Excursion index of the septum primum as a parameter for diastolic function assessment of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal diastolic function by the measurement of the excursion index of the septum primum (EISP) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Fetuses of normal Thai pregnant women were recruited for 2-dimensional echocardiographic measurements of the EISP (the ratio between the linear displacement of the flap valve and the left atrial diameter) from 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning, and negative diabetic screening at 24 to 28 weeks' gestation. The 5th, 50th and 95th percentile of the EISP were demonstrated The relationship between the EISP and gestational age were determined RESULTS: Three hundred twenty-seven measurements were obtained The normal values of the EISP according to gestational age were presented as 5th, 50th, and 95th percentile ranks. The correlation coefficients (r) between the EISP and gestational age were 0.03. The EISP were not statistically different with advancing gestation. The 5th, 50th, and 95th of the EISP were 0.32, 0.45, and 0.59 respectively. The intra-observer variability was 5.5%. CONCLUSION: The normal values of fetal EISP in the Thai population from 32 to 35 weeks' gestation were established This could serve as a baseline data in detection of the alteration of left ventricular diastolic function during fetal life.

Nasal bone hypoplasia in trisomy 21 at 15 to 24 weeks' gestation in A high risk Thai population.

OBJECTIVE: To assess the utility of nasal bone hypoplasia in the detection of fetuses with trisomy 21 in the second trimester in a high risk Thai population. MATERIAL AND METHOD: A prospective study involving pregnant women undergoing amniocentesis due to increased risk of aneuploidy from January 2005 to December 2005. Fetal biometry and nasal bone measurements were obtained at the time of amniocentesis. Linear regression model and diagnostic tests were analyzed using the SPSS computer program. RESULTS: A total of 407 fetuses were evaluated. In euploid fetuses, the Nasal Bone Length (NBL) increased linearly with advancing gestational age. Fetuses with Down syndrome had a significantly higher proportion of NBL below the 5th centile when compared with normal fetuses (p < 0.05). The optimal nasal bone threshold associated with trisomy 21 is a BiParietal Diameter/Nasal Bone Length (BPD/NBL) ratio of 10 or greater, yielded a sensitivity of 80%, specificity of 86% for detection of trisomy 21. CONCLUSION: Nasal bone hypoplasia is associated with an increased risk of Down syndrome in the presented population.

Interventricular septal thickness of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal InterVentricular Septal Thickness (IVST) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Thai pregnant women with normal fetuses were recruited for prenatal 2-dimensional M-mode echocardiographic measurements of fetal IVST at 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning and negative diabetic screening at 24 to 28 weeks 'gestation. The IVST was measured from the 4-chamber view during diastole and systole. The 5th, 50th and 95th percentile of the IVST during Diastole (IVSD) and the IVST during Systole (IVSS) were demonstrated The relationship between the IVSD and IVSS and gestational age were determined RESULTS: A total of 410 measurements were obtained. The normal values of the IVSD and IVSS according to gestational age were presented as 5th, 50th and 95th percentile ranks. The correlation coefficients (r) between the IVSD and IVSS and gestational age were 0.11 and 0.12, respectively. The IVSD and IVSS were not statistically different with advancing gestation. The 95th, percentile of the IVSD was 4.51 millimeters (mm) (range = 4.26 to 4.74 mm) and IVSS was 6.23 mm (range = 5.96 to 6.68 mm). The intraobserver variability was 7.6%. CONCLUSION: The normal values of fetal IVSD and IVSS in a Thai population from 32 to 35 weeks' gestation were established. This could be used as a baseline data in detecting the asymmetrical septal hypertrophy during fetal life.

Oral salbutamol for treatment of preterm labor.

OBJECTIVE: The aim of this study was to assess the value of oral salbutamol for the inhibition of preterm labor. MATERIAL AND METHOD: Medical records of the department from January 1, 1991 to December 31, 1999 were reviewed for all idiopathic preterm labors that were inhibited by oral salbutamol and statistically analyzed. RESULTS: Of 132 pregnancies, 81.1% (95%CI, 74.4, 87.7) were prolonged for more than 24 hours, 59.8% (95%CI, 51.5, 68.2) for more than 2 days, 32.6% (95%CI, 24.6, 40.6) for more than 1 week, and 8.3% (95%CI, 4.2, 14.4) for more than 4 weeks. Tachycardia (pulse rate > 100 beats/min) occurred in 85.6% of the patients, but those with a pulse rate higher than 140 beats/min occurred in only 3%. Hypotension occurred in only 0.8%. Neonatal complications occurred in 28%, while respiratory distress syndrome occurred in 22.7% of the babies. Perinatal mortality in the present study was 7.6 per 1,000 births. When comparing the pregnancy outcome between groups regarding the prolongation time, the pregnancy outcome was significantly better in the group that had a prolongation time of at least 48 hours. CONCLUSION: Oral salbutamol proved to be another effective method that inhibits preterm labor and consequently prolongs pregnancy. Because it requires no intensive medical nursing care and observations, and no discomfort of an intravenous line, oral salbutamol may be an alternative drug in the management of preterm labor.

First trimester umbilical cord and vessel diameters of Thai fetuses.

OBJECTIVE: To establish the reference ranges for first trimester umbilical cord and vessel diameters of Thai fetuses. MATERIAL AND METHOD: A prospective study was performed on normal pregnant women between 10(+0) and 13(+6) weeks of gestation who underwent ultrasound examination. The diameter measurements were obtained by a 7.5 MHz vaginal--or a 3.75 MHz abdominal transducer. Statistics were analyzed using SPSS computer program. RESULTS: Records of 184 pregnancies were analyzed and the outcome demonstrated a strong correlation between umbilical cord diameter and gestational age (r = 0.90; p < 0.001). Umbilical vessel diameters were also correlated with gestational age. CONCLUSION: First trimester umbilical cord and vessel diameters of Thai fetuses are related to gestational age. The presented reference ranges might be useful for further studies, such as prediction of adverse pregnancy outcome or combination with biochemical or other ultrasound markers for fetal aneuploidy screening.

Cord blood collection for the National Cord Blood Bank in Thailand.

Umbilical cord blood is an effective alternative source of hematopoietic stem cells transplantation in children and adolescents. However, the efficacy and safety of cord blood transplantation correlates with the quantity and quality of cord blood. To evaluate the collection systems and processing of cord blood donations, a pilot research program to optimize recruitment, collection and processing of cord blood donations was developed. The present results showed that the quality of the cord blood (volume, total white blood cells (WBC) count, CD34+ and sterility control) collected was satisfactory and discard rate of collecting units (24.2%) were comparable with data reported from other cord blood banks. To find the optimal mode of collection, comparison of 3 cord blood collection methods (Method 1 = Hanging method after delivering the placenta, Method 2 = Aspiration from in utero placenta, Method 3 = Aspiration from in utero placenta and Syringe-assisted aspiration) using the closed system showed that method 3 was the best method but it required more trained personnel and involved a complicated procedure. The National Cord Blood Bank started its activity in 2002 after several years of pre-clinical studies. To date, a number of transplants using cord blood from related and unrelated cord blood (first report in Thailand) donors have been successfully performed.

Correlation of 4- and 24-hour urine protein in women with initially diagnosed hypertensive disorders in pregnancy.

OBJECTIVE: To determine whether 4-hour urine protein value correlates with 24-hour urine protein value in women with hypertensive disorders in pregnancy. STUDY DESIGN: Cross-sectional study was performed in 38 in-patient pregnant women who were initially diagnosed as having hypertensive disorders in pregnancy. Urine samples were collected within 24 hours in 2 successive periods: the first 4-hour and the next 20-hour urine, in separate containers. The urine volume, urine protein and creatinine concentrations were thus separately measured. The 4- and 24-hour urine proteins were calculated and the correlation between both groups was determined by simple linear regression analysis. RESULTS: A total of 38 patients were recruited into the study, 26 had mild preeclampsia, 5 had severe preeclampsia, and 7 had superimposed preeclampsia. The result of the 4-hour urine protein was found to correlate with those of the 24-hour urine protein for patients with hypertensive disorders in pregnancy (p < 0.001). CONCLUSION: Total protein values of 4-hour samples positively correlated with values of 24-hour samples of patients with hypertensive disorders in pregnancy. This might be modified and used for urine protein collection in outpatients to improve the compliance.

Correlation between random urinary protein-to-creatinine ratio and quantitation of 24-hour proteinuria in preeclampsia.

OBJECTIVE: To determine whether random urinary protein-to-creatinine ratio correlated with the quantitation of 24-hour proteinuria in cases of preeclampsia. DESIGN: Cross-sectional descriptive study. SUBJECTS: Pregnant patients hospitalized in the obstetric ward, King Chulalongkorn Memorial Hospital due to preeclampsia. METHOD: The random urine specimens were obtained from the eligible subjects for protein-to-creatinine ratio determination, the subjects were then instructed to collect 24-hour urine samples for protein measurement. RESULTS: Twenty-five pregnant patients completed the study. There was a strong correlation between the random urinary protein-to-creatinine ratio and the quantitation of 24-hour proteinuria (r = 0.929, p < 0.001). CONCLUSION: The presented data support a strong correlation between random urinary protein-to-creatinine ratio and quantitation of 24-hour proteinuria in hospitalized pregnant patients with preeclampsia.

Reference ranges for Doppler indices of uterine arteries in pregnant women during 22-28 weeks' gestation: a study at King Chulalongkorn Memorial Hospital.

Color pulsed Doppler ultrasound was used to examine the uterine arteries of a total of 265 normal pregnant women during 22-28 weeks' gestation at the Division of Maternal-Fetal Medicine, King Chulalongkorn Memorial Hospital. Reference ranges for pulsatility index (PI) were determined and throughout this gestational range, the mean values were nearly constant and lower than 0.9 and the upper limit of 95 per cent confidence interval (CI) for the PI values were lower than 1.0. In conclusion, the authors have established the reference ranges for PI of uterine arteries in the late second to early third trimester of pregnancy in Thai pregnant women. This could be beneficial for the baseline data in the evaluation of pregnant women complicated with preeclampsia and fetal growth restriction.