Frontomaxillary facial angle in chromosomally normal Thai foetuses at 11 to 13 weeks 6 days ' gestation.

Frontomaxillary facial (FMF) angle is the angle between upper part of the anterior end of the maxillary bone and the line along the frontal bone in the midfacial profile view. Based on several previous studies, FMF angle can be useful in screening Down syndrome foetuses, in which FMF angle is significantly larger than that in euploid foetuses. However, racial factors can influence the FMF angle as seen in the different normal ranges among ethnicities. Therefore, before the clinical application of the FMF angle, a reference range for its own population should firstly be developed. In this study, a Thai reference range of FMF angle has been established. The mean FMF angle in euploid foetuses with a 60-mm crown ­ rump length (CRL) was 81.07 °, with 0.23 ° increase for each mm increase in CRL, consistent with those observed in Caucasian and Chinese populations. The measurement of FMF angle has good reproducibility.

Serial translabial sonographic measurement of cervical dimensions between 24 and 34 weeks' gestation in pregnant Thai women.

OBJECTIVE: To assess serial changes of cervical dimensions in pregnant Thai women between 24 and 34 weeks' gestation by translabial sonography. METHODS: A longitudinal study of cervical dimensions obtained by translabial sonography at 24, 28, 30, 32, and 34 weeks' gestation in 144 women was conducted. The gestational age at labor was recorded and women were defined as having preterm labor or term labor according to whether there was onset of true labor pain before or after 37 completed weeks, respectively. Cervical changes over time were analyzed by repeated ANOVA. The associations between cervical dimensions and gestational age, parity and prepregnancy body mass index were calculated by multiple linear regression analysis. RESULTS: Cervical length decreased whereas cervical width increased as gestational age advanced. Cervical length and width in women with term labor, but only cervical length in women with preterm labor, changed significantly throughout the period of 24-34 weeks' gestation (P < 0.01). The cervix was significantly longer in parous women and in women with a body mass index of more than 26 kg/m2, but was shorter in women of advanced gestational age. The cervix was significantly wider in parous women and in those of advanced gestational age. Weekly crude rate, adjusted for parity and prepregnancy body mass index, of both cervical length shortening and cervical width widening was 0.4 mm in women with term labor. Women with preterm labor had cervical shortening of 0.5 mm per week. CONCLUSIONS: Gestational age, parity and prepregnancy body mass index are significantly associated with the dynamic changes of cervical length and width in Thai women. These factors should be considered when assessing normal values of cervical dimensions and for predicting the risk of preterm delivery.

Prenatal diagnosis of fetal bladder outlet obstruction at Songklanagarind Hospital: report of 5 cases.

Five cases of fetal bladder outlet obstruction prenatally diagnosed in the Perinatology Unit, Department of Obstetrics and Gynaecology, Songklanagarind Hospital, Songkhla, from January 1990 to September 1999 were reported. Ultrasound findings demonstrated megacystis, various degrees of hydroureter and hydronephrosis and oligohydramnios. Sex could be determined in only four cases and all were male. Chromosome abnormality (trisomy 18) was documented in one case. Postmortem results in three cases established that posterior urethral valves were the cause of obstruction. All cases in our series had poor outcome based on gestational age at first diagnosis, sonographic findings, fetal urinalysis, and chromosome abnormality. Four cases underwent termination of pregnancy and the other resulted in a dead fetus in utero. The outcome of some cases may be improved by using the vesicoamniotic shunt placement procedure that increases the likelihood of fetal survival. Therefore, the recommendation is to establish this procedure at Songklanagarind Hospital in the future.

Simplified abdominal wall-lifting device for gasless laparoscopy.

OBJECTIVE: To develop a simplified abdominal wall-lifting device for gasless laparoscopy. METHODS: The device is composed of an electric-power actuator, sliding arm and abdominal wall-retractor. All parts of the device are reusable. The device provides planar displacement of the anterior abdominal wall to enable space for laparoscopy. The valveless ports and conventional instruments, as well as laparoscopic instruments, were used without a gas leak problem. RESULTS: After preliminary success in the laboratory testing, a petition was made to the hospital's Ethic Committee. Since then we have performed 40 gasless laparoscopic procedures including 13 salpingo-oophorectomies, 10 diagnostic laparoscopies, five tubal ligations, five ovarian cystectomies, four salpingectomies, two removals of pelvic IUDs and one laparoscopic hysterectomy. There were no surgical complications, including no abdominal wall trauma. The operative field was almost the same as that of the pneumoperitoneum technique, with the exception of morbidly obese patients. CONCLUSIONS: This preliminary experience demonstrates the efficiency of the simplified abdominal wall-lifting device and the potential advantages of gasless laparoscopy. Continued modifications and applications are necessary to delineate the full range of benefits of this device and technique, especially in developing countries.

Prenatal diagnosis of thalassemia in Songklanagarind Hospital in southern Thailand.

A thalassemia screening program for pregnant women has been established in Songklanagarind Hospital since 1992. After genetic counseling, a total of 5078 pregnant women accepted entry into a screening program for thalassemia. Couples at risk who should receive prenatal diagnosis were 2.8%. Total cases who accepted prenatal diagnosis were 135. Total clinical cases were 40 (29.6%) with achievement by prenatal diagnosis of 33 cases (82.5%). Genetic amniocentesis is the most acceptable method for prenatal diagnosis. Five cases (12.5%) were misdiagnosed due to contamination of maternal blood cells in amniotic fluid cases. Questionable results were reported in 2 cases (5%). Abortion occurred in one case (0.7%). Improvement of surgical technic in prenatal diagnosis reduced the complications and contamination of maternal cells. This program shows the feasibility of prevention and control of thalassemia disease in southern Thailand.

A comparative study of outcome of laparoscopic salpingo-oophorectomy versus open salpingo-oophorectomy.

OBJECTIVE: To determine the effectiveness and appropriateness of laparoscopic salpingo-oophorectomy (LSO) versus open salpingo-oophorectomy (OSO) in developing country. METHOD: A clinical study with historical control consisted of 31 LSO cases of benign ovarian cysts were compared with 41 OSO cases matched by diagnosis and difficulty. RESULTS: The operative time of the LSO cases was higher (p < 0.001), but the morbidity was comparable (p = 0.22). The postoperative hospital stay of the LSO was shorter (p < 0.001). Patients who had LSO revealed meaningfully decreased postoperative use of analgesic (p < 0.05). The time to full recovery for LSO was shorter (p < 0.001), but the hospital charges were higher (p < 0.001). CONCLUSIONS: LSO is considerable safe and effective alternative to OSO but incurs higher hospital charges. The overall cost effectiveness of LSO, especially in the developing countries, need further evaluation.

Cost-benefit analysis of laparoscopic adnexectomy.

OBJECTIVE: To determine the economic feasibility (from the patient's viewpoint) of laparoscopic adnexectomy (LA) in a developing country. METHOD: Forty-four LA cases of benign ovarian cysts or tubal pregnancy were compared with 44 conventional open adnexectomy (OA) cases treated during the same period and matched by diagnosis, procedure and degree of difficulty. RESULT: The postoperative hospital stay was 1.3 +/- 0.6 days (mean +/- S.D.) and 5.3 +/- 1.1 days (P < 0.001) for the LA and OA groups, respectively. LA cases had a shorter recovery period (5.8 +/- 2.2 days vs. 27.2 +/- 6.6 days, P < 0.001), but higher hospital charges (US$463.3 +/- 84.9 vs. US$229.8 +/- 92.2, P < 0.001), caused mainly (89.2%) by disposable laparoscopic instruments. Incremental cost-benefit analysis revealed a possible saving with LA for higher income patients (US$9.2 per day). CONCLUSIONS: LA in Thailand may have economic benefit only to the higher income patients. Benefits to other patients in developing countries will depend on future cost reductions of disposable instruments and/or more effective use of reusable instruments.