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Papers by Pharuhas Chanprapaph
Siriraj Medical Journal, 2022
Objective: To explore the effectiveness of Ayurved Siriraj Prasa-Nam-Nom (ASPNN) recipe on breast... more Objective: To explore the effectiveness of Ayurved Siriraj Prasa-Nam-Nom (ASPNN) recipe on breast milk production in early postpartum women. Methods: Fifty-four normal vaginal term delivery mothers who had inadequate milk volume were enrolled into this randomized, double-blind, placebo-controlled trial. All participants received ASPNN or placebo 1,500 mg three times/day for 3 days in the hospital and 7 days at home. Primary outcomes, including breast milk volume, %creamatocrit, and level of prolactin, were evaluated on day 1 and day 3. Satisfaction scores, adverse effects, and types of breastfeeding were also determined. Results: On day 3, milk volume was increased in both groups. The median volume of ASPNN group was 19 ml, while that of the placebo group was 30 ml. The median %creamatocrit of ASPNN and placebo group were 7.17% and 6.98%, respectively. Mean serum prolactin levels of ASPNN and placebo group were 321.76 + 114.23 ng/ml and 323.78 + 116.68 ng/ml, respectively. Although ...
Objective: To evaluate the correlation between lactating womenus breast size and breast milk prod... more Objective: To evaluate the correlation between lactating womenus breast size and breast milk production. Methods: 53 normal primiparous women with neither breastfeeding problems nor having drugs that affected milk production who delivered vaginally at Siriraj Hospital, Bangkok, Thailand were enrolled. On the 3rd day after delivery, breast size and breast milk volume were recorded by the same investigator at 3 hr after the last breastfeeding. Results: The means of breast size and breast milk volume in this study were 13.5 ± 3.7 cm and 47.8 ± 18.3 ml, respectively. Regarding to the Pearson correlation test, breast milk volume had no significant correlation with breast size (rs= -0.112, p > 0.05), but showed a negative correlation with the maternal age (rs= -0.27, p < 0.05). Conclusion: There is no significant correlation between breast milk volume and breast size. The small breast size woman should be counseled and reassured to get more confidence in breast feeding.
Objectives: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurem... more Objectives: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurements and study the duration of measurements. Subjects: One hundred and forty-seven singleton pregnant women with 10–14 weeks of gestation who had attended antenatal clinic during January 1st, 2000–August 31st, 2001 were included. Methods: Crown-rump length and NT were measured three times for each woman. Then, another examiner who was unaware of the previous results did the other three measurements. The duration of measurements was recorded. Intra-observer and inter-observer variations were analyzed by repeated ANOVA and paired t test, respectively. The correlation of NT measurements within each observer and between paired observers was evaluated by intraclass correlation coefficients (ICC). Kappa statistic was calculated for agreement. Results: Intra-observer variation of all 10 examiners at three institutes was varied from 0.20 ± 0.27 to 0.33 ± 0.41 mm. Inter-observer variation at Chia...
OBJECTIVE To assess the prevalence of GDM in GCT screened women at Maharaj Nakorn Chiang Mai Hosp... more OBJECTIVE To assess the prevalence of GDM in GCT screened women at Maharaj Nakorn Chiang Mai Hospital. STUDY DESIGN Retrospective descriptive study. SETTING Department of Obstetric and Gynecology, Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD One thousand pregnant women who attended the antenatal care clinic and delivered at Maharaj Nakorn Chiang Mai Hospital from October 2001 to December 2002 were recruited into the study. Glucose challenge test (GCT), 50-g glucose oral load with 1-hr plasma glucose measurement, was performed in GDM high-risk pregnancies. If GCT was positive, oral glucose tolerance test (OGTT), 100-g glucose orally, was done to confirm the final diagnosis. All relevant data including demographic information, previous obstetric history, risk factors for GDM, GCT and OGTT results and pregnancy outcomes were collected for further statistical analysis. MAIN OUTCOME MEASURES Prevalence of GDM in GCT screened women, obstetric complications and pregnancy outcome...
Objective : To compare the success rate of amniocentesis between model trained and non-model trai... more Objective : To compare the success rate of amniocentesis between model trained and non-model trained groups. Methods: Siriraj amniocentesis simulator was practiced by 5 inexperienced obstetric residents. Forty aspirations of red solution from the targeted balloons using spinal needle number 20-G under the ultrasound guidance were performed. Thereafter, each trainee was allowed to perform the real amniocentesis under an expert supervision within a 5-minute period. Amniocentesis success rate of previous 5 non-model trained residents was retrospectively reviewed and considered as the control group. Results: A comparison between each group was done to evaluate the success rate. There were 31 and 29 of amniocenteses performed by a model trained and non-model trained groups, respectively. In comparison, the former had a non-significantly higher success rate (96.8% vs 82.2%; p > 0.05) with a significantly shorter operating time (34.27 + 21.7 vs 73.38 + 68.5 seconds; p < 0.05) than t...
American Journal of Roentgenology
BACKGROUND. The "placental bulge" sign (focal area of myometrial-placental bulging beyond the nor... more BACKGROUND. The "placental bulge" sign (focal area of myometrial-placental bulging beyond the normal uterine contour) on ultrasound (US) or MRI is postulated to represent deeper venous invasion in placenta accreta spectrum (PAS) disorder and may represent severe PAS. OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance and interobserver agreement of US and MRI features for diagnosis of severe PAS, with an emphasis on the placental bulge sign. METHODS. This retrospective study included 62 pregnant women (mean age, 33.2 ± 5.5 [SD] years) with clinically suspected PAS who underwent both US and MRI. Five readers (two maternal-fetal medicine specialists for US, three abdominal radiologists for MRI) independently reviewed images for the given modality, blinded to the final diagnosis, and recorded the presence of a range of findings (nine on US, eight on MRI), including placental bulge. Intraoperative and pathologic findings were used to separate patients into those with and without severe PAS according to International Federation of Gynecology and Obstetrics classification. Diagnostic performance of US and MRI findings for severe PAS was evaluated, multivariable logistic regression was performed, and interobserver agreement was assessed. RESULTS. A total of 58.1% (36/62) of patients had severe PAS. On US, the finding with the highest accuracy for severe PAS was placental bulge (85.5%), which had a sensitivity of 91.7% and specificity of 76.9%. On MRI, the finding with highest accuracy was also placental bulge (90.3%), which had a sensitivity of 94.4% and specificity of 84.6%. In the multivariable regression analysis, placental bulge was an independent predictor of severe PAS on US (odds ratio [OR], 8.94; p = .02) and MRI (OR, 45.67; p = .003). Interobserver agreement analysis showed a kappa value for placental bulge of 0.48 for MRI and 0.40 for US. Given wide 95% CIs, differences among features for a given modality and differences between modalities were not statistically significant. CONCLUSION. The findings suggest a strong performance of placental bulge in diagnosing severe PAS on both US and MRI, with a potentially stronger performance on MRI. Nonetheless, interobserver agreement remains suboptimal for both modalities. CLINICAL IMPACT. Accurate prenatal diagnosis of severe PAS by imaging could help guide maternal counseling and selection of either hysterectomy or uterine-preserving surgery.
Journal of Health Research
PurposeThe purpose of this study was to explore the experiences of adolescent mothers who wean th... more PurposeThe purpose of this study was to explore the experiences of adolescent mothers who wean their babies from breastfeeding before the first six months from the perspective of a psychosocial aspect in the Thai context.Design/methodology/approachA descriptive qualitative design was applied to this study to obtain meaningful data. The adolescent mothers for the primary study and nine supplementary participants were recruited from the largest university hospital in Bangkok, Thailand. Semi-structured in-depth interviews were conducted with 20 adolescent mothers. Descriptive statistics and content analysis were used for data analysis.FindingsThe average breastfeeding duration was 3.1 months while breastfeeding exclusively lasted 1.3 months. More than half of the adolescent mothers encountered breastfeeding problems at hospitalization including sore/cracked nipples (63.6%), one side breastfeeding (27.3%) and exhaustion (9.1%). According to the content analysis, (1) breastfeeding obstac...
Breastfeeding Medicine
Lactation often affects calcium metabolism and induces bone loss. Calcium supplementation and a h... more Lactation often affects calcium metabolism and induces bone loss. Calcium supplementation and a high calcium diet are recommended to prevent bone loss, especially during inadequate calcium intake. Our study aimed at determining bone loss in breastfeeding mothers, and if it occurred, whether it was site specific and there were correlations between serum bone turnover markers. Since the 6-month exclusive breastfeeding is usually recommended in several countries, our study examined bone mineral density (BMD) in early (1-2 month), mid (3-4 month)-, and late (5-6 month) lactation compared with nonpregnant, nonlactating control women. Site-specific bone loss was monitored in lumbar vertebrae and femora. Bone turnover markers, that is, C-terminal telopeptide of type 1 collagen and N-terminal propeptide of type 1 collagen (P1NP), were determined by electrochemiluminescence immunoassays. The onset of bone loss in exclusive breastfeeding mothers was site specific, for example, in the lumbar bone at mid-lactation and in the femoral bone in late lactation. Serum ionized calcium levels in late lactation were lower than the normal levels. In addition, a correlation was found between bone turnover marker, P1NP, and femoral BMD. The onset of bone loss in exclusive breastfeeding mothers was site specific, and the lumbar bone was a vulnerable and perhaps better representative site for bone loss detection. It was suggested that the optimal starting time for calcium supplementation should be before the mid-lactation when the bone loss was observed. In addition, the biochemical marker that best predicted the onset of bone loss in lactating women was P1NP.
Journal of Ultrasound in Medicine
ABSTRACT The objective of this study is to evaluate the efficacy of sonographic cardiothoracic ra... more ABSTRACT The objective of this study is to evaluate the efficacy of sonographic cardiothoracic ratio at midpregnancy in predicting fetal hemoglobin Bart disease. Among 17,254 pregnant women screened for severe thalassemia between June 1994 and November 1998, 345 pregnant women at risk for having a fetus with hemoglobin Bart disease underwent ultrasonographic examination and cordocentesis at 18 to 21 weeks&#39; gestation. Before cordocentesis, the cardiothoracic ratio was determined and recorded. The definite fetal diagnosis was based on fetal blood analysis with high performance liquid chromatography. Among 345 pregnancies in which sonographic examination and cordocentesis were performed, 70 fetuses were affected by hemoglobin Bart disease. The mean cardiothoracic ratio was significantly higher than that of unaffected fetuses (0.55 versus 0.45, Student&#39;s t-test, P&lt;0.001). The sensitivity and specificity of the cardiothoracic ratio in prediction were calculated for various cutoff values. On the basis of the receiver operating characteristic curve, the best cutoff value was 0.50 (greater than 0.50 considered abnormal), giving the sensitivity of 98.6% and a specificity of 98.9%. In conclusion, the cardiothoracic ratio has very high accuracy in predicting hemoglobin Bart disease in pregnancies at risk. This finding suggests that invasive diagnostic method should be reserved for only the fetuses who have a cardiothoracic ratio of 0.5 or more; however, further studies are needed to confirm this observation.
Chot Mai Het Thang Phaet, 2002
Journal of Nursing Science, Dec 20, 2014
The objective of this study was to investigate the predictive power of personal factors (age, pre... more The objective of this study was to investigate the predictive power of personal factors (age, previous breastfeeding experience, attitude toward breastfeeding and self-efficacy), first feeding time and nurse support on successful exclusive breastfeeding at discharge in mothers with cesarean section. Design: Predictive research design. Methods: The subject consisted of 110 mothers with cesarean section in postpartum units at Siriraj Hospital. Data were collected by the personal data Interviewing form, the pregnancy and delivery data records, the Iowa Infant Feeding Attitude Scale, the Breastfeeding Self-Efficacy Scale-Short Form, the Nurse Support Questionnaire and the Baby-Feeding Records. Percentage, mean, standard deviation, median, and logistic regression were used in data analysis. Main findings: The findings revealed that maternal age [Exp (B) = 1.102, 95%CI = 1.009-1.203], nurse support [Exp (B) = 1.089, 95%CI = 1.021-1.161] and first feeding time [Exp (B) = 0.890, 95%CI = 0.821-0.965] could explain 36.5% (R 2 = 0.365, p < 0.05) of the variance in successful breastfeeding at discharge in mothers with cesarean section. Conclusion and recommendations: The results suggest that nurses should protect, promote and support breastfeeding in mothers with cesarean section by providing assistance and support with early breastfeeding especially in young mothers.
Journal of Obstetrics and Gynaecology Research
Objective To develop non-invasive testing for fetal haemoglobin disorders including β-thalassaemi... more Objective To develop non-invasive testing for fetal haemoglobin disorders including β-thalassaemia and sickle cell anemia using maternal plasma. Methods D21S11 STR, AMGX, AMGY, sickle cell and β-thal. mutation (IVS1-25, IVS1-1, IVS1-110) genes were used to identify paternal allele in maternal plasma. The DNA samples from 12 informative families (father, mother, CVS) whose genotypes were already known were determined to predict the expected allele in maternal plasma. Fetal DNA was mainly extracted by the QIAamp blood kit. The 45-cycle, nested and hemi-nested PCR protocols using fluorescent labeled primers were applied for fetal DNA amplification. The beta-globin mutant alleles were detected by restriction endonuclease enzyme digestion. Gene analyzer was used to determine the end PCR product. Results In the D21S11 STR marker, there were 24 reactions of the 45 cycle PCR performed with the paternal allele detection rate of 12.5%. In the sickle cell and β-thal: IVS1-110 study, there were...
Objective: To demonstrate the average value of nipple length and diameter during the first and se... more Objective: To demonstrate the average value of nipple length and diameter during the first and second half of gestation in Thai pregnant women, as well as its association with breastfeeding success rate. Methods: A total of 140 pregnant women attending the ANC unit at Siriraj Hospital were enrolled into this study during April to July 2008. They were divided equally into 2 groups by gestational age of less than 20 weeks and between 20-40 weeks, respectively. Demographic data, nipple length and width, areola width and breastfeeding success rate of each participant was retrieved for statistical analysis. Results: The mean nipple lengths of the first and second half of pregnancy were 0.79 ± 0.20 cm and 0.80 ± 0.18 cm, respectively, which were not statistically different. There was also no difference between the left and right side. The nipple width was 1.11 ± 0.27 cm. by average which did not change between gestations. The areola width increased significantly by gestational age but the...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet
To determine the correlation between the rapid biophysical profile (rBPP), the combination of amn... more To determine the correlation between the rapid biophysical profile (rBPP), the combination of amniotic fluid index (AFI), and sound-provoked fetal movement (SPFM) detected by ultrasound, and the full biophysical profile (FBP) in terms of abnormal and normal result. A prospective study was performed in 200 singleton pregnancies with no fetal anomalies between 30-42 weeks of gestation indicated for non-stress test (NST). All participants received both the standard (FBP) and the new rBPP examinations. Abnormal fetal test was defined as having a score of < or = 6 for FBP or < or = 2 for rBPP. The main outcome measurement was Spearman's correlation coefficient (r) between both examinations. The incidences of the abnormal tests were 1.5% and 6.0% in FBP and rBPP, respectively. The data showed a positive correlation between the two tests (r(s) = 0.67; p < 0.01). Regarding the operative time, FBP assessment was 25.56 +/- 8.75 times longer than rBPP. The number of abnormal NST w...
Journal of perinatal medicine, Jan 13, 2014
Background: Multiple first trimester aneuploidy sonomarkers have been introduced recently. Object... more Background: Multiple first trimester aneuploidy sonomarkers have been introduced recently. Objective: To evaluate the efficacy of first trimester sonomarkers in fetal aneuploidy detection without serum markers. Methods: There were entirely 280 fetuses with 11-13+6 weeks' gestation (crown-rump -length between 45-84 mm) enrolled to assess nuchal translucency thickness (NT), nasal bone (NB), tricuspid regurgitation (TR) and ductus venosus (DV) flow. The performance of each single marker and multiple markers for major fetal aneuploidy screening were determined. Results: Totally, 190 fetuses (67.85%) underwent invasive prenatal diagnosis with 14 major chromosome abnormalities identified including 4 cases of trisomy 21, 4 cases of trisomy 18, 3 cases of trisomy 13 and 3 cases of 45, XO. NT was the most accurate single marker with sensitivity of 71.43% and false-positive rate (FPR) of 4.14% while NB or TR was the most specific marker (99.6%) but lacked sensitivity. Among multiple first...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004
Pre-eclampsia, formerly called pregnancy-induced hypertension, refers to the new onset of hyperte... more Pre-eclampsia, formerly called pregnancy-induced hypertension, refers to the new onset of hypertension (SBP > or = 140 mmHg or DBP > or = 90 mmHg) and proteinuria (> or = 0.3 g protein in a 24-hour urine specimen or 1+ on dipstick) after 20 weeks of gestation in a previously normotensive women. It is a life-threatening, multi-organ involvement disease and remains the leading cause of maternal death. Its clinical manifestations are the result of generalized vasospasm, activation of the coagulation system, and changes in several humoral and autoregulatory systems related to volume and blood pressure control. Pre-eclampsia is responsible for high perinatal mortality and morbidity rates, primarily due to early termination of pregnancy. Fetus growth restriction, oligohyrdramnios and non-reassuring fetal status are the consequences of chronic placental hypoperfusion. Pre-eclampsia does not appear to accelerate fetal maturation, as once believed. Delivery remains the definitive tr...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
To determine the correlation between actual birthweight (BW) and fetal weight calculated from fra... more To determine the correlation between actual birthweight (BW) and fetal weight calculated from fractional thigh volume (ThiV). The authors have conducted a prospective, cross-sectional study of normal Thai fetal thigh volume. There were 176 eligible pregnant women who met the criteria of singleton with no fetal anomaly were recruited into the present study. Prior to the present study, 3 operators had been trained and standardized for fractional ThiV measurement by an expert for the first 20 cases. To generate the fetal weight calculating formula, fetal ThiV data from the first 100 cases were employed Then, the authors' new prediction formula was compared and validated with the Hadlock's and the Tongsong formula in 56 normal late-third-trimester fetuses. All patients were assessed for 2D fetal biometry and 3D fractional ThiV within one week before delivery. A total of 176 fetuses underwent ultrasound at the gestational age of 38.5 +/- 2.1 weeks. The reproducibility of fraction...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
To assess the specificity of tricuspid regurgitation (TR) in prediction of Down syndrome in Thai ... more To assess the specificity of tricuspid regurgitation (TR) in prediction of Down syndrome in Thai fetuses at 17-23 weeks' gestation and to determine the prevalence of TR among normal chromosome fetuses in a high-risk population. A prospective study was performed in 395 high-risk pregnant women who underwent amniocentesis or cordocentesis for fetal karyotyping at 17-23 weeks. The presence or absence of TR was determined by pulsed wave Doppler at the time of prenatal diagnosis. TR was diagnosed when the regurgitation flow was observed for at least half of systole or > or = 70 milliseconds with maximum velocity of > or = 100 cm/sec. The diagnostic values of TR for detection of Down syndrome were calculated. The prevalence of TR was 3.8% (14/370) in normal chromosome fetuses and 40% (2/5) in Down syndrome fetuses. Fetuses with TR had a higher chance to be Down syndrome (11.1%) than those without TR (0.8%) (95% CI of the difference, 0.09-32.9, p = 0.036). Specificity, sensitivit...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
To evaluate manual fetal stimulation (MST) through the maternal abdomen in comparison to standard... more To evaluate manual fetal stimulation (MST) through the maternal abdomen in comparison to standard nonstress test (NST) in terms of nonreactive rates and testing time. Five hundred and forty high-risk singleton pregnancies at 28 gestational weeks or more were assigned to have either NST or MST using blocked randomization (270 each). All fetal heart rate (FHR) tracings were analyzed blindly using standard NST criteria by one perinatologist. The MST group provided a significantly higher reactive rate than that of the NST group, 98.9% and 84.4% respectively, p < 0.001. Mean testing time of the reactive results of the MST group was also significantly shorter than that of the NST group, 7.94 +/- 6.27 min and 13.91 +/- 9.58 min respectively, p < 0.001. This is the first randomized controlled trial (RCT) to demonstrate the distinctive benefit of the simple and less expensive MST. MST significantly reduces the time to reactivity and increases the frequency of reactivity when compared t...
Siriraj Medical Journal, 2022
Objective: To explore the effectiveness of Ayurved Siriraj Prasa-Nam-Nom (ASPNN) recipe on breast... more Objective: To explore the effectiveness of Ayurved Siriraj Prasa-Nam-Nom (ASPNN) recipe on breast milk production in early postpartum women. Methods: Fifty-four normal vaginal term delivery mothers who had inadequate milk volume were enrolled into this randomized, double-blind, placebo-controlled trial. All participants received ASPNN or placebo 1,500 mg three times/day for 3 days in the hospital and 7 days at home. Primary outcomes, including breast milk volume, %creamatocrit, and level of prolactin, were evaluated on day 1 and day 3. Satisfaction scores, adverse effects, and types of breastfeeding were also determined. Results: On day 3, milk volume was increased in both groups. The median volume of ASPNN group was 19 ml, while that of the placebo group was 30 ml. The median %creamatocrit of ASPNN and placebo group were 7.17% and 6.98%, respectively. Mean serum prolactin levels of ASPNN and placebo group were 321.76 + 114.23 ng/ml and 323.78 + 116.68 ng/ml, respectively. Although ...
Objective: To evaluate the correlation between lactating womenus breast size and breast milk prod... more Objective: To evaluate the correlation between lactating womenus breast size and breast milk production. Methods: 53 normal primiparous women with neither breastfeeding problems nor having drugs that affected milk production who delivered vaginally at Siriraj Hospital, Bangkok, Thailand were enrolled. On the 3rd day after delivery, breast size and breast milk volume were recorded by the same investigator at 3 hr after the last breastfeeding. Results: The means of breast size and breast milk volume in this study were 13.5 ± 3.7 cm and 47.8 ± 18.3 ml, respectively. Regarding to the Pearson correlation test, breast milk volume had no significant correlation with breast size (rs= -0.112, p > 0.05), but showed a negative correlation with the maternal age (rs= -0.27, p < 0.05). Conclusion: There is no significant correlation between breast milk volume and breast size. The small breast size woman should be counseled and reassured to get more confidence in breast feeding.
Objectives: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurem... more Objectives: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurements and study the duration of measurements. Subjects: One hundred and forty-seven singleton pregnant women with 10–14 weeks of gestation who had attended antenatal clinic during January 1st, 2000–August 31st, 2001 were included. Methods: Crown-rump length and NT were measured three times for each woman. Then, another examiner who was unaware of the previous results did the other three measurements. The duration of measurements was recorded. Intra-observer and inter-observer variations were analyzed by repeated ANOVA and paired t test, respectively. The correlation of NT measurements within each observer and between paired observers was evaluated by intraclass correlation coefficients (ICC). Kappa statistic was calculated for agreement. Results: Intra-observer variation of all 10 examiners at three institutes was varied from 0.20 ± 0.27 to 0.33 ± 0.41 mm. Inter-observer variation at Chia...
OBJECTIVE To assess the prevalence of GDM in GCT screened women at Maharaj Nakorn Chiang Mai Hosp... more OBJECTIVE To assess the prevalence of GDM in GCT screened women at Maharaj Nakorn Chiang Mai Hospital. STUDY DESIGN Retrospective descriptive study. SETTING Department of Obstetric and Gynecology, Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD One thousand pregnant women who attended the antenatal care clinic and delivered at Maharaj Nakorn Chiang Mai Hospital from October 2001 to December 2002 were recruited into the study. Glucose challenge test (GCT), 50-g glucose oral load with 1-hr plasma glucose measurement, was performed in GDM high-risk pregnancies. If GCT was positive, oral glucose tolerance test (OGTT), 100-g glucose orally, was done to confirm the final diagnosis. All relevant data including demographic information, previous obstetric history, risk factors for GDM, GCT and OGTT results and pregnancy outcomes were collected for further statistical analysis. MAIN OUTCOME MEASURES Prevalence of GDM in GCT screened women, obstetric complications and pregnancy outcome...
Objective : To compare the success rate of amniocentesis between model trained and non-model trai... more Objective : To compare the success rate of amniocentesis between model trained and non-model trained groups. Methods: Siriraj amniocentesis simulator was practiced by 5 inexperienced obstetric residents. Forty aspirations of red solution from the targeted balloons using spinal needle number 20-G under the ultrasound guidance were performed. Thereafter, each trainee was allowed to perform the real amniocentesis under an expert supervision within a 5-minute period. Amniocentesis success rate of previous 5 non-model trained residents was retrospectively reviewed and considered as the control group. Results: A comparison between each group was done to evaluate the success rate. There were 31 and 29 of amniocenteses performed by a model trained and non-model trained groups, respectively. In comparison, the former had a non-significantly higher success rate (96.8% vs 82.2%; p > 0.05) with a significantly shorter operating time (34.27 + 21.7 vs 73.38 + 68.5 seconds; p < 0.05) than t...
American Journal of Roentgenology
BACKGROUND. The "placental bulge" sign (focal area of myometrial-placental bulging beyond the nor... more BACKGROUND. The "placental bulge" sign (focal area of myometrial-placental bulging beyond the normal uterine contour) on ultrasound (US) or MRI is postulated to represent deeper venous invasion in placenta accreta spectrum (PAS) disorder and may represent severe PAS. OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance and interobserver agreement of US and MRI features for diagnosis of severe PAS, with an emphasis on the placental bulge sign. METHODS. This retrospective study included 62 pregnant women (mean age, 33.2 ± 5.5 [SD] years) with clinically suspected PAS who underwent both US and MRI. Five readers (two maternal-fetal medicine specialists for US, three abdominal radiologists for MRI) independently reviewed images for the given modality, blinded to the final diagnosis, and recorded the presence of a range of findings (nine on US, eight on MRI), including placental bulge. Intraoperative and pathologic findings were used to separate patients into those with and without severe PAS according to International Federation of Gynecology and Obstetrics classification. Diagnostic performance of US and MRI findings for severe PAS was evaluated, multivariable logistic regression was performed, and interobserver agreement was assessed. RESULTS. A total of 58.1% (36/62) of patients had severe PAS. On US, the finding with the highest accuracy for severe PAS was placental bulge (85.5%), which had a sensitivity of 91.7% and specificity of 76.9%. On MRI, the finding with highest accuracy was also placental bulge (90.3%), which had a sensitivity of 94.4% and specificity of 84.6%. In the multivariable regression analysis, placental bulge was an independent predictor of severe PAS on US (odds ratio [OR], 8.94; p = .02) and MRI (OR, 45.67; p = .003). Interobserver agreement analysis showed a kappa value for placental bulge of 0.48 for MRI and 0.40 for US. Given wide 95% CIs, differences among features for a given modality and differences between modalities were not statistically significant. CONCLUSION. The findings suggest a strong performance of placental bulge in diagnosing severe PAS on both US and MRI, with a potentially stronger performance on MRI. Nonetheless, interobserver agreement remains suboptimal for both modalities. CLINICAL IMPACT. Accurate prenatal diagnosis of severe PAS by imaging could help guide maternal counseling and selection of either hysterectomy or uterine-preserving surgery.
Journal of Health Research
PurposeThe purpose of this study was to explore the experiences of adolescent mothers who wean th... more PurposeThe purpose of this study was to explore the experiences of adolescent mothers who wean their babies from breastfeeding before the first six months from the perspective of a psychosocial aspect in the Thai context.Design/methodology/approachA descriptive qualitative design was applied to this study to obtain meaningful data. The adolescent mothers for the primary study and nine supplementary participants were recruited from the largest university hospital in Bangkok, Thailand. Semi-structured in-depth interviews were conducted with 20 adolescent mothers. Descriptive statistics and content analysis were used for data analysis.FindingsThe average breastfeeding duration was 3.1 months while breastfeeding exclusively lasted 1.3 months. More than half of the adolescent mothers encountered breastfeeding problems at hospitalization including sore/cracked nipples (63.6%), one side breastfeeding (27.3%) and exhaustion (9.1%). According to the content analysis, (1) breastfeeding obstac...
Breastfeeding Medicine
Lactation often affects calcium metabolism and induces bone loss. Calcium supplementation and a h... more Lactation often affects calcium metabolism and induces bone loss. Calcium supplementation and a high calcium diet are recommended to prevent bone loss, especially during inadequate calcium intake. Our study aimed at determining bone loss in breastfeeding mothers, and if it occurred, whether it was site specific and there were correlations between serum bone turnover markers. Since the 6-month exclusive breastfeeding is usually recommended in several countries, our study examined bone mineral density (BMD) in early (1-2 month), mid (3-4 month)-, and late (5-6 month) lactation compared with nonpregnant, nonlactating control women. Site-specific bone loss was monitored in lumbar vertebrae and femora. Bone turnover markers, that is, C-terminal telopeptide of type 1 collagen and N-terminal propeptide of type 1 collagen (P1NP), were determined by electrochemiluminescence immunoassays. The onset of bone loss in exclusive breastfeeding mothers was site specific, for example, in the lumbar bone at mid-lactation and in the femoral bone in late lactation. Serum ionized calcium levels in late lactation were lower than the normal levels. In addition, a correlation was found between bone turnover marker, P1NP, and femoral BMD. The onset of bone loss in exclusive breastfeeding mothers was site specific, and the lumbar bone was a vulnerable and perhaps better representative site for bone loss detection. It was suggested that the optimal starting time for calcium supplementation should be before the mid-lactation when the bone loss was observed. In addition, the biochemical marker that best predicted the onset of bone loss in lactating women was P1NP.
Journal of Ultrasound in Medicine
ABSTRACT The objective of this study is to evaluate the efficacy of sonographic cardiothoracic ra... more ABSTRACT The objective of this study is to evaluate the efficacy of sonographic cardiothoracic ratio at midpregnancy in predicting fetal hemoglobin Bart disease. Among 17,254 pregnant women screened for severe thalassemia between June 1994 and November 1998, 345 pregnant women at risk for having a fetus with hemoglobin Bart disease underwent ultrasonographic examination and cordocentesis at 18 to 21 weeks&#39; gestation. Before cordocentesis, the cardiothoracic ratio was determined and recorded. The definite fetal diagnosis was based on fetal blood analysis with high performance liquid chromatography. Among 345 pregnancies in which sonographic examination and cordocentesis were performed, 70 fetuses were affected by hemoglobin Bart disease. The mean cardiothoracic ratio was significantly higher than that of unaffected fetuses (0.55 versus 0.45, Student&#39;s t-test, P&lt;0.001). The sensitivity and specificity of the cardiothoracic ratio in prediction were calculated for various cutoff values. On the basis of the receiver operating characteristic curve, the best cutoff value was 0.50 (greater than 0.50 considered abnormal), giving the sensitivity of 98.6% and a specificity of 98.9%. In conclusion, the cardiothoracic ratio has very high accuracy in predicting hemoglobin Bart disease in pregnancies at risk. This finding suggests that invasive diagnostic method should be reserved for only the fetuses who have a cardiothoracic ratio of 0.5 or more; however, further studies are needed to confirm this observation.
Chot Mai Het Thang Phaet, 2002
Journal of Nursing Science, Dec 20, 2014
The objective of this study was to investigate the predictive power of personal factors (age, pre... more The objective of this study was to investigate the predictive power of personal factors (age, previous breastfeeding experience, attitude toward breastfeeding and self-efficacy), first feeding time and nurse support on successful exclusive breastfeeding at discharge in mothers with cesarean section. Design: Predictive research design. Methods: The subject consisted of 110 mothers with cesarean section in postpartum units at Siriraj Hospital. Data were collected by the personal data Interviewing form, the pregnancy and delivery data records, the Iowa Infant Feeding Attitude Scale, the Breastfeeding Self-Efficacy Scale-Short Form, the Nurse Support Questionnaire and the Baby-Feeding Records. Percentage, mean, standard deviation, median, and logistic regression were used in data analysis. Main findings: The findings revealed that maternal age [Exp (B) = 1.102, 95%CI = 1.009-1.203], nurse support [Exp (B) = 1.089, 95%CI = 1.021-1.161] and first feeding time [Exp (B) = 0.890, 95%CI = 0.821-0.965] could explain 36.5% (R 2 = 0.365, p < 0.05) of the variance in successful breastfeeding at discharge in mothers with cesarean section. Conclusion and recommendations: The results suggest that nurses should protect, promote and support breastfeeding in mothers with cesarean section by providing assistance and support with early breastfeeding especially in young mothers.
Journal of Obstetrics and Gynaecology Research
Objective To develop non-invasive testing for fetal haemoglobin disorders including β-thalassaemi... more Objective To develop non-invasive testing for fetal haemoglobin disorders including β-thalassaemia and sickle cell anemia using maternal plasma. Methods D21S11 STR, AMGX, AMGY, sickle cell and β-thal. mutation (IVS1-25, IVS1-1, IVS1-110) genes were used to identify paternal allele in maternal plasma. The DNA samples from 12 informative families (father, mother, CVS) whose genotypes were already known were determined to predict the expected allele in maternal plasma. Fetal DNA was mainly extracted by the QIAamp blood kit. The 45-cycle, nested and hemi-nested PCR protocols using fluorescent labeled primers were applied for fetal DNA amplification. The beta-globin mutant alleles were detected by restriction endonuclease enzyme digestion. Gene analyzer was used to determine the end PCR product. Results In the D21S11 STR marker, there were 24 reactions of the 45 cycle PCR performed with the paternal allele detection rate of 12.5%. In the sickle cell and β-thal: IVS1-110 study, there were...
Objective: To demonstrate the average value of nipple length and diameter during the first and se... more Objective: To demonstrate the average value of nipple length and diameter during the first and second half of gestation in Thai pregnant women, as well as its association with breastfeeding success rate. Methods: A total of 140 pregnant women attending the ANC unit at Siriraj Hospital were enrolled into this study during April to July 2008. They were divided equally into 2 groups by gestational age of less than 20 weeks and between 20-40 weeks, respectively. Demographic data, nipple length and width, areola width and breastfeeding success rate of each participant was retrieved for statistical analysis. Results: The mean nipple lengths of the first and second half of pregnancy were 0.79 ± 0.20 cm and 0.80 ± 0.18 cm, respectively, which were not statistically different. There was also no difference between the left and right side. The nipple width was 1.11 ± 0.27 cm. by average which did not change between gestations. The areola width increased significantly by gestational age but the...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet
To determine the correlation between the rapid biophysical profile (rBPP), the combination of amn... more To determine the correlation between the rapid biophysical profile (rBPP), the combination of amniotic fluid index (AFI), and sound-provoked fetal movement (SPFM) detected by ultrasound, and the full biophysical profile (FBP) in terms of abnormal and normal result. A prospective study was performed in 200 singleton pregnancies with no fetal anomalies between 30-42 weeks of gestation indicated for non-stress test (NST). All participants received both the standard (FBP) and the new rBPP examinations. Abnormal fetal test was defined as having a score of < or = 6 for FBP or < or = 2 for rBPP. The main outcome measurement was Spearman's correlation coefficient (r) between both examinations. The incidences of the abnormal tests were 1.5% and 6.0% in FBP and rBPP, respectively. The data showed a positive correlation between the two tests (r(s) = 0.67; p < 0.01). Regarding the operative time, FBP assessment was 25.56 +/- 8.75 times longer than rBPP. The number of abnormal NST w...
Journal of perinatal medicine, Jan 13, 2014
Background: Multiple first trimester aneuploidy sonomarkers have been introduced recently. Object... more Background: Multiple first trimester aneuploidy sonomarkers have been introduced recently. Objective: To evaluate the efficacy of first trimester sonomarkers in fetal aneuploidy detection without serum markers. Methods: There were entirely 280 fetuses with 11-13+6 weeks' gestation (crown-rump -length between 45-84 mm) enrolled to assess nuchal translucency thickness (NT), nasal bone (NB), tricuspid regurgitation (TR) and ductus venosus (DV) flow. The performance of each single marker and multiple markers for major fetal aneuploidy screening were determined. Results: Totally, 190 fetuses (67.85%) underwent invasive prenatal diagnosis with 14 major chromosome abnormalities identified including 4 cases of trisomy 21, 4 cases of trisomy 18, 3 cases of trisomy 13 and 3 cases of 45, XO. NT was the most accurate single marker with sensitivity of 71.43% and false-positive rate (FPR) of 4.14% while NB or TR was the most specific marker (99.6%) but lacked sensitivity. Among multiple first...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004
Pre-eclampsia, formerly called pregnancy-induced hypertension, refers to the new onset of hyperte... more Pre-eclampsia, formerly called pregnancy-induced hypertension, refers to the new onset of hypertension (SBP > or = 140 mmHg or DBP > or = 90 mmHg) and proteinuria (> or = 0.3 g protein in a 24-hour urine specimen or 1+ on dipstick) after 20 weeks of gestation in a previously normotensive women. It is a life-threatening, multi-organ involvement disease and remains the leading cause of maternal death. Its clinical manifestations are the result of generalized vasospasm, activation of the coagulation system, and changes in several humoral and autoregulatory systems related to volume and blood pressure control. Pre-eclampsia is responsible for high perinatal mortality and morbidity rates, primarily due to early termination of pregnancy. Fetus growth restriction, oligohyrdramnios and non-reassuring fetal status are the consequences of chronic placental hypoperfusion. Pre-eclampsia does not appear to accelerate fetal maturation, as once believed. Delivery remains the definitive tr...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
To determine the correlation between actual birthweight (BW) and fetal weight calculated from fra... more To determine the correlation between actual birthweight (BW) and fetal weight calculated from fractional thigh volume (ThiV). The authors have conducted a prospective, cross-sectional study of normal Thai fetal thigh volume. There were 176 eligible pregnant women who met the criteria of singleton with no fetal anomaly were recruited into the present study. Prior to the present study, 3 operators had been trained and standardized for fractional ThiV measurement by an expert for the first 20 cases. To generate the fetal weight calculating formula, fetal ThiV data from the first 100 cases were employed Then, the authors' new prediction formula was compared and validated with the Hadlock's and the Tongsong formula in 56 normal late-third-trimester fetuses. All patients were assessed for 2D fetal biometry and 3D fractional ThiV within one week before delivery. A total of 176 fetuses underwent ultrasound at the gestational age of 38.5 +/- 2.1 weeks. The reproducibility of fraction...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
To assess the specificity of tricuspid regurgitation (TR) in prediction of Down syndrome in Thai ... more To assess the specificity of tricuspid regurgitation (TR) in prediction of Down syndrome in Thai fetuses at 17-23 weeks' gestation and to determine the prevalence of TR among normal chromosome fetuses in a high-risk population. A prospective study was performed in 395 high-risk pregnant women who underwent amniocentesis or cordocentesis for fetal karyotyping at 17-23 weeks. The presence or absence of TR was determined by pulsed wave Doppler at the time of prenatal diagnosis. TR was diagnosed when the regurgitation flow was observed for at least half of systole or > or = 70 milliseconds with maximum velocity of > or = 100 cm/sec. The diagnostic values of TR for detection of Down syndrome were calculated. The prevalence of TR was 3.8% (14/370) in normal chromosome fetuses and 40% (2/5) in Down syndrome fetuses. Fetuses with TR had a higher chance to be Down syndrome (11.1%) than those without TR (0.8%) (95% CI of the difference, 0.09-32.9, p = 0.036). Specificity, sensitivit...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
To evaluate manual fetal stimulation (MST) through the maternal abdomen in comparison to standard... more To evaluate manual fetal stimulation (MST) through the maternal abdomen in comparison to standard nonstress test (NST) in terms of nonreactive rates and testing time. Five hundred and forty high-risk singleton pregnancies at 28 gestational weeks or more were assigned to have either NST or MST using blocked randomization (270 each). All fetal heart rate (FHR) tracings were analyzed blindly using standard NST criteria by one perinatologist. The MST group provided a significantly higher reactive rate than that of the NST group, 98.9% and 84.4% respectively, p < 0.001. Mean testing time of the reactive results of the MST group was also significantly shorter than that of the NST group, 7.94 +/- 6.27 min and 13.91 +/- 9.58 min respectively, p < 0.001. This is the first randomized controlled trial (RCT) to demonstrate the distinctive benefit of the simple and less expensive MST. MST significantly reduces the time to reactivity and increases the frequency of reactivity when compared t...