Boonchai Uerpairojkit

Random urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with preeclampsia

OBJECTIVE To evaluate the accuracy of random urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with suspected preeclampsia. METHODS A prospective study was conducted in hospitalized pregnant women with a suspicion of preeclampsia. Random mid-stream urine specimens were obtained for protein-to-creatinine ratio determination, and then participants were instructed to collect 24-h urine samples for protein measurement. With the criterion of 24-h proteinuria of at least 300 mg as a significant proteinuria, the sensitivity and specificity of a random urinary protein-to-creatinine ratio of > or = 0.19 for prediction of significant proteinuria were analyzed and a receiver operating characteristic curve was constructed to determine the optimal cutoff value. RESULTS Forty-two patients completed the study. Sixty-nine percent of the study population had significant proteinuria. A cutoff of 0.19 demonstrated a sensitivity of 100% and a specificity of 53.8%. A ratio below 0.22 could rule out a significant proteinuria. The optimal cutoff value is 0.25 which yielded sensitivity, specificity and accuracy of 96.6%, 92.3% and 95.2% respectively. CONCLUSION In hospitalized preeclamptic patients, the random urinary protein-to-creatinine ratio at a cutoff of > or = 0.25 revealed a highly accurate prediction of significant proteinuria and could be a more practical alternative for assessment of proteinuria.

Fetal loss in threatened abortion after embryonic/fetal heart activity.

Objectives: To study the incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity. Methods: A prospective study was performed on pregnant women with clinically diagnosed threatened abortion between 6 and 14 weeks of gestation. All had a good menstrual history and the calculated gestational age using crown–rump length in the first trimester ultrasound was in agreement. Embryonic/fetal heart rate measurements were obtained by a 5 MHz vaginal probe using M‐mode and real‐time B mode imaging. All cases were followed up with respect to pregnancy outcomes. The data were analyzed using the spss computer program. Results: Eighty‐seven pregnant women were included in the study. There were three pregnancies (3.4%) which resulted in fetal loss before 20 weeks of gestation. In viable pregnancies, the mean embryonic/fetal heart rate increased with advancing gestational age. The individual values of embryonic/fetal heart rate for fetal losses were within the reference range. Conclusions: The incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity was 3.4%. There was no evident pattern of bradycardia or tachycardia that signaled the incipient of viability.

Transvaginal hysterosalpingo-contrast sonography (HyCoSy) compared with chromolaparoscopy.

Objective: To compare the efficacy and safety of HyCoSy with chromolaparoscopy for the diagnosis of tubal occlusion and uterine abnormalities.

Reference Intervals for First Trimester Embryonic/Fetal Heart Rate in a Thai Population

Objective: To establish reference intervals for first trimester embryonic/fetal heart rate in a Thai population.

Cut‐off criteria for second‐trimester nuchal skinfold thickness for prenatal detection of Down syndrome in a Thai population

Objective: To evaluate the use of progressive cut‐offs for nuchal skinfold thickness with advancing gestational age and the commonly applied cut‐off method (≥6 mm) for prenatal detection of Down syndrome in a Thai population. Method: A prospective study was performed by experienced perinatologists on 2150 women undergoing second‐trimester amniocentesis for the indications of advanced maternal age and past history of chromosomal abnormality. Reference ranges were established for nuchal skinfold thickness from the 16th to the 24th week, using either gestational‐specific centiles or the parametric method. Assaying different cut‐off criteria for both centile and the parametric methods were calculated and then compared with the commonly applied cut‐off level (≥6 mm.). Results: There were 2114 chromosomally normal pregnancies, 19 fetuses with Down syndrome (1:113), and 17 other chromosome abnormalities. In fetuses with normal karyotype the nuchal skinfold thickness increased with advancing gestational age [NF (mm)=−0.502+0.212 GA (week), r=0.36, P<0.001]. The sensitivities of an abnormal nuchal skinfold thickness using different cut‐off criteria for detecting Down syndrome were low (5.3–26.3%) with the false positive rates ranging from 2.5 to 16.5%. Conclusions: In this study, measurement of second‐trimester nuchal skinfold thickness was a poor and unreliable screening test for fetal Down syndrome in a Thai population.

Prenatal three‐dimensional ultrasonography in a case of agnathia‐otocephaly

A case of prenatally diagnosed agnathia‐otocephaly is reported. Agnathia is an extremely rare anomaly characterized by an absence or hypoplasia of the mandible and abnormal horizontal position of the ears. The targeted 2‐D ultrasonography at 24 weeks of gestation revealed abnormal lower facial profile. Surface rendering 3‐D ultrasonography was used to evaluate the facial feature, showing excellent image when compared to the fetal face at autopsy. The reported case is discussed with a short review of the literature.

Outcome of small-for-gestational-age fetuses according to umbilical artery Doppler: Is there any yield from additional middle cerebral artery Doppler?

Abstract Objective. To investigate the outcome of small-for-gestational-age (SGA) fetuses in relation to the features of umbilical artery (UA) Doppler and to explore the prognosticator of middle cerebral artery (MCA) Doppler in SGA fetuses with normal UA impedance. Methods. Two hundred ninety-seven patients were classified into Group 1 with normal UA and MCA pulsatility index (PI), Group 2 with normal UA but abnormal MCA PI and Group 3 with abnormal UA PI/absent or reversed end diastolic flow. Neonatal outcomes were compared between each group. Results. Neonatal intensive care unit (NICU) admission, duration of hospital stay and perinatal mortality were higher in Group 3 as compared to the others. Group 2 had a lower birth weight and more fetuses with 5-min Apgar score <7 than Group 1; NICU admission and need for ventilators were also significantly higher than Group 1. Conclusions. SGA fetuses with abnormal UA Doppler suffered more morbidity and mortality compared to those with normal UA Doppler. SGA fetuses with normal UA PI but abnormal MCA PI had worse outcomes compared to those with normal UA and MCA PI.

Clinical experience from Thailand: noninvasive prenatal testing as screening tests for trisomies 21, 18 and 13 in 4736 pregnancies

The purpose of this article is to report the clinical experience and performance of massively parallel sequencing‐based noninvasive prenatal testing (NIPT) as a screening method in detecting trisomy 21, 18, and 13 (T21/T18/T13) in a mixed‐risk population in Thailand.

Causes and consequences of 93 fetuses with cardiomegaly in a tertiary center in Thailand

ObjectivesTo assess etiology, perinatal mortality and associated factors of fetal cardiomegaly (FC).MethodsA retrospective study of fetuses with cardiomegaly was conducted. Demographic data, ultrasonographic findings, and outcomes were collected and analyzed.ResultsNinety-three fetuses were analyzed. The causes of FC were cardiac causes 49.5%, Bart’s hemoglobinopathies 28%, and non-Bart’s anemia 15%. Ascites, pericardial effusion, and hydrops were more prevalent in fetuses with anemia than those with cardiac abnormalities. The overall perinatal mortality was 69.9%. Although all Bart’s hydrops died, perinatal mortality of non-Bart’s anemia, and structural cardiac defect were 57.1 and 69.7%, respectively. Excluding Bart’s anemia, receiver-operating characteristic curve analysis demonstrated that cardiothoracic ratio of ≥0.58 best predictive for perinatal mortality. Earlier gestational age at diagnosis, skin edema, and chromosomal abnormality were associated with higher mortality.ConclusionsMajority causes of FC were cardiac and anemic in origin. It carried high-perinatal mortality depending on the causes.

Prenatal Diagnosis of Pulmonary Atresia by Fetal Echocardiography

With an improvement in cardiac imaging during the past 20 years, fetal echocardiography has progressively altered the practice of obstetricians and become a principle armamentarium for the diagnosis of fetal heart diseases. We presented a case of pulmonary atresia with intact ventricular septum diagnosed prenatally using fetal echocardiography.