Three–dimensional prenatal ultrasonography of thanatophoric dysplasia: Initial experience at Siriraj Hospital.

Objective: To initially report the prenatal diagnosis of thanatophoric dysplasia (TD) by using both 2 dimensional (2D-US) and 3 dimensional (3D-US) ultrasonography. Methods: During January 2004 to December 2006, 10 pregnant women who were referred to our Maternal Fetal Medicine Unit due to abnormal skeletal sonographic findings have been extensively investigated by 2D-US and 3D-US. Results: 3 cases of TD (30%) have been identified with an average gestational age of 26 weeks. Sonographic findings demonstrated short limbs, severe micromelia, telephone receiver like femoral bone, bell shaped small thorax, platyspondyly of vertebrae and normal shaped skull in all cases. Prenatal diagnosis was made earlier by 2D-US analysis and then was confirmed by 3D-US. Conclusion: 3D-US provides additional findings and increases interpreter confidence, It provides additional information in the evaluation of fetal skeletal dysplasia, including thanatophoric dysphasia, compared with 2D-US.

Transabdominal ultrasound in the assessment of postvoid residual urine volume in patients after hysterectomy.

OBJECTIVE: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy. MATERIAL AND METHOD: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization. RESULTS: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml. CONCLUSION: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.

Prediction of adverse perinatal outcome by umbilical artery to middle cerebral artery resistance index ratio in pregnancies complicated by hypertensive disorder.

This study aimed to evaluate umbilical artery to middle cerebral artery resistance index ratio above 95th percentile (UARI / MCARI 95) was able to predict adverse perinatal outcome in pregnancies complicated by hypertensive disorder. Fitty-three pregnant women with hypertensive disorder were recruited to this study. All of these women gave birth within 7 days of performing the Doppler study. The ability of UARI / MCARI 95 to predict adverse perinatal outcome was as follow: sensitivity 12.5%, specificity 89.2%, positive predictive value 33.3%, negative predictive value 70.2%, false positive rate 10.8%, false negative rate 87.5% and accuracy 66%. This ratio did not qualify as a reliable screening test for prediction of adverse perinatal outcome prediction in pregnancies complicated by hypertensive disorder.

Fetal abnormalities in the fetal anomaly clinic at Siriraj Hospital.

In order to reduce perinatal morbidity and mortality rates, a Fetal Anomaly Clinic has been set up at Siriraj Hospital. The aims are to identify abnormal fetuses and manage them in an appropriate way before delivery. From 1st May, 2000 to 30th April, 2002, 142 pregnancies with fetal abnormalities out of 10,386 pregnant women examined were found at the Fetal Anomaly Clinic, Siriraj Hospital. There were 32 fetuses (22.5%) with CNS abnormalities and neural tube defects with a mean gestational age at diagnosis of 18.6 weeks, 12 fetuses (8.5%) with gastrointestinal abnormalities with a mean gestational age at diagnosis of 17.1 weeks, 12 cases (8.5%) with cardiovascular and pulmonary abnormalities with a mean gestational age at diagnosis of 24.8 weeks, 10 cases (7%) with skeletal abnormalities with mean gestational age at diagnosis of 26.7 weeks,15 cases (10.6%) with chromosome abnormalities with a mean gestational age at diagnosis of 21.7 weeks, 18 cases (12.6%) of KUB abnormalities with a mean gestational age at diagnosis of 25.6 weeks and 43 cases (30.3%) of other abnormalities with a mean gestational age at diagnosis of 24.5 weeks. Counsellings was given before making a decision and all abnormalities were confirmed by autopsy, amniocentesis, paediatric neonatologists or paediatric surgeons.

Accuracy of residual urine measurement in post-operative gynecological patients by normal saline instillation versus Re-catheterization.

A total of 90 post-operative gynecological patients, who needed residual urine measurement were studied in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University between June 1, 1999 and April 30, 2000. Residual urine in each patient was measured by the normal saline instillation technique, followed by re-catheterization which is considered as the gold standard. The accuracy and agreement of the results of residual urine measurement by the two techniques were calculated. In comparison with re-catheterization, the accuracy of the normal saline instillation technique was 83.3%, sensitivity was 66.7%, specificity was 96.1%, positive predictive value was 92.8%, negative predictive value was 79%, false positive rate was 3.9%, and false negative rate was 33.3%. The Kappa coefficient was 0.65 (P < 0.001). No complications from either technique were found. Residual urine measurement in post-operative gynecologic patients by normal saline instillation yielded fair to good agreement with re-catheterization. Due to a high percentage of false negative rate, this new method may not be suitable for current clinical practice. Improvement in the technique and further studies are needed.