Patama Promsonthi

Noonan syndro me is a rare autosomal dominant congenital abnormality associated with a gene defect located on the short arm of chromosome 12. It is characterized by dysmorphic facies, webbed neck, short stature, lymphatic obstruction, cardiac anomalies, and intellectual disability. Prenatal diagnosis of Noonan syndrome is rare because there are no pathognomonic sonographic signs. Studies on the prenatal sonographic features of Noonan syndrome have been reported in very limited numbers. This case series of severe fetal Noonan syndrome, together with a literature review, was conducted to establish prenatal sonographic features highly suggestive of Noonan syndrome to facilitate early detection by clinicians. This study reveals that Noonan syndrome has a relatively specific pattern, which facilitates prenatal molecular genetic diagnosis. Increased nuchal translucency (NT) in the late first trimester and fluid collection in the early second trimester could be warning signs for follow-up, prompting further investigation to detect late-onset features and leading to molecular genetic confirmation. Most structural abnormalities appear in the second trimester, with progressive changes noted throughout gestation. This review better characterizes the sonographic features of fetal Noonan syndrome based on a larger sample size, illustrating a wider spectrum of prenatal phenotypes, including lymphatic drainage disorders, cardiac abnormalities, polyhydramnios, and absent ductus venosus.

Cervical priming before first-trimester surgical abortion is recommended in certain groups of women. Nitric oxide (NO) donors induce cervical ripening without uterine contractions, but the efficacy and side effects are of concern. To evaluate NO donors for cervical ripening before first-trimester surgical abortion, in terms of efficacy, side effects, and reduction of complications. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and POPLINE. We also searched reference lists of retrieved papers. We contacted experts in the field for information on both published and unpublished trials. Randomised controlled trials comparing NO donors alone or in combination with other methods for cervical ripening in first-trimester surgical abortion. Two review authors independently selected and extracted the data onto a data extraction form. We processed the data using Review Manager (RevMan 5) software. We included 9 studies involving 766 participants. There were no serious complications (infection requiring antibiotic treatment, blood transfusion, complications requiring unintended operation, cervical injury, uterine perforation, death or serious morbidity) in the included trials.NO donors were more effective in cervical ripening when compared with placebo or no treatment. Baseline cervical dilatation before the procedure was higher in NO donors group (mean difference (MD) 0.30, 95% confidence interval (CI) 0.01 to 0.58) The cumulative force required to dilate the cervix to 8 mm (MD -4.29, 95% CI -9.92 to 1.35), headache (risk ratio (RR) 1.73, 95% CI 0.86 to 3.46), abdominal pain (RR 0.87, 95% CI 0.50 to 1.50), or patient satisfaction (RR 0.95, 95% CI 0.84 to 1.07) were not different. More nausea and vomiting occurred in the women who received a NO donor (RR 2.62, 95% CI 1.07 to 6.45).NO donors were inferior to prostaglandins for cervical ripening. The cumulative force required to dilate the cervix to 8 mm to 9 mm was higher (MD 13.12, 95% CI 9.72 to 16.52), and baseline cervical dilatation was less (MD -0.73, 95% CI -1.01 to -0.45) in the NO donor group. However, the probability of dilation greater than 8 mm at three hours was higher in the NO donor group (RR 6.67, 95% CI 2.21 to 20.09). Side effects including headache (RR 5.13, 95% CI 3.29 to 8.00), palpitation (RR 3.43, 95% CI 1.64 to 7.15), dizziness (RR 3.29, 95% CI 1.46 to 7.41), and intraoperative blood loss (MD 33.59 ml, 95% CI 24.50 to 42.67) were also higher. However, abdominal pain (RR 0.33, 95% CI 0.25 to 0.44) and vaginal bleeding (RR 0.14, 95% CI 0.07 to 0.27) were less in the NO donor group. No difference for nausea/vomiting in both groups(RR 1.17, 95% CI 0.94 to 1.46). Patient satisfaction was not different.One trial compared a NO donor with a NO donor plus prostaglandin. The cumulative force required to dilate the cervix to 8 mm was higher (MD 14.50, 95% CI 0.50 to 28.50) in the NO donor group. There was no difference in headache (RR 0.88, 95% CI 0.38 to 2.00), abdominal pain (RR 0.14, 95% CI 0.02 to 1.07), or intraoperative blood loss (MD -50, 95% CI -164.19 to 64.19). NO donors are superior to placebo or no treatment, but inferior to prostaglandins for first-trimester cervical ripening, and associated with more side effects.

Cervical priming before first‐trimester surgical abortion is recommended in certain groups of women. Nitric oxide (NO) donors induce cervical ripening without uterine contractions, but the efficacy and side effects are of concern. To evaluate efficacy, side effects and complications of NO donors for cervical ripening before first‐trimester surgical abortion. We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE and POPLINE. We also searched reference lists of retrieved papers. We contacted experts in the field for information on both published and unpublished trials. Randomised controlled trials comparing NO donors alone or in combination with other methods for cervical ripening in first‐trimester surgical abortion. Two reviewers independently selected and extracted the data onto a data extraction form. We processed the data using Review Manager (RevMan5) software. We included nine studies involving 766 participants. There were no serious complications (infection requiring antibiotic treatment, blood transfusion, complications requiring unintended operation, cervical injury, uterine perforation, death or serious morbidity) in the trials included. NO donors were more effective in cervical ripening comparing with placebo or no treatment. Baseline cervical dilatation before the procedure was higher in NO donors group (mean difference 0.30, 95% CI 0.01, 0.58) The cumulative force required to dilate the cervix to 8 mm (mean difference ‐4.29, 95% CI ‐9.92, 1.35), headache (RR 1.73, 95% CI 0.86, 3.46), abdominal pain (RR 0.87, 95% CI 0.50, 1.50) or patient satisfaction (RR 0.95, 95% CI 0.84, 1.07) were not different. More nausea and vomiting occurred in the women who received a NO donor (RR 2.62, 95% CI 1.07, 6.45). NO donors were inferior to prostaglandins for cervical ripening. The cumulative force required to dilate the cervix to 8‐9 mm was higher (mean difference 13.12, 95% CI 9.72, 16.52) and baseline cervical dilatation was less (mean difference ‐0.73, 95% CI ‐1.01, ‐0.45) in the NO donor group. Side effects including headache (RR 5.13, 95% CI 3.29, 8.00), palpitation (RR 3.43, 95% CI 1.64, 7.15), dizziness (RR 3.29, 95% CI 1.46, 7.41) and intraoperative blood loss (mean difference 33.59 ml, 95% CI 24.50, 42.67) were also higher. However, abdominal pain (RR 0.33, 95% CI 0.25, 0.44) and vaginal bleeding (RR 0.14, 95% CI 0.07, 0.27) was less in the NO donor group. Patient satisfaction was not different. One trial compared a NO donor with a NO donor plus prostaglandin. The cumulative force required to dilate the cervix to 8 mm was higher (mean difference 14.50, 95% CI 0.50, 28.50) in the NO donor group. There was no difference in headache (RR 0.88, 95% CI 0.38, 2.00), abdominal pain (RR 0.14, 95% CI 0.02, 1.07) or intraoperative blood loss (mean difference ‐50, 95% CI ‐164.19, 64.19). NO donors are superior to placebo or no treatment, but inferior to prostaglandins for first‐trimester cervical ripening, and associated with more side effects. Nitric oxide donors for cervical ripening in first-trimester surgical abortion Pour certaines femmes, il est recommandé de préparer le col de l'utérus avant un avortement chirurgical au cours du premier trimestre. Les donneurs d'oxyde nitrique (ON) induisent la maturation cervicale sans contractions utérines, mais leur efficacité et à leurs effets secondaires sont une préoccupation. Évaluer l'efficacité, les effets secondaires et les complications des donneurs d'ON utilisés pour la maturation cervicale avant un avortement chirurgical au cours du premier trimestre.. Nous avons effectué des recherches dans le registre Cochrane des essais contrôlés, MEDLINE, EMBASE et POPLINE. Nous avons également effectué des recherches dans les bibliographies d'articles examinés. Nous avons contacté des experts dans le domaine pour information sur des essais publiés ou non publiés. Des essais contrôlés randomisés comparant des donneurs d'ON seuls ou en combinaison avec d'autres méthodes de maturation cervicale dans l'avortement chirurgical au premier trimestre. Deux auteurs ont choisi et extrait les données sur un formulaire d'extraction de données de façon indépendante. Nous avons traité les données au moyen du logiciel Review Manager (RevMan5). Nous avons inclus neuf études impliquant au total 766 participantes. Il n'y avait pas de complications graves (infection nécessitant un traitement antibiotique, transfusion sanguine, complications nécessitant une opération imprévue, blessure cervicale, perforation utérine, mort ou morbidité grave) dans les essais inclus. Les donneurs d'ON ont été plus efficaces pour la maturation cervicale qu'un placebo ou l'absence de traitement. La dilatation cervicale au départ de l'intervention était plus élevée dans le groupe des donneurs d'ON (différence moyenne de 0,30 ; IC 95 % 0,01 à 0,58). Il n'y avait pas de différence pour ce qui concerne la force cumulée nécessaire pour dilater le col à 8 mm (différence moyenne ‐4.29 ; IC 95 % ‐9,92 à 1,35), les céphalées (RR 1,73 ; IC 95 % 0,86 à 3,46), les douleurs abdominales (RR 0,87 ; IC 95 % 0,50 à 1,50) ou la satisfaction des patientes (RR 0,95 ; IC 95 % 0,84 à 1,07). Davantage de nausées et de vomissements sont survenus chez les femmes ayant reçu un donneur d'ON (RR 2,62 ; IC 95 % 1,07 à 6,45). Les donneurs d'ON étaient inférieurs aux prostaglandines pour la maturation cervicale. La force cumulée nécessaire pour dilater le col à 8‐9 mm était plus élevée (différence moyenne 13,12 ; IC 95 % 9,72 à 16,52) et la dilatation cervicale au départ...

Aim:  To construct a normal value for inhibin‐A concentrations at 14–20 weeks of gestation for a Thai population.Material and Methods:  Inhibin‐A concentrations from pregnant women without Down's syndrome at 14–20⁺⁶ weeks of gestation were measured. Maternal serum inhibin‐A levels were analyzed according to the gestational age.Results:  Serum specimens from 727 Thai women were analyzed. Inhibin‐A levels decreased from 14 to 17⁺⁴ weeks and then gradually rose thereafter, giving a U‐shape pattern.Conclusion:  The data of inhibin‐A concentration at 14–20 weeks of gestation for normal Thai pregnant women fitted well with quadratic regression.

To evaluate the efficacy of isosorbide mononitrate (IMN) for cervical ripening prior to first trimester surgical termination of pregnancy. A prospective, double-blind, randomized, placebo-controlled trial. Women scheduled for surgical termination of a nonviable fetus before 12 weeks of gestation from October 2008 to June 2009 were enrolled and randomly assigned to receive either 20 mg vaginally of IMN (n=24) or a placebo (n=24) 4 hours before suction evacuation. Cervical dilation before evacuation was assessed with 10-mm Hegar dilators followed by smaller sizes that were measured until the instrument passed freely through the internal os. Cervical dilation, adverse effects, termination complications, and patient satisfaction were the main outcomes. Mean cervical dilation was not significantly different between the IMN and placebo groups (6.29+/-0.99 mm vs 5.71+/-1.04 mm; P=0.05). Mean operative time did not differ between the groups (16+/-0.07 min vs 18+/-0.06 min; P=0.55), nor did patient satisfaction measured by visual analogue scale (7.04+/-1.68 vs 6.54+/-1.22; P=0.24). IMN was comparable to placebo in terms of efficacy and patient satisfaction for cervical priming prior to first-trimester termination of pregnancy.

Cervical priming before first-trimester surgical abortion is recommended in certain groups of women. Nitric oxide (NO) donors induce cervical ripening without uterine contractions, but the efficacy and side effects are of concern. To evaluate efficacy, side effects and complications of NO donors for cervical ripening before first-trimester surgical abortion. We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE and Popline. We also searched reference lists of retrieved papers. We contacted experts in the field for information on both published and unpublished trials. Randomised controlled trials comparing NO donors alone or in combination with other methods for cervical ripening in first-trimester surgical abortion. Two reviewers independently selected and extracted the data onto a data extraction form. We processed the data using Review Manager (RevMan5) software. We included eight studies involving 718 participants. There were no serious complications (infection requiring antibiotic treatment, blood transfusion, complications requiring unintended operation, cervical injury, uterine perforation, death or serious morbidity) in the trials included.NO donors were ineffective in cervical ripening comparing with placebo or no treatment. The cumulative force required to dilate the cervix to 8 mm (mean difference -4.29, 95% CI -9.92, 1.35), baseline cervical dilatation before the procedure (mean difference 0.21, 95% CI -0.12, 0.53), headache (RR 1.73, 95% CI 0.86, 3.46), abdominal pain (RR 0.87, 95% CI 0.51, 1.50) or patient satisfaction (RR 0.95, 95% CI 0.84, 1.07) were not different. More nausea and vomiting occurred in the women who received a NO donor (RR 2.62, 95% CI 1.07, 6.75).NO donors were inferior to prostaglandins for cervical ripening. The cumulative force required to dilate the cervix to 8-9 mm was higher (mean difference 13.12, 95% CI 9.72, 16.52) and baseline cervical dilatation was less (mean difference -0.73, 95% CI -1.01, -0. 45) in the NO donor group. Side effects including headache (RR 5.13, 95% CI 3.29, 8.00), palpitation (RR 3.43, 95% CI 1.64, 7.15), dizziness (RR 3.29, 95% CI 1.46, 7.41) and intraoperative blood loss (mean difference 33.59 ml, 95% CI 24.50, 42.67) were also higher. However, abdominal pain (RR 0.33, 95% CI 0.25, 0.44) and vaginal bleeding (RR 0.14, 95% CI 0.07, 0.27) was less in the NO donor group. Patient satisfaction was not different.One trial compared a NO donor with a NO donor plus prostaglandin. The cumulative force required to dilate the cervix to 8 mm was higher (mean difference 14.50, 95% CI 0.50, 28.50) in the NO donor group. There was no difference in headache (RR 0.88, 95% CI 0.38, 2.00), abdominal pain (RR 0.14, 95% CI 0.02, 1.07) or intraoperative blood loss (mean difference -50, 95% CI -164.19, 64.19). NO donors are inferior to prostaglandins for first-trimester cervical ripening, and associated with more side effects. NO donors are comparable to placebo and no treatment for cervical ripening.

To evaluate the accuracy of prenatal ultrasonographic diagnosis in fetuses with trisomy 13. The present study consisted of all fetuses diagnosed of trisomy 13 and delivered at Ramathibodi Hospital between 1997 and 2006. 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%). 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.

To study the trends in perinatal mortality rate and causes of perinatal deaths at Ramathibodi Hospital from 1995 to 2005. Retrospective descriptive study. Review of medical records and reports during academic activities. The perinatal mortality rate was 5.10 per 1,000 births. Stillbirth and early neonatal death rate were 3.45 and 1.65 per 1,000 births, respectively. The most common cause of death was macerated fetus (46.80%). Causes of death from congenital anomalies, immaturity, asphyxia and specific conditions were 20.89%, 9.47%, 8.08% and 14.76%, respectively. The perinatal mortality rate at Ramathibodi Hospital has declined from 6.70 in 1985 to 5.10 per 1,000 births and remained steady for the last 11 years. Future progress in reducing perinatal deaths requires better understanding of the etiology of stillbirth to improve the strategies for prevention.