ABSTRACT
Objective: To assess the sonographic morphology of umbilical cord coiling in chromosomally normal fetuses and estimate the specificity of hypocoiled appearance as a marker for fetal trisomy 21 in the second trimester. Methods: 555 singleton pregnancies undergoing amniocentesis for fetal karyotype were scanned at 17-22 weeks’ gestation. The umbilical cord was evaluated in a longitudinal section using 2D with color Doppler sonography. The cross-sectional data of umbilical coiling index (UCI), defined as the reciprocal of the distance between umbilical coils, were analyzed to establish the normal range according to the gestational age. A UCI less than the 5th percentile was the cut-off value for hypocolied umbilical cord. The specificity of hypocolied umbilical cord to predict fetal trisomy 21 was calculated. Results: As a result of amniocentesis, there were 527 chromosomally normal fetuses and 9 trisomy 21 fetuses. There was no significant difference in maternal characteristics between these two groups. In trisomy 21 fetuses, there was a higher proportion of fetal anomaly indicating for fetal karyotype (22.2% VS 0.6%, p = 0.003). The regression equation of UCI (cm-1, y) on gestational age (weeks, x) was y = 1.205 - 0.033x. The hypocoiled umbilical cord was characterized in 2/9 (22.2%) fetuses with trisomy 21 and in 22/527 (4.2%) chromosomally normal fetuses (p = 0.01), with specificity of 95.83%. Conclusion: The coiling pattern of umbilical cord visualized by sonography has a potential value in second-trimester screening for fetal trisomy 21. Nevertheless, further studies of this model in a larger cohort would provide more information in sensitivity and predictive values.
ABSTRACT
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.
ABSTRACT
Objective: To determine the changing of trend in methods of delivery in a university hospital, the correlation among each method of delivery as well as the correlation of the cesarean section rates and the perinatal mortality rates. Methods: The medical records of birth in Siriraj Hospital during 1979-2006 were collected and analyzed. The methods of delivery from these data were grouped and categorizes as following : vaginal delivery, cesarean section, forceps extraction, vacuum extraction, vaginal breech delivery and others. Each method of delivery was studied separately in detail for time and accordingly trend and comparatively to the others to find interaction among them. The changing of trend of perinatal mortality rates were also demonstrated to identify the correlation with the cesarean section rate. Results: There were totally 442,635 births for this study. It was found that the percentage of vaginal delivery was decreased from 82.35 % in 1979 to 58.44 % in 2006 while the cesarean section rates was increased steadily from 7.06% in 1979 to 37.77 % in 2006. The other methods of delivery such as forceps extraction, vacuum extraction and vaginal breech delivery do not play significant roles in this changing trend since they have only small proportions ranging from about 2-5% of all deliveries. In the view of perinatal mortality rate , it continuously declined and has been less than 10% in the last 10 years. Conclusion: Regarding to 28-year review, it is clearly established that methods of delivery are now changing. Cesarean section rate rises steadily with unpromising sign of stabilization and is now far beyond the rate suggested by WHO. It directly effects the downward trend of vaginal delivery and also may be to the other methods of delivery such as vaginal breech delivery, forceps extraction and vacuum extraction, approaching the extinction. This study found no significant correlation between the increasing cesarean rates and the perinatal mortality rates.
ABSTRACT
OBJECTIVE: To investigate the influence of pre-pregnancy weight on delivery outcome and birth weight in potential diabetic women with normal glucose tolerance. DESIGN: Retrospective Cohort study. MATERIAL AND METHOD: The medical records of 660 pregnant women, who attended the antenatal clinic and delivered at Siriraj Hospital between January 2003 and December 2005, were reviewed and analyzed. They all had the known pre-pregnancy weight and were at risk of gestational diabetes with the normal glucose tolerance. Any pregnant women without pre-pregnancy weight recorded were excluded from the present study. They were classified into two groups according to the pre-pregnancy BMI, one was the overweight group (BMI > or = 27 kg/m2) and the other was the normal weight group (BMI 20-25 kg/m2). Information of the complications of pregnancy, the route of delivery, birth weight, and neonatal outcomes were collected and analyzed. RESULTS: The risks of adverse pregnancy outcomes in overweight women, after adjusting for the confounding factors, were significantly increased, including pre-eclampsia (OR 3.87, 95% CI 2.09-7.25, p < 0.001), cesarean delivery (OR 2.22, 95% CI 1.45-3.39, p < 0.001), cephalopelvic disproportion (OR 2.15, 95% CI 1.35-3.42, p = 0.001), and macrosomia (OR 7.59, 95% CI 1.98-29.09, p < 0.001). CONCLUSION: Even though the screening test for gestational diabetes mellitus is normal, the overweight women still have several adverse pregnancy outcomes.