Outcome of intra-amniotic hypertonic saline instillation for second-trimester abortion.

Objective: To evaluate the efficacy and safety of intra-amniotic hypertonic saline instillation for second trimester abortion. Methods: The pregnant women whose pregnancies were complicated by serious fetal abnormalities, trisomy 21 and thalassemia HbE disease, were admitted at Siriraj Hospital from January 1, 2009 to April 30, 2010. The patients were legally induced abortion by intra-amniotic hypertonic saline instillation. Results: A total of 42 pregnant women were retrospectively studied. The average gestational age was 22.4 ± 2.2 weeks. The average instillation-abortion time was 34.8 ± 18.2 hours. All abortuses were dead at the time of abortion. The number of complete abortions were 39 cases (92.9%). There were no serious complications in this study. Conclusion: Intra-amniotic hypertonic saline instillation for second trimester abortion should be considered as a good method in terms of efficacy and safety.

Three dimensional sonographic appearances of Chinese ring intrauterine device: a case report and literature review.

A 47-year-old Chinese lady presented at our clinic with an intermittent pelvic discomfort for years. Pelvic examination was unremarkable. Transvaginal scan revealed an anteflexed uterus containing a dense echogenic circular device, 3 centimeters in diameter. The heavy sonographic reverberation pattern suggested its metallic composition. Examination with three-dimensional sonographies (3D US) in a reconstructed coronal plane (C plane) with soft tissue subtraction showed a perfectly round intrauterine device (IUD). This device was centrally located and positioned along the axis of the upper part of the uterine cavity. No evidence of myometrial migration was found. To the best of our knowledge, this article presents the first 3D image of this rare device. It also suggested the application of 3D sonographies in determining the contraceptive efficacies and management plans. 3D US images that are related to the intrauterine device were also shown and discussed.

A 6-year experience of fetal skeletal anomalies prenatal diagnosis at anomaly clinic, Siriraj Hospital.

Objective: The purposes of this study were to review the prevalence of skeletal dysplasias among fetal anomaly cases and to demonstrate common findings detected prenatally by ultrasonography. Methods: Twenty prenatal cases diagnosed of skeletal anomalies between January 2000 and December 2005 at Anomaly Clinic, Maternal-Fetal Medicine Unit, Siriraj Hospital were reviewed retrospectively. Demographic data such as maternal age, gravida, parity, gestational age at first diagnosis were collected, including prenatal ultrasound findings. Final diagnosis and pregnancy outcome after termination of pregnancy were also demonstrated. Results: The prevalence of skeletal dysplasias among fetal anomaly cases in the study interval was 3.86% (20/518 cases and 95%CI=2.51%, 5.89%). Mean maternal age was 30.3(+ 5.3) years old. The most likely time of diagnosis was 26 (+ 5.7) weeks of gestation. The most common type diagnosed prenatally was thanatophoric dysplasia (40%). All cases of prenatal ultrasound findings of suspected skeletal dysplasias demonstrated short limbs. Three cases were non-lethal anomalies and the parents decided to continue pregnancy. In the remaining 17 cases, the parents were counseled about lethal prognosis of their fetuses and only 11 cases decided to terminate pregnancy at our hospital. Thanatophoric dysplasia was the most common diagnosis after termination of pregnancy (9 in 11 cases). Conclusion: Fetal skeletal dysplasias are one of fetal anomalies which can be detected prenatally by routine ultrasonography. Detection of abnormal long bone length is the important finding. Thorough scanning of all bony characteristics can help clinicians about prenatal diagnosis and pregnancy outcomes.

Breastfeeding pattern in mothers who had problems in breastfeeding.

Objective: The main purpose of this study was to determine the exclusive breastfeeding rate in mothers who had problems in breastfeeding and were closely taken care by the well-trained breastfeeding team. The second purpose was to define the causes of non-exclusive breastfeeding. The third purpose was to compare the exclusive breastfeeding rate with the previous study of routine postpartum care. Methods: A prospective observational study was conducted. From January to July 2005, there were 4,344 mothers delivered at Siriraj Hospital. 847 of them, mothers (19.5%) had the problems in breastfeeding, therefore, they were cared and supported to breastfeed their babies by well-trained clinicians either at a service ward or at a Lactation clinic. To obtain the data of method of feeding and the problems in breastfeeding, the subjects were contacted by phone during 7 days, 1, 4 and 6 months postpartum period. Results: The rates of the exclusive breastfeeding in 7 days, 1, 4 and 6 months during postpartum period in this study were 84.6%, 76%, 41% and 27.7%, respectively. The important problems of the breastfeeding were tongue tie of the infants and the short maternal nipples (57.5% and 31.6%, respectively). Compared with the previous study, in this study, breastfeeding lasted longer and had a higher rate. Conclusion: Successful breastfeeding would be achieved if mothers receive the continuous support from the care team and their families in detecting and solving the problems of breastfeeding in early period.

Antepartum non-stress test in “high risk” pregnancy.

In 1980, the fetal heart rate nonstress test (NST) was used as the primary screening procedure for the evaluation of fetal well being at Department of Obstetrics and Gynecology Siriraj Hospital Medical School. The results of the first 2,234 patients’ test in 5 years time are presented. Reactive NST (96.69%) has a good predictive value for the well being of the fetus. The stillborn rate withib 7 days of a reactive NST was 3.7 per 1,000, with the still-births occurring in postdate pregnancies. Nonreactive NST (3.31%) group demonstrated a significant increase in the overall cesarean section rate, the rate of cesarean sections for fetal distress and the perinatal mortality rate. Basd on our experience similar to others’ reports, the NST continues to be a valuable procedure for the asseaament of fetal well being in high risk pregnancies.

Multifoetal pregnancy: Time interval between birth of the twins.

A prospective study was carried out on 276 live-born twins at 34 or more weeks gestation (or birth weight > 2,000 gm) delivered between the years 1982 – 1984, at Siriraj Hospital. Apgar scores, presentations, birth weights, and methods of delivery of the second twin were reviewed according to the time interval between delivery of the first and second twins. The study revealed the favourable outcome of the second child despite a delayed time interval beyond 15 minutes.