Microcephaly: Significance and how to approach during the zika era

Microcephaly is an uncommon but important ultrasonographic finding. The smallest-head infants trend to suffer the severest level of developmental delay. Currently, more than three SDs below the mean is accepted as the definition for microcephaly diagnosis. Wrong gestational age determination, craniosynostosis and intrauterine growth restriction (IUGR) are firstly differentiated. Then, associated abnormalities and pathognomonic clues for diagnosing the etiologic cause of microcephaly should be ultrasonographically surveyed. Teratogenic exposure, intrauterine infection (TORCH and zika) and genetic abnormalities are possible etiologies. Prognosis and management depend on gestational age, severity of head size, associated anomalies and possible cause

Efficacy of Music Therapy on Immediate Postpartum Episiotomy Pain: A randomized controlled trial

Objectives: To evaluate the effectiveness of music therapy in alleviating immediate postpartum episiotomy wound pain. Materials and Methods: A randomized controlled trial was conducted to evaluate the efficacy of music therapy in alleviating immediate pain from an episiotomy wound. Uncomplicated singleton vaginal delivery women with the second degree or less episiotomy wound at Delivery and Postpartum Inpatient Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Thailand were enrolled into the study. Visual analog scale (VAS) scoring was used for comparing pain levels.Results: One hundred postpartum women were enrolled in our study. Baseline characteristics such as age, degree of episiotomy wound tear were similar between both groups. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of the 2nd hour after finish of episiotomy wound repairing process [24.0 millimeters (8.3-41.5) and 36.5 millimeters (20.0-53.3), p < 0.001]. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of 6th hour after finish of episiotomy wound repairing process [12.0 millimeters (3.0-21.0) and 22.0 millimeters (15.0-38.0), p < 0.001] Conclusion: Music therapy is effective for reducing the perceived immediate postpartum pain of an episiotomy wound

Accuracy and factors influencing Leopold’s manoeuvres in determining vertex presentation during late third trimester of pregnancy

This prospective descriptive study was conducted for examine the accuracy of Leopold’s manoeuvres in determining vertex presentation and to identify factors which may influence the accuracy. Pregnant women gestational age more than 34 weeks were examined using Leopold’s manoeuvre for foetal presentation, and findings confirmed on subsequent ultrasonographic (US) examinations. Our study found Leopold’s manoeuvre for foetal presentation determination during the late third trimester of pregnancy has high sensitivity but low specificity. Accuracy of performance of Leopold’s manoeuvre for foetal presentation and lie were 89 and 96%, respectively. The sensitivity, specificity and PPV for vertex presentation diagnosis were 93.2, 30 and 94.9%, respectively. A larger foetal abdominal circumference decreased the accuracy of performance of Leopold’s manoeuvre (Adjusted OR 0.821, 95% CI 0.703–0.959, p = .013). Using an AC cut-off value of ≥33.01 cm, the sensitivity, specificity, PPV and NPV for accurate vertex presentation diagnosis were 54.3, 57.6, 91 and 13%, respectively.IMPACT STATEMENT What is already known about this subject? Leopold’s manoeuvre is a method for assessing fetal presentation. Previous studies have found the overall accuracy of Leopold’s manoeuvre to be 63–88%. What the results of this study add? Leopold’s manoeuvre has high sensitivity but low specificity. Increased fetal AC influences the accuracy of Leopold’s manoeuvre. What the implications are of these finding for clinical practice and/or further research? Fetal non-vertex presentation and fetal AC ≥33.01 cm measured by ultrasonographic examination during late third-trimester pregnancy should be followed for determine the fetal presentation by ultrasonographic examination, patient’ counselling and planning the route of delivery for non-vertex presentation in case of emergency. Further investigations about the cost effectiveness of universal ultrasonographic examination for fetal presentation determination in late third-trimester pregnancy are needed

Efficacy of a 28-compartment pillbox for improving iron supplement compliance in healthy pregnant women: a randomised controlled trial

A randomised controlled trial was conducted. The primary objective was to evaluate the efficacy of a pillbox for increasing iron supplement compliance by comparing the proportion of pregnant women who had no remaining iron tablets between pregnant women attending ANC who were given a pillbox to use and women with no pillbox in four-week period between ANC visits. The secondary objective was to evaluate the reasons for poor compliance and possible factors associated with the non-compliance. One hundred and ninety pregnant women were enrolled, 95 participants were randomised into each of the groups. The proportion of pregnant women who had no remaining iron tablets at the end was statistically significantly lower in the pillbox group than in the control group [53.3% and 23.1%, respectively, p < .001, RR2.308 (95% CI 1.515 − 3.517)]. The most common reason given for having of iron tablets remaining was forgetfulness. The visual analog scale (VAS) scores indicated that patient’s responsibility feeling, duration of sleep each day and presence of a handicapped or small child in care significantly influenced the proportion of pregnant women who had remaining iron tablets at the end in both groups. We concluded that a pillbox was found to be an effective tool for improving pregnant women’s compliance with taking their iron supplements.IMPACT STATEMENT What is already known about this subject? Antenatal care (ANC) influences maternal and neonatal outcomes. The incidence of anaemia in pregnant women is reported to be around 42% and approximately 50% result from iron deficiency. Maternal anaemia increases the risk of foetal low birth weight, preterm birth, perinatal mortality, stillbirth and maternal mortality. What do the results of this study add? The 28–compartment pillbox is effective for improving iron supplement compliance in healthy pregnant women. Forgetfulness is the most common reason given for having remaining iron tablets. The lower score on the visual analog scale of patient’s feeling of responsibility, long duration of sleep a day and the presence of a handicapped or small child in their care were significantly associated with having remaining iron tablets. What are the implications are of these finding for clinical practice and/or further research? The 28–compartment pillbox can be implied to routine antenatal care for improving iron supplement compliance in healthy pregnant women. Health care providers should be reminded to encourage compliance with iron supplement prescription in pregnant women who are at risk of poor compliance as indicated by low VAS of the patient’s feeling of responsibility, long duration of sleep in a day and pregnant women who have responsibility to take care of handicapped or small children

Survey on knowledge, attitude, acceptance and related factors among pregnant women in Thailand regarding antenatal thalassaemia screening

Thalassaemia is a common haematologic health condition in Southeast Asian countries (SEA) including Thailand. Reducing the birth of new thalassaemia cases is an effective method to control disease. The background level of knowledge and attitude of pregnant women on the disease influences their decision to perform antenatal screening. Unfortunately, the information about pregnant women’s knowledge and attitude on antenatal thalassaemia screening in a developing country such as Thailand is lacking. We therefore conducted this cross-sectional study to examine patients’ knowledge and to evaluate the factors which influence the patient’s knowledge and attitude on antenatal thalassaemia screening. 1006 pregnant women who attended antenatal care at the Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand were enrolled. We found that women’s knowledge on antenatal thalassaemia screening is low. A maternal age of ≥35 years was associated with a higher level of knowledge. A higher level of education and multigravidity, a family history of thalassaemia and a positive level of attitude were found more likely to have higher scores for knowledge. A higher level of education and level of knowledge score were also more likely to have a positive attitude score, but multigravidity negatively affected the attitude score. Effective counselling should be monitored among women with a lower levels of education, those with no family history of thalassaemia, and in primigravidas. Lastly, a concurrent Down syndrome screening or foetal sex determination may be useful incentives to encourage the decision to undergo screening.Impact statement What is already known about this subject? Screening for the paternal and maternal thalassaemia carrier status is important for reducing the incidence of severely thalassaemia-affected children. Poorer education and receiving genetic counselling for the first time were the predictive factors for the low post-counselling knowledge in genetic counselling before second trimester genetic amniocentesis. What do the results of this study add? Pregnant women’s knowledge of antenatal thalassaemia screening was low. We found that pregnant women aged ≥35 years had a higher level of knowledge. Women with a higher level of education, multigravidity, the presence of a family history of thalassaemia and a positive attitude were more likely to have higher scores for knowledge. A higher level of education and level of knowledge score were also more likely to have a positive attitude score but multigravidity negatively affected the attitude score. The encouraging factors, such as an adjunctive Down syndrome screening or foetal structural screening or foetal sex determination may be useful as the incentive tools. What are the implications of these finding for clinical practice and/or further research? The awareness of a possible incorrect understanding is important for the antenatal counselling in the developing countries. Intensive monitoring of effective counselling using a post-counselling test should be scheduled. The methods of effective counselling for antenatal thalassaemia in developing countries should be evaluated

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

<div><p>Objective</p><p>To establish normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in southern Thai women, and to compare these reference levels with Caucasian-specific and northern Thai models.</p><p>Methods</p><p>A cross-sectional study was conducted in 1,150 normal singleton pregnancy women to determine serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) concentrations in women from southern Thailand. The predicted median values were compared with published equations for Caucasians and northern Thai women.</p><p>Results</p><p>The best-fitting regression equations for the expected median serum levels of PAPP-A (mIU/L) and free β- hCG (ng/mL) according to maternal weight (Wt in kg) and gestational age (GA in days) were: and Both equations were selected with a statistically significant contribution (p< 0.05). Compared with the Caucasian model, the median values of PAPP-A were higher and the median values of free β-hCG were lower in the southern Thai women. And compared with the northern Thai models, the median values of both biomarkers were lower in southern Thai women.</p><p>Conclusion</p><p>The study has successfully developed maternal-weight- and gestational-age-adjusted median normative models to convert the PAPP-A and free β-hCG levels into their Multiple of Median equivalents in southern Thai women. These models confirmed ethnic differences.</p></div

Surface of predicted median PAPP-A level (mIU/L) [A] and predicted median free β -hCG (ng/mL) [B] obtained from quantile regression models against gestational (days) and maternal weight (kg).

<p>In each figure, the left upper side is the result of the quantile regression using the southern Thai data, the right upper side is based on the published equation for median value for a Caucasian population [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182538#pone.0182538.ref008" target="_blank">8</a>], and the left lower side is based on the published equation for a northern Thai population [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182538#pone.0182538.ref009" target="_blank">9</a>].</p

The relationship between the values of MoM for PAPP-A [A] and free β-hCG [B] using the southern Thai median equation from this study on the X-axis, and the northern Thai equation [9] on the Y-axis (circles).

<p>The line represents the line of equity, i.e., marking the same values on both X and Y-axes.</p

Demographic characteristics of the study population (1,150 women).

<p>Demographic characteristics of the study population (1,150 women).</p