Prevalence of urinary incontinence during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital.

OBJECTIVE: To assess prevalence of Urinary Incontinence (UI) during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: The present study population comprised > or = 36 weeks singleton pregnant women attending the ANC at King Chulalongkorn Memorial Hospital between 2009 and 2010. Questionnaire was developed from International Continence Society Questionnaire, which consisted of two parts, (1) socioeconomic demographic, characteristics related to UI, and (2) obstetric characteristic, UI experienced after delivery. Validity and reliability of the questionnaire were tested (Cronbach's alpha = 0.8). Chi-square, t-test, Pearson correlation McNemar test, and Binary logistic regression were used for comparison. RESULTS: The majority of the participants (93.8%) were aged between 20 and 39 years old. The prevalence of UI during late pregnancy and three months postpartum were 53.8% and 7.8%, respectively. This difference reached statistical significance (p < 0.001). There were 53.5% of stress UI, 20% of urge incontinence, and 7.8% of mixed type UI during late third trimester, whereas only stress UI was found in three months postpartum period. The only risk factor for late antenatal and early postpartum UI was high pre-pregnancy BMI (OR 2.3; 95% CI 1.38-3.85, p < 0.001 and OR 3.3; 95% CI 1.8-6.0, p < 0.001, respectively). CONCLUSION: The prevalence of UI was quite high during the late third trimester (53.8%) and decreased significantly three months postpartum (7.8%). Pre-pregnancy BMI is the only risk factor for developing UI in late antenatal and early postpartum period. This may help obstetricians for prediction and prevention of UI during pregnancy and postpartum in high-risk group.

Are the cardiac dimensions spared in growth-restricted fetuses resulting from uteroplacental insufficiency?

AIM: The aim of this study was to investigate the effect of intrauterine growth restriction (IUGR), specifically from uteroplacental insufficiency, on fetal cardiac dimensions. MATERIAL AND METHODS: Cardiac circumference (CC) and cardiac area (CA) were measured in four-chamber view in 143 normal fetuses between 18 and 40 weeks of gestation. A study group comprised a homogeneous group of 49 IUGR fetuses with abnormal umbilical artery impedance. Multiple regression analysis was used to compare the cardiac dimensions between normal and IUGR fetuses and to determine if there were differences in cardiac measurements between those with normal and with abnormal ductus venosus Doppler. RESULTS: Fetal cardiac dimensions did not differ significantly between normal and IUGR fetuses. In IUGR fetuses, cardiac dimensions were not statistically different between those with normal and abnormal ductus venosus Doppler. CONCLUSION: Cardiac dimensions are spared and may be used for gestational age estimation in growth-restricted fetuses resulting from uteroplacental insufficiency.

Causes and consequences of 93 fetuses with cardiomegaly in a tertiary center in Thailand.

OBJECTIVES: To assess etiology, perinatal mortality and associated factors of fetal cardiomegaly (FC). METHODS: A retrospective study of fetuses with cardiomegaly was conducted. Demographic data, ultrasonographic findings, and outcomes were collected and analyzed. RESULTS: Ninety-three fetuses were analyzed. The causes of FC were cardiac causes 49.5%, Bart's hemoglobinopathies 28%, and non-Bart's anemia 15%. Ascites, pericardial effusion, and hydrops were more prevalent in fetuses with anemia than those with cardiac abnormalities. The overall perinatal mortality was 69.9%. Although all Bart's hydrops died, perinatal mortality of non-Bart's anemia, and structural cardiac defect were 57.1 and 69.7%, respectively. Excluding Bart's anemia, receiver-operating characteristic curve analysis demonstrated that cardiothoracic ratio of ≥0.58 best predictive for perinatal mortality. Earlier gestational age at diagnosis, skin edema, and chromosomal abnormality were associated with higher mortality. CONCLUSIONS: Majority causes of FC were cardiac and anemic in origin. It carried high-perinatal mortality depending on the causes.

Outcome of pregnancies complicated by twin-twin transfusion syndrome in King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study perinatal outcomes of pregnancies complicated by twin-twin transfusion syndrome (TTTS), which were treated with the authors' intervention modalities. Maternal outcomes of these populations were also explored. MATERIAL AND METHOD: All pregnancies diagnosed TTTS that delivered in King Chulalongkorn Memorial Hospital between January 2000 and November 2009 were enrolled in this descriptive study Patients' data before August 2008 were retrospectively assessed. Perinatal survival, neonatal morbidities, and maternal outcomes were recorded and analyzed. Antenatal ultrasonographic findings were also analyzed to determine prognostic factors on perinatal outcomes. RESULTS: Twenty-five cases of TTTS were recruited in the present study. Overall perinatal survival was 58% (29/50) with no significant difference in perinatal in among various stages of disease (p = 0.19). Survival in stage I-II, stage III, and stage IV were 64.3%, 45.8%, and 75%, respectively. There was no maternal mortality in the present study The most common maternal morbidity was preeclampsia (6/25; 24%). Progression of disease was the only significant prognostic fact or for perinatal mortality (p < 0.001). CONCLUSION: Overall perinatal mortality rate of TTTS in the presented populations was still high (42%). Progression of disease was the only significant prognostic factor for poor perinatal outcome in the preset study Since the case number of the present study was too small, the conclusion that the prognosis of the conservatively treated TTTS was unrelated to the staging cannot be drawn.

Monochorionic twins with the same blood karyotype of 46,XY/47,XYY but different phenotypes.

We report the case of a 13-year-old woman who was pregnant with phenotypically discordant monochorionic twins: one with cystic hygroma and hydrops, the other one normal. Fetal blood sampling was performed by intrahepatic blood collection for karyotyping of both fetuses, revealing the same genotype of 46,XY/47,XYY in 2:1 proportion. Phenotypic discordance in monozygotic twins can have various causes, such as placental vascular anatomy, differences in allocation of the number of blastomeres or genetic postzygotic events.

Prenatal three-dimensional ultrasonography in a case of agnathia-otocephaly.

A case of prenatally diagnosed agnathia-otocephaly is reported. Agnathia is an extremely rare anomaly characterized by an absence or hypoplasia of the mandible and abnormal horizontal position of the ears. The targeted 2-D ultrasonography at 24 weeks of gestation revealed abnormal lower facial profile. Surface rendering 3-D ultrasonography was used to evaluate the facial feature, showing excellent image when compared to the fetal face at autopsy. The reported case is discussed with a short review of the literature.

Perinatal outcomes in severe preeclamptic women between 24-33(+6) weeks' gestation.

OBJECTIVE: The present study was undertaken to determine perinatal and maternal outcomes in severe preeclamptic women between 24-33-week gestation and compare the outcomes between expectant and aggressive management. MATERIAL AND METHOD: A retrospective descriptive study of 99 women with severe preeclampsia between 24-33(+6)-week gestation who delivered at the King Chulalongkorn Memorial Hospital from January 2002 to December 2005 was included. The outcomes were analyzed according to the gestational age at the time of admission (< 28 weeks' and > or = 28 weeks' gestation) according to expectant compared with aggressive management. Statistical analysis was performed by student t-test and chi2-test. RESULTS: The perinatal morbidity and mortality were significantly high in the gestational age < 28 weeks group. There were 11 perinatal deaths, 8 in those managed at < 28 weeks and 3 in those managed at 28-29 weeks' gestation (p < 0.05). Maternal morbidities were similar among both groups. There was no maternal death. CONCLUSION: Delivery at remote from term, especially < 2-week gestation, increases neonatal morbidity and mortality in severe preeclamptic women. Expectant management should be done in the tertiary care center with close maternal and fetal monitering.

Excursion index of the septum primum as a parameter for diastolic function assessment of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal diastolic function by the measurement of the excursion index of the septum primum (EISP) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Fetuses of normal Thai pregnant women were recruited for 2-dimensional echocardiographic measurements of the EISP (the ratio between the linear displacement of the flap valve and the left atrial diameter) from 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning, and negative diabetic screening at 24 to 28 weeks' gestation. The 5th, 50th and 95th percentile of the EISP were demonstrated The relationship between the EISP and gestational age were determined RESULTS: Three hundred twenty-seven measurements were obtained The normal values of the EISP according to gestational age were presented as 5th, 50th, and 95th percentile ranks. The correlation coefficients (r) between the EISP and gestational age were 0.03. The EISP were not statistically different with advancing gestation. The 5th, 50th, and 95th of the EISP were 0.32, 0.45, and 0.59 respectively. The intra-observer variability was 5.5%. CONCLUSION: The normal values of fetal EISP in the Thai population from 32 to 35 weeks' gestation were established This could serve as a baseline data in detection of the alteration of left ventricular diastolic function during fetal life.

Nasal bone hypoplasia in trisomy 21 at 15 to 24 weeks' gestation in A high risk Thai population.

OBJECTIVE: To assess the utility of nasal bone hypoplasia in the detection of fetuses with trisomy 21 in the second trimester in a high risk Thai population. MATERIAL AND METHOD: A prospective study involving pregnant women undergoing amniocentesis due to increased risk of aneuploidy from January 2005 to December 2005. Fetal biometry and nasal bone measurements were obtained at the time of amniocentesis. Linear regression model and diagnostic tests were analyzed using the SPSS computer program. RESULTS: A total of 407 fetuses were evaluated. In euploid fetuses, the Nasal Bone Length (NBL) increased linearly with advancing gestational age. Fetuses with Down syndrome had a significantly higher proportion of NBL below the 5th centile when compared with normal fetuses (p < 0.05). The optimal nasal bone threshold associated with trisomy 21 is a BiParietal Diameter/Nasal Bone Length (BPD/NBL) ratio of 10 or greater, yielded a sensitivity of 80%, specificity of 86% for detection of trisomy 21. CONCLUSION: Nasal bone hypoplasia is associated with an increased risk of Down syndrome in the presented population.

Interventricular septal thickness of Thai fetuses: at 32 to 35 weeks' gestation.

OBJECTIVE: To establish the normal value of fetal InterVentricular Septal Thickness (IVST) from 32 to 35 weeks' gestation in Thai fetuses. MATERIAL AND METHOD: Thai pregnant women with normal fetuses were recruited for prenatal 2-dimensional M-mode echocardiographic measurements of fetal IVST at 32 to 35 weeks' gestation. All had a confirmed gestational age, normal structural scanning and negative diabetic screening at 24 to 28 weeks 'gestation. The IVST was measured from the 4-chamber view during diastole and systole. The 5th, 50th and 95th percentile of the IVST during Diastole (IVSD) and the IVST during Systole (IVSS) were demonstrated The relationship between the IVSD and IVSS and gestational age were determined RESULTS: A total of 410 measurements were obtained. The normal values of the IVSD and IVSS according to gestational age were presented as 5th, 50th and 95th percentile ranks. The correlation coefficients (r) between the IVSD and IVSS and gestational age were 0.11 and 0.12, respectively. The IVSD and IVSS were not statistically different with advancing gestation. The 95th, percentile of the IVSD was 4.51 millimeters (mm) (range = 4.26 to 4.74 mm) and IVSS was 6.23 mm (range = 5.96 to 6.68 mm). The intraobserver variability was 7.6%. CONCLUSION: The normal values of fetal IVSD and IVSS in a Thai population from 32 to 35 weeks' gestation were established. This could be used as a baseline data in detecting the asymmetrical septal hypertrophy during fetal life.

Intrauterine therapy for fetal supraventricular tachycardia in a twin pregnancy.

A case of a twin pregnancy in which one fetus developed hydrops secondary to supraventricular tachycardia was detected at 21 weeks' gestation. Transplacental digoxin therapy successfully converted the supraventricular tachycardia to a normal sinus rhythm without evidence of maternal or fetal side-effects. The pregnancy proceeded to term and elective cesarean section was carried out at 37 weeks' gestation.

The management of acardiac twins at King Chulalongkorn Memorial Hospital: case series.

Acardiac twin is a rare event with high perinatal mortality rate and the management strategies remain controversial. The authors report 4 cases of twin pregnancies associated with one acardiac twin diagnosed at King Chulalongkorn Memorial Hospital during the period 1993 to 2002. Two cases were expectantly managed and intrauterine interventions were performed in order to occlude umbilical artery of the acardiac twin in 2 cases, by using Guglielmi detachable coil (GDC) embolization and absolute alcohol injection. Overall, the perinatal mortality rate for the pump twin was 50% and the survival rate of expectant management in the present series was 100%. GDC embolization was judged to be technically successful since it completely occluded the circulation to the acardiac twin. However, the pump twin was dead which might have resulted from the compromised state due to cardiac failure. At present, it seems that conservative management with close antenatal surveillance is the treatment of choice when the twin-weight ratios are substantially less than 70%. Invasive techniques should be considered when there is ultrasound evidence of hydramnios or congestive heart failure of the pump twin at a previable gestational age.

Predicting the risk of preeclampsia and small for gestational age infants by uterine artery Doppler in low-risk women.

The objective was to assess the value of uterine artery notching as a screening test for preeclampsia and fetal growth restriction in a low-risk population of healthy pregnant women. Color Doppler ultrasound was used to examine both uterine arteries in 322 healthy pregnant women at 24.9 +/- 1.9 (range 22-28) weeks of gestation. The criterion for abnormal results was a unilateral or bilateral presence of an early diastolic notch. The major end points were preeclampsia and small for gestational age (SGA) infants. Of the 322 women, 19 (5.9%) developed preeclampsia and six of them (1.9%) delivered SGA infants. An early diastolic notch was detected in 58 women (18%). The risk of developing preeclampsia and SGA infants in an abnormal Doppler study group was found to be greater than in that of a normal group (P<0.05). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting preeclampsia were 36.8, 83.2, 12.1, and 95.5%, respectively; whereas detecting SGA infants were 67, 82.9, 6.9, and 99.2%, respectively. Women with an early diastolic notch have considerably a higher risk of developing preeclampsia and SGA infants. On the other hand, women with normal uterine artery waveforms are unlikely to develop preeclampsia and SGA infants. The test may be useful to minimize unnecessary interventions.

Value of humerus length shortening for prenatal detection of Down syndrome in a Thai population.

OBJECTIVE: To assess the value of humerus length shortening for prenatal detection of Down syndrome in a Thai population. METHODS: A prospective study was performed on 3053 women undergoing second-trimester amniocentesis, between 16 and 24 weeks gestation, for the indications of advanced maternal age and a past history of chromosomal abnormality. Biparietal diameter (BPD) and humerus length measurements were obtained before the procedures. Regression equations relating BPD to humerus length were used to calculate observed humerus length/expected humerus length ratio in chromosomally normal and Down syndrome fetuses. Sensitivity, specificity, false-positive rate and likelihood ratio of a positive test result at various observed humerus length/expected humerus length ratios for detection of Down syndrome were calculated. A receiver-operator characteristic curve was used to determine the threshold screening ratio. RESULTS: There were 3003 chromosomally normal pregnancies and 24 fetuses with Down syndrome. The relationship between humerus length and BPD was: expected humerus length = 0.7403BPD - 5.1057, R2= 0.77, P < 0.001. Humerus length in Down syndrome fetuses was significantly shorter than in normal fetuses (P < 0.001). A ratio of 0.91 for observed humerus length/expected humerus length yielded a sensitivity of 41.7%, specificity of 88.3%, a false-positive rate of 11.7% and likelihood ratio of a positive test result of 3.63 (95% confidence interval 2.24-5.88) for detection of Down syndrome. CONCLUSIONS: Humerus length shortening in the second trimester appears to be a useful adjunctive screening parameter for fetal Down syndrome in a Thai population.