Placental Weight for Gestational Age and Adverse Neonatal Outcome at Bhumibol Adulyadej Hospital

Objective:To exam association between placental weight and perinatal outcome.Materials and Methods:The retrospective cohort study was performed. Data recorded from birth records were reviewed. Placental weight was divided in to three groups, abnormal and normal weight (high and low, normal) according to placenta weight percentile at 10 and 90 percentile respectively. The association to birth weight was analyzed. Result:The abnormal placental weight group was associated with increased Apgar score at 1 and 5 minute less than 7 (RR 4.0, 95% CI = 1.79-8.91 and RR 4.22, 95% CI = 1.31-13.55), NICU admission rates (RR 4.29, 95% CI = 2.42-7.59), and respiratory complication (RR 3.0, 95% CI = 1.34-6.04) when compared with the normal placental weight group. Conclusions: Abnormal placental weight was significantly associated with adverse pregnancy outcomes such as Apgar score at 1 and 5 minute less than 7, NICU admission rates and respiratory complication

Curcumin in Reduction Size of Myoma Uteri

Objective:The objectives of the study were to determine effects of curcumin in decreasing size of leiomyoma and to determine adverse effects of curcumin. Materials and Methods: The study was a prospective study conducted in reproductive women with leiomyoma in Bhumibol Adulyadej Hospital. 35 women with 81 leiomyoma lumps were recruited to participate by convenience sampling. Ultrasound measurement size of leiomyoma was done before treatment with curcumin. Patients were taken curcumin 1,200 milligrams orally per day for 6 months. Ultrasound measurement size of leiomyoma was repeated at 3 and 6 months after curcumin was started. Main outcomes measure was size of leiomyoma. Size of leiomyoma were compared between before and after taken curcumin for 6 months.Results: The mean diameter of leiomyoma was statistically different at before and after 3 (4.74 ± 2.78 centimeters VS 4.64 ± 2.75 centimeters) and 6 months (4.74 ± 2.78 centimeters VS 4.46 ± 2.61 centimeters) curcumin intake. And both mean volume of leiomyoma was statistically different at before and after 3 and 6 months curcumin intake. Adverse effect of curcumin was not found. Conclusions: Curcumin decreased size of myoma uteri after taken 6 months with statistically significant

Prevalence of Gestational Diabetes Mellitus and Pregnancy Outcomes in Women with Risk Factors Diagnosed by IADPSG Criteria at Bhumibol Adulyadej Hospital

Objective:To determine the prevalence and clinical outcomes of gestational diabetes mellitus (GDM), defined by IADPSG criteria, in pregnant women who are at risk of GDM.Study design: Descriptive study.Material and Method: We studied pregnant women who visited the antenatal clinics at Bhumibol Adulyadej Hospital between July 1, 2011 and December 31, 2012 and had risk factors of GDM. The diagnosis of GDM was defined using the IADPSG criteria. Primary outcome was the prevalence of GDM and the secondary outcomes were pregnancy related complications which included maternal and neonatal complications.Results: A total of 6,324 pregnancy women, 164 patients were diagnosed GDM. The prevalence of GDM was 2.6%. The most common clinical risk factor for GDM was age ≥30 years (75.4%). The most common maternal and neonatal complication were pregnancy induced hypertension (PIH) (12.7%) and hypoglycemia (47.6%). GDM women were significantly different from non-GDM women in PIH, primary cesarean section, hypoglycemia, Apgar <7, and NICU admission. Pregnancy outcomes between GDM A1 and A2 were significantly different. GDM A2 increased the rate of cesarean section, hypoglycemia, and NICU admission. Conclusion: Using the IADSP criteria, the prevalence of GDM was 2.6%. Compared to non-GDM regnant women, adversed pregnancy outcomes were significantly higher in GDM pregnant wome

Comparison of Respiratory Distress Syndrome (RDS) between Gestational Age 34 Weeks and 35-36 Weeks

Objective:To compare the incidence of respiratory distress syndrome (RDS) in late preterm infants at gestational age of 34 weeks and 35-36 weeks and also to compare the rates of short term neonatal complications among infants at gestational age of 34, 35-36 weeks and term (37-40 weeks).Materials and Methods:This study was a retrospective cohort design. Two hundred late preterm (99 cases for GA 34 weeks and 101 cases for GA of 35-36 weeks) and 100 normal term neonates were recruited. RDS and short-term complications in neonates who were born at the Bhumibol Adulyadej Hospital from January 2011 to June 2014 were compared. The data were analyzed with Chi-square test, Student’s t-test and analysis of variance where appropriate. Result:RDS rate was higher in the late preterm group with GA 34-346/7 weeks than in the group with GA 35-366/7 weeks (15% and 4.0% respectively with p = 0.015). There was no RDS in normal term (GA 37-40 weeks) babies. The short-term complications: oxygen requirement, hyperbilirubinemia, hypoglycemia, hypothermia, NICU admission and hospital stay were also higher in 34-346/7 week gestation group.Conclusion: The incidence of RDS is significantly higher in late preterm with GA 34-346/7 weeks than other groups

Association of Fetal Growth Rate in First Trimester and Being Large or Small for Gestational Age

Objective:To evaluate the association of fetal growth rate in first trimester and fetal birth weight.Materials and Methods: The prospective cohort study was performed at the department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Bangkok, Thailand. Fetal growth rate was measured by ultrasound twice in first trimester. First Crown Rump Length (CRL) ultrasound was measured at first antenatal care (ANC) and second CRL ultrasound was at four weeks later. Delta CRLs was calculated and divided into 3 groups: larger than expected, smaller than expected and equal as expected. Patients were followed until delivery. Fetal birth weights were stratified and labeled as large for gestational age (LGA), small for gestational age (SGA) and appropriate for gestational age (AGA) by birth weight percentile at gestational age at delivery. Fetal growth rate in first trimester and fetal birth weight were analyzed.Result:114 pregnant women were recruited. 59 fetuses were equal as expected (51%), 43 fetuses were smaller than expected (38%) and 12 fetuses were larger than expected (11%). The delta CRLs were significantly associate to fetal birth weights (p < 0.005). Diabetic mellitus and hypertension were not significantly associated to fetal birth weights.Conclusion: Fetal growth rate in first trimester was significantly associated to fetal birth weight

Recurrence Rate and Risk Factors for the Recurrence of Ovarian Endometriosis after Laparoscopic Ovarian Cystectomy

The aim of this study was to identify the recurrence rate and risk factors for the recurrence of ovarian endometriosis (OE) after laparoscopic cystectomy. This was a retrospective cross-sectional study. Subjects were OE cases who underwent laparoscopic ovarian cystectomy at Bhumibol Adulyadej Hospital (BAH). The period of this study was from January 2008 to December 2017. Ovarian histopathology and at least one-year follow-up after surgery were the prerequisite requirements. A total of 106 OE cases were included in the study. Subjects were classified into recurrence and nonrecurrence groups. It comprised of 24 and 82 cases, respectively. The mean age of the participant was 32.4 years old. The demographic characters of both groups were comparable. The recurrence rate after laparoscopic OE surgery in the present study was 22.6% (24/106). The average largest diameter of OE in the present study was 54.5 mm. Postoperative medical treatment (OR 3.15, 95% CI 1.14-8.74, p=0.02) and postoperative pregnancy (OR 2.86, 95% CI 1.03-7.93, p=0.04) were associated factors for recurrence decrement. The recurrence rate of OE after laparoscopic cystectomy was 22.6%. Postoperative medical treatment and postoperative pregnancy were a significant factor that lowered OE recurrence

Maternal and Neonatal Complications of Methamphetamine Use during Pregnancy

Background. Methamphetamine abuse has been a significant problem in Thailand. The methamphetamine abuse problem also affects pregnant women. The study of pregnancy outcomes among methamphetamine users during pregnancy is currently limited. Objective. To determine maternal and neonatal complications among methamphetamine-abusing parturients. Materials and method. This historical cohort study was conducted at Bhumibol Adulyadej Hospital (BAH), Bangkok, Thailand, between January 2017 and December 2019. The total number of women was 206 who were equally divided into a study and control group. Pregnant women who tested positive for methamphetamine in urine tests during the intrapartum period were compared to the control group with no history of drug abuse. Results. Maternal outcomes: gestational hypertension was found to be significantly increased in the study group compared to the control group at 14.6 vs. 1.0% (OR 17.4, 95%CI 2.5-134.3). Preeclampsia with and without severe features were found at higher rates in the study group without statistical significance. There were no eclamptic cases in this study. Neonatal outcomes: preterm birth rate of pregnant women who have tested positive in their urine methamphetamine test was significantly higher than in the control group (33.3%, 11.7%, OR 3.7, 95%CI 1.8-7.7). Average birth weight in the study and control group was 2779.1 ± 486.7 and 3049.5 ± 510 gm, respectively (p value < 0.001). Low APGAR score rates of both groups also had no significant difference. Conclusion. Methamphetamine use during pregnancy increased both maternal and neonatal complications in terms of gestational hypertension, preterm birth, and average birth weight

Association of low CD4 cells count and intra-uterine growth retardation in Thailand

Objective: Each year, intrauterine growth retardation (IUGR) affects 20-30 million neonates worldwide, mostly in resource-limited settings. Increased perinatal and infant mortality has been associated with IUGR. Some studies have suggested that HIV infection could increase the risk of IUGR. To confirm this hypothesis, we examined the association between HIV-related factors and the risk of IUGR in Thailand. Patients and Methods: Data from a cohort of 1436 HIV-infected pregnant women enrolled in the “Perinatal HIV Prevention Trial-1”, a clinical trial conducted from 1997 to 1999 in Thailand, were analyzed using a logistic regression, adjusting for risk factors usually associated with IUGR. Results: The rate of IUGR was 7.6%. Adjusting for a short maternal height, low body mass index, small weight gain during pregnancy, and infant female sex, a low maternal CD4 percentage was independently associated with IUGR (odds ratio 0.96, per 1% increment, 95% confidence interval 0.93 to 0.99, P = 0.03). Conclusions: The current World Health Organization recommendation to initiate combination antiretroviral therapy for immunocompromised women as early as possible during pregnancy for their own health and for the prevention of HIV mother-to-child transmission is likely to also decrease the incidence of IUGR. Encouraging immunocompromised HIV-infected women who plan to become pregnant to wait until immune restoration has been achieved may help to reduce the risk of IUGR

Early Postpartum Pharmacokinetics of Lopinavir Initiated Intrapartum in Thai Women ▿ †

Lopinavir (LPV) exposure is reduced during the third trimester of pregnancy. We report the pharmacokinetics of standard LPV-ritonavir dosing (400/100 mg twice daily) in the immediate and early postpartum period when initiated during labor. In 16 human immunodeficiency virus-infected Thai women, the median (range) LPV area under the concentration-time curve and maximum and minimum concentrations in plasma were 99.7 (66.1 to 180.5) μg·h/ml, 11.2 (8.0 to 17.5) μg/ml, and 4.6 (1.7 to 12.5) μg/ml, respectively, at 41 (12 to 74) h after delivery. All of the women attained adequate LPV levels through 30 days postpartum. No serious adverse events were reported

Reduced indinavir exposure during pregnancy.

AimTo describe the pharmacokinetics and safety of indinavir boosted with ritonavir (IDV/r) during the second and third trimesters of pregnancy and in the post-partum period.MethodsIMPAACT P1026s is an on-going, prospective, non-blinded study of antiretroviral pharmacokinetics (PK) in HIV-infected pregnant women with a Thai cohort receiving IDV/r 400/100 mg twice daily during pregnancy through to 6-12 weeks post-partum as part of clinical care. Steady-state PK profiles were performed during the second (optional) and third trimesters and at 6-12 weeks post-partum. PK targets were the estimated 10(th) percentile IDV AUC (12.9 μg ml(-1)h) in non-pregnant historical Thai adults and a trough concentration of 0.1 μg ml(-1), the suggested minimum target.ResultsTwenty-six pregnant women were enrolled; thirteen entered during the second trimester. Median (range) age was 29.8 (18.9-40.8) years and weight 60.5 (50.0-85.0) kg at the third trimester PK visit. The 90% confidence limits for the geometric mean ratio of the indinavir AUC(0,12 h) and Cmax during the second trimester and post-partum (ante : post ratios) were 0.58 (0.49, 0.68) and 0.73 (0.59, 0.91), respectively; third trimester/post-partum AUC(0,12 h) and Cmax ratios were 0.60 (0.53, 0.68) and 0.63 (0.55, 0.72), respectively. IDV/r was well tolerated and 21/26 women had a HIV-1 viral load &lt; 40 copies ml(-1) at delivery. All 26 infants were confirmed HIV negative.ConclusionIndinavir exposure during the second and third trimesters was significantly reduced compared with post-partum and ∼30% of women failed to achieve a target trough concentration. Increasing the dose of IDV/r during pregnancy to 600/100 mg twice daily may be preferable to ensure adequate drug concentrations