MyMedR

Fulltext Early warning of fetal compromise--absent end diastolic flow?

Neoh HS, Kumarasamy S, Raman S

Med J Malaysia, 1990 Mar;45(1):37-41.

PMID: 2152067

This report deals with the use of a relatively new investigative technique (Doppler ultrasound) in the management of a case of early onset pre-eclampsia and discusses the benefit of this new technique over conventional methods of fetal monitoring.

Matched MeSH terms: Ultrasonography, Prenatal*

Prenatal diagnosis of a posterior fossa cyst

Raman S, Rachagan SP, Lim CT

J Clin Ultrasound, 1991 Sep;19(7):434-7.

PMID: 1658071

Matched MeSH terms: Ultrasonography, Prenatal

Clinical versus ultrasound estimation of fetal weight

Raman S, Urquhart R, Yusof M

Aust N Z J Obstet Gynaecol, 1992 Aug;32(3):196-9.

PMID: 1445124

A prospective study was carried out on 50 patients who had their fetal weight estimated by 3 clinicians of different seniority and compared to the ultrasound estimated fetal weights using 3 different formulas. All the patients delivered within 24 hours of their clinical and ultrasound estimates. A wide range of birth-weights (1,800-4,500 g) was estimated among the 3 different races (Malay, Chinese and Indians). The results showed that there was no significant difference in birth-weight estimation amongst the 3 clinicians as well as between the 3 ultrasound formulas used. There was however significant difference between these 2 groups when compared with the actual birthweight with clinical estimation being superior to ultrasound estimation in our population. This level of significance did not extend beyond 4,000 g fetal weight (actual) thus making both clinical and ultrasound estimation of fetal weight equally accurate after 4,000 g. This has important implications for developing countries where there is a lack of technologically advanced ultrasound machines capable of doing sophisticated functions like fetal weight estimations but has experienced clinicians who could perform this function equally well if not better.

Matched MeSH terms: Ultrasonography, Prenatal*

Fulltext Prenatal diagnosis of intestinal obstruction due to ileal atresia

Raman S, Chan LL, Chang KW, Rachagan SP

Med J Malaysia, 1992 Sep;47(3):228-30.

PMID: 1491650

A case of intestinal obstruction due to ileal atresia where the diagnosis was made prenatally by ultrasound is presented. Close monitoring of the fetus was done ultrasonographically to look for any evidence of meconium peritonitis. The baby was delivered preterm but weighed 3.3 kg. Laparotomy and enterostomy was done and the baby is currently well.

Matched MeSH terms: Ultrasonography, Prenatal*

Fetal cerebral Doppler in the recognition of fetal compromise

Chandran R, Serra-Serra V, Sellers SM, Redman CW

Br J Obstet Gynaecol, 1993 Feb;100(2):139-44.

PMID: 8476805

OBJECTIVE: To establish reference ranges for the human fetal middle cerebral artery pulsatility index (MCA PI) for the local obstetric population, and to compare computerised antenatal fetal heart rate (FHR) analysis with the MCA PI as indicators of fetal compromise.

DESIGN: Prospective data collection for selected patients.

SETTING: High risk pregnancy unit of a teaching hospital.

SUBJECTS: Group 1 consisted of 18 healthy women with uncomplicated singleton pregnancies. Group 2 consisted of 27 women admitted to the high risk pregnancy unit over a 9 month period with intrauterine growth retardation and other related problems; all these women were delivered by prelabour caesarean section.

INTERVENTION: Serial Duplex sonography to determine fetal MCA PI in Groups 1 and 2. Serial FHR analysis using computerised numerical techniques in Group 2 only.

MAIN OUTCOME MEASURES: Serial MCA PI values from 24 to 39 completed weeks of gestation in Group 1. Comparison of serial MCA PI values with FHR analysis in relation to fetal outcome in Group 2.

RESULTS: In Group 1 the MCA PI diminished significantly as gestation advanced from 1.73 (SD 0.25) at 24 weeks to 1.38 (SD 0.26) at 39 weeks (P < 0.01). In Group 2 eleven babies were hypoxaemic at delivery: all had low MCA PI values while only nine had an abnormal FHR prior to delivery.

CONCLUSION: In normal pregnancy, there is a fall in the fetal MCA PI with advancing gestation which probably reflects a decreasing vascular resistance to fetal cerebral blood flow. Hypoxaemia at delivery appeared to be better recognised by the fetal MCA flow velocity waveform than the FHR analysis. This increased sensitivity, however, was achieved at the expense of a reduced specificity. Larger studies are needed to confirm the findings of this preliminary investigation.

Matched MeSH terms: Ultrasonography, Prenatal*

Racial differences in fetal morphometry in Singapore

Yeo GS, Chan WB, Lun KC, Lai FM

Ann Acad Med Singap, 1994 May;23(3):371-6.

PMID: 7944253

A systematic collection of fetal morphometric measurements was started seven years ago in 1987 with the prospective entry of data into personal computer-based stations in the Department of Obstetrics and Gynaecology, Singapore General Hospital. A cross-sectional study was done, comparing 2392 Chinese fetuses with 2117 Malay fetuses and 459 Indian fetuses from 18 to 40 weeks. The mean values of the head circumference (HC), abdominal circumference (AC) and femur length (FL) of the 3 ethnic groups were analysed. There were no statistical significant differences in the head circumference and abdominal circumference of Chinese, Malay and Indian fetuses in Singapore. The Chinese and Malay fetal femur length appeared similar but were apparently shorter than the Indian femur length. Nomograms of head circumference, abdominal circumference and femur length were constructed for application to fetuses of all 3 ethnic groups.

Matched MeSH terms: Ultrasonography, Prenatal

The role of transvaginal sonography in the diagnosis of placenta praevia

Tan NH, Abu M, Woo JL, Tahir HM

Aust N Z J Obstet Gynaecol, 1995 Feb;35(1):42-5.

PMID: 7771998 DOI: 10.1111/j.1479-828x.1995.tb01828.x

Transvaginal sonography was performed in 70 patients diagnosed to have placenta praevia by transabdominal sonography. The diagnosis was confirmed either by digital examination in theatre at term or operative finding at delivery. Forty-nine cases (70%) were correctly diagnosed to have placenta praevia by both modes of sonography. Transvaginal sonography ruled out placenta praevia in 12 cases (17%) thought to be placenta praevia by transabdominal ultrasound. Both transabdominal and transvaginal sonography demonstrated 'placental migration' in 4 cases (6%) which were no longer praevia at delivery. Five patients (7%) were erroneously believed to have placenta praevia by both sonographic techniques. Overall, the diagnostic accuracy of transvaginal sonography was 92.8% compared with 75.7% for transabdominal sonography. None of the subjects experienced any exacerbation of bleeding or other complications. The results suggest that transvaginal sonographic localization of the placenta is safe and superior to the transabdominal route.

Matched MeSH terms: Ultrasonography, Prenatal/methods*

Growth patterns of the humeral and femur length in a multiethnic population

Raman S, Teoh T, Nagaraj S

Int J Gynaecol Obstet, 1996 Aug;54(2):143-7.

PMID: 9236312

OBJECTIVES: To study whether there are any differences in growth of the femoral and humeral length between the three major ethnic groups in Malaysia viz Malays, Chinese and Indians. The effect on fetal growth by gender of the baby and parity of the mother was also studied.

METHODS: The setting was the University of Kuala Lumpur. Thirty-four Malay, 35 Chinese and 34 Indian normal pregnant middle-class women were studied longitudinally by monthly ultrasound scans for 18 to 38 weeks of gestation. The data were subjected to regression analysis; the quadratic curve was found to be the most adequate. Dummy variables were used to determine any effects by gender, parity as well as ethnicity on the length of limb growth. There was no difference in birth weights of the three ethnic groups studied, nor in gender or parity.

RESULTS: There were found to be significant differences in limb lengths of the Indians (longer) when compared with the Malays and Chinese. Parity seems to affect only Indians in whom the multiparous fetuses have shorter limb lengths than the primaparous. There appears to be no effect by gender.

CONCLUSION: There appear to be definite differences in growth of limb length between the different Malaysian ethnic groups and this should be taken into account when growth charts are used and when fetal weight formulas are calculated using limb lengths. The limitation of this study was that the numbers of subjects studied were small. Larger studies will be able to confirm or refute the findings.

Matched MeSH terms: Ultrasonography, Prenatal

Prenatal diagnosis of an extensive haemangioma of the fetal leg: a case report

Raman S, Ramanujam T, Lim CT

J Obstet Gynaecol Res, 1996 Aug;22(4):375-8.

PMID: 8870422

Extensive haemangioma with platelet consumption (Kasabach-Merritt syndrome) is rare. The lesion is usually a single cutaneous cavernous haemangioma similar to that found in our patient. Multiple superficial strawberry naevi were also seen all over the rest of the body. This condition was diagnosed antenatally in this patient with the use of colour Doppler. There is one recent report where the thrombocytopaenia was diagnosed by cordocentesis. Unfortunately the baby developed heart failure with intractable coagulopathy and died 2 days later.

Matched MeSH terms: Ultrasonography, Prenatal*

Fulltext Prenatal diagnosis of Hb Bart's hydrops fetalis in West Malaysia: the identification of the alpha thal 1 defect by PCR based strategies

George E, Mokhtar AB, Azman ZA, Hasnida K, Saripah S, Hwang CM

Singapore Med J, 1996 Oct;37(5):501-4.

PMID: 9046203

Haemoglobin Bart's hydrops fetalis is the result of complete absence of functional alpha-globin genes where the fetus is homozygous for the alpha 0-thal gene. Prenatal diagnosis can be made by analysis of fetal DNA from chorionic villus, amniotic cells and fetal blood. Earlier studies for analysing genomic DNA needed digestion with restriction enzymes and hybridisation to radiolabelled probes which took 2 weeks. We have used the polymerase chain reaction (PCR) and non-radioactive primers to identify specific target sequences with results available within 1-3 days for the diagnosis of haemoglobin Bart's syndrome. With fetal blood samples, complete absence of alpha-chain synthesis is confirmed by globin chain electrophoresis on cellulose acetate pH 6.0.

Matched MeSH terms: Ultrasonography, Prenatal

Neonatal chylous ascites--report of three cases and review of the literature

Chye JK, Lim CT, Van der Heuvel M

Pediatr Surg Int, 1997 Apr;12(4):296-8.

PMID: 9099650

Three cases of neonatal chylous ascites (CCA) were managed in the neonatal unit, University Hospital, Kuala Lumpur, over the past 9 years. Fetal ascites and polyhydramnios were the sole abnormalities detected in all three babies by antenatal ultrasonography. They were born at 36 weeks' gestation and their birth weights ranged from 3.0 kg to 3.8 kg. All three infants had abdominal distension at birth. Milky ascitic fluid was obtained after starting enteral feedings. Analysis of the ascitic fluid revealed a raised white blood cell count (predominantly lymphocytic) and triglycerides (1.4 - 3.8 mmol/l), cholesterol (1.6 - 2.8 mmol/l), and protein levels (25 - 41 g/l). Conservative management with skimmed milk and medium-chain triglycerides in one infant and Pregestimil in another was instituted. these two infants with CCA were clinically normal when reviewed at 19 months and 3.5 years of age. The third infant had a gut malrotation and associated pyloric septum; he died from complications of a laparotomy. The literature on this rare condition is reviewed.

Matched MeSH terms: Ultrasonography, Prenatal

Fulltext Fetal supraventricular tachycardia--a case report

Soh EBS, Raman S, Chia PMK

Med J Malaysia, 1998 Sep;53(3):280-3.

PMID: 10968167

A gravid patient with fetal supraventricular tachycardia is presented. A review of this rare condition and the present recommended mode of therapy are discussed.

Matched MeSH terms: Ultrasonography, Prenatal*

Relationship between fetal femur diaphysis length and neonatal crown-heel length: the effect of race

Lim JM, Hong AG, Raman S, Shyamala N

Ultrasound Obstet Gynecol, 2000 Feb;15(2):131-7.

PMID: 10775996

To determine whether racial differences affect the relationship between the fetal femur diaphysis length and the neonatal crown-heel length.

Matched MeSH terms: Ultrasonography, Prenatal/methods*

Fulltext Delayed diagnosis of cervical pregnancy: management options

Sivalingam N, Mak FK

Singapore Med J, 2000 Dec;41(12):599-601.

PMID: 11296786

Cervical pregnancy is an uncommon variety of ectopic gestation. The aetiology is obscure. Diagnosis can be missed unless early evaluation is done by experienced personnel utilising pelvic ultrasonography. Three cases of cervical pregnancy managed at this hospital are described illustrating difficulties in early diagnosis and possible association with previous uterine scar and prior curettage of the uterus for retained products of conception. Treatment options vary according to the clinical state of the patient at the time of diagnosis. Non-surgical methods including systemic methotrexate administration in one and surgical evacuation of products of conception with subsequent cervical cerclage in another are discussed. Surgical interventions like total abdominal hysterectomy with internal iliac artery ligation to arrest life-threatening pelvic haemorrhage is also described. Other treatment options include potassium chloride (KCl) alone or in combination with methotrexate.

Matched MeSH terms: Ultrasonography, Prenatal/methods

A retrospective study of the accuracy of sonographic chorionicity determination in twin pregnancies

Menon DK

Twin Res Hum Genet, 2005 Jun;8(3):259-61.

PMID: 15989753

The aim of this study was to determine the accuracy of sonographic chorionicity determination in the largest sample of twin pregnancies to date. We retrospectively analyzed 463 twin pregnancies delivered over a 6-year period to determine in each case what the antenatal sonographic prediction of chorionicity was, and then what the subsequent post partum pathological diagnosis of chorionicity was. Out of 436 twin pregnancies, 428 were correctly diagnosed for chorionicity as confirmed by pathology reports. Sonography as a screening tool for monochorionic twin pregnancies has a sensitivity of 100%, a specificity of 97.9% and a predictive value positive of 88.2%. Transvaginal scanning in the first trimester determined twin chorionicity with a sensitivity and a specificity of 100%. This study has confirmed in the largest sample to date that sonographic chorionicity determination is best done in the first trimester using vaginal scans, where it has 100% accuracy.

Matched MeSH terms: Ultrasonography, Prenatal*

Umbilical artery resistance index in diabetic pregnancies: the associations with fetal outcome and neonatal septal hypertrophic cardiomyopathy

Tan AE, Norizah WM, Rahman HA, Aziz BA, Cheah FC

J Obstet Gynaecol Res, 2005 Aug;31(4):296-301.

PMID: 16018775 DOI: 10.1111/j.1447-0756.2005.00291.x

Aim: To determine the incidence of an abnormal umbilical artery resistance index (UARI) in diabetic pregnancies and the relation to fetal outcome and the development of neonatal septal hypertrophic cardiomyopathy.

Methods: A case-control study with subjects comprising 50 randomly selected diabetic mothers and a matched control group of 50 non-diabetic pregnancies. Doppler studies of the UARI were carried out at least once per week, beginning from 36 weeks' gestation for both groups. Within 48 h post delivery, echocardiograms were carried out on the newborn infants to identify those with hypertrophic cardiomyopathy, particularly asymmetrical septal hypertrophy.

Results: The numbers of patients with abnormal UARI were similar in both the diabetic and control groups. A higher proportion of operative deliveries for intrapartum fetal distress was seen in patients with an abnormal UARI in the diabetic group. However, the groups did not differ in the numbers of infants who were small for gestational age, who had low Apgar scores or umbilical artery acidosis, and who required admission to the special care nursery. Six infants of diabetic mothers (12%) had septal hypertrophy, but none of these were associated with abnormal antenatal UARI.

Conclusion: Diabetic pregnancy is not associated with a significantly higher incidence of abnormal UARI on Doppler study than non-diabetic pregnancy. UARI is not a useful single indicator by which to predict subsequent fetal outcome or the development of neonatal septal hypertrophic cardiomyopathy in diabetic pregnancies.

Matched MeSH terms: Ultrasonography, Prenatal*

Prenatal detection of birth defects in a Malaysian population: estimation of the influence of termination of pregnancy on birth prevalence in a developing country

Ho JJ, Thong MK, Nurani NK

Aust N Z J Obstet Gynaecol, 2006 Feb;46(1):55-7.

PMID: 16441696

We studied 253 women with a pregnancy complicated by a birth defect and 506 controls to determine the frequency and type of prenatal tests and the types of defects detected antenatally. Most women had at least one ultrasound examination, but the frequency of other screening tests was low. Only 38 (15%) of defects were detected antenatally (37 by ultrasound). Birth prevalence is unlikely to be affected by pregnancy termination.

Matched MeSH terms: Ultrasonography, Prenatal

Ultrasound and clinical predictors for Caesarean delivery after labour induction at term

Tan PC, Suguna S, Vallikkannu N, Hassan J

Aust N Z J Obstet Gynaecol, 2006 Dec;46(6):505-9.

PMID: 17116055

To assess the relationship of ultrasound assessment for amniotic fluid, fetal weight, cervical length, cervical funneling and clinical factors on the risk of Caesarean delivery after labour induction at term.

Matched MeSH terms: Ultrasonography, Prenatal*

Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery

Tan PC, Vallikkannu N, Suguna S, Quek KF, Hassan J

Ultrasound Obstet Gynecol, 2007 May;29(5):568-73.

PMID: 17444553

To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term, to assess their tolerability (in terms of pain) and ability to predict need for Cesarean delivery.

Matched MeSH terms: Ultrasonography, Prenatal

Antenatal diagnosis of placenta previa accreta in patients with previous cesarean scar

Japaraj RP, Mimin TS, Mukudan K

J Obstet Gynaecol Res, 2007 Aug;33(4):431-7.

PMID: 17688608

To determine the accuracy of transabdominal and transvaginal gray-scale and color Doppler in diagnosing placenta previa accreta in patients with previous cesarean sections.

Matched MeSH terms: Ultrasonography, Prenatal/methods*

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