Somsri Pitukkijronnakorn

Maternal and perinatal outcomes in pregnancy with acute pyelonephritis

Acute pyelonephritis during pregnancy is the most serious complication of pregnancy that may result in significant maternal and fetal morbidity. It has an incidence of approximately 1—2% during pregnancy. Women with acute pyelonephritis during pregnancy may sustain significant complications such as preterm labor sepsis and shock. The aim of this study was to assess maternal and perinatal outcomes of the patient with acute pyelonephitis during pregnancy compared with control group. The study group was pregnant women with acute pyelonephritis. The control group was randomized by computer which selected pregnant women who delivered in the same period. Subsequent complications and outcome of the index pregnancy were analyzed in both groups. Statistical analysis was performed by using chi-square test and Fisher’s exact test. A P-value of b 0.05 was considered significant. During May 1994 and April 2002 55621 pregnant women were delivered at Ramathibodi Hospital. (excerpt)

Doctors' attitudes towards invasive prenatal diagnosis

Aim:  To assess the influence of a doctors gender, age group, religion and invasive prenatal diagnosis (PND) knowledge on their attitude towards invasive PND.

P29.08: Prediction of fetal macrosomia by measured fetal abdominal subcutaneous tissue thickness in term pregnancy

median measures were increased when compared with the published normal ranges. There was evidence of an upward shift of body composition measures at both 28 weeks’ and 36 weeks’ gestation, for MTFM, MTLM and SSFM, when considering the proportion of measures falling within the 5th and 95th percentile ranges. At 28 weeks’ and 36 weeks’ gestation, maternal BMI category did not significantly influence fetal body composition measures. In contrast, GWG significantly influenced fetal body composition, with higher weight gain being associated with higher measures of fetal fat mass, but not lean mass. At 28 weeks’ and 36 weeks’ gestation, there was a significant relationship between fetal body composition and infant birthweight. Conclusions: Maternal overweight and obesity is associated with a significant increase in fetal measures of both lean and fat mass.

OP32.04: Preinduction transvaginal ultrasonographic cervical assessment in predicting of successful labour induction

Objectives: Using a dedicated novel software (SonoVCAD labor), we analyzed 3D-volumes of fetal head just prior attempted instrumental delivery in theatre to see if we can define a ‘cut-off value’ based on various sonographic parameters that would predict a successful vaginal birth. Methods: We performed an offline analysis of 11 fetal head volumes stored immediately prior attempted instrumental delivery using GEs novel 3D software ‘SonoVCAD labor’. We related head direction angle, midline angle, progression distance and angle of progression with the success or failure to achieve vaginal birth. Results: Four out 11 women had Caesarean section (two without trial and two following failed trial). Seven women had successful instrumental delivery. Head direction angle of > 95 degrees was associated with successful vaginal birth. All cases that ended with Caesarean section had head direction angle of less than 95 degrees. For angle of progression, a cut off of 160 degrees or more predicted successful outcome for all cases. All cases with CS had angle of progression < 160 degrees. As regards progression distance, all cases with vaginal birth had distance > 60 mm prior to delivery. However, one woman who ended with CS had distance of 44 mm. Midline angle ranged from 28–148 degrees and did not predict the outcome in women with CS. Conclusions: Head direction angle > 95 degrees and angle of progression > 160 were predictors of successful instrumental delivery. The midline angle and progression distance did not correlate well with the outcome of the trial. We will continue analyzing these parameters in future cases to assess their diagnostic accuracy. Given this is a relatively new technique, more data are needed to elucidate the clinical contribution of this new tool and the best way to use it.

P47.07: Doctor attitude towards invasive prenatal diagnosis

Aims: To document the types of major fetal malformations present in pre-gestational diabetic women in pregnancy and the rate of antenatal diagnosis by second trimester ultrasound. Methods: Pre-gestational diabetes was defined as either type 1 or type 2 diabetes which had been diagnosed at least 1 year before the mothers estimated date of delivery (EDD). Data was collected any time from booking to delivery between 1 March 2002 and 28 February 2003, and followed through to include the outcome of the baby at 28 days postnatally. Major anomalies were coded according to the 10th revision of the International Classification of Diseases (ICD10). Results: The major congenital malformation rate is 82.1/1000 births. There were 29 major congenital anomalies in pregnancies beyond 16 weeks’ gestation and all of these had a second trimester fetal ultrasound scan. In 17 cases the anomalies were diagnosed antenatally (16 by ultrasound and 1 by amniocentesis) and in 12 cases the scan was reported as normal. Therefore the antenatal major congenital malformation detection rate is 59% in pregnancies beyond 16 weeks’ gestation. Congenital cardiac defects remain the most commonly occuring anomalies in diabetic pregnancies (11/29 malformations). Major central nervous system defects, as in the national dataset, are also over-represented. The nature of the anomalies undiagnosed was varied, ranging from hypoplastic left heart to hypospadias. However all of these cases with the exception of a case of facial dysmorphia, hypospadias and two cases of trisomy 21 might have been expected to have been detected by detailed fetal anomaly and cardiac scanning at 20–22 weeks’ gestation. Even allowing for these cases 40% of major malformations were undiagnosed antenatally. Conclusions: All women with pre-gestational diabetes should receive a detailed scan performed by a practitioner with at least UK RCR/RCOG Higher Level Obstetric scanning accreditation.