Tharangrut Hanprasertpong

Reliability of fetal nasal bone length measurement at 11–14 weeks of gestation

BackgroundNasal bone assessment has been incorporated into Down syndrome screening in first trimester. Several studies have established the normal reference values for fetal nasal bone length in the first trimester, which were found to be varied by population. However, the study on reliability of nasal bone length measurement was limited with contradictory results. This study aimed to investigate the reliability of fetal nasal bone length measurement at 11–14 weeks of gestation in the Thai population.MethodsA total of 111 pregnant women at 11–14 weeks of gestation attending for the routine first-trimester ultrasound examination were recruited. Each case was measured separately by two examiners. Examiner 1 performed the first measurement in all cases; any of the other 5 examiners consecutively performed the second measurement. Three independent measurements were performed by each examiner and they were blinded to the results of the others. Intraobserver and interobserver variabilities were evaluated with the intraclass correlation coefficient (ICC).ResultsNasal bone measurement was successfully performed in 106/111 cases (95.5%) by at least one examiner; 89 cases were performed by two examiners. The intraobserver variability was excellent for all examiners (ICC, 0.840-0.939). The interobserver variability between different pairs of examiners varied from moderate to excellent (ICC, 0.467-0.962). The interobserver variability between examiner 1 and any other examiner was good (ICC, 0.749). The Bland-Altman plot of the interobserver differences of nasal bone length measurements between examiner 1 and any other examiner showed good agreement.ConclusionsThe reliability of the fetal nasal bone length measurement at 11–14 weeks of gestation was good. The nasal bone length measurement was reproducible. Ethnicity has an effect on fetal nasal bone length, but reliability of nasal bone length measurement is critical to accuracy of screening and should be audited on an ongoing basis.

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.

Non‐puerperal uterine inversion and uterine sarcoma (malignant mixed müllerian tumor): Report of an unusual case

A 45‐year‐old woman with a history of cervical cancer (stage IIa), who had received complete radiation treatment 16 years previously, presented with a huge mass protruding from her vaginal introitus. She had had the condition for about 1 week. Diagnosis was difficult, and she elected to have a diagnostic laparoscopic procedure plus tumor removal. The pathologic investigation revealed a malignant mixed müllerian tumor of the endometrium. Post‐operative course was uneventful. She underwent postoperative pelvic radiation. No recurrence was found during the 13 months follow up period. This rare case of chronic non‐puerperal uterine inversion due to malignant mixed müllerian tumor (MMMT) is herein reported.

Effectiveness of the model for prenatal control of severe thalassemia

The aim of the research was to determine effectiveness of the model for prenatal control in reducing new cases of severe thalassemia.

Abruptio placentae and fetal death following a Malayan pit viper bite

Reports of venomous snakebites during pregnancy are uncommon. Little is known about maternal and fetal outcome following the venomous snakebite of a pregnant woman, and there is no consensus for proper management. In southern Thailand, Malayan pit viper (Calloselasma rhodostoma) bites are quite common, and we have some experience with bites of pregnant women. With these victims, the toxicity is most severely expressed in a bleeding disorder that is a significant cause of both morbidity and mortality in both the gravid woman and the fetus. Herein, because there are few such published reports, we report the case of a 43‐year‐old woman, gravida 5 para 4, 32 weeks pregnant who was bitten by a Malayan pit viper and, as a result, developed abruptio placentae, coagulopathy, and death of fetus in utero. She otherwise responded well to antivenom and blood components. A hysterotomy was performed and the postoperative course was unremarkable.

Complete hydatidiform mole with co-existing fetus: Predictors of live birth

Multiple gestation consisting of complete hydatidiform mole with co-existing fetus (CHMCF) is unusual. From our institution, we reported two cases with unfavorable obstetric consequences. The recommendation for antenatal management is still not distinctly determined. Therefore, the aim of this article was to review the literature according to the predictors of infant survival and to develop a management guidance for pregnancy with CHMCF. Between January 1, 1993 and May 31, 2016, 12 case series and 89 case reports comprising of 204 pregnant women were identified. The pregnancies successfully delivered 78 live births (37.86%). For clinical symptoms, pregnant women with antenatal complications, including pregnancy-induced hypertension (PIH), hyperthyroidism (HTD) and hyperemesis gravidarum (HG), significantly developed adverse perinatal events. Low hCG blood level was the best predictor of fetal survival (P=0.006). We developed a model using logistic regression analysis which was enhanced by including an hCG cut-off level of 400,000mIU/mL. On the basis of our intensive review, we suggest that the patient with CHMCF without antenatal obstetric problems especially PIH, HTD and HG together with initial serum hCG level less than 400,000mIU/mL is a good candidate for pregnancy continuation and reaching fetal viability.

Comparison of the effectiveness of different counseling methods before second trimester genetic amniocentesis in Thailand

The objective of this study is to compare the effectiveness of counseling methods before second trimester genetic amniocentesis.

A reference for ductus venosus blood flow at 11-13+6 weeks of gestation.

Objective: To establish reference ranges for ductus venosus (DV) blood flow assessment obtained transabdominally at 11-13+6 weeks of gestation. Methods: A cross-sectional study was conducted on singleton pregnancies with a crown-rump length (CRL) ranging from 45 to 84 mm, normal fetus, and subsequent newborn birth weight appropriate for gestational age. Measurements of DV Doppler variables were performed by experienced sonographers: peak velocity during ventricular systole (S-wave) and diastole (D-wave), nadir during atrial contraction (A-wave), time-averaged maximum velocity (TAmax), pulsatility index for veins (PIV), and peak velocity index for veins (PVIV). Results: A total of 304 fetuses were included. The mean CRL was 60.7 ± 7.2 mm (range: 45.9-75.5). The mean nuchal translucency measurement was 1.4 ± 0.4 mm. The S-wave, D-wave, A-wave, and TAmax values varied significantly with gestational age (p < 0.05) and regression models were constructed for each variable. The remaining variables, systolic/atrial wave ratio, preload index, PVIV, and PIV, did not vary significantly with gestational age within this CRL range. Conclusion: Reference ranges for DV Doppler assessment were established in normal fetuses. These ranges may be a useful tool for evaluation of anueploidy and fetal cardiac function.

A Thai Reference for Normal Fetal Nasal Bone Length at 11–13(+6) Weeks Gestation

Aim: The purpose of this study was to establish a Thai reference for normal fetal nasal bone length (NBL) at 11–13+6 weeks gestation. Methods: The fetal nasal bone was measured by sonography in pregnant women at 11–13+6 weeks gestation. All neonates who showed normal karyotypes were examined after delivery to confirm the absence of congenital abnormalities. Results: A total of 255 pregnant women were recruited. Forty-seven pregnant women were excluded from the analysis because of technically unsatisfactory examination or absent nasal bone and chromosomal abnormalities. The mean ± SD of NBL was 1.79 ± 0.33 mm and increased significantly with crown–rump length (CRL) and gestational age (p < 0.001). The best-fit equation for NBL in euploid fetuses in relation to CRL was: NBL (mm) = (0.030 × CRL (mm)) – 0.016. Conclusion: NBL in Thai fetuses at 11–13+6 weeks was found to be on average shorter than that in Caucasian, African-American and Chinese populations, but similar to those reported in Korean and Latin-American populations.

Pregnancy outcomes in Southeast Asian migrant workers at Southern Thailand

Abstract This retrospective study was conducted to determine the pregnancy outcomes and identify predictive factors of adverse outcomes in pregnant migrant workers who delivered at Songklanagarind Hospital from January 2002 to December 2012. Two hundred and forty migrant worker pregnancies were enrolled. Pre-eclampsia, gestational diabetes mellitus, pre-term birth and foetal intrauterine growth restriction found were 15, 7.9, 13.7 and 3.7%, respectively. No stillbirth was found. Apgar score was </ = 7 at 1 and 5 min and neonatal intensive care unit admission was found to be 12.1, 4.2 and 11.3%, respectively. Antenatal care place, low haemoglobin level and the presence of maternal underlying disease were significantly related to increased risk of overall adverse maternal outcomes. Only pre-term birth was significantly related to overall adverse neonatal outcomes.