Effect of Gestational Weight Gain on Overweight and Obese Pregnant Women

Objective: To examine the adherence of gestational weight gain (GWG) recommendations and pregnancy outcomes among overweight and obese pregnant women. Materials and Methods: The medical records of 405 overweight or obese pregnant women who delivered at Siriraj Hospital between September 2018 and June 2019 were reviewed. The adherence to GWG recommendations according to pre-pregnancy body mass index (BMI) was examined. The characteristics and pregnancy outcomes of the overweight and obese pregnancies as well as between the adherence and non-adherence to the GWG recommendations groups were studied and compared between the groups. Results: Adherence to the GWG recommendations between the overweight and obese pregnancy groups were significantly different at 60.2% and 44% respectively (p-value = 0.002), although the average GWG was significantly lower in the obese than overweight pregnancies (p-value = 0.003). Pre-pregnancy BMI was significantly higher in the non-adherence group compared with the adherence group (p-value = 0.025). Pregnancy outcomes as well as the prevalence of gestational diabetes mellitus between these two groups were comparable. Also, adverse pregnancy outcomes were not statistically significantly different among the adherence and non-adherence groups. Conclusion: The adherence to gestational weight gain recommendations in obese and overweight pregnancies is still a challenge. Obese pregnant women are less likely to control weight gain during pregnancy. Pre-pregnancy BMI is an important factor for overweight and obese pregnant women to achieve the GWG goal. Ensuring a proper GWG alone might not improve most adverse pregnancy outcomes in overweight and obese pregnancies

A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography

Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors’ 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended

Outcomes of Expectant Management in HIV-Infected Pregnancy with Preterm Premature Rupture of Membranes at Less Than 34-Week Gestation: A Case Series

Objective: To present outcomes of expectant management (EM) in HIV-infected pregnancy with preterm premature rupture of membranes (PPROM) at less than 34-week gestation. Case presentation: During January 2008-December 2015, there were 513 HIV-infected pregnant women giving birth at Siriraj Hospital, Thailand. Ten of them presented with PPROM at GA <34 weeks and six women received EM. The deliveries took place at GA 28 2/7 - 33 5/7 weeks. The longest interval of ROM was 15 days and the highest on-admission viral load was 633,000 copies/mL. Three of them had antepartum highly active antiretroviral therapy (HAART) for at least four weeks prior to the delivery. Mode of delivery included 3 vaginal deliveries and 3 caesarean sections. All infants’ HIV molecular tests were negative at birth. The longest follow-up interval was 12 months and HIV vertical transmission remained negative. Conclusion: Expectant management in HIV-infected women with PPROM at GA <34 weeks may be sensible because complications of prematurity outweigh the risk of vertical HIV transmission