Epidemiology and prognostic factors for successful expectant management of early-onset severe features preeclampsia: A retrospective multicenter cohort study.

BACKGROUND: To determine the incidence of early-onset severe features preeclampsia among pregnant women and compare maternal complications and perinatal outcome characteristics of expectance and immediate delivery management with identified prognosis factors for successful expectant management. MATERIALS AND METHODS: A retrospective descriptive multicenter cohort study of pregnant women diagnosed with severe features preeclampsia before 34 weeks of gestation according to the American College of Obstetricians and Gynecologists guidelines was conducted at Khon Kaen University, Srinagarind Hospital and Khon Kaen Hospital between January 1, 2015 and December 31, 2019. Medical records were reviewed for incidence of early-onset severe features preeclampsia, with maternal complications and perinatal outcome characteristics compared for expectant and immediate delivery management. RESULTS: In total, 42,948 deliveries were recorded during the study period. Of these, 971 were diagnosed with severe features preeclampsia (22 per 1,000 deliveries). Two hundred and sixty-five women (6.3 per 1,000 deliveries) were diagnosed with early-onset severe features preeclampsia before 34 weeks of gestation. No differences were recorded in characteristics between the expectant and delivery management groups. Perinatal outcomes were significantly different between the expectant and delivery management groups; birth weight below 1,500 g (23.5 % versus 58.9 %, p < 0.001), neonatal intensive care unit (65.9 % versus 87.2 %, p < 0.001); neonatal resuscitation (22.3 % versus 57.1 %, p < 0.001). Birth asphyxia, stillbirth and intrapartum death only occurred in women with early-onset severe features preeclampsia in the delivery management group. CONCLUSIONS: Incidence of early-onset severe features preeclampsia was 6.3 per 1,000 deliveries. For women with complications such as early-onset severe features preeclampsia, expectant management significantly benefitted neonatal outcomes, with no differences in maternal outcomes compared to the immediate delivery management group. The gestational age at diagnosis of more than 30 weeks and uric acid level of less than 5.5 mg/dL (327.14 µmol/L) were significant factors for the successful expectant management.

Fetal and Neonatal Modified Myocardial Performance Indices in Preeclamptic versus Normotensive Pregnancies: A Prospective Cohort Study.

OBJECTIVE: To compare fetal and neonatal cardiac functions in terms of global, systolic, and diastolic function between the preeclampsia and normotensive blood pressure of pregnancies. METHODS: A prospective cohort study was conducted at a university hospital in Northeast Thailand. Twenty-nine pregnancies diagnosed as preeclampsia with or without severe features were compared with 29 normotensive pregnancies. Global cardiac, systolic, and diastolic function were assessed at prenatal and postnatal periods, by a professionally trained obstetrician and pediatric cardiologist, respectively. RESULTS: The fetal left modified myocardium performance index (Mod-MPI) in preeclampsia and normotensive blood pressure were 0.60±0.08 and 0.59±0.08 (p-value=0.341), respectively, while fetal right Mod-MPI were 0.57±0.16 and 0.54±0.21 (p-value=0.861), respectively. There were no statistically significant differences in terms of fetal isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ejection time (ET), aortic peak systolic velocity (Ao PSV), pulmonary artery peak systolic velocity (PA PSV), mitral valve (MV) E:A ratio, or tricuspid valve (TV) E:A ratios between the two groups. Neonatal mitral valve E peak systolic velocity (MV-E PV) in preeclamptic and normotensive blood pressure groups were significantly different at 51.1±8.02 cm/s and 43.56±5.21cm/s (p-value=0.036), respectively, whereas neonatal left Mod-MPI, mitral valve A peak systolic velocity (MV-A PV), MV E:A ratio, and Ao PSV were not significantly different (p-value=0.436, 0.119, 0.379, and 0.709), respectively. CONCLUSION: Neonatal MV-E PV of the preeclampsia group was significantly higher than the normotensive blood pressure group, while there were no statistically significant differences in terms of global cardiac and diastolic functions during the fetal period between two groups.

Calcium Consumption During Pregnancy: A Multicenter Study in a Middle-Income Country in Southeast Asia.

OBJECTIVE: To perform a cross-sectional observational study of calcium consumption among pregnant women from multicenter tertiary care hospitals in the middle-income country in Southeast Asia. STUDY DESIGN: A cross-sectional observational study. SETTING: The study was conducted in four geographical regions (northern, northeastern, southern, and central) of Thailand. Five participating hospitals consisted of one university hospital in each region and one additional tertiary care hospital in the central region. MATERIALS AND METHODS: A cross-sectional study was performed nationwide from 1st November 2017 to 31st January 2019. All singleton aged 19-40 years were included. Exclusion criteria were any conditions that influenced calcium-containing food consumption. Dietary intake self-records immediately after eating for two working days and one holiday were analyzed via INMUCAL-NV3.0 dietary program. RESULTS: The 1549 records were obtained. The mean age was 29 ± 5.7 years. Most participants were primigravida (48.6%). The average gestational age was 20.6 ± 8.8 weeks. Mean calcium consumption was 602.4 mg/day (95% CI; 589.2615.6 mg/day) mg/dL. Inadequate calcium consumption prevalence based on the Thai dietary reference intake (less than 800 mg/day) and US Institute of Medicine (less than 1000 mg/day) were 82.0% and 93.4%, respectively. CONCLUSION: The mean calcium consumption among pregnant women in the middle-income country in Southeast Asia was 602.4 mg/day (95% CI 589.2-615.6 mg/day). Inadequate calcium consumption of Thai pregnant women prevalence was 82.0% and 93.4% according to Thai dietary reference intake in pregnancy and the US Institute of Medicine.

Comparison of Low Dose versus High Dose of Oxytocin for Initiating Uterine Contraction During Cesarean Delivery: A Randomized, Controlled, Non-Inferiority Trial.

BACKGROUND: Oxytocin is used for initiating uterine contraction and preventing postpartum hemorrhage during caesarean delivery. Using a lower dosage of oxytocin may lower the risk of adverse effects while still being effective in stimulating initial uterine contraction. We aimed to compare the effectiveness and side effects of the standard 10 IU bolus of oxytocin with those of a 5 IU bolus during caesarean delivery. PATIENTS AND METHODS: We enrolled women in a randomized, double-blind, study comparing intravenous injections of high-dose (10 IU) and low-dose (5 IU) oxytocin administered after clamping of the umbilical cord. The primary outcome was adequate uterine contraction within the first 3 mins after administration. Secondary outcomes included uterine tone, use of additional uterotonic agents, additional obstetrics procedures, and oxytocin-related adverse events. RESULTS: A total of 155 women underwent randomization, with 78 in the low-dose group and 77 in the high-dose group. The proportion of women with adequate uterine contraction during the first 3 mins was 84.6% in the low-dose group and 77.9% in the high-dose group (relative risk, 1.09; 95% CI, 0.93 to 1.26). Methylergonovine maleate was used in 14.1% of cases in the low-dose group and 36.4% in the high-dose group (relative risk, 0.40; 95% CI, 0.22 to 0.73). The necessity for additional obstetric procedures, estimated blood loss >500 mL, neonatal outcomes, and oxytocin-related adverse effects did not differ significantly between the two groups. CONCLUSION: The 5 IU bolus of oxytocin was noninferior to the standard 10 IU bolus of oxytocin for initiating adequate uterine contraction, required fewer additional uterotonic agents, and led to fewer oxytocin-related adverse events.

Transperineal versus transvaginal sonographic measurements of cervical length in pregnant women between 16 and 24 weeks of gestation.

PURPOSE: To investigate the correlation between cervical length measurements using transvaginal and transperineal approaches at 16-24 weeks of gestation. METHODS: The prospective study recruited 110 singleton pregnant women. All the measurements were performed by one operator who was blinded to the results of both approaches. Cervical length was first measured by transvaginal sonography (TVUS) then transperineal sonography (TPUS). The transvaginal approach was used as the reference measurement. Patient preference regarding the sonographic approaches was evaluated using questionnaire. RESULTS: Cervical length was successfully measured by TVUS in all cases. TPUS was successful in 108/110 participants. There was high correlation between the results of TVUS and TPUS (Pearson's correlation coefficient was .94; 95% CI .9 to .95. Lin's concordance correlation coefficient was .94; 95% CI .92-.96). The estimated difference in cervical length measured using TVUS and TPUS was .2 mm. The 95% tolerance interval for paired observation was -1.8 to 2.3 mm. The interobserver coefficient of TPUS measurement was .98 (95% CI .92-.99). TPUS was rated as resulting in mild or no discomfort and was preferred by most women. CONCLUSION: TVUS and TPUS techniques showed high correlation in cervical length measurement with high interobserver reliability. More patients preferred TPUS. TPUS should be considered as an alternative method of cervical length measurement.

Presentation of Compound Heterozygous Hemoglobin Constant Spring and Hemoglobin Pakse in Neonates.

BACKGROUND: Mutations causing α thalassemia are divided into deletion and nondeletion groups. In the nondeletion group, hemoglobin constant spring (Hb CS) and hemoglobin Pakse (Hb Pakse) are both caused by a termination codon mutation leading to elongation of the α2 globin gene. In the case of Hb CS, the mutation is TAA→CAA, whereas the mutation causing Hb Pakse is TAA→TAT. Clinical hematologic phenotypes are not significantly different. It is important to identify compound heterozygotes for purposes of genetic counseling. METHODS: We report 5 neonates with compound heterozygous Hb CS/Hb Pakse mutations with respect to clinical courses, hematologic profiles, and management. RESULTS: Among 5 cases (3 male babies and 2 female babies) with mean birth weight 2982 g (range, 2660 to 3440 g), 3 were diagnosed as compound heterozygous Hb CS/Hb Pakse, 1 as homozygous Hb E with compound heterozygous Hb CS/Hb Pakse, and 1 as heterozygous Hb E with compound heterozygous Hb CS/Hb Pakse. Clinical manifestations included fetal anemia (1 case), neonatal hyperbilirubinemia (5), neonatal anemia (2), hepatosplenomegaly (1), and cholestatic jaundice (1). Three cases required a single phototherapy; 2 cases needed double phototherapy for treatment of severe hyperbilirubinemia. During the first few months of life, all cases had mild anemia, slightly low mean corpuscular volume, wide red cell distribution width, and low red cell counts. At 1 to 3 years of age, all patients still had mild microcytic hypochromic anemia with Hb levels around 10 g/dL, increased reticulocyte count, and wide red cell distribution width. CONCLUSIONS: Misdiagnosis of Hb Pakse could occur via Hb typing using Hb electrophoresis, because the band comigrates with that of Hb CS. DNA study is the definitive method for diagnosis.

Clinical Course of Homozygous Hemoglobin Constant Spring in Pediatric Patients.

BACKGROUND: Hemoglobin (Hb) Constant Spring is an alpha-globin gene variant due to a mutation of the stop codon resulting in the elongation of the encoded polypeptide from 141 to 172 amino acid residues. Patients with homozygous Hb Constant Spring are usually mildly anemic. METHODS: We retrospectively describe clinical manifestations, diagnosis, laboratory investigations, treatment, and associated findings in pediatric patients with homozygous Hb Constant Spring followed-up at Srinagarind Hospital. RESULTS: Sixteen pediatric cases (5 males and 11 females) were diagnosed in utero (N=6) or postnatal (n=10). Eleven cases were diagnosed with homozygous Hb Constant Spring, 4 with homozygous Hb Constant Spring with heterozygous Hb E, and 1 with homozygous Hb Constant Spring with homozygous Hb E. Three cases were delivered preterm. Six patients had low birth weights. Clinical manifestations included fetal anemia in 6 cases, hepatomegaly in 1 case, hepatosplenomegaly in 2 cases, splenomegaly in 1 case. Twelve cases exhibited early neonatal jaundice, 9 of which required phototherapy. Six cases received red cell transfusions; 1 (3), >1 (3). After the first few months of life, almost all patients had mild microcytic hypochromic anemia and an increased reticulocyte count with a wide red cell distribution (RDW), but no longer required red cell transfusion. At 1 to 2 years of age, some patients still had mild microcytic hypochromic anemia and some had normocytic hypochromic anemia with Hb around 10 g/dL, increased reticulocyte count and wide RDW. Associated findings included hypothyroidism (2), congenital heart diseases (4), genitourinary abnormalities (3), gastrointestinal abnormalities (2), and developmental delay (1). SUMMARY: Pediatric patients with homozygous Hb Constant Spring developed severe anemia in utero and up to the age of 2 to 3 months postnatal, requiring blood transfusions. Subsequently, their anemia was mild with no evidence of hepatosplenomegaly. Their Hb level was above 9 g/dL with hypochromic microcytic blood pictures as well as wide RDW. Blood transfusions have not been necessary since then.

Maternal Serum Angiogenic Growth Factors in Intrauterine Growth Restriction versus Normal Pregnancies.

Objective: To assess maternal serum angiogenic growth factors level of soluble fms-like tyrosine kinase-1 (sFlt-1), placenta growth factor (PlGF) and sFlt-1/PlGF ratio among pregnant women with intrauterine growth restriction (IUGR) compared to those with normal pregnancies. Study design: A prospective cross-sectional study conducted at Srinagarind Hospital, Khon Kaen University, Thailand from July 2014 to April 2015. Material and Method: Twenty-one singleton pregnant women of gestational age between 26 to 39 weeks who had IUGR, and 21 normal pregnant women matched for gestational age were recruited. Descriptive statistics were used for demographic characteristics. Student t-test and Wilcoxon rank-sum test was used when appropriated to compare between the groups. Main outcome measures: Levels of sFlt-1 and PIGF and sFlt-1/PlGF ratio. Results: There were no statistical significant differences in gestational age, maternal age, parity status, maternal blood pressure level and hematocrit level between the groups. Median PlGF level among pregnant women with IUGR was significantly lower than that in control group (121 and 834.8 ng/ml respectively, p-value <0.01). The sFlt-1 level in pregnancies complicated by IUGR was slightly higher than that noted among normal pregnancies (2644 ng/ml and 2,136 ng/ml respectively, a p-value 0.105). The sFlt-1/PlGF ratio among pregnant women with IUGR was significant higher than that observed among normal pregnant women (34.1 and 2.6 respectively, p-value <0.01). Conclusion: Pregnancy with IUGR had low level of PlGF and high sFlt-1/PlGF ratio when compare with normal pregnancy.

Short cervix detection in pregnant women by transabdominal sonography with post-void technique.

PURPOSE: This study aimed to evaluate the diagnostic properties of transabdominal sonography with the post-void technique for cervical length measurement. METHODS: This study was a prospective cohort study. The inclusion criteria were pregnant women aged 18-40 years with gestational age of 18-23 completed weeks. Transabdominal sonography with vertical bladder depth of less than 5 cm and transvaginal cervical length measurements were carried out by a single experienced sonographer. RESULTS: There were 307 eligible pregnant women. The mean age of all subjects was 29.0 years. The mean cervical length obtained through transabdominal and transvaginal measurement was 3.33 and 3.47 cm, respectively. Ten patients (3.3 %) were identified as having a short cervix using transvaginal sonography, and 12 patients (3.9 %) were identified using transabdominal sonography. CONCLUSION: Transabdominal sonography with vertical bladder depth of less than 5 cm performed better compared with transvaginal sonography. It may not be necessary to perform transvaginal sonography if transabdominal sonography reveals the cervical length to be more than 2.5 cm.

Contraceptive practices and pregnancy intendedness among pregnant adolescents.

BACKGROUND: Adolescent pregnancy is a major health problem in many developing countries. OBJECTIVE: To assess contraceptive practices and pregnancy intendedness in pregnant adolescents. MATERIALS AND METHODS: This study was prospectively conducted from September 2013 to June 2014. All consecutively pregnant women between 15 and 19 years old attending the Antenatal Clinic at Srinagarind Hospital and the Khon Kaen Branch of the Planned Parenthood Association of Thailand were invited for participation. Face-to-face interviews by trained interviewers using standardized questionnaires were carried out. Logistic regression was used to determine an adjusted odds ratio (aOR) and 95% confidence interval (CI) of independent predictors. RESULTS: Two hundred participants were enrolled. Mean age was 17.2 years. One hundred and eighteen (59.0%) were currently in school. Seventy-five (37.5%) participants had never used any contraceptive methods. Of the 125 participants who had ever used contraception, regular use of contraceptives was reported in only 21 participants (16.8%). Only two participants (1.0%) had ever used an intrauterine device or implant. Participants' age was a significant independent factor associated with non-use of contraceptives (aOR, 6.42; 95% CI, 2.94-14.04). Of the 200 participants, 132 (66.0%) declared that the pregnancy was unintended. Significant independent factors predicting unintended pregnancy were educational status (aOR, 6.17; 95% CI, 3.27-13.75) and participants' age (aOR, 5.76; 95% CI, 2.42-13.70). CONCLUSION: Non-use and use of contraceptive methods with high failure rates were major reasons leading to adolescent pregnancies. Participants' age was an independent factor predicting non-use of contraceptives. Educational status and age of the participants were significant factors predicting unintended pregnancy.

Second trimester genetic ultrasound for Down syndrome screening at Srinagarind Hospital.

OBJECTIVE: To assess the value of second trimester genetic ultrasound for screening of Down syndrome conducted at Srinagarind Hospital, Khon Kaen, Thailand. MATERIAL AND METHOD: The present study sample comprised of 4,033 pregnant women at high risk forfetal chromosomal abnormality, from 17th to 23th week, who had performed second trimester genetic ultrasound before genetic amniocentesis between September 1996 and December 2011. Archived medical records relating to results ofgenetic ultrasound and genetic amniocentesis were extracted and studied. MAIN OUTCOME MEASURE: Sensitivity ofgenetic ultrasound in the detection of fetal Down syndrome. Results: There were 3,966 chromosomally normal pregnancies (98.3%), 43 fetuses with Down syndrome (1.1%), and 24 fetuses with other chromosomal abnormality (0.6%). 30 of 43 (69.8%) fetuses with Down syndrome had abnormal genetic ultrasound. The overall sensitivity of second trimester genetic ultrasound for detecting Down syndrome was 69.8% with a false-positive rate of 50.4% and likelihood ratio of 1.38. Of all the sonographic markers, short femur, and short humerus indicated the highest sensitivity at 65.1% and 44.2%. According to likelihood ratio (LR+), chest abnormality, 2 vessel umbilical cord, andfacial abnormality including cleft lip and palate, have highest likelihood ratio (LR+) of 61.49, 46.12, and 46.10, and had sensitivity at 4.7%, 2.3%, and 2.3% respectively. CONCLUSION: The sensitivity of second trimester genetic ultrasound for detection offetal Down syndrome at Srinagarind Hospital was rather high, and probably is an alternative method ofprenatalprediction for high risk pregnant women who refused genetic amniocentesis.

Effectiveness of the model for prenatal control of severe thalassemia.

OBJECTIVE: The aim of the research was to determine effectiveness of the model for prenatal control in reducing new cases of severe thalassemia. METHODS: Pregnant women at six tertiary centers were recruited to follow the model, consisting of (1) carrier screening using mean corpuscular volume (for alpha-thal-1 and beta-thal) and CMU-E screen (for HbE trait), (2) carrier diagnosis, (3) the couples at risk were counseled and offered prenatal diagnosis, and (4) termination of affected pregnancy. All neonates were evaluated for thalassemia. RESULTS: Of the 12,874 recruited pregnancies, 7008 were valid for analysis. Of them, 281 couples were identified to be at risk, Of the 281, 58 affected fetuses were identified and 55 pregnancies were terminated, whereas three did not accept pregnancy termination. All 6727 neonates at no risk were proven to be unaffected. The model had sensitivity and positive predictive value of 100% and 20%, respectively. The model could detect all of affected fetuses. CONCLUSION: The model could prenatally identify affected fetuses with a detection rate and negative predictive value of 100%. The model was highly effective to prenatally detect affected fetuses with an acceptable false positive rate.

Normogram of fetal middle cerebral artery peak systolic velocity at 20-37 weeks of gestation at Srinagarind Hospital.

OBJECTIVE: To establish normal references of fetal middle cerebral artery peak systolic velocity (MCA PSV) at 20 to 37 weeks of gestation at Srinagarind Hospital. MATERIAL AND METHOD: A descriptive cross-sectional study was performed Normal fetuses at 20 to 37 weeks of gestation were studied by gray scale ultrasonography initially and then Doppler of MCA PSV. RESULTS: At least 18 pregnant women of each gestational age with an uncomplicated singleton were enrolled The MCA PSV was increased as gestational age advanced from 24.34 cm/sec (SD 3.91) at 20 weeks to 59.04 cm/sec (SD 10.80) at 37 weeks. CONCLUSION: A normogram of fetal MCA PSV at 20 to 37 weeks of gestation at Srinagarind hospital was generated.

Fetal pleural effusions with spontaneous resolution: a case report.

A 42-year-old pregnant woman was referred with massive fetal bilateral pleural effusions. Observation with serial ultrasound was made. The documented spontaneous resolution of fetal pleural effusion was recorded. Neonatal examination revealed a completely healthy infant with normal respiration. Fetal pleural effusion can cause fetal lung compression, abnormal neonatal respiration and finally, neonatal mortality. Regular ultrasounds are one of the supportive options due to spontaneous resolution that can occur in 9 to 22% of the cases.

Incidence, causes and pregnancy outcomes of hydrops fetalis at Srinagarind Hospital, 1996-2005: a 10-year review.

OBJECTIVE: To identify the incidence and determine causes and pregnancy outcomes of hydrops fetalis at Srinagarind Hospital. STUDY DESIGN: A retrospective descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University. MATERIAL AND METHOD: A retrospective medical record review of all pregnant women and newborns who were diagnosed with hydrops fetalis at all gestational ages and delivered at Srinagarind Hospital between 1996 and 2005. RESULTS: During the period of study, the incidence of hydrops fetalis was 1.80 per 1,000 total births (82 cases of 45,499 total births). Thirty-nine cases (47.56%) were idiopathic, 30 cases (36.58%) were Hb Bart's hydrops fetalis, and three (3.66%) cases were caused by congenital infection. The others 10 cases (12.19%) were achondrogenesis, Turner syndrome, twin-to-twin transfusion syndrome, severe anemia with unknown primary cause, cystic hygroma, multiple congenital anomalies, and Rh isoimmunization. The mortality rate of hydrops fetalis in the present series was 98.78%. One case, caused by Rh isoimmunization, survived. Maternal complications were 30 cases (36.59%) consisting of preeclampsia, preterm labor, disseminated intravascular coagulopathy, placenta previa, and postpartum hemorrhage. CONCLUSION: The incidence of hydrops fetalis was 1.80 per 1,000 total births. The common known cause was Hb Bart's hydrops fetalis. The mortality rate of hydrops fetalis in the present study was very high.

Fetal biometry charts for normal pregnant women in northeastern Thailand.

OBJECTIVES: 1) To construct normal fetal biometry charts of fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) from 14 to 41 weeks of gestation in northeastern Thailand. 2) To compare the results with other studies. STUDY DESIGN: A cross sectional descriptive study. SETTING: Division of Fetal Diagnosis and Therapy, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University. MATERIAL AND METHOD: The fetuses of 635 pregnant women with an uncomplicated singleton pregnancy between 14 and 41 weeks of gestation in northeastern Thailand from 1 October 2005 to 31 December 2006. All recruited pregnant women enrolled had an abdominal ultrasonography for fetal biometry and the results were compared with other studies using student's T distribution. MAIN OUTCOME MEASURES: Fetal biometry charts for normal pregnant women between 14 and 41 weeks of gestation in northeastern Thailand. RESULTS: Six hundred and twenty eight normal fetuses from 635 pregnant women were measured for fetal biometry charts. The comparison of the presented charts with others was significantly larger than the North in all parameters (except AC), but was consistent to those from the South (only BPD and FL). However when the authors compared then with central Thailand and Western countries, there were only significant differences in some gestational ages. CONCLUSION: The authors established normal fetal biometry charts for northeastern Thai pregnant women that could be implemented in the population of this region.

Autopsy findings of fetal death.

OBJECTIVE: To study the autopsy findings associated with fetal death in the division of reproductive pathology. MATERIAL AND METHOD: Descriptive study of 35 fetal deaths with placentas after postmortem examinations in the division of reproductive pathology between January 2005 and December 2005. The fetal deaths and placentas were examined by a perinatal pathologist in the surgical pathology room, Department of Pathology and Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University. The demographic data of the mothers, the gestational age from obstetric information, diagnosis before abortus or delivery. The postmortem examinations including abnormal macroscopic or microscopic findings were analyzed. RESULTS: The associated pathologies of fetal death could be identified 87.5% for groups of fetal weight less than 500 grams and in 77.8% for groups of fetal weight 500 grams or more. The most common associated pathology of fetal death in both groups was congenital anomaly, was 50% and 25.9% respectively. Macerated fetuses were found in 48.2% of all cases. Causes of macerated groups were identified in 66.7% of cases. Hydropic fetuses were 14.3% (5 cases) of all fetal deaths in which the cause of death was identified before delivery in two cases and was identified in postmortem examination in one case. Thus, the identified causes of fetal death in hydrops fetalis were 60%. CONCLUSION: Most common associated pathology of fetal deaths is congenital anomaly.

Correlation of weight estimation in large and small fetuses with three-dimensional ultrasonographic volume measurements of the fetal upper-arm and thigh: A preliminary report.

OBJECTIVE: To determine the correlation of measuring fetal upper-arm and thigh volume using three-dimensional ultrasonography with weight estimation in large and small fetuses. MATERIAL AND METHOD: The authors included 46 pregnant women admitted for delivery in the Labor Room at Srinagarind Hospital, Khon Kaen University, between February 1 and September 30, 2004. Inclusion criteria were: 1) singleton pregnancy; 2) delivery within 48 hours after study; 3) estimation birthweight < 2,500 g (small fetuses group: n = 22) or > 3,500 g (large fetus group: n = 24). All patients received two- and three-dimensional ultrasound examinations by an experienced practitioner The upper-arm and thigh volume were assessed using a three-dimensional ultrasound scanner. RESULTS: In the large fetus group, upper-arm and thigh volume measurements by three-dimensional ultrasound strongly correlated with birthweight, r = 0.805 (95%CI = 0.594-0.912) and r = 0. 739 (95%CI = 0.478-0.880), respectively. In the small fetuses group, the upper-arm and thigh volume measurements, by three-dimensional ultrasound, strongly correlated with birthweight, r = 0.868 (95%CI = 0.689-0.946) and r = 0.835 (95%CI = 0.638-0.929), respectively. CONCLUSION: Upper-arm and thigh volumes measured by three-dimensional ultrasound highly correlates with weight estimation in large and small fetuses and can be used as a new modality for estimating fetal weight.

Prenatal prevention for severe thalassemia disease at Srinagarind Hospital.

OBJECTIVE: To evaluate the results and cost-effectiveness of prenatal prevention measurement in severe thalassemia diseases at Srinagarind Hospital. STUDY DESIGN: Descriptive study. SETTING: Antenatal care (ANC) Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. SUBJECTS: 1,498 thalassemic screened pregnant women first presenting at ANC Clinic at gestational age less than 17 weeks. MATERIAL AND METHOD: Medical records of thalassemic screened pregnant women between February 2002 and February 2005 were analyzed. Those with a value of mean corpuscular volume (MCV) less than 80 fl, or positive dichlorophenol indophenol precipitation test (KKU-DCIP Clear Reagent Kit) underwent hemoglobin (Hb) typing by high performance liquid chromatography (HPLC) together with thalassemia investigation (complete blood count, MCV and Hb typing) of their husbands and to identify couples at risk of 3 severe thalassemia diseases; Hb Bart's hydrops fetalis, homozygous, -thalassemia and, -thalassemia/ Hb E disease. Then they were advised to undergo DNA analysis and, if they had fetal risk, appropriate prenatal diagnosis was offered. MAIN OUTCOME MEASURE: Number of affected fetuses detected by prenatal diagnosis. RESULTS: Nine hundred and ninety six pregnant women (66.49%) were positive on screening. Of these, 642 (64.46%) had thalassemia investigation done with their spouses. There were 19 couples at risk (1.27% of total screened pregnant women) for having fetal severe thalassemia disease from initial laboratory results. Most of them were, -thalassemia/ Hb E diseases. We found only 10 pregnant women (52.63%) that had undergone prenatal diagnosis. The consequent results were two affected fetuses (20%), one was Hb Bart's hydrops fetalis, and the other was, o-thalassemia/ Hb E disease. In these cases, their parents decided to discontinue the pregnancy. Our prevention program could save 1.14 million bahts for the cost of treatment in two prevented severe thalassemia cases. CONCLUSION: The prenatal prevention program of severe thalassemia disease at Srinagarind Hospital can effectively detect affected fetuses and reduce severe thalassemia disease, which is a major health problem in Thailand.

Three-dimensional ultrasonographic findings of the rare chromosomal abnormality 48, XXY/+18: a case report.

The 48, XXY/+18 is a very rare aneuploidy syndrome which combines the aberration in both autosome and sex chromosome. The authors report a case diagnosed prenatally by lymphocyte culture from fetal blood samples following cordocentesis, 2-dimensional (2DUS) and 3-dimensional ultrasonography (3DUS). At 33 1/7 weeks gestation in an ultrasound examination by indication large for date; single umbilical artery with absence of the left umbilical artery, polyhydramnios and fetal growth restriction were demonstrated. The fetus presented with microcephaly, prominent occiput, low-set ears, micrognathia, hypertelorism, small mouth, bilateral club hands with overlapping fingers, rocker-bottom feet. Karyotyping from the cordocentesis led to the diagnosis of 48, XXY/+18, which was confirmed by the chromosomal analysis of the umbilical cord blood after the baby was born. This is the first reported case of the very rare aneuploidy syndrome in the literature.