Charintip Somprasit

The association between perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant Thai women.

CONTEXT Thyroid hormone is critical for fetal neurodevelopment. Perchlorate and thiocyanate decrease thyroidal iodine uptake by competitively inhibiting the sodium/iodide symporter. It is clear that perchlorate and thiocyanate anions can influence thyroid function. However, as pollutants in the environment, their impact is conflicting. OBJECTIVE The objective was to determine the effects of environmental perchlorate and/or thiocyanate exposure on thyroid function in first-trimester pregnant women. DESIGN AND PATIENTS A cross-sectional study was conducted in 200 pregnant Thai women with a gestational age of 14 weeks or less. MEASURES Urinary iodide, perchlorate, thiocyanate, and serum thyroid function tests were measured. RESULTS The women were aged 28.6 ± 6.1 years and the mean gestational age was 9.6 ± 2.7 weeks. Median urinary iodide, perchlorate, and thiocyanate concentrations were 153.5 μg/L, 1.9 μg/L, and 510.5 μg/L, respectively. Using Spearmans rank correlation analyses, there were positive correlations between serum TSH and urine perchlorate to creatinine (r = 0.20, P = .005) and TSH and thiocyanate to creatinine ratios (r = 0.22, P = .001). There were negative correlations between free T4 and the perchlorate to creatinine ratio (r = -0.18, P = .01) and free T4 and the thiocyanate to creatinine ratio (r = -0.19, P = .008). In multivariate analyses adjusting for log thiocyanate to creatinine ratio, log iodide to creatinine ratio, and gestational age, log perchlorate to creatinine ratio was positively associated with log TSH (P = .002) and inversely associated with log free T4 (P = .002). Log thiocyanate to creatinine ratio was a significant positive predictor of log TSH (P = .02) in women with a urine iodide level of less than 100 μg/L. CONCLUSIONS Low-level environmental exposure to perchlorate and thiocyanate is common in Thailand. Low-level exposure to perchlorate is positively associated with TSH and negatively associated with free T4 in first-trimester pregnant women using multivariate analyses. In multivariate analyses, thiocyanate exposure is also positively associated with TSH in a subgroup of pregnant women with low iodine excretion.

Maternal vitamin D status, its associated factors and the course of pregnancy in Thai women

There are limited data on the prevalence of vitamin D inadequacy in pregnant women living in Southeast Asia and changes in their vitamin D status during pregnancy.

A Cross-sectional Study of Resting Cardio-respiratory and Metabolic Changes in Pregnant Women

[Purpose] We examined cardiorespiratory and metabolic changes across the 1st (G1), 2nd (G2) and 3rd (G3) trimesters in pregnant women. [Subjects and Methods] Forty-two healthy, active, non-smoking, pregnant women participated in this study. They were divided into G1, G2 and G3 groups depending on their mean gestational ages at the time of testing which were 10.5 ±2.9, 19.2 ±3.4, and 33.3 ±2.4 weeks of gestation, respectively. Cardio-respiratory and metabolic variables, VO2 (oxygen consumption), VCO2 (carbon dioxide production), and VE (minute ventilation), were measured using indirect calorimetry (IC, gas analyser) to estimate ventilatory equivalents of oxygen (VE/VO2) and carbon dioxide (VE/VCO2), RER (respiratory exchange ratio) and REE (resting energy expenditure). [Results] Women in the late pregnancy period had higher resting VCO2 and RER, whereas the VE/VCO2 ratio was significantly lower than in G1 and in G2. Even though the values of VO2 and REE increased throughout the course of pregnancy, no significant differences were found. [Conclusion] In pregnant women, resting cardiorespiratory and metabolic variables continuously changed throughout the 3 trimesters. Changes in VE/VCO2 and RER indicate shifting metabolic energy substrates. In addition, changes in cardiorespiratory variables, in parallel with gas exchange, indicate a better gas exchange process.

Antimullerian Hormone Changes after Laparoscopic Ovarian Cystectomy for Endometrioma Compared with the Nonovarian Conditions

Laparoscopic ovarian cystectomy is recommended for surgical procedure of endometrioma. The negative impact on ovarian reserve following removal had been documented. Little evidence had been reported for nonovarian originated effects. Objective. To evaluate the impact of laparoscopic ovarian cystectomy for endometrioma on ovarian reserve, measured by serum antimullerian hormone (AMH), compared to nonovarian pelvic surgery. Materials and Methods. A prospective study was conducted. Women who underwent laparoscopic ovarian cystectomy (LOC) and laparoscopic nonovarian pelvic surgery (NOS) were recruited and followed up through 6 months. Clinical baseline data and AMH were evaluated. Results. 39 and 38 participants were enrolled in LOC and NOS groups, respectively. Baseline characteristics (age, weight, BMI, and height) and preoperative AMH level between 2 groups were not statistically different. After surgery, AMH of both groups decreased since the first week, at 1 month and at 3 months. However, as compared to the LOC group at 6 months after operation, the mean AMH of the NOS group had regained its value with a highly significant difference. Conclusion. This study demonstrated the negative impact of nonovarian or indirect effects of laparoscopic surgery to ovarian reserve. The possible mechanisms are necessary for more investigations.

Transvaginal color Doppler study of uterine artery: Is there a role in chronic pelvic pain?

Aim:  To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP).

Possibility of using superoxide dismutase and glutathione peroxidase as endometriosis biomarkers

Objective To study the possibility of using superoxide dismutase (SOD) and glutathione peroxidase (GPx) as combined preoperative biomarkers for endometriosis. Participants and methods Female patients aged between 18 and 45 years old who came to the Gynecology outpatient clinic, Thammasat University Hospital, during September 2013–2016 with the complaint of gynecologic symptoms suspected of endometriosis, and who were positively diagnosed with endometriosis, were included in this study. All patients underwent conservative laparoscopic ovarian cystectomy with histopathological report. The control group consisted of healthy females of reproductive age who came to the outpatient clinic. The plasma SOD and GPx were measured from blood samples with commercial kits. A receiver operating characteristic curve was generated for plasma activity of SOD, GPx, and combined tests. The cutoff values were selected at the most appropriate sensitivity and specificity. Result All 36 cases were included in this study. Mean ages of patients in the patient and control groups were 33.1 and 28.6 years old, respectively. SOD and GPx activities of disease and control group were 6.15 and 8.11, 463.9 and 472.34 nmole/min/mL unit, respectively. The sensitivity and 1–specificity of the combined test were calculated at 0.78, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value being 68.75, 80.77, 76.50, 69.23, and 80.33, respectively. Conclusion A combination testing of SOD and GPx can possibly be used as preoperative biomarker for endometriosis.

P01.05: The value of middle cerebral artery‐umbilical artery pulsatility index ratio in prediction of severe fetal growth restriction

There were classified patients into 2 groups, group 1 with normal MCA/UA PI ratio (MCA/UA PI > 1.08) and group 2 with abnormal MCA/UA PI ratio. Adverse perinatal outcome as neonatal intensive care unit admission, Apgar score at 1 min < 7, need for ventilators, respiratory distress syndrome and need for blood transfusion were compared between 2 groups. Results: Of the 54 pregnancies in this study, 37 patients (68.5%) were classified into group 1 and 17 patients (31.5%) into group 2. There were significantly higher adverse perinatal outcome in group 2 (P values < 0.05). Conclusions: IUGR fetuses with abnormal MCA/UA PI ratio suffered more morbidity than with normal MCA/UA PI ratio. The MCA/UA ratio is a good predictor of adverse perinatal outcome.

P01.04: Cerebroplacental pulsatility ratio predicts perinatal outcome in IUGR fetuses

Objectives: To investigate the relationship between unexplained elevated MSAFP and adverse pregnancy outcomes in our population. Methods: A retrospective cohort study was conducted by reviewing all triple test results that were positive for neural tube screening. Results: We identified 53 women with raised mid trimester MSAFP > 2.5 multiples of median (MoM) between July 2007 to December 2009. Of these, 12 cases were excluded from the study because of presence of structural fetal abnormalities and 3 cases were lost to follow-up. Of the remaining 38 pregnancies with unexplained raised MSAFP, 10 (26%) cases were associated with poor fetal outcome. These included spontaneous second trimester miscarriage (n = 2), preterm rupture of membranes (n = 2), intrauterine fetal growth restriction (n = 5), and stillbirth (n = 1). Maternal complications included recurrent antepartum bleed (n = 1) and severe preeclampsia (n = 1). Conclusions: Our findings reiterate that unexplained raised MSAFP is associated with significantly high rate of adverse pregnancy outcome and warrants close monitoring with regular antenatal checks and serial growth scans.

P24.08: Correlation of fetal Doppler flow and perinatal outcomes in patient with preeclampsia

Objectives: The Umbilical Vein (UV) has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been describedin severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsation could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intrapartum hypoxia. Methods: In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CTG) and 26 fetuses with abnormal CTGs (GA > 37 w and cervical dilatation > 3 cm). Perinatal outcome was assessed according to presence or absence of UV pulsations. Results: The 2 groups were comparable. (GA, cervical dilatation, Umbilical artery PH, S/D ratio, PI and RI) Intraabdominal UV pulsation were present in 6 (23.1%) of abnormal CTG and none of normal CTG group. (P = 0.005) Five of 6 (83.3%) fetuses with UV pulsation under went cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score < 7 was more in fetuses with UV pulsations (16.7% vs. 5%) although not significant. NICU admission was considerably more in UV pulsation group. (33% vs. 5%, P = 0.123) After exclusion of LBW fetuses the UV pulsation was present in 4(19%) of abnormal CTG group, who 3 of them under went cesarean section. Neither umbilical artery PH < 7 nor Apgar score < 7 or NICU admission were seen in these 4 neonates. Conclusions: Pulsation in UV was seen in 23% of fetuses with abnormal CTG during intrapartum period. Cesarean delivery and NICU admission was increased in fetuses with UV pulsations, although not statisticly significant. When LBW fetuses were excluded no case of U/A PH < 7, Apgar score < 7 or NICU admission were seen.

P46.11: Changes of the ductus venosus in intrauterine growth restriction fetuses during maternal hyperoxygenation

of fetal deterioration. Abnormal DV flow patterns have been associated with adverse fetal outcomes and increased perinatal mortality. We describe pathological ductus venosus waveforms with intermittent reverse-flow in the presence of otherwise normal Doppler measurements in severely growth-restricted fetuses with normal echocardiography. Methods: We performed repeated detailed fetal monitoring including Doppler and CTG in two cases with severe IUGR from 26 weeks of gestation onwards. Perinatal outcome was obtained in both cases. Results: Fetal size was below the 3rd percentile (abdominal circumference) in both cases. There were no signs of fetal abnormalities and no chromosomal abnormalities. Doppler measurements revealed a markedly increased uterine resistance in both cases. However, umbilical artery and fetal arterial Doppler were normal at the beginning of the monitoring period. Computerized CTG analysis registered normal short-term variations. DV waveforms showed considerable variation in the pulsatility index including intermittent reverse flow during atrial contraction in the first case, and persistent reverse or zero flow during atrial contraction in the second case. Over the course of several weeks we observed a flattening of the fetal growth curve and arterial redistribution. In both cases elective Cesarean section was performed at 37 and 33 weeks of gestation with birthweights of 1604 g and 690 g, respectively. The infants were admitted to the neonatal ICU for further management. Conclusion: While we still strongly believe that the flow measurements of the ductus venosus are an important and useful indicator of the fetal situation, these cases are an example of rare exceptions in which the pathology of the DV should not be interpreted as a sign of fetal decompensation, if other fetal Doppler findings are contradictory.