Mirror syndrome associated with fetal cardiac anomaly: A case report.

A rare mirror syndrome (Ballantyne syndrome) was seen in a woman who carried a hydropic fetus caused by fetal atrio-ventricular septal defect (AVSD). Diagnosis was made with confidence after ruling out cardiogenic pulmonary edema and preeclampsia. Placental pathology demonstrated multifocal villous edema and accelerated maturation of trophoblasts which may support the earlier reports about potential etiologic roles of the placenta to trigger the disease.

A 6-year experience of fetal skeletal anomalies prenatal diagnosis at anomaly clinic, Siriraj Hospital.

Objective: The purposes of this study were to review the prevalence of skeletal dysplasias among fetal anomaly cases and to demonstrate common findings detected prenatally by ultrasonography. Methods: Twenty prenatal cases diagnosed of skeletal anomalies between January 2000 and December 2005 at Anomaly Clinic, Maternal-Fetal Medicine Unit, Siriraj Hospital were reviewed retrospectively. Demographic data such as maternal age, gravida, parity, gestational age at first diagnosis were collected, including prenatal ultrasound findings. Final diagnosis and pregnancy outcome after termination of pregnancy were also demonstrated. Results: The prevalence of skeletal dysplasias among fetal anomaly cases in the study interval was 3.86% (20/518 cases and 95%CI=2.51%, 5.89%). Mean maternal age was 30.3(+ 5.3) years old. The most likely time of diagnosis was 26 (+ 5.7) weeks of gestation. The most common type diagnosed prenatally was thanatophoric dysplasia (40%). All cases of prenatal ultrasound findings of suspected skeletal dysplasias demonstrated short limbs. Three cases were non-lethal anomalies and the parents decided to continue pregnancy. In the remaining 17 cases, the parents were counseled about lethal prognosis of their fetuses and only 11 cases decided to terminate pregnancy at our hospital. Thanatophoric dysplasia was the most common diagnosis after termination of pregnancy (9 in 11 cases). Conclusion: Fetal skeletal dysplasias are one of fetal anomalies which can be detected prenatally by routine ultrasonography. Detection of abnormal long bone length is the important finding. Thorough scanning of all bony characteristics can help clinicians about prenatal diagnosis and pregnancy outcomes.

Transabdominal ultrasound in the assessment of postvoid residual urine volume in patients after hysterectomy.

OBJECTIVE: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy. MATERIAL AND METHOD: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization. RESULTS: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml. CONCLUSION: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.

Success rate of second-trimester termination of pregnancy using misoprostol.

OBJECTIVE: To evaluate the efficacy and maternal side effects of misoprostol usage for second trimester termination 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: The medical records of 94 pregnant women, between 14-28 weeks of gestation, who were admitted for medical termination of pregnancy, were reviewed. Each patient received 400 microg of misoprostol vaginally every 12 hours as recommended by RTCOG for termination of pregnancy. Main outcome measures included success rate of abortion within 48 hours, induction to abortion interval and maternal side effects. RESULTS: The success rate of abortion within 48 hours was 89.46%. Mean induction to abortion interval was 22.1 hours. The most common maternal side effect was fever (24.5%). The rate of incomplete abortion was 28.6% of successful cases. No factor, including age, parity and viability of fetus affected the success rate significantly. No serious maternal complication was detected. CONCLUSION: Misoprostol 400 microg vaginally every 12 hours can be used effectively and safely for second trimester pregnancy termination.

Primary abscess of the omentum: A case report.

A Thai woman, 63 years old, presented with high grade fever, abdomino-pelvic mass with pain five days before admission. Physical examination and ultrasonography suspected an ovarian tumor with complication. The operation was performed three days after admission. The greater omental abscess was found, while other visceral organs were normal. Partial omentectomy was performed, and histopathological report showed acute and chronic inflammation with multiple microabscesses. Antimicrobial therapy was continued post-operatively until clinical improved. Although primary abscess of the omentum is uncommon, it should be included in the differential diagnosis of the inflammatory abdomino-pelvic mass.