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Alpha thalassemia major (ATM) is a hemoglobinopathy that usually results in perinatal demise if in utero transfusions (IUTs) are not performed. We established an international registry (NCT04872179) to evaluate the impact of IUTs on survival to discharge (primary outcome) as well as perinatal and neurodevelopmental secondary outcomes. Forty-nine patients were diagnosed prenatally, 11 were diagnosed postnatally, and all 11 spontaneous survivor genotypes had preserved embryonic zeta-globin levels. We compared 3 groups of patients; group 1, prenatally diagnosed and alive at hospital discharge (n = 14), group 2, prenatally diagnosed and deceased perinatally (n = 5), and group 3, postnatally diagnosed and alive at hospital discharge (n = 11). Group 1 had better outcomes than groups 2 and 3 in terms of the resolution of hydrops, delivery closer to term, shorter hospitalizations, and more frequent average or greater neurodevelopmental outcomes. Earlier IUT initiation was correlated with higher neurodevelopmental (Vineland-3) scores (r = -0.72, P = .02). Preterm delivery after IUT was seen in 3/16 (19%) patients who continued their pregnancy. When we combined our data with those from 2 published series, patients who received ≥2 IUTs had better outcomes than those with 0 to 1 IUT, including resolution of hydrops, delivery at ≥34 weeks gestation, and 5-minute appearance, pulse, grimace, activity, and respiration scores ≥7. Neurodevelopmental assessments were normal in 17/18 of the ≥2 IUT vs 5/13 of the 0 to 1 IUT group (OR 2.74; P = .01). Thus, fetal transfusions enable the survival of patients with ATM and normal neurodevelopment, even in those patients presenting with hydrops. Nondirective prenatal counseling for expectant parents should include the option of IUTs.

Objective: To examine the external validity of the Fetal Medicine Foundation (FMF) competing‐risks model for the prediction of small‐for‐gestational age (SGA) at 11–14 weeks' gestation in an Asian population. Methods: This was a secondary analysis of a multicenter prospective cohort study in 10 120 women with a singleton pregnancy undergoing routine assessment at 11–14 weeks' gestation. We applied the FMF competing‐risks model for the first‐trimester prediction of SGA, combining maternal characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI) and serum placental growth factor (PlGF) concentration. We calculated risks for different cut‐offs of birth‐weight percentile (< 10th, < 5th or < 3rd percentile) and gestational age at delivery (< 37 weeks (preterm SGA) or SGA at any gestational age). Predictive performance was examined in terms of discrimination and calibration. Results: The predictive performance of the competing‐risks model for SGA was similar to that reported in the original FMF study. Specifically, the combination of maternal factors with MAP, UtA‐PI and PlGF yielded the best performance for the prediction of preterm SGA with birth weight < 10th percentile (SGA < 10th) and preterm SGA with birth weight < 5th percentile (SGA < 5th), with areas under the receiver‐operating‐characteristics curve (AUCs) of 0.765 (95% CI, 0.720–0.809) and 0.789 (95% CI, 0.736–0.841), respectively. Combining maternal factors with MAP and PlGF yielded the best model for predicting preterm SGA with birth weight < 3rd percentile (SGA < 3rd) (AUC, 0.797 (95% CI, 0.744–0.850)). After excluding cases with pre‐eclampsia, the combination of maternal factors with MAP, UtA‐PI and PlGF yielded the best performance for the prediction of preterm SGA < 10th and preterm SGA < 5th, with AUCs of 0.743 (95% CI, 0.691–0.795) and 0.762 (95% CI, 0.700–0.824), respectively. However, the best model for predicting preterm SGA < 3rd without pre‐eclampsia was the combination of maternal factors and PlGF (AUC, 0.786 (95% CI, 0.723–0.849)). The FMF competing‐risks model including maternal factors, MAP, UtA‐PI and PlGF achieved detection rates of 42.2%, 47.3% and 48.1%, at a fixed false‐positive rate of 10%, for the prediction of preterm SGA < 10th, preterm SGA < 5th and preterm SGA < 3rd, respectively. The calibration of the model was satisfactory. Conclusion: The screening performance of the FMF first‐trimester competing‐risks model for SGA in a large, independent cohort of Asian women is comparable with that reported in the original FMF study in a mixed European population. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-μg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-μg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and associating factors of sexual dysfunction in Thai women using contraception with intrauterine device (IUD)., Material and Method: A cross-sectional study was conducted in IUD users at the Family Planning Unit, Siriraj Hospital. Data were recruited between October 2012 and June 2013. The participants answered the questionnaires to collect demographic, obstetric-gynecological data, and female sexual function index (FSFI) score., Results: Two hundred seventy one IUD users participated in this study. The mean age was 32.1 +/- 7.1 years old, mean body mass index (BMI) was 24.1 +/- 5.3 kg/m2. The prevalence of sexual dysfunction in IUD users was 50.9%. The associating factor that affected the sexual dysfunction significantly was observed in BMI group (p-value 0.033). Subgroup analysis illustrated that the underweight group had more sexual dysfunction. The lowest FSFI score was observed in the underweight group. The score was 23.50 +/- 4.52. The significant domains were found to be desirable and arousal domains., Conclusion: The prevalence of female sexual dysfunction in the period after IUD using was 50.9%. The BMI was a significant associating factor Underweight women showed higher trend of sexual dysfunction than other group, especially in the desire and arousal domain.