Three dimensional sonographic appearances of Chinese ring intrauterine device: a case report and literature review.

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.

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.

Fetal neck myofibroma.

Magnetic resonance imaging (MRI), as an adjunct to ultrasonography, has become a promising tool in prenatal diagnosis and therapy. In this report, the authors described a case of giant solid mass arising in the fetal neck region diagnosed by prenatal sonographic examination at the gestational age of 33 weeks'. MRI was used to confirm the diagnosis, and to assist fetal airway assessment. Due to the concern of fetal airway compromise, the ex utero intrapartum treatment (EXIT) was strategically planned with help from specialists in the according fields. This allowed the authors to secure the fetal airway before fetomaternal circulation was disconnected. It was performed successfully through Cesarean section at the time of birth. Histopathology revealed infantile myofibroma, which is a rare form of such a tumor arising on the fetal head and neck region diagnosed prenatally.

Real-time three dimensional sonographic features of an early third trimester fetus with achondrogenesis.

Generalized shortening of fetal long bones detected from prenatal sonographic examination usually raise a tentative diagnosis of skeletal dysplasia. Information obtained from grey-scale scan is frequently not sufficient to provide a definite diagnosis, and the images are not readily comprehensible for the parents-to-be. Lately, three-dimensional sonography has become increasing available in obstetric practice. The authors report here a rare case of fetal achondrogenesis, which is a lethal form of skeletal dysplasia, in a 30-week-old fetus using real-time three-dimensional ultrasound. The prenatal findings of fetal achondrogenesis from this technique were thoroughly described, along with postnatal radiography and autopsy results. Sonographic features from this imaging technique allow for an accurate diagnosis and better understanding of the parents. This facilitates the genetic counseling process, as well as the parental options for further care.

Effect of halogen light in fetal stimulation for fetal well-being assessment.

OBJECTIVE: To evaluate the shortening of the time of nonstress test (NST) by using transabdominal fetal stimulation with halogen light. STUDY DESIGN: Experimental research. MATERIAL AND METHOD: The authors enrolled 176 pregnant women between 32 and 42 weeks of gestation indicated for NST at the Division of Maternal Fetal Medicine, Siriraj Hospital, Mahidol University. They were randomly assigned to receive either NST (control) or halogen light stimulation test (LST). The stimulation was performed at the beginning of the test and repeated every 10 minutes until reassuring fetal heart rate (FHR) acceleration was achieved, or up to 3 times. All tracings were interpreted blindly by one investigator at the end of the tests. RESULTS: The mean (+/- SD) duration from starting the test to the first FHR acceleration was not significantly different between the control group and the LST group (5.6 +/- 7.2 and 5.4 +/- 5.2 minutes, respectively). The average testing time (+/- SD) to achieved reactivity was 10.5 +/- 8.8 minutes in the controls and 9.6 +/- 6.7 minutes in the LST group. This was not statistically different. The incidence of nonreactive tests was not significantly different between the LST and the controls (15.9% and 11.4%, respectively). Among the LST subjects, term fetuses and women with BMI < 27 kg/m2 required less time to reach reactivity, 2.4 and 2.3 minutes respectively. CONCLUSION: Transabdominal halogen light stimulation did not shorten the duration of NST in the presented population. However, the presented data suggests that the fetus at term could respond to visual stimulation, especially when the gestational age is more advanced.

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.

Active lupus and pregnancy: How to handle.

We report herein the case of a 20-year-old Thai woman who developed lupus flare in the second trimester of pregnancy, as manifested by autoimmune hemolytic anemia, thrombocytopenia and glomerulonephritis. The patient underwent treatment with intravenous dexamethasone and, subsequently, pulse methylprednisolone to control plausible lupus exacerbation in the central nervous system. The disease subsided after an inevitable development of spontaneous abortion. We reviewed the current status of knowledge on interactions between pregnancy and systemic lupus erythematosus, proper management, and safety immunosuppressive drugs to ensure a more favorable outcome. This will be helpful for physicians to provide sound advice regarding pregnancy for lupus patients in their reproductive years.