The Association between Antenatal Umbilical Cord Coiling Index Pattern and Meconium-stained Amniotic Fluid in Gestational Diabetic Mellitus

Objective:To compare the pattern of antenatal umbilical cord coiling index (aUCI) with meconium-stained amniotic fluid in gestational diabetic mellitus (GDM) women.Materials and Methods: Gestational diabetic mellitus women between 28 weeks to 32 weeks and 6 days of gestation were included for standard ultrasonography with umbilical cord coiling measurement from a reciprocal value of the distance between a pair of coils (aUCI = 1/distance in cm). All pregnant women were divided into 2 groups (abnormal aUCI and normal aUCI) and recorded meconium-stained amniotic fluid before delivery. After delivered, total umbilical cord were measured for postpartum umbilical cord coiling index (pUCI).Results:Total of 149 GDM women, 58 women were abnormal aUCI (38.93%). The abnormal aUCI showed significantly association with meconium-stained amniotic fluid (p=0.046), low Apgar score (p=0.023) and neonatal hypoglycemia (p=0.018) when compared with normal aUCI group. The correlation of aUCI and pUCI was poor (p=0.554).Conclusion: This study showed that abnormal aUCI in GDM women was significantly associated with meconium-stained amniotic fluid. However, the aUCI had poorly correlation with pUCI

A six-hour urinary protein-creatinine ratio for predicting significant proteinuria in preeclampsia

Objective: To determine an optimal cutoff level of urinary protein-creatinine ratio (PCR) obtaining from 6-hour urine collection specimens from women admitted with suspected preeclampsia for investigation of significant proteinuria. Study design: Diagnostic test. Subject: Pregnant women admitted for evaluation of preeclampsia were studied prospectively. They were instructed to collect a 24-hour urine in two separate containers: one for first six hours urine specimen, the other for following 18 hours urine specimen. Each sample was measured for volume, protein, and creatinine values. The first 6-hour urinary PCR and total 24-hour proteinuria were calculated. A receiver operating characteristic curve (ROC) of the 6-hour urinary PCR was constructed in order to determine the optimal cutoff level for estimate the degree of proteinuria. Results: A total of 120 out of 126 women completed the study; 96 (80%) had significant proteinuria. This study had shown moderate correlation between 6-hour urine protein and 24-hour urine protein.By using a 6-hour urinary PCR, the optimal cutoff level to predict significant proteinuria was ≥ 0.20 which yielded sensitivity, specificity, PPV, NPV and area under the ROC curve of 93.7%, 64.0%, 90.8%,72.7% and 0.788 respectively. On the other hand, a cutoff level of ≥ 0.10 had shown a sensitivity of 100% and specificity of 20.8%, while the cutoff level of ≥ 0.75 offered 100% specificity, but poor sensitivity of 55.7%. Conclusions: The 6-hour urinary PCR at ≥ 0.20 is the most appropriate value for diagnosis of significant proteinuria in preeclampsia

A Two-hour Urinary Protein-creatinine Ratio for Predicting Significant Proteinuria in Preeclampsia

Objective: To determine an optimal cutoff level of urinary protein-creatinine ratio (PCR) obtaining from 2 hours urine collection from women admitted with suspected preeclampsia for predicting significant proteinuria. Study design: Diagnostic test. Subject: Pregnant women with gestational age > 20 weeks who were admitted at Bangkok Metropolitan Administration Medical College and Vajira Hospital for evaluation of preeclampsia were studied prospectively. They were instructed to collect a 24-hour urine in two separate containers: one for the first 2 hours urine and the other for the following 22 hours urine specimens. Each sample was measured for volume, protein, and creatinine values. The first 2-hour urinary PCR and total 24-hour proteinuria were calculated. A receiver operating characteristic curve (ROC) of the 2-hour urinary PCR was constructed in order to determine the optimal cutoff level for estimate the degree of proteinuria. Results: A total of 182 out of 187 women completed the study; 137 (75%) had significant proteinuria. This study demonstrated moderate correlation between 2-hour urine protein and 24-hour urine protein(r=0.451). By using a 2-hour urinary PCR, the optimal cutoff level to predict significant proteinuria was ≥ 0.30 which yielded sensitivity, specificity, PPV, NPV and area under the ROC curve of 71.5%, 71.1%, 88.3%, 45.1% and 0.801 respectively. On the other hand, a cutoff level of ≥ 0.05 had a sensitivity of 100%, while the cutoff level of ≥ 2.0 offered 100% specificity. Conclusions: The 2-hour urinary PCR is not a good test to predict significant proteinuria due to its high false negative rate

Prevalence and Risk Factors of Striae Gravidarum in Primiparae

Objectives: To determine the prevalence and associated factors of striae gravidarum in Thai singleton primiparae. Study design: Descriptive study. Materials and methods: Two hundred and seventy-two primiparous women who had delivered after 20 weeks of gestation at Bangkok Metropolitan Administration Medical College and Vajira Hospital were recruited. Data were obtained by interviewing postpartum women according to the pre-constructed questionnaires. The questionnaires were composed of four categories: general data, pregnancy data, the symptom of appearance of striae gravidarum and application of cosmetic products such as cream or lotion. The characteristics of participants with and without striae gravidarum were compared. Results: 67.6% of the study participants developed striae gravidarum. From multivariable analysis, the most significant factor was inflammatory acne (odds ratio = 6.7, 95% confidence interval [CI] 2.3-19.7; p-value = 0.001) compared with those without acne or with non-inflammatory acne. Other significant associated factor (p-value 25 kg/m2 (odds ratio 2.8; 95% CI 1.0-7.5), light skin color (odds ratio 2.1; 95% CI 1.1-3.9) and fetal birth weight > 3000 g (odds ratio 1.9; 95% CI 1.0-3.6). Conclusions: The prevalence of striae gravidarum in Thai singleton primiparae was 67.6%. Inflammatory acne developed during pregnancy, younger maternal age, high pre-pregnancy BMI, light skin color, fetal weight > 3000 g were associated with striae gravidarum

Antepartum and Intrapartum Risk Factors Associated with Low One-minute Apgar Score: a Case-control Study

Objective:To determine antepartum and intrapartum risk factors associated with low 1-minute Apgar score (≤ 7). A further aim was to develop a predictive model for low Apgar score at 1 minute based on significant risk factors.Materials and Methods:A case-control study was conducted by including 600 newborns delivered at Vajira Hospital between January 2011 and October 2012. Cases were 200 newborns with 1-minute Apgar score of ≤ 7, while controls were 400 newborns with the score of > 7. Antepartum and intrapartum characteristics were compared between both groups. The independent risk factors were determined by multivariable analysis and were transformed into components of a risk model. The performance of this model was assessed through a receiver-operating characteristic curve analysis. Results: Complete data of 600 newborns were obtained. By multivariable analysis, four antepartum and intrapartum variables were identified as independent factors associated with low 1-minute Apgar score. These included number of antenatal care, meconium stained amniotic fluid, mode of delivery and low birth weight. The independent variables were integrated into a predictive score which ranged from 0–7 points. The optimal cut-off score of ≥ 2 yielded high sensitivity of 74.5% but low specificity of 52.5% for the prediction of low 1-minute Apgar score. Conclusions: Low 1-minute Apgar score was significantly associated with number of antenatal care, meconium stained amniotic fluid, operative obstetric deliveries, and low birth weight. The risk model based on antepartum and intrapartum characteristics yielded high sensitivity but low specificity to predict low 1-minute Apgar score

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Serum CA-125 in Normal First Trimester of Pregnancy and Ectopic Pregnancy

Objectives:To compare the mean serum CA-125 level between normal first trimester pregnancy and ectopic pregnancy, and to determine the cut point of CA-125 level for diagnostic aim.Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira hospital, Navamindradhiraj University between December 2012 and September 2013. Two compared groups were invited from 2 resources. The first group was normal intrauterine pregnant women who came to antenatal care unit. Another group was women with diagnosed ectopic pregnancy and further pathologically confirmed. Blood was drawn from each woman for standard antenatal/preoperative laboratory investigations along with serum CA-125. Levels of CA-125 between both groups were compared. The prediction of ectopic pregnancy was assessed by receiver-operating characteristic (ROC) curve.Result: There were 30 normal pregnancies and 30 ectopic pregnancies in this study. No statistically significant difference was found in terms of age, parity, and gestational age between normal and ectopic pregnancy group. The mean serum CA-125 level in ectopic pregnancy group (24 ± 10 IU/ml) was lower than normal pregnancy group (48 ± 36 IU/ml) which statistically significant difference (P value 0.02). When serum CA-125 level of 30 IU/ml was used as a cutoff value for diagnosis of ectopic pregnancy; sensitivity 73.3% and specificity 73.3%.Conclusion:The measurement of serum CA-125 levels may be useful in discriminating ectopic from normal intrauterine pregnancy

Covid-19 knowledge, attitudes, and practices among healthcare workers in urban community Bangkok, Thailand

Objective. This study examined associations between socio-demographic characteristics and knowledge, attitudes, and practices (KAP) related to COVID-19 among healthcare workers in Bangkok, Thailand. Materials and methods. A cross-sectional online survey was distributed among healthcare workers in Bangkok, Thailand from July - August 2021. Results. A total of 637 responses were received. Most participants were clinical workers (68.4%), and nearly half (47.3%) had been at risk of infection with COVID-19 (ever screening test). Binary logistic regression analysis found associations between high knowledge scores and the 26–35-year age group (OR=1.776-1.562, 95%CI 1.021–2.853), having a bachelor’s degree or higher (OR=1.672, 95%CI 1.058–2.644), and clinical workers (OR=1.784, 95CI% 1.188–2.678). The 36 year and above age group was associated with higher attitude scores (OR=2.406, 95%CI 1.567–3.695). Higher practice scores were associated with females (OR=1.913, 95%CI 1.057–3.464), and clinical workers (OR=1.903, 95CI% 1.170–3.095). Correlation analysis found a positive correlation between practice scores and knowledge (r=0.322, p <0.001) and attitudes (r=0.263, p <0.001). Conclusion. Although healthcare workers demonstrated overall high knowledge, attitude, and practice scores, this study identified several factors that influence KAP. This study can guide public health strategies regarding healthcare workers during the third wave of the COVID-19 pandemic in Thailand

Prevalence of perceived stress and coping strategies among healthcare workers during the COVID-19 outbreak at Bangkok metropolitan, Thailand.

BackgroundHealthcare workers (HCW), who are crucial workforce, have experienced stress during the COVID-19 pandemic. They have been learning to fight against and support patients as much as possible. Thus, this study aims to account for the psychological impact of the COVID-19 outbreaks on the healthcare workers of medical school hospitals in terms of their perceived stress and coping styles.MethodThis cross-sectional study was conducted from June to August, 2021. 517 HCWs self-administered the online survey. Perceived Stress Scale (PSS-10) in Thai-version was used to examine the perceived stress symptoms. Brief-COPE score was used to determine the coping strategies. Independent sample t-test, one-way analysis of variance (ANOVA), and multivariable regression analysis were utilized. The level of significance was set at p-value ResultThe prevalence of perceived stress among the HCWs was 41.97%. Coping strategies were used to deal with stress during the outbreak for problem-solving (Mean ± SD = 0.25 ± 0.60) and positive attitude (Mean ± SD = 2.85 ± 0.62). Significant difference was observed in the use of coping strategies among those who differ in marital status (F2, 514 = 7.234, p-value = 0.001), having children (t515 = -4.175, p-value ConclusionThe impact of the COVID-19 pandemic on mental distress remains. The findings of this study suggest further study to assess the HCWs' stress after the pandemic. HCWs should consider merging each of the coping strategies to balance work and lifestyle in pandemic situations