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T Tongsong

Publications and source records attributed to T Tongsong.

At least 55 records · Page 3Linked to original sources
PubMed1999

Prenatal sonographic diagnosis of ectopia cordis.

PURPOSE: We present a small series of prenatally diagnosed cases of ectopia cordis. METHODS: Four fetuses with prenatally diagnosed ectopia cordis were sonographically evaluated and followed up. RESULTS: The fetuses were diagnosed with ectopia cordis at 9, 13, 21, and 29 weeks' menstrual age. The case diagnosed at 9 weeks is the earliest prenatal diagnosis reported, to our knowledge. The diagnoses were based on the demonstration of a fetal heart outside the thoracic cavity with Doppler waveforms typical of intracardiac flow. One fetus had isolated ectopia cordis, and 3 had other associated anolmalies. The diagnosis was postnatally confirmed in all cases. Therapeutic abortion was done in 2 cases. One infant survived, and the fourth died shortly after birth. Chromosome study was successfully performed in 2 cases and was normal in both of them. CONCLUSIONS: This small series suggests that ectopia cordis can be readily diagnosed in utero as early as the first trimester. Later in pregnancy, sonography provides important information for planning surgical correction.

Adult↗
PubMed1999

Sonographic diagnosis of intrauterine growth restriction (IUGR) by fetal transverse cerebellar diameter (TCD)/abdominal circumference (AC) ratio.

OBJECTIVE: To evaluate the validity of TCD/AC ratio in predicting IUGR. STUDY DESIGN: Prospective descriptive analysis. SETTING: Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. SUBJECTS: Women meeting the inclusion criteria consisting of: (1) singleton pregnancies after 28 weeks of gestation; (2) known accurate gestational age; and (3) clinically suspected IUGR. METHODS: The patients were sonographically examined for TCD/AC ratio. The best cut-off value of TCD/AC ratio in predicting IUGR was determined by a receiver operating characteristic (ROC) curve. The fetus with a TCD/AC ratio greater than the cut-off value would be antenatally diagnosed as IUGR for every gestational week. Standard definition of IUGR was a low birthweight, less than the 10th percentile. RESULTS: One hundred and sixty-seven pregnancies with suspected IUGR were analyzed. The prevalence of IUGR among the study group was 51.5%. The best cut-off value of the TCD/AC ratio for predicting IUGR was 15.4%, giving the sensitivity, specificity, positive predictive value and negative predictive value of 73.26%, 80.25%, 79.75%, and 73.86%, respectively. CONCLUSION: The sonographic fetal TCD/AC ratio as a gestational age-independent method can be helpful in antenatal diagnosis of IUGR, especially in pregnancy with uncertain gestational age.

Abdomen↗
PubMed1999

First trimester sonographic diagnosis of holoprosencephaly.

OBJECTIVE: To describe our experience with sonographic diagnosis of fetal holoprosencephaly in first trimester. SUBJECTS: A total of three fetuses with early prenatal diagnosis of holoprosencephaly were sonographically evaluated and followed up. RESULTS: The study revealed that all showed monoventricular cavity, fused thalami, no falx and cavum septum pellucidum. All of them were correctly diagnosed sonographically in the first trimester. Extracranial anomalies had also been identified in all three fetuses and all of them had facial abnormalities. Cytogenetic studies were successfully carried out in only one case. No polyhydramnios was demonstrated in all cases. CONCLUSION: This small series indicates that holoprosencephaly can be diagnosed in the first trimester. The most valuable clue to the diagnosis is the demonstration of the single ventricle.

Adult↗
PubMed1999

Prenatal sonographic features of sacrococcygeal teratoma.

OBJECTIVE: To describe the potential role of ultrasound in prenatal diagnosis of fetal sacrococcygeal teratoma (SCT). SUBJECTS: A total of four fetuses with prenatal diagnosis of SCT were sonographically evaluated and followed-up. RESULTS: Fetal SCT was diagnosed at 13, 17, 26 and 27 weeks of gestation. Three of them had predominantly solid tumors with scattered cystic areas, whereas the other one had an entirely cystic tumor. One had a rapid growth tumor and finally developed early hydrops. Three had polyhydramnios and delivered prematurely. The diagnosis was posnatally confirmed in all cases. In the case with the large tumor, a cesarean section was done to avoid traumatic delivery. Two cases survived and the tumors were successfully resected, whereas the others died due to heart failure secondary to hydrops in one case and prematurity in the other one. CONCLUSION: This small series suggests that SCT be readily diagnosed in utero, possibly as early as first trimester. The important clue was an abnormal mass in the sacrococcygeal area. The prenatal diagnosis can contribute to changes in clinical decision.

Female↗
PubMed1999

Prenatal diagnosis of Meckel syndrome: a case report.

OBJECTIVE: To demonstrate the major sonographic findings associated with Meckel syndrome and to emphasize the importance of prenatal sonography in helping to establish the correct diagnosis. SUBJECTS: Two fetuses with prenatal diagnosis of Meckel syndrome were sonographically evaluated. RESULTS: Both fetuses were demonstrated to have evidence of renal cystic dysplasia, occipital cephalocele and postaxial polydactyly. One case was diagnosed at 16 weeks of gestation whereas the other was detected at 36 weeks. Of interest, the first case had only unilateral renal cystic dysplasia and contralateral renal agenesis and mild degree of oligohydramnios. The other related anomalies which were not detected prenatally included cerebellar hypoplasia in case 1 and micrognathia in case 2. CONCLUSION: The main sonographic findings included renal cystic dysplasia, occipital cephalocele and postaxial polydactyly.

Adult↗
PubMed1999

The rapid biophysical profile for assessment of fetal well-being.

OBJECTIVE: To determine the efficacy of the rapid biophysical profile (BPP), the combination of amniotic fluid index (AFI) and sound-provoked fetal movement (SPFM) detected by ultrasound, in predicting intrapartum fetal distress in high-risk pregnancies, compared with the nonstress test (NST). STUDY DESIGN: The prospective study of diagnostic tests was conducted on a total of 1,069 high-risk singleton pregnancies, undergoing antepartum assessment of both the standard NST and the new rapid BPP, including AFI and SPFM detected by ultrasound. Intrapartum continuous fetal heart rate (FHR) monitoring was performed in all of them. The diagnostic indices of the NST and the rapid BPP was calculated in term of predicting intrapartum fetal distress. RESULTS: The rapid BPP was a reliable predictor of intrapartum fetal distress with higher sensitivity and specificity. Its accuracy was better than that of the NST. The incidence of fetal compromise among positive, equivocal, and negative tests of the rapid BPP are 78.57, 15.82 and 0.9%, respectively, whereas the incidence among nonreactive and reactive NST are 31.63 and 2.52%, respectively. CONCLUSIONS: The rapid BPP is an effective predictor of intrapartum fetal distress in high-risk pregnancies. It may suffice as an inexpensive and less time-consuming method of evaluating antepartum fetal well-being.

Amniotic Fluid↗
PubMed1999

Fetal sonographic cardiothoracic ratio at midpregnancy as a predictor of Hb Bart disease.

The objective of this study is to evaluate the efficacy of sonographic cardiothoracic ratio at midpregnancy in predicting fetal hemoglobin Bart disease. Among 17,254 pregnant women screened for severe thalassemia between June 1994 and November 1998, 345 pregnant women at risk for having a fetus with hemoglobin Bart disease underwent ultrasonographic examination and cordocentesis at 18 to 21 weeks' gestation. Before cordocentesis, the cardiothoracic ratio was determined and recorded. The definite fetal diagnosis was based on fetal blood analysis with high performance liquid chromatography. Among 345 pregnancies in which sonographic examination and cordocentesis were performed, 70 fetuses were affected by hemoglobin Bart disease. The mean cardiothoracic ratio was significantly higher than that of unaffected fetuses (0.55 versus 0.45, Student's t-test, P<0.001). The sensitivity and specificity of the cardiothoracic ratio in prediction were calculated for various cutoff values. On the basis of the receiver operating characteristic curve, the best cutoff value was 0.50 (greater than 0.50 considered abnormal), giving the sensitivity of 98.6% and a specificity of 98.9%. In conclusion, the cardiothoracic ratio has very high accuracy in predicting hemoglobin Bart disease in pregnancies at risk. This finding suggests that invasive diagnostic method should be reserved for only the fetuses who have a cardiothoracic ratio of 0.5 or more; however, further studies are needed to confirm this observation.

Female↗
PubMed1999

Placental thickness at mid-pregnancy as a predictor of Hb Bart's disease.

The measurement of placental thickness can effectively differentiate normal pregnancies from affected pregnancies requiring invasive work-up. The objective was to evaluate the efficacy of placental thickness at mid-pregnancy in predicting fetal Hb Bart's disease in pregnancies at risk. Among 17 254 pregnant women screened for severe thalassaemia between June 1994 and December 1998, 345 pregnancies at risk for having a fetus with Hb Bart's disease underwent ultrasound examinations and cordocentesis at 18-21 gestational weeks. Before cordocentesis, the placental thickness was measured and recorded. The definite fetal diagnosis was performed with high performance liquid chromatography. The efficacy of placental thickness in predicting Hb Bart's disease was evaluated by sensitivity and specificity. Various cut-off values of the placental thickness were used for calculation and the best cut-off value was determined by a receiver-operating characteristic (ROC) curve. Of 345 pregnancies at risk, 70 fetuses with Hb Bart's disease were finally diagnosed. The mean placental thickness (+/-SD) of the normal pregnancies and pregnancies with Hb Bart's fetuses were significantly different, 24.6+/-5.2 mm and 34. 5+/-6.7 mm, respectively (Student's t-test, p<0.001). The sensitivity and specificity of placental thickness in prediction were calculated for various cut-off values. Based on the ROC curve, the best cut-off value was 30 mm (>30 mm considered abnormal), giving a sensitivity of 88.57 per cent, specificity of 90.18 per cent, positive-predictive value of 78.48 per cent and negative-predictive value of 96.87 per cent. For couples at risk, when sonographic placental thickness is normal, the risk of having an Hb Bart's fetus is markedly decreased. The measurement of placental thickness can effectively, though not absolutely, differentiate the normal pregnancies from affected ones requiring invasive work-up.

Adult↗
PubMed1998

Prenatal strategies for reducing severe thalassemia in pregnancy.

OBJECTIVE: To describe the prenatal strategy in reducing new cases of severe thalassemia at Maharaj Nakorn Chiang Mai Hospital. The study design involved a prospective descriptive analysis set in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. SUBJECTS: Pregnant women attending antenatal clinic. METHODS: The strategy included: (1) carrier identification by retrospective (history review) and prospective screening program; (2) the couples at risk were counseled and offered cordocentesis; (3) analysis of fetal blood with high performance liquid chromatography (HPLC) or electrophoresis; and (4) counseling for termination of pregnancy in case of affected fetus. The prospective screening consisted of testing for a carrier by a simple erythrocyte osmotic fragility test (EOFT) in women with no risk and testing the husbands of the women with abnormal tests. A pregnancy in which both of the couple were carriers was considered a risk. RESULTS: Cordocentesis was performed in 554 pregnancies at risk, 252 and 302 from retrospective and prospective screening, respectively. Sixty of 252 of the first group had severe thalassemia. In the prospective screening program of 12 680 women, 459 risk couples were identified, 302 pregnancies underwent cordocentesis and 53 (17.5%) had severe thalassemia. This strategy enabled us to identify 113 cases of severe thalassemia (Hb Bart's; 60, beta-thal entities; 53) from 554 cases at risk. CONCLUSION: The strategy proves valuable in the control of severe thalassemia. This extensive experience suggests the strategy be considered an effective way in the control of severe thalassemia in high prevalence areas.

Carrier State↗
PubMed1998

Prenatal diagnosis of osteogenesis imperfecta type II.

OBJECTIVE: To characterize the prenatal sonographic features of osteogenesis imperfecta (OI) type II. DESIGN: Descriptive (case series). SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. SUBJECTS: Six fetuses with prenatal diagnosis of OI were evaluated. RESULTS: Six fetuses were prenatally diagnosed as OI type II in five mothers without familial history of the disease. One mother had two consecutive pregnancies complicated with this condition. The first five cases were classified as OI type IIA, while the last one was OI type IIB. All of subtype A exhibited typical triad of bone shortening, diffuse hypomineralization and multiple fractures of long bones including beaded ribs whereas the subtype B showed shortening of only femurs, normal bone echodensity and isolated fractures of long bones. The postnatal radiography and autopsy confirmed the prenatal diagnosis in all cases. Other findings may occasionally be found, including polyhydramnios, oligohydramnios, hydrop fetalis and small for gestational age. CONCLUSION: The triad of bone shortening, decreased bone density and numerous fractures including beaded ribs permits a confident diagnosis of OI type IIA. Furthermore, sonographic features may differentiate the subtype of OI type II, depending on degree of bone shortening and echodensity.

Female↗
PubMed1998

Amniocentesis-related fetal loss: a cohort study.

OBJECTIVE: To assess the risk of fetal loss attributable to second-trimester amniocentesis. METHODS: A cohort study was undertaken among singleton pregnant women undergoing genetic amniocentesis and controls matched prospectively on a one-to-one basis, matched strictly for maternal age, parity, and socioeconomic status. Both groups were recruited at 15-24 weeks' gestation and observed until delivery. The fetal loss rates of the groups were compared. RESULTS: A total of 2256 pairs were recruited to the study. After excluding those pairs lost to follow-up, those with fetal malformation, and those later proven to have major chromosomal abnormalities, 2045 matched pairs were compared by pregnancy outcomes. There were no significant differences in fetal loss rates, premature deliveries, or placental abruptions between the study and control groups (P > .05). However, this study did not have enough statistical power to identify differences of less than 1%. CONCLUSION: Second-trimester amniocentesis is probably not associated with a greater fetal loss rate than that of matched controls.

Abortion, Spontaneous↗
PubMed1998

Prenatal sonographic diagnosis of holoprosencephaly.

The purpose of this series was to describe the sonographic features of fetal holoprosencephaly prenatally. The study was undertaken at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. A total of 12 fetuses with prenatal diagnosis of holoprosencephaly were sonographically evaluated and followed-up. The study revealed that all showed monoventricular cavity, fused thalami, no falx and cavum septum pellucidum. Eight of them were correctly diagnosed sonographically in the first two trimesters. Extrafacial anomalies were also identified in half of the fetuses and all of them had facial abnormalities. Twenty-five per cent (3 cases) had polyhydramnios and only one case had oligohydramnios. Chromosome study revealed that 70 per cent had normal chromosomes, 30 per cent were aneuploidy, trisomy 13; 2 cases and trisomy 18; 1 case. In conclusion, this series indicates that ultrasound has a high predictive value in the diagnosis of holoprosencephaly. The most valuable clue to the diagnosis is the demonstration of the single ventricle. Additionally, demonstration of facial abnormalities may add confidence to the diagnosis. Conversely, should any of these facial features be serendipitously encountered, a careful examination of the intracranial contents is recommended.

Adult↗