Normal reference of cervical blood perfusion in pregnancy.

OBJECTIVE: To develop normal reference of cervical blood perfusion in pregnancy by using 3D power Doppler-derived FMBV at 16 to 24 weeks gestation. MATERIAL AND METHOD: The present prospective cohort study recruited the normal singleton pregnant women at 16 to 24 weeks gestation who had antenatal care and midtrimester ultrasound screening at Ramathibodi Hospital between June and September 2012. Transvaginal ultrasound (TVU) measurements of cervical length (CL), cervical volume (CV), vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were performed. The pregnant women with multifetuses, severe fetal anomalies, unknown delivery status, abortion, stillbirth, and preterm birth were excluded from the present study. RESULTS: The authors recruited 168 cases but 25 cases were excluded. Only 143 cases were included into the study. The mean of gestational age at ultrasound examination and delivery was 21 and 39 weeks respectively. There were no perinatal morbidity and mortality in the present study. The average values of cervical profiles of CL, CV VI, FI, and VFI were 4.2 cm, 31.6 cm3, 6.4, 38.9, and 2.6 respectively. CONCLUSION: The normal reference of cervical blood perfusion in Thai pregnant women was established. The VI, FI, and VFI of the normal term singleton pregnancy at 16 to 24 weeks gestation were 6.4, 38.9, and 2.6 respectively.

Fetal loss associated with second trimester amniocentesis.

OBJECTIVE: To evaluate the fetal loss rate associated with second trimester amniocentesis. METHODS: All cases of pregnant women ≥35 years old with gestational age beyond 16 weeks between 1997 and 2006 were included in this study. The study group consisted of all cases that the patients decided to have second trimester genetic amniocentesis. The control group was a randomized selection of pregnant women who refused any procedures. The ratio of the study case to the control case was 2:1. The fetal loss rates after amniocentesis before 24, and 28 complete weeks and the pregnancy outcome were analyzed. RESULTS: 2,990 cases in the study group and 1,495 cases in the control group were used for this analysis. The mean maternal age in the study group and control group were 36.89 ± 1.63 and 36.78 ± 1.59 years old, respectively (P = 0.239). The procedure-related fetal loss before 24 and 28 complete weeks were 0.17 and 0.50%, respectively. The most common presenting symptom before fetal loss in the study cases was abdominal pain. Almost all of the cases leading to abortion had symptoms initiated after 48 h post procedure. Significantly higher chances of abortion occurred in pregnant women ≥41 years old (P = 0.008). CONCLUSION: The procedure-related fetal loss rates in pregnant women ≥35 years old after amniocentesis before 24 and 28 complete weeks were 0.17 and 0.50%, respectively. The certain factors influencing the risk of fetal loss might be independent of the amniocentesis procedure.

The value of mid-trimester routine ultrasonographic screening in antenatal detection of congenital malformations.

OBJECTIVE: To evaluate the detection rate of major fetal anomalies by mid-trimester routine ultrasound screening in a single center with low-risk population. MATERIAL AND METHOD: The present study was a cross sectional study. All pregnant women attending the antenatal clinic between January 1996 and December 2002 had routine ultrasound screening between 18-22 weeks'gestation. The ultrasonographic results were compared with the pregnancy outcome in aspects of prediction of major fetal anomalies. RESULTS: Three hundred and sixteen fetuses out of 29,839 (1.06%) had major anomaly. One hundred and forty four fetuses (45.57%) were diagnosed as having major anomaly by routine ultrasound screening. One hundred and seventy two fetuses (54.43%) were undiagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value were 45.57%, 99.97%, 94.74% and 99.42% respectively. CONCLUSION: Although the rate of the detection of major congenital fetal anomaly was low, almost all lethal and life threatening anomalies could be diagnosed antenatally thus allowing the option of counseling, pregnancy termination, or selective referral.

Doctors' attitudes towards invasive prenatal diagnosis.

AIM: To assess the influence of a doctor's gender, age group, religion and invasive prenatal diagnosis (PND) knowledge on their attitude towards invasive PND. METHODS: All non-obstetric and gynecologic doctors were surveyed using a structured questionnaire. The questionnaire enquired about demographic information, and doctors' knowledge, attitude and experience regarding invasive PND for themselves, and their spouses, relatives, friends, colleagues and patients. RESULTS: Responses from the 289 respondents revealed that two-thirds of respondents knew only a little about invasive PND. Most males and females were in the 31-39 and < or =30-year-old groups, respectively. There were no statistically significant differences in gender, age group, religion and invasive PND knowledge when recommending of invasive PND. If fetal anomalies were detected, most of the females in the Buddhist group (P < 0.05), males with quite a lot of PND knowledge group (p < 0.05) and younger doctors group (P < 0.05) would their own terminate pregnancies, or those of wives and relatives. CONCLUSION: Attitudes towards invasive PND and pregnancy termination was influenced by gender, age group, religion and PND knowledge. Females and younger doctors from both gender groups tended to recommend the termination of pregnancy if they found fetal anomalies.

Prenatal ultrasonographic findings in "trisomy 13".

OBJECTIVE: To evaluate the accuracy of prenatal ultrasonographic diagnosis in fetuses with trisomy 13. MATERIAL METHOD: The present study consisted of all fetuses diagnosed of trisomy 13 and delivered at Ramathibodi Hospital between 1997 and 2006. RESULTS: There were 15 cases of trisomy 13. Twelve cases (80.0%) were detected by prenatal ultrasonographic examination, and 3 cases (20.0%) were missed. Mean maternal age was 31.4 years old. Sixty-six percent were diagnosed in 2" trimester (mean 19.4 weeks). The earliest gestational age for detection was 12 weeks 6 days. The most common abnormal ultrasonographic findings were holoprosencephaly (46.7%), and facial defects (40.0%). CONCLUSION: The accuracy of prenatal sonographic diagnosis in trisomy 13 fetuses was 80%. The most sensitive prenatal ultrasonographic findings in trisomy 13 were holoprosencephaly and facial defects.

Labial leiomyoma: a case report.

Leiomyoma is common in the myometrial layer of the uterus, and rarely found in other genital organs. Previous reports show multiple sites of leiomyoma outside the uterus eg. vagina, oral mucosa or mandible vascular leiomyoma. Leiomyoma is normally a benign smooth muscle tumor and behaves as a hormone sensitive tumor Leiomyomas develop during the reproductive age and regress after menopause. The case of a 25 year old female with a large left labial leiomyoma presented as Bartholin's cyst. Illustrates the diagnostic difficulties in such cases. The management in this case was surgical excision. The definite diagnosis was confirmed by histologic examination as a labial leiomyoma.