Serial follow-up of abnormal flow velocity waveforms of dying fetus in a case of chronic hypertension.
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Adult↗
Biomedical subjects
F M Chang
Publications and source records attributed to F M Chang.
Prediction of fetal macrosomia by single ultrasonic fetal biometry.
A total of 1,056 fetuses underwent single ultrasonographic measurement of fetal biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), and estimated body weight within five days of delivery. The accuracy of these parameters and estimated body weight equations in the prediction of macrosomia (birth weight > or = 4,000 g) was evaluated. With the use of receiver operator characteristic curves, the optimal cutoff value for each parameter with the best sensitivity, specificity and accuracy was selected. BPDs > or = 9.4 cm had the best sensitivity (68.8%), specificity (74.3%), and accuracy (74.1%). ACs > or = 35 cm had the best sensitivity (81.3%), specificity (81.5%), and accuracy (81.5%). FLs > or = 7.0 cm had the best sensitivity (68.8%), specificity (74.5%), and accuracy (74.3%). The estimated body weight equations did not increase the prediction values whether or not FL was included. Both had the same prediction values at > or = 3,700 g, ie, sensitivity (71.9% vs 71.9%), specificity (92.1% vs 93.8%), and accuracy (91.5% vs 93.2%). The results showed AC to be the best single parameter for predicting macrosomia. Combinations of these parameters were better than a single parameter in the prediction of macrosomia.
Anthropometry↗
Clinical case-controlled study of small-for-gestational-age babies.
In this series, we compared the prenatal risk factors and perinatal complications of small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) babies systemically through a case-controlled study. A total of 115 SGA babies were retrospectively compared with 115 AGA matched pairs at the National Cheng Kung University Hospital. We analyzed the prenatal risk factors, signs of fetal distress and perinatal outcome between these two groups. Univariate analysis showed significant differences for the following items: 1) maternal risk factors, 2) fetal risk factors, 3) presence of prenatal risk factors, 4) abnormal fetal heart rate tracings, 5) low one-minute Apgar scores, 6) low five-minute Apgar scores, 7) thick meconium staining, 8) presence of fetal distress, 9) pediatric ICU care, and 10) presence of perinatal complications. Multivariate logistic regression showed that maternal hypertension and fetal anomaly were statistically significant risk factors associated with SGA in this series. In conclusion, SGA babies demonstrate higher frequencies of maternal and fetal risk factors, signs of fetal distress and perinatal complications than AGA babies.
Case-Control Studies↗
Simultaneous measurement of serotonin, catecholamines and their metabolites in cat and human plasma by in vitro microdialysis-microbore high-performance liquid chromatography with amperometric detection.
A method for the simultaneous measurement of norepinephrine, epinephrine, dopamine, 3,4-dihydroxyphenylacetic acid, homovanillic acid, serotonin and 5-hydroxyindole-3-acetic acid in cat and human plasma by in vitro microdialysis-microbore high-performance liquid chromatography with electrochemical detection is described. The detection limit (signal-to-noise ratio = 3) is about 0.05-0.1 pg per injection. The volume of plasma samples required is very small (< 200 microliters), hence there is minimal blood loss in repeated blood sampling, especially in experiments using small animals. Within 15 min, a fast isocratic separation of these analytes by using a microbore reversed-phase ODS column is achieved, hence over 90 analyses can be performed in a single working day. As microdialysis per se is not destructive to plasma samples, the remaining plasma sample and perfusate can be repeatedly analysed for other substances. This simple, efficient and sensitive method can therefore be used as a routine clinical and basic research technique in the investigation of blood biogenic amines and their metabolites.
Animals↗
Antenatal detection of hydranencephaly at 12 weeks, menstrual age.
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Abortion, Therapeutic↗
Early prenatal diagnosis of acrania by transvaginal ultrasonography.
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Adult↗
The primary application of three-dimensional ultrasonography in obstetrics.
To date, no report of three-dimensional ultrasonography in obstetrics has been available in the literature. In this study we describe the primary experience with three-dimensional ultrasonography for the prenatal evaluation of nine fetuses between 21 and 33 weeks of gestation. We found that it provides more information for clinical diagnosis than the traditional two-dimensional ultrasonography. The following advantages are notable: (1) the anatomic area of interest can be located first with the conventional real-time two-dimensional mode, then switched to reveal three-dimensional images, instantly; (2) three images are exhibited concurrently; (3) each of the three images can be arrayed separately and scrolled to search for the area of interest within the scanned volume; (4) the three-dimensional ultrasonography can be equipped with Doppler color flow mapping for the study of the fetal cardiovascular system. In conclusion, we believe that three-dimensional ultrasonography can greatly strengthen diagnostic potential, which deserves obstetricians' attention.
Cardiovascular System↗
Early sonographic diagnosis of fetal acrania.
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Adult↗
Comparison of umbilical blood gas and acid-base status of small-for-date and normal Chinese newborns.
A prospective study of umbilical arterial blood gas in appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) babies was performed at our hospital from August 1989 to July 1990. A total of of 512 cases were included, 432 cases in the AGA group and 80 cases in the SGA group, with gestational ages ranging from 26 to 42 weeks. Umbilical arterial blood was collected immediately after delivery of the newborns. Comparisons of maternal age, gestational age, birth body weight and body length of infants. Apgar scores at one minute and five minutes, cord arterial blood pH, pO2, pCO2, base excess, bicarbonate, total CO2, O2 saturation and O2 content between the AGA and SGA groups were taken into account. Our results demonstrated significant differences in birth body weight, birth body length, Apgar scores at one minute and five minutes and gestational age in the SGA group compared with those in the AGA group. The parameters of cord arterial blood gas were not correlated with gestational age in either group. The mean pH value in the AGA group (7.30 +/- 0.05) was higher than that in the SGA group (7.28 +/- 0.08). The same trend of difference was also noted between the AGA (7.30 +/- 0.04) and SGA (7.27 +/- 0.07) babies who were delivered by Cesarean section (p < 0.05). The latter results imply a more academic state in SGA babies which is independent of labor. Prepartum asphyxia plays an important role in determining the prognosis of SGA babies. We suggest routine umbilical cord blood gas and acid-base analysis at delivery to assess fetal asphyxia.
Acid-Base Equilibrium↗
Antithrombin III activity in normal and toxemic pregnancies.
From August 1989 to October 1990, 83 pregnant Chinese women were the subjects for measuring the levels of plasma functional antithrombin III (AT III) activity. The correlations of AT III activity with perinatal outcome and the changes in maternal hepatorenal function were analyzed. The population was divided into four groups: Group I (n = 30), normal pregnancies; Group II (n = 23), mild pre-eclampsia; Group III (n = 26), severe pre-eclampsia; and Group IV (n = 4), eclampsia. The results demonstrated that: 1) AT III activity decreased with the severity of toxemia (p < 0.001), 2) AT III activity correlated with the degree of perinatal outcome and maternal morbidity, and 3) reduction of AT III activity correlated with impairment of maternal hepatorenal function. In conclusion, plasma AT III activity is a valuable parameter in the evaluation of toxemia.
Adult↗
Fetal alcohol syndrome: report of a case.
Fetal alcohol syndrome is an uncommon occurrence in Taiwan, especially in the southern area. We report here a case who demonstrated severe intrauterine growth retardation with major limb reduction, chest hypoplasia and characteristic facial dysmorphism-short palpebral fissures, hypoplastic philtrum, and a thin upper lip. The mother had been consuming large quantities of alcohol, 6 bottles of "rice wine" per day (800 grams of absolute alcohol per day) during the pregnancy. The maternal serum level of ethanol was as high as 173 mg/dl. According to previous reports, we causally suggest that maternal ethanol abuse may be related to fetal anomalies in this case.
Adult↗
Clinical validation of two equations in antenatal prediction of Chinese fetal weight by ultrasonography.
The purpose of this series is to prospectively validate the Chinese equations for predicting fetal weight developed in a previous study. A total of 640 Chinese fetuses were examined antenatally for biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) by real-time ultrasonography within two days of delivery. The results showed the actual birth weight (BW) to be highly correlated with the estimated body weight for both the equation using BPD and AC (EBW1) (r = 0.888, p less than 0.0001) and the equation using BPD, AC and FL (EBW2) (r = 0.890, p less than 0.0001). Our results demonstrate that the Chinese equations developed by Hsieh et al are a better fit for Chinese fetuses than the foreign equations are. Also, the two Chinese equations predict fetal weight well between 2,000 g and 4,000 g, but further modification is needed in cases where the BW is less than 2,000 g or greater than 4,000 g.
Asian People↗
Autograft versus allograft for benign lesions in children.
Benign bone lesions in children are often so large in size that there is not an adequate amount of bone available for an autograft to fill the resultant cavity after surgical curettage. This study compared autografts and allografts with respect to the time required and the success of graft incorporation. Fifty-four patients with 61 lesions were studied. Lesions were classified as small volume (less than 60 cc) or large volume (more than 60 cc) and were separated into four groups: small-volume autograft, large-volume autograft, small-volume allograft, and large-volume allograft. Allografts appeared comparable to autografts when small-volume lesions were treated. The healing time was slightly longer for allografts with an average period of 21 months versus 27 months for autografts. Autografts were superior to allografts in rate and completeness of healing for solitary large lesions. This increased efficacy presumes a somewhat older child in which an adequate amount of bone is available for an autograft. A young child with multicentric or polyostotic lesions can still achieve successful incorporation with allografts. In this study, 38% healed completely and 29% healed partially. Allografts have a distinct place in the treatment of benign bone lesions in children.
Adolescent↗
Doppler velocimetry of intraplacental fetal arteries.
Doppler velocimetry of the umbilical and intraplacental fetal arteries was studied by color flow mapping in 39 normal pregnancies. The systolic-diastolic ratio (S/D) and pulsatility index of the intraplacental fetal artery downstream to the umbilical artery decreased significantly with advancing gestational age, and its S/Ds were persistently lower than those of the umbilical artery. The difference in the S/D between the umbilical artery and its intraplacental downstream branches decreased with advancing gestational age and approached zero as the pregnancy progressed to term. We conclude that intraplacental fetal arteries, possibly fetal arteries in main stem villi, can be imaged by color flow mapping and that there is a significant "resistance gradient" between the intraplacental fetal artery and the umbilical artery. Intraplacental fetal artery velocimetry using color flow mapping may give further insights into the umbilical-placental circulation.
Adult↗
Antenatal ultrasonographic diagnosis of hypotelorism.
Hypotelorism is one of the most important fetal anomalies, which deserves early antenatal detection and management. To date, only a few cases of antenatally diagnosed hypotelorism have been reported. In this series, we report a case of hypotelorism and microphthalmia diagnosed prenatally. A 30-year-old female, G1P0, was admitted to our hospital due to chronic bronchitis and a breech presentation of the fetus at 38 weeks of gestation. Routine ultrasound screening revealed hypotelorism. Associated anomalies detected by ultrasound were alobar holoprosencephaly, microcephaly, microphthalmia and oligohydramnios. After delivery, hypotelorism with holoprosencephaly was confirmed, which corresponded with the antenatal ultrasound findings. In conclusion, systemic routine ultrasound screening of fetal orbits is the best way to prenatally detect hypotelorism and microphthalmia.
Face↗
Percutaneous ultrasound-guided fetal blood sampling: experience in the first 100 cases.
Percutaneous ultrasound-guided fetal blood sampling was performed on 100 pregnancies with various fetal problems. Our technique involved the use of a 45 degree needle guide attached to a sector probe. Their gestational ages ranged from 17-38 weeks, mostly over 20-35 weeks. Seventy percent of cases were successful at the first sampling and 33% of cases had bleeding from the punctured cord. In 43 cases, a positive diagnosis was established after ultrasound-guided fetal blood sampling, including 25 Hemoglobin Bart's hydrops fetalis, 2 beta-thalassemia major, 1 hemophilia, 1 rubella infection, 1 syphilis and 13 chromosome aberrations. There were 33 survivors in this series. Seven anomalous fetuses ended in intrauterine deaths. Sixty cases resulted in neonatal deaths after spontaneous or induced labors. No fetal loss occurred in 25 normal fetuses. One fetal loss was probably related to the procedure (fetal loss rate 1/100). No immediate fetal death after sampling procedure was noted. In conclusion, ultrasound-guided fetal blood sampling had reasonable safety and technical feasibility. More common use of this technique in fetal investigations is justified and expected.
Blood Specimen Collection↗
The antenatal blood gas and acid-base status of normal fetuses and hydropic fetuses with Bart hemoglobinopathy.
Funipuncture offers direct access to the fetal circulation. The blood gas and acid-base status of the fetus can be studied, and fetal hypoxia and acidosis can be diagnosed directly. To establish normal ranges of fetal blood gas and acid-base status, we analyzed umbilical venous blood samples obtained by funipuncture from 62 normal fetuses (20-35 weeks). These fetuses were studied because of suspected fetal diseases and were subsequently proved to be normal by the fetal blood examinations. Umbilical vein pH and pO2 decreased whereas pCO2 and bicarbonate increased with gestational age. The umbilical vein base excess did not correlate with gestational duration, but oxygen saturation tended to decrease with gestational age. Twenty hydropic fetuses with Bart hemoglobinopathy were also studied; they were found to be more acidotic, hypoxic, and hypercarbic than normal fetuses.
Acid-Base Equilibrium↗
Antenatal fetal blood flow in the descending aorta and in the umbilical vein and their ratio in normal pregnancy.
One hundred and sixty sequential measurements of umbilical vein blood flow (UVBF) and descending aorta blood flow (DABF) in normal fetuses were performed in utero by the duplex real-time ultrasound and pulsed Doppler technique. Throughout pregnancy from 26 to 41 weeks the blood flow velocity of the umbilical vein (UV) and the descending aorta (DA) remained relatively constant, while the diameter of UV and DA, UVBF and DABF increased with advancing gestational age. Moreover, the UVBF-to-DABF ratio was nearly constant, with a mean value of 64% from 26 weeks onwards. The DABF-to-abdominal area (DABF-to-AA) ratio was constant throughout pregnancy, with a mean value of 7.0 ml/min/cm2. We call these two constants the umbilical-aortic index and descending-aortic index. These relationships may be of help in the diagnosis of intrauterine growth retardation and other fetal disorders.
Adult↗