Roengsak Leetanaporn

Etiology and Outcome of Non-Immune Hydrops fetalis in Southern Thailand

Objective: To study the etiology and outcome of non-immune hydrops fetalis in southern Thailand. Methods: The medical records and videotape recordings of all pregnant women diagnosed with non-immune fetal hydrops, from January 1993 to December 2002 were reviewed. Results: Non-immune hydrops fetalis was documented in 71 cases. The causes of fetal hydrops were identified in 87.3%. Homozygous α-thalassemia-1 dominated as the cause of non-immune fetal hydrops (28.2%), followed by structural abnormalities (15.5%) and infection (12.7%). The underlying etiology remained unknown in 9 cases (12.7%). The overall survival rate of non-immune hydrops fetalis cases was 4.2%. Spontaneous regression occurred in 2 cases. Two cases were lost to follow up after initial evaluation. Termination of pregnancy was performed in 47 cases. There were 12 dead fetuses in utero, 2 stillbirths, 5 early neonatal deaths and only 3 cases survived. Conclusions: Homozygous α-thalassemia-1 is the most common cause of non-immune hydrops fetalis in southern Thailand, and the overall prognosis of non-immune hydrops fetalis is poor. We suggest that an effective thalassemia-screening program for prevention and control of homozygous α-thalassemia-1 be established in all areas where the α-thalassemia-1 gene is prevalent.

A survey of the knowledge and attitudes of pregnant Thai women towards Down syndrome screening

Aim:  To determine the knowledge and attitudes of pregnant Thai women towards Down syndrome screening.

Variability of Nuchal Translucency Measurement

Objectives: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurements and study the duration of measurements. Subjects: One hundred and forty-seven singleton pregnant women with 10–14 weeks of gestation who had attended antenatal clinic during January 1st, 2000–August 31st, 2001 were included. Methods: Crown-rump length and NT were measured three times for each woman. Then, another examiner who was unaware of the previous results did the other three measurements. The duration of measurements was recorded. Intra-observer and inter-observer variations were analyzed by repeated ANOVA and paired t test, respectively. The correlation of NT measurements within each observer and between paired observers was evaluated by intraclass correlation coefficients (ICC). Kappa statistic was calculated for agreement. Results: Intra-observer variation of all 10 examiners at three institutes was varied from 0.20 ± 0.27 to 0.33 ± 0.41 mm. Inter-observer variation at Chiang Mai University was 0.40 ± 0.37 mm which was the highest value compared with those at Prince of Songkla and Khon Kaen University (p < 0.05). The mean duration of measurements was in range of 8–12 min. The intra-observer repeatability of the first two measurements showed ICCs varying from 0.61 to 0.94. The inter-observer repeatability of paired examiners showed a variation in ICC from 0.28–0.90. The kappa value expressing the intra- and inter-observer repeatability as being >95th or ≤95th percentile was 0.73 and 0.72, respectively. Conclusions: NT measurement was reproducible for small variation and good agreement. The duration of measurements was acceptable.

Outcomes of multifetal pregnancies

Aim:  To determine the outcomes of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy.

Simplified abdominal wall-lifting device for gasless laparoscopy

Objective: To develop a simplified abdominal wall‐lifting device for gasless laparoscopy. Methods: The device is composed of an electric‐power actuator, sliding arm and abdominal wall‐retractor. All parts of the device are reusable. The device provides planar displacement of the anterior abdominal wall to enable space for laparoscopy. The valveless ports and conventional instruments, as well as laparoscopic instruments, were used without a gas leak problem. Results: After preliminary success in the laboratory testing, a petition was made to the hospitals Ethic Committee. Since then we have performed 40 gasless laparoscopic procedures including 13 salpingo‐oophorectomies, 10 diagnostic laparoscopies, five tubal ligations, five ovarian cystectomies, four salpingectomies, two removals of pelvic IUDs and one laparoscopic hysterectomy. There were no surgical complications, including no abdominal wall trauma. The operative field was almost the same as that of the pneumoperitoneum technique, with the exception of morbidly obese patients. Conclusions: This preliminary experience demonstrates the efficiency of the simplified abdominal wall‐lifting device and the potential advantages of gasless laparoscopy. Continued modifications and applications are necessary to delineate the full range of benefits of this device and technique, especially in developing countries.

A Comparative Study of Outcome of Laparoscopic Salpingo‐Oophorectomy versus Open Salpingo‐Oophorectomy

Objective: To determine the effectiveness and appropriateness of laparoscopic salpingo‐oophorectomy (LSO) versus open salpingo‐oophorectomy (OSO) in developing country.

Frontomaxillary facial angle in chromosomally normal Thai foetuses at 11 to 13 weeks 6 days’ gestation

Frontomaxillary facial (FMF) angle is the angle between upper part of the anterior end of the maxillary bone and the line along the frontal bone in the midfacial profile view. Based on several previous studies, FMF angle can be useful in screening Down syndrome foetuses, in which FMF angle is significantly larger than that in euploid foetuses. However, racial factors can influence the FMF angle as seen in the different normal ranges among ethnicities. Therefore, before the clinical application of the FMF angle, a reference range for its own population should firstly be developed. In this study, a Thai reference range of FMF angle has been established. The mean FMF angle in euploid foetuses with a 60-mm crown–rump length (CRL) was 81.07°, with 0.23° increase for each mm increase in CRL, consistent with those observed in Caucasian and Chinese populations. The measurement of FMF angle has good reproducibility.