Tannirandorn Y

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.

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.

Pyomyoma in a Perimenopausal Woman with Intrauterine Device

Pyomyoma (suppurative leiomyoma) is a rare disease, which is considered to be a serious complication of uterine leiomyoma. Since 1945, only 18 patients have been reported and ours is the 19th. Although it is frequently reported in pregnant women or postmenopausal women who have vascular disease, our case is a 42-year-old woman in the perimenopausal period who presented with fever and a tender lower abdominal mass. She used the intrauterine device as a contraceptive method but leiomyoma had never been found before. Ultrasonographic findings suggested an ovarian tumor. She was diagnosed as having infected malignant ovarian cancer with an elevated CA 125 level that was initially treated with broad spectrum antibiotics; then she underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathological findings showed acute and chronic inflammation of the endometrium with abscess formation in an intramural leiomyoma. The intrauterine device might be the origin of pyomyoma due to a direct spread of the infection from the uterine cavity. Pyomyoma may be difficult to diagnose especially in those with a nonspecific clinical presentation without any history of leiomyoma. Delayed diagnosis may result in serious complications, whereas adequate surgery and broad spectrum antibiotics may decrease serious morbidity and mortality.

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 Diagnosis of Pulmonary Atresia by Fetal Echocardiography

With an improvement in cardiac imaging during the past 20 years, fetal echocardiography has progressively altered the practice of obstetricians and become a principle armamentarium for the diagnosis of fetal heart diseases. We presented a case of pulmonary atresia with intact ventricular septum diagnosed prenatally using fetal echocardiography.