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.

Three–dimensional prenatal ultrasonography of thanatophoric dysplasia: Initial experience at Siriraj Hospital.

Objective: To initially report the prenatal diagnosis of thanatophoric dysplasia (TD) by using both 2 dimensional (2D-US) and 3 dimensional (3D-US) ultrasonography. Methods: During January 2004 to December 2006, 10 pregnant women who were referred to our Maternal Fetal Medicine Unit due to abnormal skeletal sonographic findings have been extensively investigated by 2D-US and 3D-US. Results: 3 cases of TD (30%) have been identified with an average gestational age of 26 weeks. Sonographic findings demonstrated short limbs, severe micromelia, telephone receiver like femoral bone, bell shaped small thorax, platyspondyly of vertebrae and normal shaped skull in all cases. Prenatal diagnosis was made earlier by 2D-US analysis and then was confirmed by 3D-US. Conclusion: 3D-US provides additional findings and increases interpreter confidence, It provides additional information in the evaluation of fetal skeletal dysplasia, including thanatophoric dysphasia, compared with 2D-US.

Incidence of large-for-gestational age newborn: a comparison between pregnant women with abnormal and normal screening test for gestational diabetes.

OBJECTIVE: To evaluate the incidence of large-for-gestational age (LGA) newborn between pregnant women with abnormal and normal glucose challenge test (GCT). DESIGN: Retrospective cohort study. MATERIAL AND METHOD: Two hundred and sixty pregnant women, who were at risk for gestational diabetes mellitus (GDM), received screening following practice guideline. The women were divided into two groups. The study group comprised of 130 women whose screening test results of 50-g 1-hour GCT were abnormal but had not been diagnosed with GDM (normal oral glucose tolerance test). The control group comprised of 130 women whose GCT results were normal. Comparison of various maternal and neonatal characteristics as well as the incidence of LGA between the groups was made. RESULTS: There were no significant differences in age, gestational age at first antenatal care, body mass index, and risk of GDM between the two groups. The study group had a significantly higher number of parity and number of risk factors of GDM than the control group. There was no significant difference in the incidence of LGA newborn between the two groups (8.5% in the study group and 10.8% in the control group, p = 0.528). There were also no significant differences in gestational age at delivery, pre-eclampsia, pre-term delivery, hyperbillirubinemia of the newborn between the two groups. There were no cases of maternal acute postpartum hemorrhage, and birth asphyxia. CONCLUSION: The incidence ofLGA newborn was similar between non-GDMwomen with abnormal and normal screening GCT results in Siriraj Hospital.

Adverse pregnancy outcomes in gestational diabetes mellitus.

OBJECTIVE: To evaluate adverse pregnancy outcome in women diagnosed with gestational diabetes mellitus (GDM) at Siriraj hospital. STUDY DESIGN: Cross- sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: One hundred and sixty two women who were diagnosed with GDM and who received treatment following clinical practice guideline at Siriraj hospital were enrolled. Data were abstracted from medical record regarding adverse pregnancy outcomes of both the mothers and their infants. RESULTS: The most common clinical risk for GDM was age > or = 30 years (116 cases, 71.6%), followed by family history of diabetes mellitus (81 cases, 50%) and obesity (47 cases, 29%). Majority of the women were GDM class A1 (156 cases, 96.3%) and only six cases (3.7%) were GDM class A2. Maternal complications were found in 35 cases (21.6%) and the most common complications were postpartum hemorrhage (17 cases, 10.5%), mild preeclampsia (6 cases, 3.7%) and severe preeclampsia (3 cases, 1.9%). The most common neonatal complication was hypoglycemia (111 cases, 68.5%). This occurred in all infant of GDM class A2 mothers. Macrosomia was found in 29 cases (17.9%). No significant differences in maternal and neonatal complications were found between GDM class A1 and class A2. CONCLUSION: Women with GDM who were diagnosed and treated following treatment guidelines demonstrated no severe maternal and neonatal complications.

Noninvasive diagnosis of fetal anemia and fetal intravascular transfusion therapy: experiences at Siriraj Hospital.

Traditionally, when fetal hydrops are found along with certain markers indicating fetal anemia, fetal blood sampling would be performed through cordocentesis to confirm the diagnosis. This procedure, however comes with an inherent risk of losing the whole pregnancy. When anemia was verified, treatment options were limited and the prognosis was grim. In this article, the authors described their experiences of using prenatal Doppler studies as a noninvasive venue in the diagnosis and treatment of fetal anemia. Once the diagnosis of fetal anemia is made, the patient will be asked to undergo an algorithm to investigate the definite cause of anemia, along with simultaneous ultrasound-guided intravascular fetal transfusion in selected cases. The authors selected two cases of fetal anemia of different etiologies and treatment outcomes to demonstrate the significance of early diagnosis and intervention. Review of the relevant medical literatures and the proposed algorithms were also provided.

Non-compliance to clinical practice guideline for screening of gestational diabetes mellitus in Siriraj Hospital.

OBJECTIVE: To evaluate the rate of non-compliance to Clinical Practice Guideline (CPG) for screening of Gestational Diabetes Mellitus (GDM) and related factors in Siriraj Hospital. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: One-hundred-and-fifty-nine pregnant women at risk for GDM and who delivered at Siriraj Hospital were enrolled Data were collected from history and medical records including base line characteristics, clinical risk factors of GDM, and compliance to guideline. Rate of non-compliance and related factors were evaluated RESULTS: The rate of non-compliance to GPG for screening of GDM at Siriraj Hospital was 22% (95%CI 16.3%-29.1%). The rate was highest among women who had AnteNatal Care (ANC) at a private clinic (82.1%), followed by the private cases in the hospital (40%). Those who received ANC at the hospital had the lowest non-compliance rate of 6.6%. The most common neglected risk factor was maternal age > or = 30 years. Significant higher compliance was found among women with 2 or more clinical risk factors compared to those with only 1 risk factor (p = 0.028). CONCLUSION: The rate of non-compliance to CPG for screening of GDM at Siriraj Hospital was 22%. Highest non-compliance rate was found among the private cases. The most common neglected risk factor was maternal age > or = 30 years.

Result of ambulatory diet therapy in gestational diabetes mellitus.

OBJECTIVES: To evaluate the effectiveness of an ambulatory program for glycemic control of women with gestational diabetes mellitus (GDM). MATERIAL AND METHOD: A total of 33 women with GDM whose FBS from OGTT > or = 105 mg/dl were scheduled to attend weekly ambulatory care for dietary therapy with their family. FBS and 2-hour postprandial blood glucose were monitored every visit for a few weeks. At the end of this program, those with poor glycemic control were admitted for further tight dietary control by conventional 3-day course after which insulin was finally started for the women whose glycemic control remained poor. RESULTS: After the ambulatory program, 14 of 33 cases (42.4%) achieved good glycemic control without hospitalization. Another 6 cases (18.2%) did not need insulin therapy after admission for 3-day intensive dietary therapy. Altogether, 20 out of 33 cases (60.6%) of GDM whose FBS from OGTT > or = 105 mg/dl could avoid insulin therapy after attending the ambulatory program alone or with additional 3-day intensive dietary therapy course. Similar effectiveness was observed from the authors' previous study on 3-day intensive dietary therapy alone. CONCLUSION: The authors' current ambulatory dietary therapy program has shown to be effective in achieving good glycemic control and avoiding unnecessary insulin therapy and admission in most cases of women with GDM. In the future, an even more effective ambulatory diet control may ascertain that once a woman is hospitalized, insulin should be started right away.

Efficacy of fetal echocardiography and an evaluation of indications.

Fetal echocardiography has been accepted as a prenatal noninvasive diagnostic tool of cardiovascular diseases in fetuses for more than three decades. There are limited data in Thailand. A retrospective study of prenatal, natal and postnatal data of pregnant women who had fetal echocardiography at Siriraj Hospital, Bangkok, Thailand, from January 1999 to July 2005 was conducted. In total, there were 117 pregnant women who had fetal echocardiography under standard indications. Median age of pregnant women was 30.2 (17.3-44.2) years old. Median gestational age at the first fetal echocardiography was 29 (17-40) weeks. Median number of time the women had fetal echocardiography was 1 (1-10). Indications for fetal echocardiography were; obstetricians suspected of fetal cardiovascular diseases, multiple anomalies, family history of congenital heart diseases, chromosome anomalies, hydrops fetalis, and other indications (53.8%, 12%, 11.1%, 8.5%, 8.5% and 6.0% respectively). There were 49 (41.8%) cases who had abnormal cardiovascular problems, i.e., structural heart diseases 26 cases, rhythm disturbance 15 cases, and cardiac masses 8 cases. Upon comparison with postnatal echocardiography and/or autopsy findings, fetal echocardiography had a sensitivity of 96.9%, specificity of 90.6%, and accuracy of 92.8%. There was various degrees of risk to have cardiovascular problems for each of the indication taking fetal echocardiography and postnatal data into consideration. Fetal echocardiography had an impact on the management in 57.3% of cases. Conclusion: Fetal echocardiography is a reliable prenatal diagnostic tool for cardiovascular problems with high accuracy and has an impact on the management at prenatal, natal and postnatal period. Different indications for fetal echocardiography have an effect on the relative risk of fetal cardiovascular diseases.

Maternal grief after abortion and related factors.

OBJECTIVE: To investigate maternal grief after abortion and the factors that might relate to the intensity of maternal grief. DESIGN: Cross-sectional, descriptive study. SUBJECT: 132 women who attended the abortion clinic, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Thailand. METHOD: The subjects were asked to complete the questionnaires including demographic characteristics, history of previous pregnancy, and Perinatal Grief scales, two weeks after abortion. The data was then analyzed to determine maternal grief and related factors of grief intensity. RESULTS: There were 7 women with severe grief intensity (5.3%), 50 with moderately grief intensity (37.9%) and 75 with mild grief intensity (56.8%). The factors associated with PGS scores were low income, had had ultrasonography, gestational age of > 16 weeks and methods of treatment. CONCLUSION : Grief is worldwide among women who have recently aborted. The related factors with grief intensity can be used for screening psychological problems of the women who experience abortion. If found, the physicians can closely observe and help them to work through their coping mechanism and prepare them to get another successful pregnancy in the future.

Effect of 3-day intensive dietary therapy during admission in women after diagnosis of gestational diabetes mellitus.

OBJECTIVE: To determine the impact of 3-day intensive dietary therapy during admission on glycemic control. MATERIAL AND METHOD: GDM women, with level of fasting blood glucose (FBS) at or above 105 mg/dl on their oral glucose tolerance test (OGTT), were hospitalized. After 3-day intensive dietary therapy, the women were stratified by FBS value and mean 2-hour postprandial blood glucose. Those with poor glycemic control, FBS at or above 105 mg/dl, were prescribed insulin therapy. RESULT: Between 1 August 2001 to 31 December 2002, a total of 9861 pregnant women were screened for clinical risk factors of GDM at their first antenatal visits, and 4663 had at least 1 risk. After 50-gm glucose challenge test and 100-gm OGTT GDM was diagnosed in 300 women. Only 18% (54 in 300 cases) of GDM had level of FBS at or above 105 mg/dl on OGTT. They were admitted in a special ward for further investigation and initial management. After 3 days of intensive dietary therapy, the FBS and mean 2-hour postprandial blood glucose level were monitored and stratified in 3 groups. Only 42.6% of admission group (23 in 54 cases) still had FBS at or above 105 mg/dl and required insulin therapy (group 1). One third (18 in 54 cases) could avoid insulin therapy due to the level of FBS below 105 mg/dl and mean 2-hour postprandial blood glucose below 120 mg/dl (group 2). This second group was discharged, and due to attend the high risk pregnancy clinic a few weeks later The third group (group 3), comprising one fourth (13 in 54 cases), had FBS below 105 mg/dl but had a mean 2-hour postprandial blood glucose at or above 120 mg/dl. This third group were also discharged and were monitored glycemic profile by FBS and 2-hour postprandial blood glucose every time during their visits to the high risk pregnancy clinic. According to criteria of 2-hour postprandial blood glucose at or above 120 mg/dl on two or more occasions within a 1-2 weeks interval, no one in group 3 needed insulin therapy afterward CONCLUSION: GDM women with FBS at or above 105 mg/dl on their OGTT, should be prescribed intensive dietary therapy alone for 3 days inside hospital rather than initiating insulin immediately after diagnosis. One third had a benefit of avoiding insulin therapy. Only 42% failed to achieve good glycemic control and still needed insulin therapy. One fourth showed optimal glycemic control after this intervention (FBS below 105 mg/dl) but had mean 2-hour postprandial blood glucose at or above 120 mg/dl. Longer trial of dietary therapy should be considered in this last group to avoid over treatment of insulin therapy.

Incidence of gestational diabetes mellitus diagnosed before 20 weeks of gestation.

The objectives of this study were to determine the incidence of gestational diabetes mellitus (GDM) before 20 weeks of gestation and evaluate associated risk factors. A total of 1200 pregnant women who started their antenatal care at Siriraj Hospital before 20 weeks of gestation and were at risk of developing GDM were enrolled. A 50-gram glucose challenge test was used as a screening method and 100-gram oral glucose tolerance test was used to diagnose the condition. All women were screened during their first visit and again at 28-32 weeks of gestation. The results showed that the incidence of GDM diagnosed before 20 weeks of gestation was 5.3% (95% CI 4.1-6.7%), and another 4.9% were diagnosed during 28-32 weeks. This demonstrated the usefulness and effectiveness of the current guideline for GDM screening that approximately half of women with GDM could be diagnosed early in their pregnancies. The 2 independent risks for developing GDM before 20 weeks of gestation were age > or = 30 years and GDM in previous pregnancy (adjusted OR 2.5, 95% CI 1.3-5.0, and 7.1, 95% CI 1.8-27.6, respectively). This specific group of women should be counseled regarding the importance of early GDM screening during their pregnancy.

The cost analysis of ultrasound screening for fetal anomalies.

Objectives : To determine the effectiveness of ultrasound screening for fetal anomalies at different gestational ages and to define an appropriate cost for each ultrasound screening. Materials and methods: 470 pregnant women participated in our ultrasound screening programme from October 1st, 2002 to September 15th, 2003. 757 scans were appointed throughout the first, second and third trimesters, numbering 240,257 and 260 scans, respectively. The ultrasound cost were reduced to about 30% of the normal price (800 baht for 2-3 scans). Results : out of757 scans, 7 abnormal fetuses were found. All abnormalities were detected around 18-20 weeks of gestation No abnormalities were found at other gestational ages. The abnormalities included infantile polycystic kidney, cleft lip, trisomy 13,gastroschisis and 3 cases of echogenic foci of hearts. Using this reduced cost, these pregnant women were easily able to participate in this research Programme. Conclusion: In order to reduce perinatal morality and morbidity, ultrasound screening for fetal anomalies can be performed between 18-20 weeks gestation. If the fetus is found to be abnormal, proper management and care can be planned before delivery. An important obstacle is the high cost of having a scan performed. Therefore, a reduced cost should be considered to recruit more pregnant women to participate in this policy. A reasonable cost for each ultrasound was found to be 425 baht.

Accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To evaluate the accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma in comparison with standard paraffin section. METHOD: A total of 111 patients with endometrial carcinoma diagnosed from fractional curettage underwent pre-operative transvaginal ultrasonography to assess myometrial invasion. Operation for surgical staging was subsequently performed and the hysterectomy specimen was evaluated for depth of myometrial invasion by standard paraffin section blinded from transvaginal ultrasound results. Final histopathologic diagnosis and depth of myometrial invasion were obtained from standard paraffin section. Ultrasonographic assessment was compared with the histopathological results. RESULTS: In evaluation of myometrial invasion, transvaginal ultrasound yielded the sensitivity of 69.4 per cent, specificity of 70.6 per cent, positive predictive value of 53.2 per cent, negative predictive value of 82.8 per cent, and accuracy of 70.3 per cent. The accuracy, sensitivity, specificity, negative predictive value, false positive and negative rates were comparable between grade 3 and grade 1 and 2 tumors. However, the positive predictive value was significantly higher among grade 3 than grade 1 and 2 tumors. The Kappa coefficients were 0.57 and 0.22 for grade 3 and grade 1 and 2 tumors respectively. CONCLUSION: Transvaginal ultrasound for assessment of depth of myometrial invasion in endometrial carcinoma provided acceptable accuracy compared with standard paraffin section. This technique might be of value for the decision making in the intra-operative management of endometrial carcinoma.

Uterine artery resistance index above 95 percentile: prevalence and adverse perinatal outcome prediction in pregnancies complicated by hypertensive disorders.

Uterine artery resistance index (UARI) was determined in a cohort of pregnant women complicated by a hypertensive disorder. The prevalence of the value above 95 percentile (UARI95) and its prediction of adverse perinatal outcomes were evaluated. Fifty-eight women were included in the study. The prevalence of UARI95 in this group of women was 27.6 per cent. The correlations between mean UARI95 and adverse perinatal outcomes were: 31.6 per cent sensitivity, 74.4 per cent specificity, with only 60.3 per cent accuracy. The mean UARI95 does not qualify as a reliable screening test for adverse perinatal outcomes in pregnancies complicated by hypertensive disorders.

A model for malignancy probability prediction of adnexal masses.

OBJECTIVE: To develop a model for pre-operative malignancy probability determination in a patient with an adnexal tumor or tumors by the application of multivariate logistic regression analysis to variables at the time of pelvic sonography. METHOD: Pre-operative ultrasound examination including Doppler analysis was performed on 117 consecutive women scheduled for surgery because of an adnexal mass or masses. Each tumor was classified as probably benign or malignant using a subjective evaluation system on the gray-scale morphological images. Then, Doppler sonography was carried out. The resistance index (RI) and pulsatility index (PI) of the vessel with the highest velocity were recorded. Multivariate logistic regression analysis was performed with the histological outcome as the dependent variable. Independent variables included patient's age, menopausal status, gray-scale morphological data, RI and PI. The probability of malignancy was formulated from statistical analysis. RESULTS: There were 117 women included in the study, 83 (71%) with histologically benign and 34 (29%) with histologically malignant ovarian tumors. Regression analysis on the five variables resulted in the retention of only patient's age, morphological data and RI as significant contributing factors for malignancy prediction. The probability of malignancy was 1/(1+e(-z)) where e was the base value for natural logarithms and z was the regression equation: -3.6355 + 1.8028 (age) + 2.1047 (morphological data) + 2.9816 (RI). CONCLUSION: A model for estimation of probability of malignancy for an adnexal tumor was derived using multivariate logistic regression analysis. The prediction should be more accurate than that from either gray-scale ultrasound imaging or Doppler velocimetry alone. The test of the model is now on-going.

Risk factor-based selective screening program for gestational diabetes mellitus in Siriraj Hospital: result from clinical practice guideline.

A clinical practice guideline for the screening and diagnosis of gestational diabetes mellitus (GDM) is currently implemented at Siriraj Hospital. During the year 2000, a total of 9325 pregnant women were screened for clinical risk factors during their first antenatal visits, and 3770 had at least 1 risk. After the 50 g glucose challenge test and 100 g oral glucose tolerance test, GDM was diagnosed in 235 women. The incidence of GDM was 6.2 per cent (95% CI 5.5-7.1) among high-risk pregnant women, and 2.5 per cent (95% CI 2.2-2.9) of all pregnant women. Significant risk factors identified from the present study were family history of DM (adjusted OR 1.86, 95% CI 1.38-2.51), age > or = 30 years (adjusted OR 2.41, 95% CI 1.72-3.39), history of unexplained intrauterine fetal death (adjusted OR 4.30, 95% CI 2.04-9.04), and obesity (adjusted OR 2.83, 95% CI 1.88-4.25). The risk of developing GDM also increased when more than 1 clinical risk factor was identified. The results support the value of this screening program for GDM. Every obstetrician should be aware of the need to screen for GDM in every pregnant woman and a similar program should also be introduced to other settings.

Ultrasonographic prenatal diagnosis of Treacher Collins syndrome: a case report.

A case of Treacher Collins syndrome (TCS) diagnosed prenatally using ultrasonography is reported. The pregnant woman was gravida 2, para 0. Her husband had stigmata of the syndrome. Ultrasonography revealed polyhydramnios, abnormal fetal ears and marked micrognathia. Abortion occurred spontaneously at 26 weeks of gestation. The abortus bore clinical features of the syndrome.

Fetal abnormalities in the fetal anomaly clinic at Siriraj Hospital.

In order to reduce perinatal morbidity and mortality rates, a Fetal Anomaly Clinic has been set up at Siriraj Hospital. The aims are to identify abnormal fetuses and manage them in an appropriate way before delivery. From 1st May, 2000 to 30th April, 2002, 142 pregnancies with fetal abnormalities out of 10,386 pregnant women examined were found at the Fetal Anomaly Clinic, Siriraj Hospital. There were 32 fetuses (22.5%) with CNS abnormalities and neural tube defects with a mean gestational age at diagnosis of 18.6 weeks, 12 fetuses (8.5%) with gastrointestinal abnormalities with a mean gestational age at diagnosis of 17.1 weeks, 12 cases (8.5%) with cardiovascular and pulmonary abnormalities with a mean gestational age at diagnosis of 24.8 weeks, 10 cases (7%) with skeletal abnormalities with mean gestational age at diagnosis of 26.7 weeks,15 cases (10.6%) with chromosome abnormalities with a mean gestational age at diagnosis of 21.7 weeks, 18 cases (12.6%) of KUB abnormalities with a mean gestational age at diagnosis of 25.6 weeks and 43 cases (30.3%) of other abnormalities with a mean gestational age at diagnosis of 24.5 weeks. Counsellings was given before making a decision and all abnormalities were confirmed by autopsy, amniocentesis, paediatric neonatologists or paediatric surgeons.

Prenatal diagnosis of cardiovascular diseases.

Fetal echocardiography is a safe means to obtain reliable anatomical and hemodynamic data of the fetal heart. The procedure is essential for prenatal diagnosis of cardiovascular abnormalities. In addition, fetal echocardiography is useful to follow-up the progression, monitoring during treatment and making a plan of treatment especially in life-threatening cardiac conditions. The objective of this study was to find the distribution of indications for fetal echocardiography, fetal cardiac anomalies detected, outcome of the fetuses and to assess the accuracy of the procedure. A retrospective study was done at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Pregnant women whose fetuses had prenatal echocardiographic data and gave birth from January 1999 to December 2001 were included. The total number of pregnant women was 54 cases. The indications for fetal echocardiography were suspicion of fetal cardiovascular disease by the obstetrician 42.6 per cent, family history of congenital heart diseases 14.8 per cent, multiple organ system anomalies 14.8 per cent, chromosomal anomalies 11.1 per cent, hydrops fetalis 9.3 per cent, maternal systemic diseases 5.6 per cent and previous pregnancy with a dead fetus in utero 1.9 per cent. The gestational age at the time of the first fetal echocardiography ranged from 17 to 39 weeks (median 28 weeks). The number of fetal echocardiography done in each case ranged from 1 to 10 (median 1.4). Prenatal diagnosis of the abnormal cardiovascular system in fetuses was found in 19 cases (35.2%). There were abnormal cardiac anatomies in 42 per cent, cardiac tumors or abnormal masses in 37 per cent and rhythm disturbances in 21 per cent. When compared with postnatal echocardiography and/or autopsy finding, fetal echocardiography had a sensitivity of 100 per cent, specificity of 96.3 per cent and accuracy of 97.8 per cent. Conclusion: Fetal echocardiography has good accuracy in the diagnosis of cardiovascular diseases. Obstetrician's suspicion is important in the prenatal diagnosis of heart disease that would have affected the short and long-term outcome of the fetus.

Ultrasound measurement of tibia and fibula bone length in Thai fetus.

A prospective cross-sectional study was conducted in order to construct reference centile charts for tibia and fibula bone length of Thai fetuses. A total of 621 normal pregnant women, who attended the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited between 12 and 41 weeks of gestation. We identified pregnant women who had regular menstrual period for at least 3 months without contraception prior to the current pregnancy; and whose uterine size at the time of examination was compatible with menstrual age. Each fetus was measured only once at a randomly assigned gestation age specifically for the purpose of this study. A total of 461 fetal tibia and fibula lengths were measured due to unfavorable fetal position in some cases. Regression models were fitted to estimate the mean and standard deviation for each parameter at each gestational age. The centile charts of both lower limb lengths for Thai fetuses were derived from regression equations and are presented.