Prenatal ultrasonographic findings in "trisomy 13".

OBJECTIVE: To evaluate the accuracy of prenatal ultrasonographic diagnosis in fetuses with trisomy 13. MATERIAL METHOD: The present study consisted of all fetuses diagnosed of trisomy 13 and delivered at Ramathibodi Hospital between 1997 and 2006. RESULTS: There were 15 cases of trisomy 13. Twelve cases (80.0%) were detected by prenatal ultrasonographic examination, and 3 cases (20.0%) were missed. Mean maternal age was 31.4 years old. Sixty-six percent were diagnosed in 2" trimester (mean 19.4 weeks). The earliest gestational age for detection was 12 weeks 6 days. The most common abnormal ultrasonographic findings were holoprosencephaly (46.7%), and facial defects (40.0%). CONCLUSION: The accuracy of prenatal sonographic diagnosis in trisomy 13 fetuses was 80%. The most sensitive prenatal ultrasonographic findings in trisomy 13 were holoprosencephaly and facial defects.

Impact of stress urinary incontinence and overactive bladder on quality of life in Thai women attending the urogynecology clinic.

OBJECTIVE: To investigate the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on the quality of life (QOL) using disease specific health-related QOL questionnaire. MATERIAL AND METHOD: Three hundred and nineteen women with SUI and/or OAB, attending the urogynecolgy clinic, Ramathibodi Hospital were recruited in the present study. Information on QOL was collected, using the Thai version of modified incontinence-specific quality of life questionnaire (I-QOL) and short form incontinence impact questionnaire (IIQ-7). RESULTS: In 319 cases, the diagnosis of SUI, OAB, and both were 55 cases, 78 cases, and 186 cases, respectively. There was no statistically significant difference in patients' characteristics in three groups. The patients with both SUI and OAB showed significantly lower scores in all domains of I-QOL than the SUI and OAB groups, whereas QOL, assessed by IIQ-7, showed significant impairment in the combined SUI and OAB group, only in the emotional health domain. CONCLUSION: Stress urinary incontinence and overactive bladder have a detrimental impact on patient health-related QOL. Women with a combination of SUI and OAB have the greatest impairment in QOL.

Intrapartum fetal abdominal circumference by ultrasonography for predicting fetal macrosomia.

OBJECTIVE: To evaluate the diagnostic value of sonographic measurement of fetal abdominal circumference (AC) for the prediction of fetal macrosomia. MATERIAL AND METHOD: A prospective clinical trial was conducted at Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. The study consisted of 361 singleton pregnant women who were admitted for delivery at labor room. All women underwent sonographic measurements of the fetal abdominal circumference (AC) during the early intrapartum period. The AC values were correlated to actual fetal birth weight. The cut-off value of AC for predicting of fetal macrosomia was analyzed. RESULTS: Among 361 cases, the mean maternal age was 29.0 +/- 5.5 years (range, 15-46). The median gestational age was 39 weeks (range, 31-42). The mean fetal birth weight was 3,179.83 +/- 450.91 gm (range, 1,180-4,560). The prevalence of macrosomia was 11.08% (40/361). A cut-off value of abdominal circumference > or = 35 cm was the best predicting of fetal macrosomia. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 87.50%, 84.74%, 85.04%, 41.67%, and 98.19%, respectively. CONCLUSION: The intrapartum fetal AC measurement was useful in predicting of fetal macrosomia. An AC measurement of > or = 35 cm was the best value of fetal macrosomia prediction.

Pregnancy outcome of twin pregnancy in Ramathibodi Hospital.

OBJECTIVES: To evaluate maternal and neonatal complications and pregnancy outcomes of twin pregnancies. MATERIAL AND METHOD: The retrospective analysis included data on the twin pregnancies delivered at Ramathibodi Hospital between January 1995 and December 2000. The data retrieved from the medical records included demographic data, complications of pregnancy, and maternal and neonatal outcomes. Statistical analysis was performed. RESULTS: Of 374 twin pregnancies, 321 cases had completed medical records. Incidence of twin pregnancies was 8.6 per 1,000 births. Most common maternal complication was preterm delivery (49.2%). Other maternal complications were anemia (21.5%), pregnancy induced hypertension (13.4%), premature rupture of membranes (10%), postpartum hemorrhage (5.6%) and antepartum haemorrhage (1.9%), respectively. Median gestational age at delivery was 37 weeks. Most common route of delivery was caesarean section (58.3%). Most common neonatal complication was low birth weight (62.3%). Perinatal mortality rate was 45 per 1,000 births. Prematurity was the most common cause of neonatal death. No neonatal death was found after 34 weeks of gestation. CONCLUSION: Twin pregnancy has high maternal and neonatal complications, especially preterm delivery that increases risk of significant neonatal morbidity and mortality.

How to approach common urogynaecological problems?

Urogynaecology is dedicated to the treatment of women with pelvic floor dysfunction such as urinary orfecal incontinence and prolapse (bulging or falling) of the vagina, bladder and/or the uterus. Pelvic organ prolapse simply means displacement from the normal position. On average, 11% of women will undergo surgery for this condition. Pelvic organ prolapse quantification system (POP-Q) is an objective, site-specific system for describing the anatomic position that can be used to determine the stage of the prolapse. Urinary incontinence (leakage of urine) is a very common condition affecting at least 10-20% of women under age 65 and up to 56% of women over the age of 65. The most common subtypes of urinary incontinence are (1) stress urinary incontinence (SUI) ; (2) urge urinary incontinence (UUI) ; and (3) mixed urinary incontinence (MUI). Patients presenting with symptoms of pelvic organ prolapse or incontinence should undergo a thorough medical evaluation consisting of a targeted history (include bladder diary or voiding diary), physical examination, urinalysis and urine culture, and postvoid residual volume (PVRV) by pelvic ultrasound. Treatment options for patients with pelvic organ prolapse and urinary incontinence are nonsurgical (lifestyle interventions, pelvic floor muscle rehabilitation, and pessary placement) and surgical management.

Adnexal masses in pregnancy.

OBJECTIVE: To determine incidence and maternal and fetal outcomes of pregnant women undergoing surgical management for adnexal mass. MATERIAL AND METHOD: A cohort study was performed in patients who presented with adnexal masses in pregnancy that required surgical management during April, 1986 to March, 2001. The maternal and fetal outcomes were analyzed. RESULTS: One hundred eighteen patients of 116,323 deliveries were identified with adnexal masses that required surgical management. The incidence was 1 in 986 deliveries. One hundred and three cases had complete data for analysis. A malignant tumor or a tumor of low malignant potential was found in 3 cases (2.9%). In 4 patients, the only finding at the time of operation were leiomyomas. Eighty-four of 103 cases (81.6%) had an elective operation and 19 cases (18.4%) had an emergency operation. There were 3 spontaneous abortions, 3 preterm deliveries, and 1 intrauterine growth restriction in all patients. Patients who underwent elective and emergency operation had the same adverse pregnancy outcome. CONCLUSION: The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. The percentage of malignant tumors or tumors of low malignant potential was 2.9%. Patients who underwent elective operation had the same adverse pregnancy outcome compared with those who underwent emergency operation.

Pregnancy induced hypertension in twin pregnancy.

OBJECTIVE: To compare the incidence, severity and pregnancy outcomes of pregnancy induced hypertension in twins and singleton gestations. MATERIAL AND METHOD: The cohort study enrolled 305 twins and 298 singleton gestations at Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand between January 1996 and December 2001. The rates of pregnancy induced hypertension and pregnancy outcomes were statistically analysed in both groups. P-value of< 0.05 was considered statistically significant. RESULTS: Pregnancy induced hypertension was found to at develop 18.36% in the twin gestations, compared with 5.03% in the singleton gestations (P < 0.05). Women with twin gestations had higher rates of pregnancy induced hypertension (RR 3.65, 95% CI 2.11-6.30, P<0.05) and occurred earlier than singleton gestations (35.86+/-2.50 VS 37.40+/-1.18 weeks, P<0.05). Twin gestations with pregnancy induced hypertension had significantly higher rate of cesarean delivery, low birthweight, NICU admission and perinatal death than singleton gestations with pregnancy induced hypertension (P< 0.05). Moreover the abruptio placenta, postpartum hemorrhage and perinatal mortality in twin gestations with pregnancy induced hypertension group were significantly higher than in normotensive group (P< 0.05). CONCLUSION: The incidence of pregnancy induced hypertension was significant higher and occurred earlier with greater adverse pregnancy outcomes among twin gestations than singleton gestations. Moreover, the rate of adverse maternal and perinatal outcomes in twin gestations with pregnancy induced hypertensive group was higher than in normotensive group.

Labial leiomyoma: a case report.

Leiomyoma is common in the myometrial layer of the uterus, and rarely found in other genital organs. Previous reports show multiple sites of leiomyoma outside the uterus eg. vagina, oral mucosa or mandible vascular leiomyoma. Leiomyoma is normally a benign smooth muscle tumor and behaves as a hormone sensitive tumor Leiomyomas develop during the reproductive age and regress after menopause. The case of a 25 year old female with a large left labial leiomyoma presented as Bartholin's cyst. Illustrates the diagnostic difficulties in such cases. The management in this case was surgical excision. The definite diagnosis was confirmed by histologic examination as a labial leiomyoma.

Lower urinary tract symptoms in Thai women attending the menopause clinic: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of lower urinary tract symptoms and associated factors in women attending the menopause clinic. METHOD: Nine hundred and fifty-six women attending the menopause clinic, Ramathibodi Hospital were interviewed regarding their general health issues and lower urinary tract symptoms by means of an anonymous questionnaire. Demographic data, obstetric history, and underlying diseases were analysed by using Student t-test, Chi-square and Fisher exact test. P < 0.05 was considered as a level of significance. RESULTS: A total of 956 women, mean age 52.89 +/- 5.80 years, completed the questionnaire. The prevalence of stress incontinence, nocturia, urgency, frequency, and urge incontinence were 58.3%, 40.3%, 33.9%, 22.7%, and 6.6%, respectively. Lower urinary tract symptoms was found to be associated with marital status, coexisting medical diseases, menopausal status, previous term delivery, and vaginal delivery (P < 0.05). CONCLUSIONS: Lower urinary tract symptoms was a common problem among women attending the menopause clinic. Marital status, coexisting medical diseases, menopausal status, parity, and mode of delivery were associated with this problem.

Alleviation of the climacteric symptoms with oral sequential hormone replacement therapy.

The efficacy of the oral hormone replacement therapy (HRT) preparation estradiol valerate/levonorgestrel (EV/LNG, Klimonorm) in the alleviation of the menopausal complaints of peri- and postmenopausal Thai women was studied in a prospective, open, uncontrolled phase IV clinical trial. Of the 50 peri- or postmenopausal women screened, 39 completed the study. From them 31 were postmenopausal and 8 perimenopausal. The participants received EV/LNG over a period of 6 cycles. The Menopause Rating Scale II (MRS II) was used to assess the effect of EV/LNG on the menopausal symptoms. The changes in the main parameters of the MRS II during the treatment with EV/LNG showed that the general score decreased by 34.9 per cent after 3 months and was kept at the same value after 6 months of treatment. The somato-vegetative complaints decreased by 32.5 per cent after 3 months and by 35 per cent after 6 months. The psychological complaints decreased by 34.1 per cent after 3 months and by 32.9 per cent after 6 months. The urogenital complaints decreased by 29.3 per cent after 3 months, and remained at the same level after 6 months of treatment. In conclusion, the 6-months administration of the oral HRT preparation estradiol valerate/levonorgestrel caused a considerable alleviation of the climacteric symptoms in menopausal women.