The correlation of beta-subunit human chorionic gonadotropin level in the serum and first morning urine of patients with gestational trophoblastic disease.

The purpose of this cross-sectional study was to determine the correlation of beta subunit human chorionic gonadotropin (beta-hCG) level in the serum and first morning urine samples of patients with gestational trophoblastic disease (GTD). A total of 81 paired serum and first morning urine samples from 24 patients diagnosed with GTD, who had their follow-up at the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. The paired serum and first morning urine samples were measured for beta-hCG level, using enzyme-linked immunosorbent assay (ELISA). After logarithmic transformation, serum beta-hCG level was strongly and significantly correlated to those of first morning urine samples, with the correlation coefficient of 0.97 (p < 0.01). Among the disease-remission group (serum beta-hCG of less than 5 mIU/ml), the correlation coefficient was 0.52 (p < 0.01), which was still statistically significant. Stronger statistical significance was found in the disease-active group (serum beta-hCG of 5 mIU/ml or higher), with the correlation coefficient of 0.95 (p < 0.01). We concluded that the level of serum beta-hCG was strongly and significantly correlated with those of first morning urine samples, especially in patients with active disease. Determination of beta-hCG level using first morning urine samples can be used as an effective mean in the follow-up of patients with GTD.

Benign cystic teratoma of the ovary : a review of 608 patients.

This retrospective study reports on 608 cases of benign cystic teratoma of the ovary treated at Siriraj Hospital over a ten-year period from 1988-1997. Mean age of the patients was 33.7 + 11.3 years. Approximately one-third of the patients (35.0%) were asymptomatic when the teratomas were discovered, of the rest, the common presenting symptoms were abdominal pain (52.9%) or palpable abdominal mass (30.6%). The tumors were between 6-10 cm in greatest diameter in more than half of the patients (53.6%) and in 78 patients (12.8%), the tumors were bilateral. Complications from the tumors were found in 72 patients (11.8%): 68 cases of torsion (94.4%); two were spontaneous rupture (2.8%); and two were infected (2.8%). The mean age of patients with twisted tumor was significantly less than that of patients with uncomplicated tumor (p = 0.02), and abdominal pain was found more commonly in the patients with twisted tumor (p < 0.001). Among cases with torsion, more than 90 per cent of the tumors were found to be of intermediate size (6-15 cm), while only 68.8 per cent were found in uncomplicated cases (p < 0.001). Surgical treatment was conservative in 63.8 per cent) and radical in 36.2 per cent of the patients.

Charts of Thai fetal biometries: 2. Biparietal diameter.

A cross-sectional study was conducted in order to construct a new reference chart for Thai fetal biparietal diameter (BPD). A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were recruited. Measurements were made once at a randomly assigned gestational age specifically for the purpose of this study only. Due to unfavorable fetal position in some cases, BPD data were available in 613 measurements. Linear regression models were fitted separately to estimate the mean and standard deviation as functions of gestational age. Reference centiles were constructed from both equations, assuming the data were normally distributed. A new reference centiles chart for BPD is presented and compared with previously published data. Our derived centiles were clearly lower than those from Western studies showing the importance of racial differences between populations. This elucidates the need to develop fetal biometries charts specifically for each region.

Charts of Thai fetal biometries: 3. Femur length.

A cross-sectional study was conducted in order to construct a new reference chart for Thai fetal femur length (FL). A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were enrolled. Measurements were made once at a randomly assigned gestational age specifically for the purpose of this study only. Femur length data were available in 608 measurements due to unfavorable fetal position in some cases. Linear regression technique was used to model separately the mean and standard deviation as functions of gestational age. Reference centiles were constructed from a combination of both models, assuming the data were normally distributed. A new reference centiles chart for FL is presented and compared with previously published data. While our derived centiles were clearly lower than those from Western studies, they were found comparable with those from a Thai study. This demonstrated the important effect of racial differences between populations on fetal biometries and elucidates the need to develop fetal biometries charts specifically for each region.

Charts of Thai fetal biometries: 4. Abdominal circumference.

A cross-sectional study was conducted in order to construct a new reference chart for Thai fetal abdominal circumference (AC). A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were recruited. Measurements were made once at a randomly assigned gestational age specifically for the purpose of this study only. Due to unfavorable fetal position in some cases, AC data were available in 615 measurements. Linear regression models were fitted separately to estimate the mean and standard deviation as functions of gestational age. Reference centiles were constructed from both equations, assuming the data were normally distributed. A new reference centiles for AC is presented and compared with previously published data. Our derived centiles were lower than those from Western studies which may partly be due to racial differences. This emphasizes the need to develop fetal biometries charts specifically for each region.

Charts of Thai fetal biometries: 1. Methodology.

A cross-sectional study was conducted in order to construct new reference charts for Thai fetal biometries that are commonly used in obstetric ultrasound practice. We discussed and illustrated a sound appropriate study design and statistical analysis which lead to more valid results. A total of 621 normal pregnant women between 12-41 weeks of gestation and their fetuses were recruited. Each fetus was measured once at a randomly assigned gestational age specifically for the purpose of this study only. Stepwise linear regression technique was used to model the mean and its standard deviation as functions of gestational age. Goodness of fit and normality of the data were checked before the final models were chosen. Reference centiles were derived, taking into account the increasing variation as pregnancy proceeds. We demonstrated the stated technique with humerus data from the same study. Reference charts for other fetal biometries have been derived and are presented in subsequent papers.

Cesarean hysterectomy in Siriraj Hospital: a 5-year review.

Cesarean hysterectomy remains a necessary procedure for life saving during abdominal delivery. The procedure itself is usually associated with considerable perioperative morbidity, especially when performed under emergency conditions. Obstetricians should identify patients at risk and anticipate the procedure and its complications. Knowledge of this operation and skill at its performance can be very helpful in reducing perioperative maternal and perinatal morbidity.

Mean platelet volume of normal pregnant women and severe preeclamptic women in Siriraj Hospital.

This study only shows that MPV in severe preeclamptic women is statistically greater than in normal pregnant women. The increase in MPV occurs while there are still no changes in platelet number. MPV may be better and more sensitive than platelet number in detecting changes in platelets. This may be useful in high risk patients. The study neither reveals that increase in MPV antecedes the development of preeclampsia nor can it predict the severity of the disease. There should be further prospective studies on MPV in the future both in preeclamptic women and normal pregnant women.