Predicting fetal intrauterine growth retardation by using reference centile charts for the ratio of fetal transverse cerebellar diameter to abdominal circumference in a Thai population.

Objective: To predict fetal intrauterine growth retardation (IUGR) by using the centile chart for the ratio of transverse cerebellar diameter to abdominal circumference (TCD/AC) throughout pregnancy from 13-40 weeks. Methods: A total of 643 pregnant women were recruited in this study. The exclusion criteria of 643 normal pregnant women were uncertain date of last menstrual period, multiple pregnancies, fetal abnormalities and maternal conditions which could affect fetal growth. The known 20 small IUGR infants were also tested. Transverse cerebellar diameter and abdominal circumference of all the subjects were measured out by gestational age. The approximately equal numbers of fetuses were measured at each week of gestation. The mean and standard deviation of TCD/AC ratio is estimated at each week of gestation. In addition the 5th, 10th, 50th, 90th and 95th percentiles were calculated at each week of gestation. Results: Of 643 pregnant women, 149 (23.1%) were scanned before 20 weeks of gestation and 286 (44.5%) were scanned between 20 and 30 weeks of gestation. The last group was rechecked after 30 weeks of gestation. TCD/AC ratio slowly declined from early pregnancy until about 20 weeks then remained stable. After 30 weeks of gestation it started to decline again. A TCD/AC ratio greater than the 90 th centile was present in 80% (16/20) known small for gestational age (SGA) infants. (SGA has not been defined). Conclusion: The normal reference value of TCD/AC ratio in Thai fetus were shown in this study. The TCD/AC ratio is a stable, gestational age independent parameter during 20-30 weeks of gestation that may be useful in the early detection of fetal intrauterine growth retardation (IUGR).

Maternal body mass index at term does not predict the severity of preeclampsia.

OBJECTIVE: Maternal pre-pregnancy weight is a risk of developing preeclampsia. Whether it is also associated with the disease severity is still elusive. This retrospective cohort was to determine the association between body mass index (BMI) at term and severity of preeclampsia. MATERIAL AND METHOD: BMIs on the delivery date of 229 patients were analyzed with various indicators of the disease severity. The corrected BMI (cBMI), calculated by an exclusion of feto-placental unit, was additionally analyzed. RESULTS: Neither maternal BMI nor cBMI correlated with the disease severity (p = 0.15 and 0.36). Patients who did and did not require MgSO4 do not have different BMI or cBMI (p = 0.12 and 0.23). Neonatal weight from severe disease arm does not differ from those with mild disease (p = 0.51). Counter-intuitively the correlations between birth weight and maternal BMI were stronger in the severe compared to the mild group (p = 0.0 and 0. 03). CONCLUSION: Neither BMI nor cBMI at the time of delivery predict the severity of preeclampsia or the need for seizure prophylaxis. Birth weight of the baby born from preeclamptic mother might be affected by multiple factors.

Prenatal diagnosis of thalassemia and hemoglobinopathies: 20 years experience at Siriraj Hospital.

Objective: To show the experience of prenatal diagnosis of Thalassemia and hemoglobinopathies in Siriraj Hospital. Methods: Hb Bart’s hydrops fetalis can be detected by DNA study from polymerase chain reaction (PCR) product in the first trimester of pregnancy either by chorionic villus sampling (CVS) or aminocentesis but in late pregnancy it can be detected unambiguous by ultrasonography at 18-20 weeks gestation, the suspected cases are confirmed by fetal blood sampling and Hb electrophoresis. Prenatal diagnosis (PND) for β-thalassemia diseases can be done at early pregnancy by direct visualization of the PCR products on electrophoresis or by dot blot analysis of amplified DNA with a set of HRP-labeled oligonucleotide probes complementary to the mutations. If the mutation is unknown. The couples have to wait for Hb analysis by HPLC or in vitro globins chain analysis from fetal blood in the second trimester. Results: The results of PND at Siriraj Hospital are summarized as Hb Bart’s Hydrops fetalis 228 cases, Homozygous Beta-Thalassemia 126 cases, and Beta Thalassemia/Hb E disease 550 cases. There are various methods of sampling namely chorionic villous sampling, amniocentesis, fetal blood sampling, ultrasound, or even combined method. There are minimal incidences of fetal loss 9 out 904 cases which comparatively give us one of the best center for prenatal diagnosis in Asia. Conclusion: Of the 904 pregnancies, the diagnosis were obtained in 891 pregnancies in which had 5 fetal loss from dead fetus in utero after fetal blood sampling in the second trimester. The other complication occurred after sampling failure.

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.

Reference centile chart for transverse cerebellar diameter (TCD) in Thai fetuses throughout gestation.

Objective: To create a reference centile chart for transverse cerebellar diameter in Thai fetuses throughout gestation. Methods: A total of 780 pregnant women between 13-40 weeks gestation, who attended at the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited. Each fetus was measured only once for the purpose of this study. The mean and fitted centiles were estimated at each week of gestation using linear regression modeling. Results: A total of 752 fetuses were measured for fetal transverse cerebellar diameter. Linear regression models were fitted to estimate the meant 95% confidence interval for transverse cerebellar diameter at each gestational age. The centile chart of this parameter was also presented. Conclusion: Reference centile chart for fetal transverse cerebellar diameter of Thai fetuses was created.

Antiseptics for preventing omphalitis.

BACKGROUND: Omphalitis may cause serious complications and contribute to neonatal morbidity and mortality. From January 1997 to August 1998, the incidence of omphalitis in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital had been increased from 0.9 to 17.4 per 1,000 live births. A prospective randomized trial using antiseptic applied directly to the umbilical stump was conducted aiming to reduce an epidemic outbreak of omphalitis in the newborn nursery. OBJECTIVE: To determine which antiseptic is appropriate for preventing omphalitis in the newborn infants. PATIENTS AND METHOD: Newborn infants delivered in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital were randomized into group A (Triple dye) or group B (70% Alcohol). The infant with omphalitis was assessed by a pediatrician or a neonatology fellow. At home, the same antiseptic will be continually applied to the umbilical stump daily until a few days after cord detachment. Relative risk was calculated and statistical significance was tested by Chi-square test. RESULTS: Four hundred and twenty-seven infants were enrolled. Birth weight, gestational age and gender of the infants in both groups were not different. There were no known maternal risk factors for omphalitis. Omphalitis was observed in 9/213 (4.2%) infants in group A and 23/214 (10.7%) infants in group B. The relative incidence rate between each group was statistically significant (p<0.01). Triple dye group was 60 per cent less likely to develop omphalitis compared to 70 per cent Alcohol group (RR 0.39, 95% CI: 0.19-0.83). The mean duration for cord detachment were 13.6 and 11.5 days in group A and group B, respectively. CONCLUSION: During an epidemic outbreak of omphalitis, Triple dye was the most appropriate and effective antiseptic to prevent omphalitis but could delay cord separation.

Ultrasonographic findings in tubal pregnancy.

The ultrasonographic findings in 48 cases of tubal pregnancies were studied in the Perinatology Unit, Department of Obstetrica and Gynaecology, Siriraj Hospital. All patients were scanned with linear array transducer. The ultrasonographic findings demonstrated a slightly enlargement of uterus in 26 cases. No evidence of intrauterine gestation sac was seen in all cases. In 4 cases, pseudosacs were found while the decidual reaction was found, as evidences of a sharp intrauterine echoes in 16 cases. The adnexal complex mass was found in 43 patients of which 6 extrauterine gestational sacs were found. The presence of blood in the cul-de-sac was found in 41 patients.

Ovarian pregnancy: A case report of a live baby delivery.

A brief review of the literature on ovarian pregnancy is made. A case of on ovarian pregnancy in which a live baby was delivered abdominally is reported. Although ovarian pregnancy is one of the rarest forms of extrauterine pregnancy, its incidence is generally estimated to be between 0.7% to 1.07% of all ectopic gestations, or one ovarian pregnancy in 25,000 to 40,000 pregnancies. At Siriraj Hospital, an incidence of ovarian pregnancy is about 2.5% of all ectopic gestations, or one ovarian pregnancy in 8,100 pregnancies. Of these cases over 95% occurred before the 28th week of gestition. There were onlyu a few patients who delivered after the 28th week with a viable baby. The symptoms of ovarian pregnancy differ slightly from those of the more common forms of ectepic gestation. In case of advanced ovarian pregnancy, there may not be a profound difference from normal intrauterine pregnancy or abdominal pregnancy. Therefore it is virtually impossible to make a preoperative clinical diagnosis.

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.