Y. C. Wong

SHOULD ASSESSMENT OF AMNIOTIC FLUID VOLUME FORM AN INTEGRAL PART OF ANTENATAL FETAL SURVEILLANCE OF HIGH RISK PREGNANCY

Summary: This study was conducted to evaluate the role of the Amniotic Fluid Index (AFI), used along with nonstress cardiotocography (NST) and fetal acoustic stimulation test (FAST), when required, in prediction of adverse pregnancy outcome. Over a 3‐year period 565 pregnant women had antepartum fetal surveillance due to various high risk pregnancy factors and delivered within 7 days of the test. Antepartum fetal surveillance included nonstress cardiotocography together with estimation of AFI. Need for induction of labour, presence of meconium at rupture of membranes, Caesarean section for fetal distress, Apgar score at 5 minutes, need for neonatal endotracheal intubation, admission to neonatal special care unit and perinatal death were the main outcome measures.

Analysis of cystic hygroma, ascitic, and pleural fluids by conventional lymphocyte culture and fluorescent in situ hybridization

Serous fluids from cystic hygromas, pleural effusions, and ascites are an easily accessible and plentiful source of lymphocytes. The feasibility and reliability of using these as alternative sources to conventional amniotic fluid or fetal blood cultures have been studied here. In some cases of prenatal diagnosis, especially in pregnancies complicated by the presence of cystic hygromas and fetal hydrops, obtaining amniotic fluid or fetal blood can be difficult due to obstruction by the cyst or oligohydramnios. A total of 14 cases with fetal hydrops detected ultrasonigraphically between 15 and 33 weeks of pregnancy over a period of 1 year have been subjected to conventional amniotic fluid or fetal blood karyotyping, along with samples of fluids from cystic hygromas, ascites or pleural effusions as obtained. Pleural fluids (n=4), cystic hygroma fluids (n=5), and ascitic fluids (n=6) were obtained. The culture failure rate was low, 2/14. Karyotypically, two of the fluids, both from cystic hygromas, were 45,X; the rest were normal. A rapid 1‐day additional test of fluorescent in situ hybridization (FISH) was carried out on uncultured cells of the alternative fluids using probes for the most commonly occurring aneuploidies, 13, 18, 21, X and Y, with good results.

Early Asymmetric IUGR and Aneuploidy

Objective: To determine the incidence of chromosomal abnormalities in fetuses with asymmetric growth retardation in the second and early third trimesters of pregnancy.

Simple Office Methods to Predict Ovulation: The Clinical Usefulness of a New Urine Luteinizing Hormone Kit Compared to Basal Body Temperature, Cervical Mucus and Ultrasound

Summary: A new urine luteinizing hormone (LH) kit, First Response (Tam‐brands Inc., Palmer, MA) was compared with basal body temperature (BBT), cervical mucus scoring and abdominal ultrasound follicular scanning in their ability to predict ovulation to within 2 days of the serum LH peak. BBT was kept daily. From day 10 daily ultrasound scanning and cervical mucus examination were performed and serum oestradiol, luteinizing hormone, follicular stimulating hormone and progesterone were assayed.

The Role of Transvaginal Ultrasonography and Colour Doppler Imaging in the Detection of Ectopic Pregnancy

Objective: To assess the use of transvaginal ultrasound and colour Doppler imaging in the detection of ectopic pregnancy.

Routine screening with fetal echocardiography for prenatal diagnosis of congenital heart disease

ABSTRACTCongenital cardiac anomalies are the most common congenital anomalies, occurring in approximately eight of 1000 live births. Proper perinatal and neonatal management is dependent upon accurate prenatal diagnosis. Approximately 10% of fetuses with cardiac abnormalities have identified risk factors; hence, most of the anomalies occur in pregnancies without prenatal risk factors. The application of detailed fetal echocardiography for prenatal screening, at present reserved mainly for high-risk cases, requires further evaluation before being recommended for the general population.This article presents our experience of evaluating the accuracy of fetal echocardiography as a screening method in detecting cardiac anomalies in the general population of Singapore. We reviewed data from 39 808 pregnant women who received antenatal care at the National University Hospital, Singapore, between January 1986 and December 1994, and who underwent routine fetal echocardiography at 21–22 weeks of gestation. We ident...

Sinusoidal‐like Fetal Heart Rate Tracing in a Case of Acute Fetomaternal Haemorrhage

EDITORIAL COMMENT: This case indicates that when fetomaternal haemorrhage is the cause of critical fetal reserve as observed by cardiotocography the fetus may be doomed in spite of prompt delivery by emergency Caesarean section, although there are reports of successful fetal outcome with immediate delivery in such cases. The moral of this case report is that cardiotocographic evidence of reduced fetal reserve of any degree indicates delivery when the pregnancy is at term, especially when there are other complications, such as fetal growth retardation.

Early fetal blood sampling--another available option for early prenatal diagnosis.

Fourteen cases had early fetal blood sampling (FBS) performed between 13 and 18 weeks gestation in the Antenatal Diagnostic Centre, National University Hospital, Singapore from Jan 1988 to December 1994. The indications were: a) ultrasound abnormality (n = 6), b) hydrops (n = 1), c) screening for blood disorders (n = 2), d) amnio results inconclusive or to confirm abnormal amnio results (n = 5). This article analyses retrospectively the early FBS procedure and its outcome. There were no procedure related fetal losses in this study. The reliable rapid results obtained following the procedure enabled the obstetrician to counsel the couple regarding the current pregnancy and advise them accordingly for the subsequent pregnancy. Thus we found it useful not only in our patients but also for patients from overseas who get their results within a week to plan their stay.

Discrepancy between Cytogenetic and FISH Results on an Amniotic Fluid Sample of 45,X/46,X,idic(Y)(p11)

The presence of abnormal ultrasound markers showing a thick nuchal fold with short middle phalanx of the fifth finger in an otherwise normal-appearing female fetus led to the sampling of amniotic fluid at 16 weeks gestation. Cytogenetic analysis with routine G-banding showed a 45,X karyotype in all 20 cells analysed from two flasks. However, fluorescent in situ hybridization on uncultured cells showed presence of a Y signal in 9 cells, 11 cells showing a single signal for the X. A cytogenetic analysis of the fetal blood at 23 weeks confirmed the presence of two cell lines, 45,X and 46,X,idic(Y)(p11). The couple opted to have the pregnancy terminated. However, the fetus was not available to carry out confirmatory tests.