Theera Tongsong

Single transvaginal sonographic measurement of cervical length early in the third trimester as a predictor of preterm delivery

Objective To evaluate the accuracy of a single sonographic measurement of cervical length early in the third trimester as a predictor of preterm delivery. Methods A total of 771 women attending the antenatal clinic at the Maharaj Nakorn Chiang Mai Hospital between January 1, 1990, and November 30, 1993, with singleton gestations, cervical competence, accurate dates of last menstrual period, and gestational ages between 28–30 weeks, were recruited into the study. Forty-one were excluded, ten because of induced preterm delivery, 24 because of measurement problems, and seven because they were lost to follow-up. We analyzed the remaining 730 women. Results Ninety-one (12.5%) women ended with preterm births and the remaining 639 (87.5%) delivered at term. The mean (± standard deviation) cervical lengths of the term and preterm groups were statistically significantly different at 37 ± 5 and 34 ± 6 mm, respectively (P < .001). The likelihood ratio of cervical length at various cutoff points was calculated. The appropriate cutoff point based on the receiver operating characteristic curve (35 mm) was associated with a significantly increased likelihood of preterm delivery (20 versus 7%) and was detected in two-thirds of preterm births. This cutoff point gave a sensitivity and specificity of 65.9 ± 5.1% (95% confidence interval [CI]) and 62.4 ± 5.2% (95% CI), respectively. Conclusion A single transvaginal sonographic measurement of cervical length at 28–30 gestational weeks can be used to predict the risk of preterm delivery, using a cutoff point of 35 mm, but its cost-effectiveness should be assessed further.

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.

Sonographic Markers of Hemoglobin Bart Disease at Midpregnancy

Objective. To evaluate the efficacy of various sonographic markers at midpregnancy in predicting fetal hemoglobin Bart disease. Methods. Four hundred eighty‐eight pregnancies at risk of having fetuses with hemoglobin Bart disease were recruited for prenatal diagnosis with cordocentesis at 18 to 21 gestational weeks. Before cordocentesis, the sonographic markers, including cardiothoracic ratio, placental thickness, pericardial effusion, pleural effusion, ascites, subcutaneous edema, cord edema, dilated umbilical vein, and amniotic fluid index, were assessed and recorded. The definite fetal diagnosis was based on blood analysis. The efficacy of each sonographic marker in predicting hemoglobin Bart disease was evaluated by sensitivity and specificity. Results. Among 488 pregnancies undergoing prenatal diagnosis, 100 fetuses were proved to be affected by hemoglobin Bart disease. The cardiothoracic ratio gave the highest sensitivity, 95.0%, with specificity of 96.1%, followed by placental thickness. Signs of hydrops fetalis were observed in 33.0% of cases; they did not increase the sensitivity of the cardiothoracic ratio but strongly reinforced the diagnosis when they appeared. Conclusions. At midpregnancy, sonographic markers can effectively differentiate normal pregnancies from those with fetal hemoglobin Bart disease. Among couples at risk with no sonographic markers, the risk of having an affected child is nearly eliminated. The most sensitive marker was the cardiothoracic ratio, followed by placental thickness.

Cordocentesis at 16-24 weeks of gestation: experience of 1320 cases

The objective of this study was to assess the safety and efficacy of diagnostic cordocentesis at midpregnancy. 1320 singleton pregnancies with no obvious congenital anomalies, a gestational age of 16–24 weeks, and proper indications underwent cordocentesis using the freehand technique. The results of each procedure was prospectively collected and subsequently analysed for the results and pregnancy outcomes. The mean maternal age was 31.1 years and the mean gestational age at the time of cordocentesis was 19.8 weeks. The most common indication was the risk of severe thalassaemia syndrome (69.8%) and was followed by rapid karyotyping. Of 1320 cordocenteses, 1281 (97%) were done successfully at the first attempt. The mean duration of the procedure was 10.5 min and was significantly longer in the first 50 cases of practice for each operator. The maternal blood contamination rate was higher when the cord insertion was targeted. The procedure‐related complications included transient bleeding at puncture site (20.2%), transient fetal bradycardia (4.3%), chorioamnionitis (two cases), and cord haematoma (one case). Of 1281 successful cases, 184 fetuses had severe disease. The total fetal loss rate was 3.2% and the procedure‐related loss was 1%. The other obstetric complications were comparable with those in the general population. We conclude that cordocentesis at midpregnancy is a useful, relatively safe, and effective procedure for prenatal diagnosis. Copyright

Misoprostol for second trimester termination of pregnancies with prior low transverse cesarean section

Recently, misoprostol has become a major method used for pregnancy interruption in our institute because of its low cost, effectiveness and drug stability. However, although misoprostol use in women with a scarred uterus at term has been reported several times, only very few case reports of its use in the second trimester have been publishedw1,2x. The purpose of this study was to see if misoprostol could be used as an alternative for such use. This case series consisted of pregnancies with previous low transverse cesarean section with unfavorable cervix indicated for second trimester termination with various indications, including hemoglobin Bart’s disease(42.9%), aneuploidy (19.0%), dead fetus(23.8%) and others(14.3%). Each patient was counseled and closely attended in labor unit with extreme precaution for uterine rupture. Vital signs, uterine contraction and adverse outcomes of misoprostol were recorded at at least 1-h intervals. Terbutaline sulfate 250 mg intravenously or subcutaneously was used in case of hyperstimulation. Oxytocin intravenous infusion was allowed for augmentation of labor as needed

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).

Alcoholization: The choice of intrauterine treatment for chorioangioma

Chorioangioma is a vascular tumor of the placenta. Most are small and asymptomatic, whereas the large tumors are clinically significant and often associated with polyhydramnios and fetal heart failure. To prevent fetal loss from these complications, many interventions have been proposed, including intrauterine transfusion in anemic cases and fetoscopic surgery to ablate the feeding vessels. The case presented herein had large chorioangiomas, 8 and 4 cm in diameter, associated with polyhydramnios and early signs of hydrops fetalis, diagnosed at 27 weeks gestation. After extensive counseling, we performed alcohol ablation of the feeding vessel of the larger tumor. Signs of fetal heart failure and hydrops fetalis disappeared dramatically. The pregnancy was extended for 2 weeks, followed by premature rupture of the membranes and spontaneous labor at 32 weeks gestation and a surviving female baby, weighing 1360 g, was delivered uneventfully. This preliminary experience suggests that alcoholization may be one of the best choices for this condition due to its high efficacy, simplicity, safety and very low cost. To our knowledge, this is the first report using alcoholization for the treatment of hydrops fetalis secondary to chorioangioma.

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).

Antenatal sonographic features of 100 alpha-thalassemia hydrops fetalis fetuses.

To characterize the sonographic findings of α‐thalassemia hydrops fetalis.

Cervical length in normal pregnancy as measured by transvaginal sonography

Cervical length may have potential use as a predictor of preterm delivery [1,2] and diagnosis of cervical incompetence. To determine the risk of preterm delivery or outcome of cervical incompetence, a normogram of cervical length for each period of pregnancy is essential. The objective of this longitudinal study is to determine the cervical length in normal pregnancy as measured by transvaginal sonography. This study was undertaken at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University Thailand, from 1 March 1992 to 30 September 1996. The subjects met the following inclusion criteria: (1) gestational age between 14 and 40 weeks; (2) history of regular menstruation and knowledge of the exact dates of the last menstruation; (3) singleton pregnancy without medical or