Somchai Tanawattanacharoen

Dengue Hemorrhagic Fever during Pregnancy : Antepartum, Intrapartum and Postpartum Management

Dengue hemorrhagic fever is a common tropical disease in Thailand that nowadays has an increasing incidence during adulthood.

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.

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.

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.

Monochorionic twins with the same blood karyotype of 46, XY/47, XYY but different phenotypes

We report the case of a 13‐year‐old woman who was pregnant with phenotypically discordant monochorionic twins: one with cystic hygroma and hydrops, the other one normal. Fetal blood sampling was performed by intrahepatic blood collection for karyotyping of both fetuses, revealing the same genotype of 46,XY/47,XYY in 2:1 proportion. Phenotypic discordance in monozygotic twins can have various causes, such as placental vascular anatomy, differences in allocation of the number of blastomeres or genetic postzygotic events.

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