Physician's weak points at court.
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Education, Medical↗
Biomedical subjects
B Uerpairojkit
Publications and source records attributed to B Uerpairojkit.
Fetal loss in threatened abortion after embryonic/fetal heart activity.
OBJECTIVES: To study the incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity. METHODS: A prospective study was performed on pregnant women with clinically diagnosed threatened abortion between 6 and 14 weeks of gestation. All had a good menstrual history and the calculated gestational age using crown-rump length in the first trimester ultrasound was in agreement. Embryonic/fetal heart rate measurements were obtained by a 5 MHz vaginal probe using M-mode and real-time B mode imaging. All cases were followed up with respect to pregnancy outcomes. The data were analyzed using the SPSS computer program. RESULTS: Eighty-seven pregnant women were included in the study. There were three pregnancies (3.4%) which resulted in fetal loss before 20 weeks of gestation. In viable pregnancies, the mean embryonic/fetal heart rate increased with advancing gestational age. The individual values of embryonic/fetal heart rate for fetal losses were within the reference range. CONCLUSIONS: The incidence of fetal loss in threatened abortion after detection of embryonic/fetal heart activity was 3.4%. There was no evident pattern of bradycardia or tachycardia that signaled the incipient of viability.
Abortion, Threatened↗
Occlusion of umbilical artery using a Guglielmi detachable coil for the treatment of TRAP sequence.
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Adult↗
Evaluation of fetal femur length to detect Down syndrome in a Thai population.
OBJECTIVE: To assess the value of femur length shortening for prenatal detection of Down syndrome in a Thai population. METHOD: A prospective study was performed by experienced perinatologists on 3137 women undergoing second-trimester amniocentesis, between 16 and 24 weeks of gestation, for the indications of advanced maternal age and past history of chromosomal abnormality. Biparietal diameter and femur length measurements were obtained before the procedures. Regression equations relating biparietal diameter to femur length were used to calculate observed femur length/expected femur length ratio in the chromosomally normal and Down syndrome fetuses. Sensitivity, specificity, false-positive rate and likelihood ratio of a positive test result at various observed femur length/expected femur length ratios for detection of Down syndrome were calculated. A receiver-operator characteristic curve was used to determine threshold screening ratio. RESULTS: There were 3084 chromosomally normal pregnancies, 26 fetuses with Down syndrome (1:118), and 27 other chromosomal abnormalities. The relationship between femur length and biparietal diameter (BPD) was: expected femur length=-7.631+0.814 BPD, R(2)=0.78, P<0.001). Femur length in Down syndrome fetuses was significantly shorter than in normal fetuses (P<0.001). A ratio of 0.91 for observed femur length/expected femur length yielded a sensitivity of 42.3%, specificity of 86.2%, false positive rate of 13.8% and likelihood ratio of a positive test result of 3.07 (95% CI 1.94-4.84) for detection of Down syndrome. CONCLUSIONS: In this study, femur length shortening in the second trimester appears to be a useful screening parameter for fetal Down syndrome in a Thai population.
Adult↗
Fetal intestinal volvulus: a clinico-sonographic finding.
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Adult↗
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.
Adult↗
Fetal transverse cerebellar diameter in Thai population.
We developed a nomogram for transverse cerebellar diameter (TCD) in Thai fetuses by recruitment of 153 normal pregnant women in the first trimester. The gestational age calculated by the certain last menstrual period and the first trimester ultrasound were in agreement. The pregnant women were stratified into 4 groups and scanned at four weekly intervals: group A was first scanned at 14 weeks, group B at 15 weeks, group C at 16 weeks, and group D at 17 weeks. A total of 699 measurements from 14 to 40 weeks of gestation were obtained. The data were analyzed for mean and standard deviation; and the best fit mathematical model was derived. The TCD grew progressively along gestational age. The growth rate was slightly less than that of a Western study after 28 weeks of gestation. This could serve as the basis for gestational dating in fetuses with aberrant fetal growth.
Adolescent↗
Atrial flutter in fetuses and early childhood: a report of eight cases.
Atrial flutter is an uncommon arrhythmia in children. The presenting features and treatment responses of two fetuses and six children with atrial flutter were presented. Two patients were diagnosed prenatally at 31 and 35 weeks' gestation. One patient was successfully controlled in utero by maternal administration of digoxin and the other by direct current cardioversion after delivery. Two fetuses and 2 of 6 children had normal cardiac structure by echocardiogram. Three patients had right atrial enlargement due to atrial primun septal defect, secundum atrial septal defect with primary pulmonary hypertension, and endomyocardial fibrosis. One patient developed atrial flutter with sinus node dysfunction after surgical correction of total anomalous pulmonary venous connection. Four cases presented as atrial flutter with regular atrioventricular conduction (2:1 or 3:1 conduction) while the remainder presented with irregular atrioventricular conduction. Heart failure was presented in two patients and improved after the arrhythmias were controlled. Successful termination of atrial flutter was accomplished by using DC cardioversion in 4 patients and one patient converted to normal sinus rhythm following combination of digoxin and amiodarone administration. Digoxin was administered for one year as the prophylactic medication in six patients. None had recurrence of atrial flutter during the follow-up period of one to four years. Two patients required chronic digoxin and amiodarone therapy. We concluded that atrial flutter in fetuses and early childhood carries a good prognosis. Acute treatment with direct current cardioversion is sufficient in most patients, combination of digoxin and amiodarone may be an alternative therapy to convert atrial flutter.
Anti-Arrhythmia Agents↗
Sonographic findings in clinically diagnosed threatened abortion.
OBJECTIVE: To determine the sonographic appearances in pregnant women who presented with vaginal bleeding in the first 20 weeks of gestation. METHOD: Pregnant women of under 20 gestational weeks diagnosed clinically as threatened abortion were recruited for ultrasound scan at the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University. The sonographic findings were reported as viable pregnancy, anembryonic pregnancy, embryonic death, incomplete abortion, complete abortion, ectopic pregnancy, molar pregnancy and inconclusive findings. Patients with inconclusive findings were followed weekly until final diagnoses were established. All patients were followed-up to 20 weeks or until the final outcomes were revealed. RESULTS: Two hundred and sixty eight pregnant patients were enrolled. Ultrasound scans demonstrated 100 viable fetuses (37.3%), 73 embryonic deaths (27.3%), 46 anembryonic pregnancies (17.2%), 6 molar pregnancies (2.2%), 3 ectopic pregnancies (1.1%), 14 complete abortions (5.2%) and 26 inconclusive findings (9.7%). Follow-up scan on patients with inconclusive findings revealed 9 anembryonic pregnancies (3.3%), 9 incomplete abortions (3.3%), 1 embryonic death (0.4%) and 1 viable pregnancy (0.4%). Six patients (2.3%) were lost to follow-up. The viable pregnancy rate according to maternal age was highest at the maternal age of 25 to 29 years old (49%), whereas, it was lowest at the maternal age of 40 to 44 years old (0%). The viable pregnancy rate according to gestational age was highest at 6 to 8 weeks (61.2%), whereas, it was lowest at 18 to 20 weeks (20%). CONCLUSION: Sonographic findings in patients with clinically diagnosed threatened abortion demonstrated viable pregnancies in around one-third of the cases. Use of ultrasound in clinically diagnosed threatened abortion may assist clinicians in establishing a definite diagnosis so that appropriate care could be offered to the patients.
Abortion, Threatened↗
Transvaginal hysterosalpingo-contrast sonography (HyCoSy) compared with chromolaparoscopy.
OBJECTIVE: To compare the efficacy and safety of HyCoSy with chromolaparoscopy for the diagnosis of tubal occlusion and uterine abnormalities. METHODS: Sixty infertile women in whom the cause of infertility was thought to be tubal occlusion or uterine abnormalities and who satisfied the inclusion and exclusion criteria as specified in the study protocol were included. HyCoSy was performed during the first half of the menstrual cycle at least 24 hours prior to chromolaparoscopy. The results from both HyCoSy and chromolaparoscopy were compared in assessing tubal occlusion and uterine pathology. RESULTS: For the evaluation of fallopian tubes, we found corresponding results between HyCoSy and chromolaparoscopy in 80.0%. The agreement between both procedures in assessing the uterine pathology was 80.4%. Twenty-two women experienced adverse events. The most common complaint was pelvic pain. Other events encountered were: nausea (3 women) and vaginal bleeding (2 women). All events were thought to be not related to the study drug. CONCLUSION: HyCoSy showed good diagnostic performance in the evaluation of the fallopian tubes and uterus in infertile women. The adverse events reported in this study are minor and procedure-related (catheter insertion) rather than the trial substance.
Adult↗
Reference intervals for first trimester embryonic/fetal heart rate in a Thai population.
OBJECTIVE: To establish reference intervals for first trimester embryonic/fetal heart rate in a Thai population. METHODS: A prospective descriptive cross-sectional study was performed on normal pregnant women registered at the antenatal clinic in their first trimester. All had a good menstrual history and the calculated gestational age using crown-rump length (CRL) in the first trimester ultrasound was in agreement. Crown-rump length and embryonic/fetal heart rate measurements were obtained by a 5 MHz vaginal probe combined with a duplex color Doppler machine. All of the newborns were proved to be normal at birth. We constructed and compared embryonic/fetal heart rate expressed as beats/min relating to gestational age (GA) (days) and CRL. The data was analyzed and the best fit mathematical model was derived using the SPSS computer program. RESULTS: 547 cases were enrolled into the study. The median embryonic/fetal heart rate increased from 124 beats/min at GA of 40-44 days to 177 beats/min at GA 60-64 days, thereafter, embryonic/fetal heart rate gradually decreased to 159 beats/min at GA 95-99 days. The best fit regression equation was: embryonic/fetal heart rate (beats/min) = -21.666 + 5.4796 GA (day) - 0.0383 GA (day)2, R = 0.5, p < 0.0001). In addition, embryonic/fetal heart rate also correlated with CRL. The median embryonic/fetal heart rate increased from 131 beats/min at CRL of 5-9 mm to 177 beats/min at CRL 20-34 mm, thereafter, embryonic/fetal heart rate gradually decreased to 155 beats/min at CRL 75-79 mm. The best fit regression equation was: embryonic/fetal heart rate (beats/min) = 127.361 + 3.4939 CRL (mm) - 0.0749 CRL (mm)2 + 0.0004 CRL (mm)3, R = 0.58, p < 0.0001). CONCLUSION: Reference intervals for first trimester embryonic/fetal heart rate in a Thai population were established. Our reference intervals may be useful for further studies, such as the prediction of spontaneous abortion or chromosomal disorders after ultrasound-proven viability in the first trimester.
Adult↗
Cut-off criteria for second-trimester nuchal skinfold thickness for prenatal detection of Down syndrome in a Thai population.
OBJECTIVE: To evaluate the use of progressive cut-offs for nuchal skinfold thickness with advancing gestational age and the commonly applied cut-off method (> 6 mm) for prenatal detection of Down syndrome in a Thai population. METHOD: A prospective study was performed by experienced perinatologists on 2150 women undergoing second-trimester amniocentesis for the indications of advanced maternal age and past history of chromosomal abnormality. Reference ranges were established for nuchal skinfold thickness from the 16th to the 24th week, using either gestational-specific centiles or the parametric method. Assaying different cut-off criteria for both centile and the parametric methods were calculated and then compared with the commonly applied cut-off level (> or = 6 mm.). RESULTS: There were 2114 chromosomally normal pregnancies, 19 fetuses with Down syndrome (1:113), and 17 other chromosome abnormalities. In fetuses with normal karyotype the nuchal skinfold thickness increased with advancing gestational age [NF (mm) = -0.502 + 0.212 GA (week), r = 0.36, P < 0.001]. The sensitivities of an abnormal nuchal skinfold thickness using different cut-off criteria for detecting Down syndrome were low (5.3-26.3%) with the false positive rates ranging from 2.5 to 16.5%. CONCLUSIONS: In this study, measurement of second-trimester nuchal skinfold thickness was a poor and unreliable screening test for fetal Down syndrome in a Thai population.
Adult↗
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.
Blood Cell Count↗
Prenatal ultrasound diagnosis in Thailand.
Ultrasound technology has been extensively employed in obstetric and gynecologic practice for several decades. It has been used not only in gestational age estimation, placental location, amniotic fluid assessment but also in antenatal diagnosis of fetal abnormalities of various systems. The incidence of Congenital Heart Disease (CHD) is currently estimated to be 8 to 9 out of every 1,000 live births. Congenital heart disease is thought to be a multifactorial disorder in over 90% of the cases. Pioneer studies on the ultrasound investigation of the heart were reported in the early 1970s. Since the introduction of high resolution real-time ultrasound in the late 1970s, reports on ultrasound assessment of fetal cardiac anatomy and function have been appearing with increasing frequency in both the obstetric and cardiologic literature. At present, fetal echocardiography is a well established technique for the prenatal diagnosis of CHD. However, the distribution of the technique is still limited as it requires both a very experienced operator and meticulous scanning. Screening the entire obstetric population does not appear possible at present. Therefore fetal echocardiography is as necessarily directed toward selected pregnancies carrying a higher-than-normal risk of fetal cardiac anomalies. The progressive developments in cardiac ultrasound during the past two decades have substantially altered the practice of perinatologists, obstetricians and cardiologists. Total cardiac ultrasound studies are now becoming the primary armamentarium in the diagnosis of fetal congenital heart diseases. Since a 92% sensitivity of 4-chamber view in screening fetal heart diseases was first reported in 1987, 4-chamber view has been widely recommended for routine use in fetal sonographic examinations. Recent studies have demonstrated somewhat variable results and have suggested incorporation of the out flow should thoroughly understand the advantages and limitations of fetal cardiac scanning especially the 4-chamber view in order that the appropriate information and management plan can be offered to the patients. Fetal cardiac scanning is well recognized as one of the most tedious scanning of all fetal organ systems. With a tremendous advancement in ultrasound resolution including color imaging capacity several kinds of fetal cardiac anomalies could be diagnosed antenatally which inevitably allows more proper management plan for couples engaged in these.
Arrhythmias, Cardiac↗
Intrauterine therapy of fetal atrial flutter.
An increased awareness of fetal arrhythmias by obstetricians has resulted in a growing number of diagnosed cases of fetal cardiac problems. A fetus with atrial flutter diagnosed at 31 weeks of gestation was successfully converted to normal sinus rhythm in utero by maternal administration with digitalis. The fetal heart rate stayed in a normal rhythm with a maintenance dose of 0.5 mg/day. The fetus was delivered spontaneously at term and the neonatal heart rate has been in normal rhythm without any medical treatment.
Adult↗
Intrauterine adenoviral infection associated with fetal non-immune hydrops.
A 27-week fetus with hydrops fetalis associated with fetal tachyarrhythmia and adenovirus infection was documented by viral polymerase chain reaction (PCR). The fetal tachyarrhythmia was converted to normal sinus rhythm by maternal pharmacological therapy with digoxin. Subsequently, resolution of the hydropic changes occurred and a viable normal-appearing preterm fetus at 29 weeks' gestation was delivered after preterm labour. This case demonstrates the first documented report of intrauterine adenovirus-associated fetal tachyarrhythmia and hydrops fetalis.
Adenoviridae↗
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.
Down Syndrome↗