To determine the prevalence and possible factors of repeat teenage pregnancy including their pregnancy outcomes compared to primi-gravida teenage pregnancy. Methods: 1,684 medical records of teenage pregnancy delivered or received termination of pregnancy at Siriraj hospital from July 2009 to June 2011 were reviewed. The characteristics and pregnancy outcomes of primi- and multi-gravida teenage pregnancies were studied and compared between groups. Results: The prevalence of repeat pregnancies among the study population was around 20% (338/1,684). Age of multi-gravida teenagers and their husbands were significantly higher than those of primi-gravida. Only 5% of primigravida and 25% of multi-gravida were documented as using contraception before getting pregnant (p < 0.001). Oral contraceptive was the most common method using in both groups. Multi-gravida teenagers were significantly diagnosed as anemia before delivery or termination of pregnancy (p = 0.03), although immediate pregnancy outcomes among the two groups were not significantly different. Before they were discharged from the hospital, less than half of them got immediate contraceptive methods especially long-acting reversible contraception. Conclusion: The prevalence of repeat pregnancy among teenagers at Siriraj Hospital was approximately 20%. Lack of proper contraception might be the factor related to repeat pregnancy. Although immediate pregnancy outcomes among primi-and multi-gravida teenagers were not significantly different, long term outcomes of both teenage mothers and their children were still limited