Transvaginal sonography for fetal crown-rump length measurement in a Thai population.

A prospective descriptive cross-sectional study was undertaken at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University to establish a reference interval for fetal crown-rump length (CRL) in a Thai population using transvaginal ultrasound. This study was performed on normal pregnant women registered at the antenatal clinic in their first trimester. All had a good menstrual history. CRL measurement was obtained by a 5 MHz vaginal probe. All of the newborns were proved to be normal at birth. We constructed and compared CRL (mm) relating to gestational age (GA) (days). Five hundred and forty seven cases were enrolled into the study. CRL was correlated with gestational age. The best fit regression equation was the quadratic model: CRL (mm) = -13.872 - 0.014 GA (day) + 0.0097 GA (day)2, R = 0.92, p < 0.0001). Centiles and a chart for CRL derived from the regression equation are presented. In conclusion, a reference interval for fetal crown-rump length in a Thai population has been established. This data may be useful in the early detection of genetic or environmental disorders affecting fetal growth in the first trimester of pregnancy.

Uterine blood flow response to hormonal replacement therapy in asymptomatic postmenopausal women: a transvaginal Doppler study.

To evaluate the effect of continuous hormonal replacement therapy (HRT) on Doppler parameters of uterine blood flow in asymptomatic postmenopausal women. Thirty-eight asymptomatic postmenopausal women were recruited into the study from the outpatient menopause clinic, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University. The study population was divided into 20 cases without any HRT (group 1) and 18 cases using continuous conjugated equine estrogen 0.625 mg/day combined with medroxyprogesterone acetate 2.5 mg/day (group 2). The duration of HRT was 21.3 +/- 9.5 (13-56) months. A transvaginal colour flow imaging system (ALOKA SSD-2000 MultiView, Tokyo, Japan) was used to assess uterine blood flow. Quantitative data from areas of colour were evaluated by pulsed Doppler spectrum analysis. Resistance indices (RI) were measured as indicators of uterine perfusion. Both groups were statistically similar with respect to age, parity, age at menopause, height and weight. The endometrial thickness in group 1 and 2 were 3.8 +/- 0.8 and 4.1 +/- 0.6 millimetres, respectively. The left uterine artery RIs of group 1 and 2 were 0.86 +/- 0.08 and 0.84 +/- 0.07, respectively (p = 0.33). The right uterine artery RIs of group 1 and 2 were 0.87 +/- 0.07 and 0.83 +/- 0.06, respectively (p = 0.06). In conclusion, continuous HRT had a non-significant influence on uterine blood flow in the postmenopausal women.

Fetal hematology.

The objective of this study was to establish normal fetal hematological parameters throughout gestation. Samples of pure fetal blood from 35 fetuses of 21-38 weeks' gestation were obtained by fetal blood sampling under continuous ultrasound guidance. The hematological parameters were determined with automated cell counter within 30 minutes after the procedures. Fetal red blood cell and granulocyte counts rose significantly with advancing gestation, whereas, the mean corpuscular volume fell. There were no significant changes in fetal hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width, total white blood cell count, lymphocyte count, mid-cell count, platelet count, mean platelet volume, and platelet distribution width with increasing gestation. The growing application of fetal blood sampling to the prenatal diagnosis renders mandatory a knowledge of normal fetal blood values. These results may provide useful reference values for prenatal diagnoses of hematological disorders.

Transvaginal hysterosalpingo-contrast sonography (HyCoSy) compared with chromolaparoscopy: a preliminary report.

Fifteen infertile women who required tubal passage evaluation by chromolaparoscopy were recruited. Those who had lower genital tract infection or abnormal uterine bleeding were excluded from the study. Transvaginal HyCoSy was performed during the first half of the menstrual cycle at least 24 hours prior to chromolaparoscopy. The results from both transvaginal HyCoSy and chromolaparoscopy were compared in assessing tubal patency and uterine pathology. A high correlation was noted regarding uterine examination using transvaginal HyCoSy compared with chromolaparoscopy (sensitivity, specificity, PPV and NPV were 91.7%, 33.3%, 84.6% and 50%, respectively). The correlation of the outcome between the two procedures in assessing tubal patency, when combining both tubes, was also high (sensitivity, specificity, PPV and NPV were 100%, 55.6%, 80% and 100%, respectively). The most common adverse event was only mild pelvic pain which did not necessitate any treatment. These preliminary results reveal the potential value of transvaginal HyCoSy as an alternative in infertility investigations. It seems to be as effective but less invasive than conventional chromolaparoscopy. The adverse events reported in this study relate more to the procedure (catheter insertion) rather than the trial substance.

Nomogram of nuchal fold thickness of Thai fetuses.

The aim of the study was to establish normal values of nuchal fold thickness during 14-21 weeks of pregnancy. Three hundred Thai pregnant women before 12 weeks of gestation were recruited. Gestational age was determined by last menstrual period and confirmed by crown-rump length. Subjects with date-size discrepancy of more than 7 days were excluded from the study. Nuchal fold thickness was measured twice, first during 14-17 weeks, and then during 18-21 weeks. Five hundred and nine measurements were obtained. Nomogram of nuchal fold thickness was constructed. Mean values of nuchal fold thickness increased steadily from 2.59 +/- 0.77 millimeters (mm) at 14 weeks to 4.12 +/- 0.98 mm at 21 weeks. Average rate of increase were 0.22 mm per week. In conclusion, nuchal fold thickness increased with advancing gestational age from 14 to 21 weeks of pregnancy. Different normal cut-off levels for each gestational week may be more appropriate for screening of fetal Down syndrome in Thai pregnant women.