Biomedical subjects

B Uerpairojkit

Publications and source records attributed to B Uerpairojkit.

31 records · Page 2Linked to original sources

PubMed1998

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.

Adult↗

PubMed1998

Fetal complete heart block: an expectant management.

Fetal complete heart block is a rare cardiac arrhythmia occurring in prenatal life. The diagnosis usually requires a multimodality approach of imaging technology especially M-mode and Doppler ultrasound. The management guideline is not conclusive. We presented 2 cases of fetal complete heart block diagnosed prenatally. The fetuses were closely monitored conservatively and delivered at term. Permanent cardiac pacemakers were performed neonatally with satisfactory outcomes.

Adult↗

PubMed1997

Diagnosis of congenital malformations using two-dimensional and three-dimensional ultrasonography.

Three-dimensional ultrasonography is a promising new method for the prenatal diagnosis of fetal malformations, which offers several potential advantages, including the reduction of scanning time and the ability to store images that can be reviewed and reconstructed at a later date. Three-dimensional ultrasonography, however, has many of the same limitations as the conventional two-dimensional version.

Anthropometry↗

PubMed1997

Prenatal diagnosis of pulmonary atresia by fetal echocardiography.

With an improvement in cardiac imaging during the past 20 years, fetal echocardiography has progressively altered the practice of obstetricians and become a principle armamentarium for the diagnosis of fetal heart diseases. We presented a case of pulmonary atresia with intact ventricular septum diagnosed prenatally using fetal echocardiography.

Adult↗

PubMed1997

Growth of the fetal forehead and normative dimensions developed by three-dimensional ultrasonographic technology.

Sonographic imaging of the fetal face is important since a number of chromosomal aberrations are associated with facial malformations. In the past, imaging of the fetal forehead and diagnosis of frontal bossing had been based on subjective evaluation using two-dimensional ultrasonography. The purpose of this study was to evaluate quantitatively the fetal forehead using three-dimensional technology to generate normative data throughout gestation. This should allow the objective diagnosis of abnormal growth of the fetal forehead, such as frontal bossing. We also report a case of a fetus with frontal bossing in whom the generated nomogram was applied. A cross-sectional study was performed in 130 normal healthy singleton pregnancies between 16 and 38 weeks' gestation. Using three-dimensional ultrasonography, a line connecting the apex of the philtrum and the nasion was drawn across the anterior forehead, which delineated the area of the forehead for analysis. The forehead length, forehead height, and forehead area under the curve were measured and the forehead index was calculated. A second order polynomial growth function was noted throughout gestation for the forehead length (r = 0.93), forehead height (r = 0.97), and forehead area (r = 0.97). The fetal forehead index remained relatively constant throughout gestation. The results of this study provide normative data of fetal forehead length, width, and area using three-dimensional ultrasonographic technology. Normative dimensions of the fetal forehead developed and presented herein are expected to serve as a basis for the objective assessment of presumed fetal facial abnormalities and may facilitate the detection of the associated syndromes. This is demonstrated in our case report of an achondroplastic fetus in whom all forehead dimensions were above the 95th percentile.

Craniofacial Abnormalities↗

PubMed1997

Evaluation of adnexal masses using three-dimensional ultrasonographic technology: preliminary report.

The purpose of the current study was to demonstrate the ability of three-dimensional ultrasonographic technology to enhance the morphologic scoring system and further improve the ability to differentiate benign from malignant ovarian masses. We performed conventional two-dimensional and three-dimensional transabdominal and transvaginal ultrasonography on eight women with adnexal masses. All patients underwent exploratory laparotomy or diagnostic laparoscopy. The three-dimensional ultrasonographic findings were compared with the two-dimensional ultrasonograms, the intraoperative observations, and gross and histopathologic findings. The morphologic scoring system as described by Sassone and coworkers was adopted, with scores of less than 9 suggestive of benign lesions, and this system was applied in both the two-dimensional and three-dimensional ultrasonographic examinations. The morphologic scores were subsequently compared. The images were dissected in the XYZ planes, and the areas suggestive of malignancy, as suggested by two-dimensional ultrasonography, were determined to be either negative or positive and confirmatory. In each of the eight adnexal masses, three-dimensional ultrasonography confirmed the preoperative diagnoses. The morphologic scores did not differ between two-dimensional and three-dimensional ultrasonograms for the benign cysts. In one case of benign solid fibroma, both the two-dimensional and three-dimensional gray scale morphologic scores were falsely positive at greater than 9. In one case of malignant serous papillary cystadenocarcinoma the two-dimensional morphologic score was a 9, where- as the three-dimensional score was 13. This difference in scores can be attributed to the additional views available with three-dimensional volume scanning, which allowed better characterization of the pathologic conditions. In addition, three-dimensional sonographic technology had the added advantage of high-speed image acquisition and recording to decrease the time of scanning to improve patient comfort. Furthermore, three-dimensional ultrasonography allowed the real-time analysis of the acquired image data to be conducted at a later time when the patient is off the examination table. Our preliminary results suggest that three-dimensional transvaginal ultrasonographic technology can enhance and facilitate the morphologic evaluation of both benign and malignant adnexal masses.

Adult↗

PubMed1996

Flow velocity waveforms of the ductus arteriosus in appropriate and small-for-gestational-age fetuses.

OBJECTIVES: To assess ductus arteriosus velocity waveforms in the appropriate and small-for-gestational-age (SGA) fetuses. STUDY DESIGN: Ductus arteriosus flow velocity waveforms were obtained in 14 normal fetuses in a longitudinal study and in 139 normal fetuses in a cross-sectional study with pulsed and continuous Doppler ultrasonography. Ductus velocity waveforms were also determined in 25 SGA fetuses whose gestational age ranged between 20 and 34 weeks (mean +/- SD: 30 +/- 4.1 weeks). RESULTS: Mathematical modeling demonstrated that the peak systolic velocity, lowest diastolic velocity, and mean velocity of the ductus arteriosus increased with advancing gestation in both the longitudinal and cross-sectional study, but considerable individual variability was seen in the longitudinal study. The pulsatility index did not change significantly. The ductal parameters were in the normal range in all the SGA fetuses. CONCLUSIONS: The blood velocity of the ductus arteriosus increase with advancing gestation. Our results suggest that Doppler ultrasonographic study of the fetal ductus arteriosus, unlike Doppler study of the umbilical artery or middle cerebral artery, is not useful as an indicator of adverse fetal outcome.

Blood Flow Velocity↗

PubMed1996

Cerebellar Doppler velocimetry in the appropriate- and small-for-gestational-age fetus.

OBJECTIVE: To compare superior cerebellar artery flow velocity waveforms in the appropriate-for-gestational-age (AGA) and the small-for-gestational-age (SGA) fetus. METHODS: Superior cerebellar artery velocity waveforms were obtained prospectively from 172 AGA fetuses at 17-41 weeks' gestation. The pulsatility index (PI) was used to quantify the waveforms. Superior cerebellar artery velocity waveforms were also obtained from 30 SGA fetuses divided into group A (n = 15), with a normal umbilical artery PI, and group B (n = 15), with an abnormal umbilical artery PI. The transverse cerebellar diameter was measured in all SGA fetuses. RESULTS: The superior cerebellar artery PI was best represented by a second-order polynomial equation [PI = 0.145 + 0.101 x (gestational age) - 0.00197 (gestational age)2]. Small-for-gestational-age fetuses of group A had a superior cerebellar artery PI in the normal range, whereas 13 of 15 fetuses of group B (86.7%) had a PI value less than the individual 95% confidence interval. The transverse cerebellar diameter in group A fetuses was in the normal range in ten of 15 cases, whereas it was in the normal range for all group B fetuses. CONCLUSION: Small-for-gestational-age fetuses with an abnormal umbilical artery PI have "cerebellar-sparing effect," as suggested by a superior cerebellar artery PI less than the normal range and a normal transverse cerebellar diameter.

Arteries↗

PubMed1996

Adrenal artery velocity waveforms in the appropriate and small-for-gestational-age fetus.

The purpose of this study was to compare adrenal artery flow velocity waveforms in the appropriately grown and the small-for-gestational-age fetus. Adrenal artery flow velocity waveforms were prospectively obtained from 131 appropriate- and 21 small-for-gestational-age fetuses with pulsed Doppler ultrasonography. The success rate in recording the adrenal artery was 84% (131/155) and 100% in the appropriate- and small-for-gestational-age fetuses, respectively. The pulsatility index (PI) was used to quantify the waveforms. The PI in the appropriate-for-gestational-age fetuses decreased linearly with gestational age (PI = 1.7-0.016 x gestational age). In ten small-for-gestational-age fetuses the adrenal artery PI was below the 95% confidence interval. Small-for-gestational-age fetuses with abnormal adrenal artery PI had a significantly higher incidence of fetal heart rate decelerations, preterm delivery and Cesarean sections when compared to small-for-gestational-age fetuses with normal adrenal artery PI. Our data indicate that the PI of the adrenal artery in the normal fetus decreases with advancing gestation, and they suggest that in the small-for-gestational-age fetus there is an increased blood flow to the adrenal gland. We postulate that management of the small-for-gestational-age fetus may be aided by the study of the adrenal artery flow velocity waveforms.

Adrenal Glands↗

PubMed1995

Normal nuchal thickness in the midtrimester indicates reduced risk of Down syndrome in pregnancies with abnormal triple-screen results.

OBJECTIVE: Our purpose was to determine whether nuchal thickness measurement can identify the euploid fetuses in midtrimester pregnancies at increased risk for Down syndrome on the basis of maternal age and serum screening. STUDY DESIGN: Nuchal thickness was obtained prospectively in 651 consecutive fetuses at 14 to 21 weeks' gestation and at > or = 1:270 risk for Down syndrome on the basis of unconjugated estriol, alpha-fetoprotein, and human chorionic gonadotropin levels. The risk of Down syndrome with a normal nuchal thickness was determined. A receiver-operator characteristic curve was used to determine a serum-based risk threshold below which the risk for Down syndrome was low. The prevalence of Down syndrome in fetuses with both a normal nuchal thickness and a below-serum-risk threshold was compared with prevalence in either those above threshold risk or with an abnormal nuchal thickness. RESULTS: There were eight cases of trisomy 21 and one case each of 46,XX/47,XXX, 46,XY/47,XY, +7, and 46,XX, 11q-. The sensitivity of an abnormal nuchal thickness (> or = 6 mm) for detecting Down syndrome was four in eight (50%) (95%) confidence interval 15.3% to 84.6%). The risk of Down syndrome was significantly increased with an abnormal compared with a normal nuchal thickness, four in 13 (30.8%) versus four in 638 (0.6%), p < 0.0001. A risk threshold was defined at > or = 1:100 on the basis of the receiver-operator characteristic plot. Of 390 cases with a normal nuchal thickness and a serum risk estimate < 1:100, there were no cases of Down syndrome (0/390 vs 8/253, p = 0.002). CONCLUSION: Normal nuchal thickness significantly reduces the risk of Down syndrome and may help reduce the number of amniocenteses done for abnormal triple screen results.

Adult↗

PubMed1995

Abdominal venous system in the normal fetus.

OBJECTIVE: To assess flow velocity waveforms of the abdominal venous system in the normal fetus. METHODS: Sixty-seven normal fetuses between 17-42 weeks' gestation were each studied once. Flow velocity waveforms were obtained from the following: 1) umbilical vein at the entrance into the abdomen, 2) umbilical sinus, 3) portal vein before its division, 4) anterior division of the portal vein, 5) posterior division of the portal vein, 6) ductus venosus at its origin from the umbilical vein, 7) splenic vein at its origin, 8) splenic vein close to the umbilical sinus, 9) renal vein, 10) adrenal vein, 11) common iliac vein before the origin of the inferior vena cava, 12) inferior vena cava, and 13) left hepatic vein. RESULTS: Five different patterns were noted on the velocity waveforms of the abdominal venous system: continuous, monophasic, biphasic, triphasic, and tetraphasic. CONCLUSION: In the normal fetus, all veins leading to the liver have continuous flow, except the umbilical sinus, which has a monophasic pattern. The ductus venosus has a biphasic pattern. The veins that open into the inferior vena cava have triphasic flow velocity waveforms. The left hepatic vein occasionally has a tetraphasic pattern.

Abdomen↗

PubMed1995

Blood flow velocity waveforms of the abdominal arteries in appropriate- and small-for-gestational-age fetuses.

The aim of this study was to describe flow velocity waveforms of abdominal arteries in the appropriate- and small-for-gestational-age fetus. Splenic artery, superior mesenteric artery, hepatic artery and renal artery velocity waveforms were obtained from 57 appropriate-for-gestational-age and nine small-for-gestational-age fetuses with color flow Doppler ultrasonography. The pulsatility index was used to quantify the arterial waveforms. Repeated measure analysis of variance indicated significant differences in the pulsatility index values in both the appropriate-for-gestational-age and small-for-gestational-age fetuses. A multiple comparison test revealed a significantly lower value for the pulsatility index in the splenic artery when compared to that of the other vessels for both the appropriate- and small-for-gestational-age fetuses. In the small-for-gestational-age fetuses, a lower pulsatility index value was observed at the superior mesenteric artery level when compared to the renal artery. Because of its lower frequency of successful insonation, the hepatic artery was not considered for the analysis. In the normal fetus, the splenic artery had the lowest pulsatility index when compared to the other arteries we investigated. This difference remained in small-for-gestational-age fetuses, reflecting a lower vascular resistance at the fetal spleen in both normal and small-for-gestational-age fetuses. It appears that in small-for-gestational-age fetuses the renal artery has a higher pulsatility index than the superior mesenteric artery, suggesting a preferential distribution of blood flow to the bowel.

Abdomen↗

PubMed1995

Evaluation of current antepartum fetal tests.

Three hundred high-risk pregnancies of at least 28 weeks' gestation were included in this prospective descriptive study. Fetal movement count was performed daily. Maternal perception of sound provoked fetal movement (MPSPFM), fetal acoustic stimulation test (FAST), amniotic fluid index (AFI) and doppler umbilical artery pulsatility index were tested weekly until delivery. All fetal testing performed within a week of delivery was compared with fetal outcome. Fetal outcome was considered poor when there was perinatal death, intrapartum fetal distress, a five minute Apgar score of less than 7, thick meconium-stained amniotic fluid or admission to the neonatal intensive care unit. Seventeen pregnancies were considered poor outcome (prevalence of 5.7%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa index (KI) of each test to predict poor fetal outcome were evaluated. A combination of FAST and AFI is the most reliable antepartum fetal test. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa index of the combination of FAST and AFI were 70.0%, 99.6% 87.5%, 98.8%, 98.5% and 0.77%, respectively.

Female↗