Suchaya Luewan

Outcomes of pregnancy complicated with hyperthyroidism: a cohort study

ObjectiveTo determine maternal and fetal outcomes of women complicated with hyperthyroidism compared with those in normal pregnant women.Materials and methodsThis cohort study was conducted on singleton pregnant women complicated by hyperthyroidism without other medical complications between January 1994 and December 2008, at tertiary center. The normal controls were identified to match the cases with the ratio of 2:1. The baseline characteristics as well as maternal and fetal outcomes were analyzed and compared for pregnancy outcomes.ResultsOf the 203 pregnant women diagnosed for hyperthyroidism, 180 cases met the inclusion criteria, and 360 controls were matched. The activity of the disease was controlled to be euthyroid state in most cases. Maternal complications were comparable between both groups except that the study group had potentially higher incidence of pregnancy-induced hypertension. The mean gestational age (±SD), and mean birth weight were significantly lower in the study group. The incidence of fetal growth restriction, fetus with low birth weight and preterm births were significantly higher in the study group with a relative risk of 1.3, 1.4, and 1.3, respectively.ConclusionPregnant women with hyperthyroidism were significantly associated with an increased risk of fetal growth restriction, preterm birth and low birth weight and had a tendency to have a higher rate of pregnancy-induced hypertension.

Fetal cardiac dimensions at 14–40 weeks' gestation obtained using cardio‐STIC‐M

To establish normative reference ranges of fetal cardiac dimensions derived from volume datasets acquired using spatiotemporal image correlation with M‐mode display (cardio‐STIC‐M).

The complete three‐vessel view in prenatal detection of congenital heart defects

To evaluate the effectiveness of the complete three‐vessel view (c3VV) in assessment of fetuses with prenatally diagnosed congenital heart defects (CHD).

Venous Doppler studies in low-output and high-output hydrops fetalis

OBJECTIVE The objective of the study was to compare fetal venous Doppler flow reflecting cardiac function in fetuses with hydrops fetalis between a group of congenital heart defect (low cardiac output) and a fetal anemia group (high cardiac output). STUDY DESIGN This was a prospective cross-sectional analysis. It was conducted at the Maharaj Nakorn Chiang Mai Hospital, Tertiary center, Medical School. The study included fetuses with hydrops fetalis secondary to cardiac causes (low output group) and anemia (high output group). All fetuses underwent ultrasound examination to assess ductus venosus (DV) and umbilical vein (UV) Doppler indices. The results were related to normal reference range and were also compared between the group of high-output and the low-output group. RESULTS Sixty-nine hydropic fetuses were available for analysis, 50 in the high-output group and 19 in the low-output group. The peak velocity index, preload index, and the pulsatility index of the DV were significantly low in the high-output group, whereas they were significantly high in the low-output group. The umbilical vein pulsations were found in 78.9% of the fetuses with low-output hydrops fetalis but only 28.0% of fetuses in the high output group (P < .001). CONCLUSION New insights gained from this study are that hydrops caused by severe anemia because of hemoglobin Barts is not associated with high central venous pressures as is seen in hydropic fetuses with coronary heart disease. This suggests that cardiac decompensation is not the primary mechanism of hydrops in these anemic fetuses. Additionally, umbilical vein pulsations are not a sign of cardiac failure in the anemic group.

Fetal Therapy in Fetal Thyrotoxicosis: A Case Report

Introduction: Fetal thyrotoxicosis, often caused by maternal Grave’s disease, can have adverse effects on fetal outcomes, such as growth impairment or fetal hydrops. Therefore, intrauterine treatment is recommended. Objective: To describe the experience of intrauterine medical treatment of fetal thyrotoxicosis. Case: A 19-year-old woman with a history of Grave’s disease in a euthyroid clinical status after subtotal thyroidectomy became pregnant 2 months after thyroidectomy. At gestational age 28 weeks, persistent fetal tachycardia was identified and the diagnosis of fetal thyrotoxicosis was established by fetal thyroid function test on umbilical cord blood obtained by cordocentesis. Intrauterine treatment for hyperthyroidism was initiated with antithyroid drugs (150 mg/day of propylthiouracil) via maternal oral administration. Fetal heart rate, size of fetal thyroid gland and umbilical cord blood sampling for thyroid function test were monitored. Fetal heart rate became normal and fetal thyroid function tested on fetal cord blood at 1 month after antithyroid fetal therapy was also normal. Fetal thyrotoxicosis improved but the mother had some degree of hypothyroidism from fetal therapy and needed thyroid hormone replacement. The remaining course of gestation was uneventful. The patient had spontaneous labor and delivery at 38 weeks of gestation resulting in normal female baby, 2,900 g, and had no clinical of neonatal thyrotoxicosis. Maternal thyroid medications were stopped immediately after birth. Conclusion: Intrauterine treatment of fetal thyrotoxicosis with medication via the maternal circulation can possibly improve fetal outcome.

Fetal ventricular shortening fraction in hydrops fetalis.

OBJECTIVE: To estimate fetal ventricular shortening fraction, representing cardiac contractility, derived from cardiospatiotemporal image correlation with M-mode display “STIC-M” in fetuses with hydrops fetalis secondary to high-output (fetal anemia) and low-output causes (congenital heart defects). METHODS: A cross-sectional study was conducted in normal fetuses (group 1), fetuses with hemoglobin Barts disease with (group 2) and without (group 3) hydrops fetalis, and those with hydrops fetalis resulting from cardiac defects (group 4). Volume data sets of cardiospatiotemporal image correlations were acquired for each group for subsequent offline analysis with cardiospatiotemporal image correlation with M-mode display. Group 1 data were used to construct reference ranges of left and right ventricular shortening fraction for assessment of fetuses in the remaining groups. RESULTS: A total of 606 measurements, 15–35 per week, were performed in normal fetuses to construct reference ranges as well as Z-scores of left and right ventricular shortening fraction. Both parameters were decreased with increasing gestation with weak correlation (r2=0.141, P<.001 and r2=0.055, P<.001, respectively). Shortening fraction did not significantly change among 111 fetuses with hemoglobin Barts disease with and without hydrops. However, left and right ventricular shortening fraction were significantly decreased (mean Z-scores 5 standard deviations and 8 standard deviations below the mean, respectively) in 21 hydropic fetuses as a result of congenital heart defects (P<.001). CONCLUSION: Fetuses with hydrops fetalis secondary to cardiac defects and anemia have a different pattern of shortening fraction. Hydrops fetalis resulting from cardiac defect is primarily caused by cardiac decompensation; whereas in fetal anemia, it is probably caused by hypervolemia with cardiac decompensation occurring when the cardiac compensatory mechanism is exhausted. LEVEL OF EVIDENCE: II

Midpregnancy cordocentesis training of maternal–fetal medicine fellows

To describe systematic cordocentesis training among maternal–fetal medicine (MFM) fellows.

Outcomes of pregnancies affected by hemoglobin H disease

To determine the outcomes of pregnancies affected by hemoglobin H (HbH) disease.

Outcomes of pregnancies complicated by beta-thalassemia/hemoglobin E disease.

To assess the outcomes of pregnancies affected by beta‐thalassemia/hemoglobin E (β‐thal/HbE) disease.

Pattern recognition using transabdominal ultrasound to diagnose ovarian mature cystic teratoma

To determine the validity of sonographic pattern recognition in the diagnosis of mature cystic teratoma.