Efficacy of cryoanalgesia in decreasing pain during second trimester genetic amniocentesis: a randomized trial

Objective

To evaluate the effectiveness of cryoanalgesia in decreasing the degree of pain sensation during second trimester genetic amniocentesis.

Materials and methods

We performed a prospective randomized study comparing the anticipated and actual pain before and after second trimester genetic amniocentesis between pregnant women who received and did not receive cryoanalgesia. The pain was measured using the visual analog score (VAS), ranging from 0 to 10.

Results

Three hundred and seventy-two pregnant women participated in our study. One hundred and eighty-four and 188 pregnant women were randomized to cryoanalgesia received and non-cryoanalgesia received groups, respectively. The pre-procedure anxiety mean VAS scores and the anticipated pain mean VAS scores between the groups were not significantly different (P?=?0.25 and 0.18, respectively). The pre-procedure anxiety and the anticipated pain mean?±?SD VAS scores in the cryoanalgesia and non-cryoanalgesia groups were 5.7?±?0.37 vs. 8.0?±?0.82 and 5.4?±?1.34 vs. 5.6?±?1.42, respectively. The post-procedure pain and anxiety mean VAS scores in the cryoanalgesia group were statistically less significant than those from the non-cryoanalgesia group (mean?±?SD?=?3.2?±?1.60 and 3.8?±?1.58, respectively, P?=?0.004). Most pregnant women claimed to have experienced moderate pain and accepted to undergo a second trimester genetic amniocentesis again if indicated.

Conclusion

Cryoanalgesia is effective in decreasing the pain sensation and could be routinely applied to all pregnant women before the second trimester genetic amniocentesis.     

Outcomes of multifetal pregnancies

AIM: To determine the outcomes of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. METHODS: A retrospective analysis was conducted of the information from medical records relating to all multifetal pregnancies. The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. RESULTS: There were 387 multifetal pregnancies during the study period, which was 1.3% of all the deliveries; 334 cases (86.3%) were spontaneous conceptions and 53 cases (13.7%) were the result of assisted reproductive therapy. Higher-order fetuses (> or =3) represented 8% of all multifetal pregnancies, 13% in the spontaneous group and 87% in the assisted group. The overall cesarean delivery rate was 73.9%. The assisted reproductive therapy group had a cesarean rate of 90.6% compared with 71.3% in the spontaneous group (P = 0.008). The assisted multifetal pregnancy group had more preterm labors and a longer maternal hospital stay than the spontaneous group. One maternal death occurred in the assisted group. The main causes of early neonatal death were prematurity, infection and congenital malformation. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, infection and longer hospital stay (6 days vs 15 days, P < 0.001). More complications occurred in higher-order fetuses than with twins. CONCLUSIONS: Assisted multifetal pregnancies were more likely to be delivered by cesarean section and had a higher rate of higher-order fetuses, preterm birth and neonatal prematurity-related complications with a longer hospital stay in both mothers and newborns, than spontaneous multifetal pregnancies.     

A Thai Reference for Normal Fetal Nasal Bone Length at 15 to 23 Weeks' Gestation

Objective. The purpose of this study was to establish a Thai reference for normal fetal nasal bone length at 15 to 23 weeks' gestation. Methods. The fetal nasal bone was measured by sonography in 295 pregnant women at 15 to 23 weeks' gestation from May to August 2005. One of the first 4 authors performed 3 measurements for each woman when the fetus was in the midsagittal plane and the nasal bone was close to a 45° or 135° angle to the ultrasound beam. All neonates were examined after delivery to confirm an absence of congenital abnormalities. Results. The median nasal bone length increased by gestational age from 3.6 mm at 15 weeks to 7.3 mm at 23 weeks in a linear relationship. The fifth percentile nasal bone lengths were 2.5, 3.04, 3.28, 3.64, 4.21, 4.82, 5.69, and 6.13 mm at 15, 16, 17, 18, 19, 20, 21, and 22 weeks, respectively. The median time for measurement was 5 minutes. Conclusions. The nasal bone length in Thai fetuses at 15 to 23 weeks was found to be on average shorter than that in white and African American fetuses.     

The Effects of EDTA on Blood Clot in Regenerative Endodontic Procedures

Introduction

In regenerative endodontic procedures (REPs), a blood clot acts as a natural scaffold for regenerating dental pulp tissue. In current protocols, 17% EDTA is recommended for liberating growth factors from root dentin. Although EDTA affects clot formation in periodontal studies, the anticoagulant effect of EDTA has not been shown in REPs. Therefore, this study aimed to evaluate the effects of 17% EDTA on the characteristics and fiber density of blood clots using in vitro dentin blocks.

Variability of nuchal translucency measurement: a multicenter study in Thailand

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 Chiang Mai University was 0.40 +/- 0.37 mm which was the highest value compared with those at Prince of Songkla and Khon Kaen University (p < 0.05). The mean duration of measurements was in range of 8-12 min. The intra-observer repeatability of the first two measurements showed ICCs varying from 0.61 to 0.94. The inter-observer repeatability of paired examiners showed a variation in ICC from 0.28-0.90. The kappa value expressing the intra- and inter-observer repeatability as being >95th or < or = 95th percentile was 0.73 and 0.72, respectively. CONCLUSIONS: NT measurement was reproducible for small variation and good agreement. The duration of measurements was acceptable.     

Prenatal diagnosis of complete trisomy 9: a case report and review of the literature

Complete trisomy 9 is a very rare chromosome aneuploidy, associated with specific patterns of multisystem dysmorphism and a wide spectrum of congenital anomalies. We present a case of complete trisomy 9 with prenatal sonographic findings in the second trimester. The combination of sonography and karyotyping from cordocentesis enabled us to establish the prenatal diagnosis. An additional clinical feature of this syndrome that has not been reported previously is an aortopulmonary communication. A review of the literature specifically dealing with prenatal sonographic findings with complete trisomy 9 is also presented.