Fetal biometry charts for normal pregnant women in northeastern Thailand.

OBJECTIVES: 1) To construct normal fetal biometry charts of fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) from 14 to 41 weeks of gestation in northeastern Thailand. 2) To compare the results with other studies. STUDY DESIGN: A cross sectional descriptive study. SETTING: Division of Fetal Diagnosis and Therapy, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University. MATERIAL AND METHOD: The fetuses of 635 pregnant women with an uncomplicated singleton pregnancy between 14 and 41 weeks of gestation in northeastern Thailand from 1 October 2005 to 31 December 2006. All recruited pregnant women enrolled had an abdominal ultrasonography for fetal biometry and the results were compared with other studies using student's T distribution. MAIN OUTCOME MEASURES: Fetal biometry charts for normal pregnant women between 14 and 41 weeks of gestation in northeastern Thailand. RESULTS: Six hundred and twenty eight normal fetuses from 635 pregnant women were measured for fetal biometry charts. The comparison of the presented charts with others was significantly larger than the North in all parameters (except AC), but was consistent to those from the South (only BPD and FL). However when the authors compared then with central Thailand and Western countries, there were only significant differences in some gestational ages. CONCLUSION: The authors established normal fetal biometry charts for northeastern Thai pregnant women that could be implemented in the population of this region.

Autopsy findings of fetal death.

OBJECTIVE: To study the autopsy findings associated with fetal death in the division of reproductive pathology. MATERIAL AND METHOD: Descriptive study of 35 fetal deaths with placentas after postmortem examinations in the division of reproductive pathology between January 2005 and December 2005. The fetal deaths and placentas were examined by a perinatal pathologist in the surgical pathology room, Department of Pathology and Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University. The demographic data of the mothers, the gestational age from obstetric information, diagnosis before abortus or delivery. The postmortem examinations including abnormal macroscopic or microscopic findings were analyzed. RESULTS: The associated pathologies of fetal death could be identified 87.5% for groups of fetal weight less than 500 grams and in 77.8% for groups of fetal weight 500 grams or more. The most common associated pathology of fetal death in both groups was congenital anomaly, was 50% and 25.9% respectively. Macerated fetuses were found in 48.2% of all cases. Causes of macerated groups were identified in 66.7% of cases. Hydropic fetuses were 14.3% (5 cases) of all fetal deaths in which the cause of death was identified before delivery in two cases and was identified in postmortem examination in one case. Thus, the identified causes of fetal death in hydrops fetalis were 60%. CONCLUSION: Most common associated pathology of fetal deaths is congenital anomaly.

Prenatal prevention for severe thalassemia disease at Srinagarind Hospital.

OBJECTIVE: To evaluate the results and cost-effectiveness of prenatal prevention measurement in severe thalassemia diseases at Srinagarind Hospital. STUDY DESIGN: Descriptive study. SETTING: Antenatal care (ANC) Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. SUBJECTS: 1,498 thalassemic screened pregnant women first presenting at ANC Clinic at gestational age less than 17 weeks. MATERIAL AND METHOD: Medical records of thalassemic screened pregnant women between February 2002 and February 2005 were analyzed. Those with a value of mean corpuscular volume (MCV) less than 80 fl, or positive dichlorophenol indophenol precipitation test (KKU-DCIP Clear Reagent Kit) underwent hemoglobin (Hb) typing by high performance liquid chromatography (HPLC) together with thalassemia investigation (complete blood count, MCV and Hb typing) of their husbands and to identify couples at risk of 3 severe thalassemia diseases; Hb Bart's hydrops fetalis, homozygous, -thalassemia and, -thalassemia/ Hb E disease. Then they were advised to undergo DNA analysis and, if they had fetal risk, appropriate prenatal diagnosis was offered. MAIN OUTCOME MEASURE: Number of affected fetuses detected by prenatal diagnosis. RESULTS: Nine hundred and ninety six pregnant women (66.49%) were positive on screening. Of these, 642 (64.46%) had thalassemia investigation done with their spouses. There were 19 couples at risk (1.27% of total screened pregnant women) for having fetal severe thalassemia disease from initial laboratory results. Most of them were, -thalassemia/ Hb E diseases. We found only 10 pregnant women (52.63%) that had undergone prenatal diagnosis. The consequent results were two affected fetuses (20%), one was Hb Bart's hydrops fetalis, and the other was, o-thalassemia/ Hb E disease. In these cases, their parents decided to discontinue the pregnancy. Our prevention program could save 1.14 million bahts for the cost of treatment in two prevented severe thalassemia cases. CONCLUSION: The prenatal prevention program of severe thalassemia disease at Srinagarind Hospital can effectively detect affected fetuses and reduce severe thalassemia disease, which is a major health problem in Thailand.

Correlation of weight estimation in large and small fetuses with three-dimensional ultrasonographic volume measurements of the fetal upper-arm and thigh: A preliminary report.

OBJECTIVE: To determine the correlation of measuring fetal upper-arm and thigh volume using three-dimensional ultrasonography with weight estimation in large and small fetuses. MATERIAL AND METHOD: The authors included 46 pregnant women admitted for delivery in the Labor Room at Srinagarind Hospital, Khon Kaen University, between February 1 and September 30, 2004. Inclusion criteria were: 1) singleton pregnancy; 2) delivery within 48 hours after study; 3) estimation birthweight < 2,500 g (small fetuses group: n = 22) or > 3,500 g (large fetus group: n = 24). All patients received two- and three-dimensional ultrasound examinations by an experienced practitioner The upper-arm and thigh volume were assessed using a three-dimensional ultrasound scanner. RESULTS: In the large fetus group, upper-arm and thigh volume measurements by three-dimensional ultrasound strongly correlated with birthweight, r = 0.805 (95%CI = 0.594-0.912) and r = 0. 739 (95%CI = 0.478-0.880), respectively. In the small fetuses group, the upper-arm and thigh volume measurements, by three-dimensional ultrasound, strongly correlated with birthweight, r = 0.868 (95%CI = 0.689-0.946) and r = 0.835 (95%CI = 0.638-0.929), respectively. CONCLUSION: Upper-arm and thigh volumes measured by three-dimensional ultrasound highly correlates with weight estimation in large and small fetuses and can be used as a new modality for estimating fetal weight.

Three-dimensional ultrasonographic findings of the rare chromosomal abnormality 48, XXY/+18: a case report.

The 48, XXY/+18 is a very rare aneuploidy syndrome which combines the aberration in both autosome and sex chromosome. The authors report a case diagnosed prenatally by lymphocyte culture from fetal blood samples following cordocentesis, 2-dimensional (2DUS) and 3-dimensional ultrasonography (3DUS). At 33 1/7 weeks gestation in an ultrasound examination by indication large for date; single umbilical artery with absence of the left umbilical artery, polyhydramnios and fetal growth restriction were demonstrated. The fetus presented with microcephaly, prominent occiput, low-set ears, micrognathia, hypertelorism, small mouth, bilateral club hands with overlapping fingers, rocker-bottom feet. Karyotyping from the cordocentesis led to the diagnosis of 48, XXY/+18, which was confirmed by the chromosomal analysis of the umbilical cord blood after the baby was born. This is the first reported case of the very rare aneuploidy syndrome in the literature.

Effectiveness of intravenous meperidine for pain relief in the first stage of labour.

OBJECTIVE: To determine the effectiveness and side effects of intravenous meperidine in labour pain relief. MATERIAL AND METHOD: A double blind, randomized controlled trial was conducted in 84 parturients, using normal saline as control. Visual analogue scale, postpartum parturients' opinion of effectiveness, sedative scores, nausea/vomiting, dizziness, delivery method, Apgar scores, and naloxone prescription were assessed. RESULT: There were no statistically significant differences between the mean and median of visual analogue scale of meperidine and control group. In addition, the sedative scores, nausea/vomiting and dizziness in the meperidine group occurred more than those in the control group significantly. Even mean of the pain increment in the meperidine group was less than those in the control group (p < 0.05). The parturients' opinion on the effectiveness of pain relief during labor within 24 hours of the first postpartum day was only 23.80 per cent in the meperidine group, however, it was statistically significantly different when compared to 7.10 per cent in the control group. CONCLUSION: Intravenous meperidine exhibited the effectiveness of pain relief of only 23.80 per cent of the subjects, in addition, it may cause many side effects.