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T Tongsong

Publications and source records attributed to T Tongsong.

At least 73 records · Page 4Linked to original sources
PubMed1997

Termination of second-trimester pregnancy with intracervicovaginal misoprostol.

To evaluate the efficacy and side effects of intracervicovaginal misoprostol in termination of second-trimester pregnancy in women with live fetuses. A total of 50 pregnant women between 14 and 27 week's gestation undergoing termination of pregnancy for medical, obstetrical and genetic reasons were recruited to receive 200 ug misoprostol gel administered intracervicovaginally every 12 hours. The rates of successful abortions within 24 hours and 48 hours were 54 per cent and 92 per cent respectively. The mean time from induction to abortion was 27.5 hours. The rate of complete abortion, defined as the passage of the fetus and placenta without operative assistance was 80 per cent. Side effects were fever (8%), nausea and vomiting (6%) and diarrhea (2%). Thirty one patients (62%) required meperidine as analgesia. Two patients (4%) had postpartum hemorrhage. Intracervicovaginal misoprostol is an effective, cheap, safe and relatively convenient method for termination of second-trimester pregnancy with a live fetus.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Antenatal sonographic features of 100 alpha-thalassemia hydrops fetalis fetuses.

OBJECTIVE: To characterize the sonographic findings of alpha-thalassemia hydrops fetalis. METHODS: Descriptive study of the ultrasound findings in 100 women with antenatal diagnosis of hydrops fetalis due to alpha-thalassemia. RESULTS: Mean (+/- SD) maternal age was 27.5 + 5.7 years (17-41 years). Mean menstrual age was 31.3 +/- 4.7 weeks (22-42 weeks). All fetuses were stillborn or died very shortly after birth. The indications for sonographic examination included early onset of pre-eclampsia, large for date, decreased fetal movement and nonreactive NST, or bradycardia and premature contractions. The sonographic features found in more than 90% of cases included hepatosplenomegaly, cardiac enlargement, edematous placenta, and ascites. Other common findings were oligohydramnios (82%), subcutaneous edema (75%), decreased fetal movement (74%), cord edema (63%), and enlarged umbilical vessel (62%). Pericardial or pleural effusion was seen in only 15% of cases. None of the fetuses showed any morphological abnormality. Early findings (22-28 weeks) included evidence of a thickened placenta and/or minimal ascites and/or slight cardiomegaly. CONCLUSIONS: The sonographic characteristics of alpha-thalassemia hydrops fetalis ranged from no obvious morphological abnormalities to evidence of fluid retention. These typical abnormal findings generally did not appear until the late second trimester or early third trimester.

Adult↗
PubMed1996

Preinduction cervical ripening with intravaginal prostaglandin E1 methyl analogue misoprostol: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of intravaginal prostaglandin E1 methyl analogue misoprostol in cervical ripening in patients with unfavorable cervix (Bishop score < 4) requiring labor induction. METHOD: A randomized controlled clinical trial of 62 women in the third trimester with various indications for induction of labor were randomly allocated to receive either 100 micrograms misoprostol inserted vaginally (32) or placebo similarly applied (30). Transvaginal sonography was performed to measure the cervical length before and 12 hrs after insertion. RESULTS: The mean change in cervical length and Bishop score was significantly greater in the misoprostol group (24 mm and score 8) compared with in the placebo group (2.2 mm and score 1) (p = 0.001). All but one patients receiving misoprostol went into labor while only one in the placebo group did so. The interval from insertion to vaginal delivery was significantly shorter in the misoprostol group (12.0 vs 25.5 hrs, p < 0.001). Delivery occurred within 24 hrs in 75% and 30% of patients in the misoprostol and placebo groups respectively. Uterine tachsystole occurred more frequently in the misoprostol group (38%) than in the placebo group (0%) (p < 0.001). All could be rapidly reversed by tocolytics without apparent untoward intrapartum effects. No significant differences were noted in the 2 groups in terms of perinatal outcomes and mode of delivery. CONCLUSION: Intravaginal misoprostol is an effective, cheap and safe method for cervical ripening. The higher frequency of uterine tachysystole in the misoprostol group did not increase the risk of adverse intrapartum and neonatal outcomes.

Administration, Intravaginal↗
PubMed1996

A comparison of serum magnesium sulfate levels in pregnant women with severe preeclampsia between intravenous and intramuscular magnesium sulfate regimens: a randomized controlled trial.

The frequency of blood samples that achieved therapeutic level was lower in the group of maintenance with intravenous regimen than the intramuscular regimen significantly at 15, 30, 60, 120 and 240 minutes after loading dose. The mean level of serum magnesium sulfate in the intravenous group was significantly lower than intramuscular group. This study supported to choose the maintenance by intramuscular regimen. However, further study is required to analyse the effect of higher level of magnesium sulfate in Thai patients.

Adult↗
PubMed1995

Single transvaginal sonographic measurement of cervical length early in the third trimester as a predictor of preterm delivery.

OBJECTIVE: To evaluate the accuracy of a single sonographic measurement of cervical length early in the third trimester as a predictor of preterm delivery. METHODS: A total of 771 women attending the antenatal clinic at the Maharaj Nakorn Chiang Mai Hospital between January 1, 1990, and November 30, 1993, with singleton gestations, cervical competence, accurate dates of last menstrual period, and gestational ages between 28-30 weeks, were recruited into the study. Forty-one were excluded, ten because of induced preterm delivery, 24 because of measurement problems, and seven because they were lost to follow-up. We analyzed the remaining 730 women. RESULTS: Ninety-one (12.5%) women ended with preterm births and the remaining 639 (87.5%) delivered at term. The mean (+/- standard deviation) cervical lengths of the term and preterm groups were statistically significantly different at 37 +/- 5 and 34 +/- 6 mm, respectively (P < .001). The likelihood ratio of cervical length at various cutoff points was calculated. The appropriate cutoff point based on the receiver operating characteristic curve (35 mm) was associated with a significantly increased likelihood of preterm delivery (20 versus 7%) and was detected in two-thirds of preterm births. This cutoff point gave a sensitivity and specificity of 65.9 +/- 5.1% (95% confidence interval [CI]) and 62.4 +/- 5.2% (95% CI), respectively. CONCLUSION: A single transvaginal sonographic measurement of cervical length at 28-30 gestational weeks can be used to predict the risk of preterm delivery, using a cutoff point of 35 mm, but its cost-effectiveness should be assessed further.

Adult↗
PubMed1995

Pregnancy outcome of threatened abortion with demonstrable fetal cardiac activity: a cohort study.

UNLABELLED: Pregnancy with visible fetal heart beat complicated by first trimester threatened abortion had significant increased risk of subsequent spontaneous abortion compared with normal pregnancy. OBJECTIVE: To compare pregnancy outcomes in cases complicated by first trimester threatened abortion with those that were not. METHODS: Prospective cohort study of 255 cases of first trimester threatened abortions but with visible heart beat and 265 other normal pregnancies. RESULTS: Spontaneous abortion rates of 5.5% (with relative abortal risk of 2.91) was found for study group, compared to 1.88% for controls (p < 0.05). Preterm delivery was also higher, but was not statistically significant. CONCLUSIONS: First trimester bleeding with visible fetal heart beat appears to associate significantly with higher subsequent spontaneous abortion rate than those without.

Abortion, Threatened↗
PubMed1994

Use of vaginosonographic measurements of endometrial thickness in the identification of abnormal endometrium in peri- and postmenopausal bleeding.

One hundred and seventy seven women with peri- and postmenopausal bleeding were subjected to vaginosonographic examination followed by thorough pathological examination of the uterine curetting samples. A mean endometrial thickness (double layer) of 13.2 +/- 3.6 mm and 8.2 +/- 4.8 mm were found in those with and without histological abnormalities, respectively. Endometrial thickness of less than 7 mm, however, was found to be predictive of normal endometrium (100% sensitivity, 46% specificity) and can, therefore, be used to separate those who require diagnostic curettage from those who do not. These findings suggest that this relatively simple, noninvasive procedure can be used as a screening test for patients with peri- or postmenopausal bleeding.

Aged↗
PubMed1994

Transvaginal ultrasound in threatened abortions with empty gestational sacs.

OBJECTIVE: To determine whether transvaginal ultrasound criteria alone can distinguish viable from non-viable gestational sacs at a single examination. METHOD: A prospective descriptive study was undertaken and analysis performed on 211 pregnancies complicated by threatened abortion and empty gestation sacs diagnosed by transvaginal ultrasound. The main outcome measure was the final diagnosis of viable or non-viable gestation on subsequent transvaginal sonography. RESULTS: The study shows that a single transvaginal ultrasound examination is useful in differentiating viable from non-viable gestation sacs. The mean sac diameter (MSD) was found to be the most useful criterion for determining non-viability. An MSD of > or = 17 mm that lacked an embryo and an MSD of > or = 13 mm without visible yolk sac were reliable predictors of non-viable gestation sacs at a single examination with 100% specificity and 100% positive predictive value. An MSD > or = 13 mm without visible yolk sac was the most sensitive criterion. Using MSD criteria, 73% of non-viable gestations could be reliably identified without any false-positive diagnoses. Deformed shape, low position and thin decidual reaction are strong indicators of non-viable gestations but are not 100% accurate. There is still a significant proportion of empty sacs, where no accurate distinction between viable and non-viable can be made according to one criterion at a single examination and in these cases serial examinations should be carried out before any active management is advocated. CONCLUSION: In most cases, transvaginal sonographic criteria alone can distinguish viable from non-viable empty gestational sacs at a single examination.

Abortion, Threatened↗
PubMed1994

Accuracy of ultrasonic fetal weight estimation: a comparison of three equations employed for estimating fetal weight.

This study was conducted to compare the accuracy in estimating the fetal weight of three equations with ultrasound in 104 pregnant women. Equation I log 10 (EFW) = 1.85479 + 0.09008 (BPD) + 0.02466 (AC) Equation II log 10 (EFW) = 2.24784 + 0.09122 (FL) + 0.002798 (BPD x AC) -0.0010112 (AC x FL) Equation III log 10 (EFW) = -1.7492 + 0.166 (BPD) + 0.046 (AC) - 2.646 (AC x BPD)/1000 There was no difference in either the overall mean errors of 95 per cent CI among the three equations, except in the least error for equation II in these with birthweight of less than 2,000 grams and for equation III in these with birthweight of more than 3,000 grams. It was concluded, therefore, that predictions based on either equation I or II developed from local Thai population, which have an almost identical overall mean error when compared with one another or with Shepard's (i.e. equation III), can be used in our clinical.

Abdomen↗
PubMed1994

Comparison of the acoustic stimulation test with nonstress test. A randomized, controlled clinical trial.

The nonstress test (NST) is a helpful adjunct in the management of high-risk pregnancies. It has high predictability and a low false-negative rate but unfortunately has fairly high false-positive results. Attempts have been made to find a suitable stimulant to help decrease nonreactive results as well as to shorten the duration of testing: the recently introduced fetal acoustic stimulation test (AST) may have such attributes. This prospective, randomized clinical trial was carried out to assess the new test. A total of 1,300 individual tests were performed on high-risk pregnancies. Cases were randomized to receive either the AST or NST. All tracings were interpreted blindly by an independent perinatologist. The incidence of nonreactive tests was 6.8% in the AST group and 13.8% in the NST group (P < .001). There was a significant reduction in the time needed for a reactive test to occur. It can be concluded, therefore, that AST offers a greater advantage over NST by lowering both the incidence of nonreactive tests and testing time, thereby resulting in less of a need for the contraction stress test and biophysical profile.

Acoustic Stimulation↗
PubMed1993

Amniotic fluid volume as a predictor of fetal distress in intrauterine growth retardation.

OBJECTIVE: To determine the efficacy of sonographic assessment of amniotic fluid volume (AFV) in predicting intrapartum fetal distress in pregnancies with intrauterine growth retardation (IUGR) compared with the nonstress test (NST). METHOD: A prospective study of 242 pregnancies with IUGR who underwent antepartum assessment of AFV and NST with intrapartum continuous FHR monitoring was conducted and analyzed. RESULT: AFV was a reliable predictor of intrapartum fetal distress with sensitivity, specificity, positive and negative predictive values of 84.0%, 83.41%, 36.84% and 97.84%, respectively. The efficacy of AFV was comparable with that of the NST. CONCLUSION: Sonographic assessment of AFV is an effective predictor of intrapartum fetal distress in pregnancies with IUGR.

Adult↗
PubMed1993

Transvaginal sonographic features in diagnosis of ectopic pregnancy.

OBJECTIVES: To evaluate the efficacy of pelvic transvaginal sonography (TVS) in patients with clinical presentation of extrauterine pregnancy (EUP) and positive beta-hCG. METHODS: Three hundred and twenty-one patients with clinical suspicion of EUP were subjected to TVS at Maharaj Nakorn Chiang Mai Hospital. The criteria for entry to the study were (1) clinical suspicion of EUP, with stable hemodynamic condition, (2) correct final diagnosis must be known, (3) serum beta-hCG must be determined, by assay sensitivity of 10 mIU/ml (4) TVS was examined by the same sonographer. Frequencies of each TVS feature in EUP and IUP were determined. Among the patients with positive beta-hCG and empty uterus, the accuracy indices of various TVS features in predicting EUP were calculated. RESULTS: Patients with measurable beta-hCG were divided into two main groups, namely those with demonstrable typical intrauterine gestational sac (52/201), and those without (149/201). None of the subjects in the first group had EUP. Among the latter group of patients, with empty uterus, TVS signs could be further divided into 3 subgroups: (1) Direct sign, clear evidence of extrauterine gestational sac. This group had positive predictive value 100%, but low sensitivity (26%). (2) Indirect signs of EUP, i.e. adnexal mass and pelvic fluid, especially echogenic fluid. Echogenic fluid, adnexal mass and their combination had positive predictive value for EUP 92.3%, 92.8% and 95.0%, respectively. Complex adnexal mass gave the highest sensitivity (85.7%). (3) No positive sign on TVS, which is very unlikely to be EUP, and was found in only 2.8% of EUP. CONCLUSIONS: The results of this study indicate that TVS can help to facilitate the diagnosis of EUP in most cases. EUP can be confidently diagnosed by demonstration of adnexal ring, and excluded by visualization of intrauterine sac. Complex adnexal mass and echogenic fluid are extremely helpful in making the diagnosis.

Chorionic Gonadotropin↗
PubMed1993

Amniotic fluid volume as a predictor of fetal distress in postterm pregnancy.

OBJECTIVE: To determine the efficacy of amniotic fluid volume (AFV) assessment in predicting intrapartum fetal distress in postterm pregnancy compared with the conventional nonstress test (NST). METHOD: A prospective study of 252 postterm patients who underwent antepartum assessment of AFV and NST with intrapartum continuous FHR monitoring was conducted and subjected to analysis. RESULT: AFV was significantly more accurate in predicting intrapartum fetal distress than the NST with sensitivity, specificity, positive and negative predictive values of 72.73%, 90.87%, 26.67% and 98.65%, respectively. CONCLUSION: AFV assessment was an effective method in predicting fetal distress in postterm pregnancy.

Amniotic Fluid↗
PubMed1993

Study of intrauterine growth from birthweight at Maharaj Nakhon Chiang Mai Hospital.

Intrauterine growth curve and normogram for newborns at Maharaj Nakhon Chiang Mai Hospital are constructed. Birthweight at various gestational weeks of deliveries were determined within 24 hrs after birth. All 1,311 Thai pregnant women selected, fitted the criteria of inclusion deliveries at Maharaj Nakhon Chiang Mai Hospital from May 1983 to April 1991 (8 yrs). Their gestational age distribution was between 28 wks to 42 wks. Clinical status at birth was satisfactory. There were no obstetric or medical complications during pregnancy. Mean birthweight and standard deviation of newborns for each gestational age at delivery were calculated and presented in tabular and graphic form. Mean birthweight for 40 wks of gestation was 3.144 +/- 382 g. In addition, normogram of 10th, 50th, 90th percentile ranks of birthweight for each gestational age was constructed. These values may be useful as baseline data of intrauterine growth curve to evaluate fetal growth in our population.

Adolescent↗
PubMed1993

Ultrasonic fetal transverse trunk diameter in normal northern Thai women.

Fetal transverse trunk diameter (TTD) were measured by two obstetric sonographers, using Aloka model SSD 630 and 650. The measurements were performed on 1,009 occasions in 235 women during normal pregnancies between the 14th and 40th weeks (age range 17-37 years) (4.5 measurements per pregnancy, on average). The relation between TTD and menstrual age was determined and mathematical modeling of the data demonstrated that the linear quadratic function was optimal (r2 = 0.973). The most fitted regression equation was obtained by regression analysis. 1.) TTD = -2.69055 + 0.38326 G.A - 0.00140137 GA2 2.) GA = 7.222585 + 2.82632 TTD + 0.02605 TTD2. Interestingly, TTD value for each gestational week in this study is not so different from that of the European data. Predicted TTD values for a given gestational week were determined and presented in tabular form. The values from this study may be important baseline data for evaluation of fetal growth in our population.

Adolescent↗