Saknan Manotaya

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.

Predicting the risk of preeclampsia and small for gestational age infants by uterine artery Doppler in low-risk women

Abstract. The objective was to assess the value of uterine artery notching as a screening test for preeclampsia and fetal growth restriction in a low-risk population of healthy pregnant women. Color Doppler ultrasound was used to examine both uterine arteries in 322 healthy pregnant women at 24.9±1.9 (range 22–28) weeks of gestation. The criterion for abnormal results was a unilateral or bilateral presence of an early diastolic notch. The major end points were preeclampsia and small for gestational age (SGA) infants. Of the 322 women, 19 (5.9%) developed preeclampsia and six of them (1.9%) delivered SGA infants. An early diastolic notch was detected in 58 women (18%). The risk of developing preeclampsia and SGA infants in an abnormal Doppler study group was found to be greater than in that of a normal group (P<0.05). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting preeclampsia were 36.8, 83.2, 12.1, and 95.5%, respectively; whereas detecting SGA infants were 67, 82.9, 6.9, and 99.2%, respectively. Women with an early diastolic notch have considerably a higher risk of developing preeclampsia and SGA infants. On the other hand, women with normal uterine artery waveforms are unlikely to develop preeclampsia and SGA infants. The test may be useful to minimize unnecessary interventions.

Fetal facial sonographic markers for second trimester Down syndrome screening in a Thai population

To assess the efficacy of using facial sonographic markers for screening fetuses in the second trimester for Down syndrome (DS) in a high‐risk Thai population.

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.

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.

Intrauterine therapy for fetal supraventricular tachycardia in a twin pregnancy.

A case of a twin pregnancy in which one fetus developed hydrops secondary to supraventricular tachycardia was detected at 21 weeks’ gestation. Transplacental digoxin therapy successfully converted the supraventricular tachycardia to a normal sinus rhythm without evidence of maternal or fetal side‐effects. The pregnancy proceeded to term and elective cesarean section was carried out at 37 weeks’ gestation.

An enhancement of coronary blood flow in a fetus with supraventricular tachycardia

Modern obstetric ultrasound has allowed a detailed evaluation of many fetal small arteries in both normal and abnormal conditions. Recently, a study of a very tiny fetal coronary artery has been proved possible when the imaging condition is optimal (Baschat et al., 1997). An augmentation of fetal coronary blood flow reflecting an attempt to compensate for an increase in oxygen demand by means of autoregulation process has been demonstrated with Doppler ultrasound in both acute and chronic fetal stress conditions such as acute fetomaternal hemorrhage, fetal ductal constriction, and intrauterine growth restriction (IUGR) (Baschat et al., 2003). We present herein the first case of coronary blood flow enhancement in a fetus with supraventricular tachycardia (SVT) demonstrated with Doppler ultrasound. The evidence of the enhancement of blood flow disappeared when the fetal heart rate was eventually converted to normal sinus rhythm with maternal ingestion of flecainide. A 26-year-old pregnant woman, gravida 1, was referred to our high-risk pregnancy clinic at 29 weeks’ gestation for a rapid fetal heart rate detected at prenatal clinic. Our sonographic examination revealed a fetal biometry consistent with gestational age. No structural anomaly was noted. Fetal echocardiography demonstrated a normal cardiac anatomy. A rapid heart rate of 220–240 bpm with 1-to-1 atrioventricular conduction was noted in M-mode. Color Doppler ultrasound clearly demonstrated a holosystolic tricuspid regurgitation and a prominent coronary blood flow (Figure 1a). Spectral Doppler showed an increased inferior vena cava (IVC) reversed flow at atrial contraction and an intact ductus venosus waveform. A biphasic coronary waveform with a diastolic peak flow of 45.5 cm/s was noted (Figure 1b). Fetal SVT was diagnosed and the fetus was initially treated with maternal ingestion of digoxin. The fetal heart rate resisted converting to sinus rhythm after 5 days when maternal digitalis level reached the therapeutic range of 1.2 ng/mL.Treatment was then switched

Are the cardiac dimensions spared in growth-restricted fetuses resulting from uteroplacental insufficiency?

Aim:  The aim of this study was to investigate the effect of intrauterine growth restriction (IUGR), specifically from uteroplacental insufficiency, on fetal cardiac dimensions.

Intrauterine Therapy of Fetal Atrial Flutter

An increased awareness of fetal arrhythmias by obstetricians has resulted in a growing number of diagnosed cases of fetal cardiac problems. A fetus with atrial flutter diagnosed at 31 weeks of gestation was successfully converted to normal sinus rhythm in utero by maternal administration with digitalis. The fetal heart rate stayed in a normarhythm with a maintenance dose of 0.5 mg/day. The fetus was delivered spontaneously at term and the neonatal heart rate has been in normal rhythm without any medical treatment.