Densak Pongrojpaw

Transvaginal color Doppler study of uterine artery: Is there a role in chronic pelvic pain?

Aim:  To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP).

The Efficacy of Lidocaine Spray in Pain Relief during Outpatient-Based Endometrial Sampling: A Randomized Placebo-Controlled Trial

Abnormal vaginal bleeding is one of the most frequent problems found in gynecology. Endometrial histopathology is needed for definite diagnosis. It was obtained either from endometrial tissue sampling or from standard uterine curettage. Office endometrial tissue sampling is an easy and low morbid procedure. It is usually associated with pain and discomfort. Topical anesthetic agent is needed for pain relieving. This study was conducted in outpatient gynecology clinic, Thammasat University Hospital, Thailand. It was a double blind randomized controlled trial. A total of 140 participants were enrolled in study and control group. Each group consisted of 70 cases. Study group received topical spray of 10% lidocaine (40 mg) before endometrial aspiration. Topical spray of 0.9% normal saline was performed in control group. Novak curettage was an application for endometrial tissue obtaining in this study. Visual analog scale (10cm-VAS) was used for pain evaluation. Demographic character of both groups showed no statistical difference. The percentage of participants who had severe pain (VAS≥7) during tenaculum application and Novak curettage insertion and during procedure were 28.5% (20/70) versus 12.9% (9/70), 55.7% (39/70) versus 38.5% (27/70), and 78.5% (55/70) versus 60% (42/70) in control and study group, respectively. Both groups had no significant differences of postoperative pain at 15 minutes and 2 hours. This study indicates that topical lidocaine spray can relieve pain during endometrial tissue sampling.

P01.05: The value of middle cerebral artery‐umbilical artery pulsatility index ratio in prediction of severe fetal growth restriction

There were classified patients into 2 groups, group 1 with normal MCA/UA PI ratio (MCA/UA PI > 1.08) and group 2 with abnormal MCA/UA PI ratio. Adverse perinatal outcome as neonatal intensive care unit admission, Apgar score at 1 min < 7, need for ventilators, respiratory distress syndrome and need for blood transfusion were compared between 2 groups. Results: Of the 54 pregnancies in this study, 37 patients (68.5%) were classified into group 1 and 17 patients (31.5%) into group 2. There were significantly higher adverse perinatal outcome in group 2 (P values < 0.05). Conclusions: IUGR fetuses with abnormal MCA/UA PI ratio suffered more morbidity than with normal MCA/UA PI ratio. The MCA/UA ratio is a good predictor of adverse perinatal outcome.

P01.04: Cerebroplacental pulsatility ratio predicts perinatal outcome in IUGR fetuses

Objectives: To investigate the relationship between unexplained elevated MSAFP and adverse pregnancy outcomes in our population. Methods: A retrospective cohort study was conducted by reviewing all triple test results that were positive for neural tube screening. Results: We identified 53 women with raised mid trimester MSAFP > 2.5 multiples of median (MoM) between July 2007 to December 2009. Of these, 12 cases were excluded from the study because of presence of structural fetal abnormalities and 3 cases were lost to follow-up. Of the remaining 38 pregnancies with unexplained raised MSAFP, 10 (26%) cases were associated with poor fetal outcome. These included spontaneous second trimester miscarriage (n = 2), preterm rupture of membranes (n = 2), intrauterine fetal growth restriction (n = 5), and stillbirth (n = 1). Maternal complications included recurrent antepartum bleed (n = 1) and severe preeclampsia (n = 1). Conclusions: Our findings reiterate that unexplained raised MSAFP is associated with significantly high rate of adverse pregnancy outcome and warrants close monitoring with regular antenatal checks and serial growth scans.

P24.08: Correlation of fetal Doppler flow and perinatal outcomes in patient with preeclampsia

Objectives: The Umbilical Vein (UV) has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been describedin severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsation could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intrapartum hypoxia. Methods: In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography (CTG) and 26 fetuses with abnormal CTGs (GA > 37 w and cervical dilatation > 3 cm). Perinatal outcome was assessed according to presence or absence of UV pulsations. Results: The 2 groups were comparable. (GA, cervical dilatation, Umbilical artery PH, S/D ratio, PI and RI) Intraabdominal UV pulsation were present in 6 (23.1%) of abnormal CTG and none of normal CTG group. (P = 0.005) Five of 6 (83.3%) fetuses with UV pulsation under went cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score < 7 was more in fetuses with UV pulsations (16.7% vs. 5%) although not significant. NICU admission was considerably more in UV pulsation group. (33% vs. 5%, P = 0.123) After exclusion of LBW fetuses the UV pulsation was present in 4(19%) of abnormal CTG group, who 3 of them under went cesarean section. Neither umbilical artery PH < 7 nor Apgar score < 7 or NICU admission were seen in these 4 neonates. Conclusions: Pulsation in UV was seen in 23% of fetuses with abnormal CTG during intrapartum period. Cesarean delivery and NICU admission was increased in fetuses with UV pulsations, although not statisticly significant. When LBW fetuses were excluded no case of U/A PH < 7, Apgar score < 7 or NICU admission were seen.

P46.11: Changes of the ductus venosus in intrauterine growth restriction fetuses during maternal hyperoxygenation

of fetal deterioration. Abnormal DV flow patterns have been associated with adverse fetal outcomes and increased perinatal mortality. We describe pathological ductus venosus waveforms with intermittent reverse-flow in the presence of otherwise normal Doppler measurements in severely growth-restricted fetuses with normal echocardiography. Methods: We performed repeated detailed fetal monitoring including Doppler and CTG in two cases with severe IUGR from 26 weeks of gestation onwards. Perinatal outcome was obtained in both cases. Results: Fetal size was below the 3rd percentile (abdominal circumference) in both cases. There were no signs of fetal abnormalities and no chromosomal abnormalities. Doppler measurements revealed a markedly increased uterine resistance in both cases. However, umbilical artery and fetal arterial Doppler were normal at the beginning of the monitoring period. Computerized CTG analysis registered normal short-term variations. DV waveforms showed considerable variation in the pulsatility index including intermittent reverse flow during atrial contraction in the first case, and persistent reverse or zero flow during atrial contraction in the second case. Over the course of several weeks we observed a flattening of the fetal growth curve and arterial redistribution. In both cases elective Cesarean section was performed at 37 and 33 weeks of gestation with birthweights of 1604 g and 690 g, respectively. The infants were admitted to the neonatal ICU for further management. Conclusion: While we still strongly believe that the flow measurements of the ductus venosus are an important and useful indicator of the fetal situation, these cases are an example of rare exceptions in which the pathology of the DV should not be interpreted as a sign of fetal decompensation, if other fetal Doppler findings are contradictory.

P46.10: Changes in the ductus venosus in fetuses with growth restriction

of fetal deterioration. Abnormal DV flow patterns have been associated with adverse fetal outcomes and increased perinatal mortality. We describe pathological ductus venosus waveforms with intermittent reverse-flow in the presence of otherwise normal Doppler measurements in severely growth-restricted fetuses with normal echocardiography. Methods: We performed repeated detailed fetal monitoring including Doppler and CTG in two cases with severe IUGR from 26 weeks of gestation onwards. Perinatal outcome was obtained in both cases. Results: Fetal size was below the 3rd percentile (abdominal circumference) in both cases. There were no signs of fetal abnormalities and no chromosomal abnormalities. Doppler measurements revealed a markedly increased uterine resistance in both cases. However, umbilical artery and fetal arterial Doppler were normal at the beginning of the monitoring period. Computerized CTG analysis registered normal short-term variations. DV waveforms showed considerable variation in the pulsatility index including intermittent reverse flow during atrial contraction in the first case, and persistent reverse or zero flow during atrial contraction in the second case. Over the course of several weeks we observed a flattening of the fetal growth curve and arterial redistribution. In both cases elective Cesarean section was performed at 37 and 33 weeks of gestation with birthweights of 1604 g and 690 g, respectively. The infants were admitted to the neonatal ICU for further management. Conclusion: While we still strongly believe that the flow measurements of the ductus venosus are an important and useful indicator of the fetal situation, these cases are an example of rare exceptions in which the pathology of the DV should not be interpreted as a sign of fetal decompensation, if other fetal Doppler findings are contradictory.