Phudit Jatavan

A Simple Rule for Prenatal Diagnosis of Total Anomalous Pulmonary Venous Return

The objective of this series was to describe a simple rule for prenatal diagnosis of total anomalous pulmonary venous return (TAPVR). Fourteen fetuses had a prenatal diagnosis of TAPVR by the simple rule, including the following components: (1) the major criterion, which was the absence of a connection between the pulmonary vein and the left atrium; and (2) at least 1 of the following minor criteria: (a) the presence of a vascular confluence behind the atria, (b) abnormal spectral Doppler waveforms in the pulmonary veins, (c) a smooth posterior wall of the left atrium, (d) increased retroatrial space, (e) a dilated coronary sinus (cardiac type), (f) a dilated superior vena cava or brachiocephalic vein, and (g) an additional vessel on the 3‐vessel/3‐vessel and trachea view or a vertical descending vein. All were accurately diagnosed, and none were missed by the diagnosis. In summary, the simple rule described is helpful in increasing the number of accurate prenatal diagnoses of TAPVR.

Prenatal Diagnosis of Aortopulmonary Window: A Case Series and Literature Review

Aortopulmonary window (APW) is a rare congenital heart defect, characterized by a connection between the ascending aorta and the pulmonary trunk before bifurcation. Prenatal diagnosis of APW is essential, as a surgical correction early after birth is required in most cases to prevent congestive heart failure secondary to high pulmonary blood flow. We report a series of three cases of APW that were detected by prenatal echocardiography. The key feature of diagnosis is demonstration of connection between the pulmonary artery and the aorta above the level of the two semilunar valves. Based on our cases and literature review, diagnostic clues for prenatal diagnosis of APW are summarized and proposed.

Pregnancy outcomes among women with hemoglobin E trait

Abstract Objective: To compare the maternal and fetal outcomes between pregnant women complicated with hemoglobin E (HbE) trait and normal controls. Patients and methods: A retrospective cohort study was conducted by assessment of the database of maternal–fetal medicine units from January 2003 to December 2013 to identify singleton pregnant women complicated by HbE trait. Pregnancies with medical complications or fetal anomalies were excluded. The normal controls were low-risk pregnancies and were non-carrier status for thalassemia and hemoglobinopathy. Result: During the study period, 1073 women with HbE trait and 2146 normal controls were included. The baseline characteristics of the two groups were comparable except that the number of prenatal visit was statistically higher in study group (8.55 ± 3.03 versus 7.85 ± 4.33, p = <0.001). Most pregnancy outcomes were not significantly different. However, the rate of asymptomatic bacteriuria was minimally higher in the study group, 3.5% versus 2.3%; p = 0.042 (relative risk 1.19; 95%CI: 0.98–1.43). Note that the rates of gestational diabetes tend to be higher in the group of HbE trait (7.6% versus 6.8%), but did not reach a statistical level. Conclusion: The HbE trait does not significantly increase risk of common adverse pregnancy outcomes, except for minimal increase in asymptomatic bacteriuria.

Fetal hemoglobin Bart’s hydrops fetalis: pathophysiology, prenatal diagnosis and possibility of intrauterine treatment

Abstract This review aimed at comprehensively summarizing current available reports regarding the ultrasound markers and biomarkers in predicting fetal Hb Bart’s disease and evaluate the potential role of cardiac function assessment in a clinical practice. This review involves various methods in prenatal predicting fetal Hb Bart’s disease or alpha-thalassemia major and attempts to provide valuable insights regarding the underlying mechanisms responsible for heart failure in Hb Bart’s fetuses. Moreover, this information may be used to predict the cardiac function before the development of hydrops fetalis. Finally, the affected Hb Bart’s fetus could be the best model of the study on cardiovascular response to fetal anemia, thus the cardiovascular ultrasound and molecular assessment may be helpful in predicting the prognosis or in making a choice in the management of the fetal anemia condition. In conclusion, ultrasound findings especially cardiomegaly and an increase in peak systolic velocity of the middle cerebral artery (MCA-PSV) are helpful in predicting the future hydrops fetalis and ultrasound assessment of fetal cardiac function is potentially helpful in clinical practice. Finally, this review highlights the pathogenesis of hydropic changes secondary to fetal anemia.

Hemodynamic studies of isolated absent ductus venosus

The objective of this article is to evaluate hemodynamic changes among fetuses with isolated absent ductus venosus (IADV) diagnosed by prenatal ultrasonography.

Second‐trimester maternal serum screening for fetal Down syndrome: As a screening test for hemoglobin Bart's disease: A prospective population‐based study

The purpose of this study is to determine the effectiveness of second‐trimester maternal serum screening for Down syndrome as a screening test for fetal hemoglobin (Hb) Barts disease among an unselected population.

Fetal isovolumetric time intervals as a marker of abnormal cardiac function in fetal anemia from homozygous alpha thalassemia‐1 disease

To determine whether fetal isovolumetric time intervals can be an early sonographic marker of fetal anemia in fetuses with homozygous alpha thalassemia‐1.

A retrospective comparison of pregnancy outcomes between women with alpha-thalassaemia 1 trait and normal controls

Abstract The objective of this retrospective cohort study was to compare pregnancy outcomes between low-risk pregnant women with alpha-thalassaemia-1 trait and normal controls. The database of the Maternal–Foetal Medicine unit was used to identify low-risk singleton pregnant women complicated by alpha-thalassaemia-1 trait who gave birth between January 2002 and October 2014. The low-risk pregnancies with non-carrier status for thalassaemia were assigned into the control group, with a control-to-case ratio of 10:1. During the study period, 595 women with alpha-thalassaemia-1 trait and 5950 normal controls were identified. There was no significant difference in the incidence of preterm birth and most obstetric outcomes between the two groups. However, a statistically significant difference was detected between them in terms of gestational age at delivery, 37.76 ± 2.81 vs. 38.11 ± 2.50 weeks (p = .001), birth weight, 2876 ± 581 vs. 2948 ± 527 g (p = .002) as well as the rate of low-birth weight, 17.1 vs. 12.8% (p = .002). In conclusion, this study provides new insights that alpha-thalassaemia-1 trait has minimal effect on gestational age at delivery and low-birth weight whereas other common adverse pregnancy outcomes are not increased. Impact statement What is already known on this subject: Thalassaemia trait is associated with some degree of anaemia. What the results of this study add: The prevalence of common adverse outcomes such as preterm birth, stillbirth, low Apgar scores and pregnancy-induced hypertension were not significantly different between both the groups, possibly caused by too small sample size to gain enough power. However, the rate of low-birth weight was significantly increased among pregnancy with alpha-thalassaemia-1 trait. What the implications are of these findings for clinical practice and/or further research: The information may be provided for alpha thalassaemia-1 trait mothers and their families. Physicians should guard against the occurrence of adverse pregnancy in these mothers. Prospective control study should be conducted to overcome the limitation of retrospective nature.

Effect of cordocentesis on fetal myocardial performance

To compare fetal Tei index before, immediately after and 30 min after cordocentesis for prenatal diagnosis.

Quantitative Cardiac Assessment in Fetal Tetralogy of Fallot

The purpose of this study was to quantitatively assess cardiac function and biometric parameters in fetuses with a diagnosis of tetralogy of Fallot and compare them to those in healthy fetuses.