PRENATAL STRATEGIES FOR REDUCING SEVERE THALASSEMIA IN PREGNANCY

Objective: To describe the prenatal strategy in reducing new cases of severe thalassemia at Maharaj Nakorn Chiang Mai Hospital. The study de sign involved a prospective descriptive analysis set in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Subjects: Pregnant women attending antenatal clinic. Methods: The strategy included: (1) carrie r identification by retrospective (history review) and prospective scr eening program; (2) the couples at risk were counseled and offered cor docentesis; (3) analysis of fetal blood with high performance liquid c hromatography (HPLC) or electrophoresis; and (4) counseling for termin ation of pregnancy in case of affected fetus. The prospective screenin g consisted of testing for a carrier by a simple erythrocyte osmotic f ragility test (EOFT) in women with no risk and testing the husbands of the women with abnormal tests. A pregnancy in which both of the coupl e were carriers was considered a risk. Results: Cordocentesis was perf ormed in 554 pregnancies at risk, 252 and 302 from retrospective and p rospective screening, respectively. Sixty of 252 of the first group ha d severe thalassemia. In the prospective screening program of 12 680 w omen, 459 risk couples were identified, 302 pregnancies underwent cord ocentesis and 53 (17.5%) had severe thalassemia. This strategy enabled us to identify 113 cases of severe thalassemia (Hb Bart's; 60, beta-t hal entities; 53) from 554 cases at risk. Conclusion: The strategy pro ves valuable in the control of severe thalassemia. This extensive expe rience suggests the strategy be considered an effective way in the con trol of severe thalassemia in high prevalence areas. (C) 1998 Internat ional Federation of Gynecology and Obstetrics.