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Objective: Hemoglobin (Hb) Bart's disease is a severe manifestation of alpha‐thalassemia, resulting in fetal tissue hypoxia and severe anemia. There is limited research available on assessing speckle‐tracking analysis of the fetal heart as a response to fetal anemia caused by Hb Bart's disease. This study aimed to assess the diagnostic performance of fetal cardiac measurements derived from speckle‐tracking analysis to identify fetuses with Bart's anemia between 17 and 24 weeks of gestation. Methods: This prospective cohort study included 115 women with singleton pregnancies at risk for fetal Hb Bart's disease who underwent either amniocentesis or cordocentesis at Siriraj Hospital, Bangkok, Thailand, in the period between January 2019 and January 2021. Speckle‐tracking analysis of the fetal heart was performed in the four‐chamber view (4CV), assessing ventricular size and shape, ventricular contractility and left ventricular function, prior to invasive prenatal testing. Logistic regression analysis was used to determine significant cardiac predictors and calculate the probability of a fetus having Hb Bart's anemia. Results: Among the cohort, 38 (33.0%) fetuses were diagnosed with Hb Bart's disease, and of these, nine (23.7%) cases exhibited fetal hydrops. In comparison to the control group, affected fetuses displayed enlargement of the 4CV, with a globular shape of the right ventricular chamber. Additionally, there were significant reductions in both global and longitudinal left ventricular contractility in non‐hydropic affected fetuses compared with the controls. At mid‐gestation, no significant differences were observed in transverse contractility or left ventricular function, except for the ejection fraction, between the two groups. Based on logistic regression analysis, combined cardiac measurements derived from speckle‐tracking analysis, as a function of head circumference, could differentiate non‐hydropic fetuses with Hb Bart's anemia from unaffected fetuses, achieving a sensitivity of 100%, specificity of 98.7% and overall accuracy of 99.1%. Conclusions: Speckle‐tracking analysis of the fetal heart has the potential to accurately identify early fetal cardiac changes during the second trimester in individuals with Bart's anemia. These findings not only offer a novel predictive marker for Hb Bart's anemia, but also help address the question of the underlying mechanisms of heart failure associated with fetal anemia. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of excessive gestational weight gain (GWG) among overweight and obese pregnant women, its associated factors, and pregnancy outcomes., Methods: A total of 355 overweight or obese singleton pregnant women who were included. Obstetric characteristics, weight gain, and pregnancy outcomes, were extracted from medical records. GWG was categorized according to the Institute of Medicine recommendation. Comparisons were made between individuals with inadequate, normal, and excessive GWG. Logistic regression analysis was performed to determine independent associated factors for excessive GWG., Results: Majority of the women were overweight (68.7%), 38.9% were nulliparous, and mean pre-pregnancy body mass index was 28.9 kg/m2. Excessive GWG was observed in 53% of the women. Women with excessive GWG had significantly higher weight gain in every trimester. Risk of excessive GWG increased in women ≤30 years, while gestational diabetes (GDM) significantly decreased the risk. Women with excessive GWG had a significantly higher primary cesarean section rate. Both women with normal and excessive GWG showed higher rate of having large for gestational age (LGA) infants (P=0.003). Maternal age of ≤30 years significantly increased the risk of excessive GWG (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.11-3.27) and GDM significantly decreased this risk (aOR, 0.40; 95% CI, 0.24-0.67)., Conclusion: The incidence of excessive GWG among overweight and obese women was 53%. Maternal age of ≤30 years significantly increased this risk while women with GDM were significantly decreased risk. Primary cesarean section and fetal LGA significantly increased in women with excessive GWG.

Objective: The purposes of the study were to develop reference ranges and maturation patterns of fetal cardiac function parameters measured by speckle tracking echocardiography (STE) using multiple biometric variables at 17 to 24 weeks' gestation among Thai fetuses and to compare with other previous reports., Study Design: The four-chamber view of the fetal heart in 79 healthy fetuses was suitably analyzed by STE to establish the best-fit regression model. The 95% reference intervals and Z -score equations of fetal cardiac function parameters were computed., Results: The fractional area change of both ventricles, left ventricular (LV) end-diastolic and end-systolic volumes, LV stroke volume, LV cardiac output (CO), and LV CO per kilogram were all increased according to gestational age (GA) and five fetal biometric measurements. However, the global longitudinal strain, basal-apical length fractional shortening (BAL-FS), BAL annular free wall and septal wall FS, BAL free wall and septal wall annular plane systolic excursions, 24-segment transverse width FS, as well as LV ejection fraction were all independent of GA or other somatic characteristics. There were varying development patterns between fetal right and left ventricles of these cardiac function indices across the gestation period., Conclusion: Our study created Z -score and corresponding centile calculators, 5th and 95th centile reference tables, and corresponding graphs and determined the normal evolution across gestation using multiple somatic growth and age variables between 17 and 24 gestational weeks. These nomograms serve as an essential prerequisite for quantitatively evaluating fetal cardiac contractility and allow for precisely detecting early changes in the fetal heart function., Key Points: · Most fetal cardiac function measurements were correlated with all the independent variables.. · Fetal ventricular function parameters have their own characteristic maturation changes.. · Racial variability may not occupy an important place for fetal myocardial function during these GA.., Competing Interests: None declared., (Thieme. All rights reserved.)

Introduction: The aim of the study was to establish normal reference values obtained by fetal speckle tracking analysis of the fetal heart between 17 and 24 weeks of gestation among Thai fetuses and compare the nomograms with previous studies., Methods: The 4-chamber view (4CV) of the fetal heart in 79 normal fetuses was analyzed by speckle tracking analysis to determine the best-fit regression model. The 95% reference intervals and Z-score equations of fetal cardiac parameters were computed., Results: The end-diastolic length, width, area, and circumference of the 4CV as well as the ventricular end-diastolic length, 24-segment widths, and area were all increased as a function of gestational age (GA), and 5 fetal biometric parameters. In contrast, the global sphericity index (SI), 24-segment SI, and right ventricle/left ventricle width and area ratios did not change with GA or fetal biometric measurements. There were few differences in Z-score reference ranges of fetal cardiac measurements between the current study and previous studies conducted in different patient populations., Conclusion: Our study provided z-score and corresponding centile calculators, 5th and 95th centile reference tables, and corresponding graphs for evaluating the size and shape of the 4CV and the right and left ventricles using 6 independent variables between 17 and 24 weeks of gestation. These results provide normal reference ranges for future studies of fetuses with pathologies that may alter the size and shape of the 4CV and ventricles., (© 2021 S. Karger AG, Basel.)

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated infection (COVID-19) is affecting populations worldwide. This statement may serve as guidance for infection prevention and safe ultrasound practices during the COVID-19 pandemic. Ultrasound examination is a fundamental part of obstetric care, yet it is a potential vector for transmission of SARS-CoV-2. Decontamination methods should always be implemented for ultrasound equipment, especially in the presence of suspected or confirmed COVID-19 cases. There must be workflow policies to protect pregnant women and healthcare providers from nosocomial cross transmission of SARS-CoV-2. Cleaning and disinfecting of equipment must be in accordance with their potential of pathogen transmission. Consider using telemedicine and genetic technologies as an adjunctive of obstetric ultrasound to reduce patient crowding. Patient triage and education of healthcare providers of infection prevention are crucial to minimize cross contamination of SARS-CoV-2 during obstetric ultrasound.

Conjoined twins are a rare, but serious, complication of monozygotic twins. Early prenatal diagnosis of conjoined twins is increasingly made with transvaginal ultrasound and color Doppler studies. Most prenatally diagnosed conjoined twins are terminated due to the high perinatal mortality, but advancement in pediatric surgery has allowed for successful postnatal separation in a small number of cases, and some parents may consider this option over termination of pregnancy. It is important to get a detailed prenatal ultrasound for the site and extent of fusion for an accurate categorization. Three-dimensional ultrasound (3DUS) provides images that can facilitate counselling for the parents. Additional information that impacts on diagnosis, prognostication, and perinatal management of conjoined twins could be obtained from selective use of 3DUS, particularly those with atypical fetal union. Most of the proposed additional benefits of 3DUS are based on case reports. Magnetic resonance imaging (MRI) has been increasingly used for the purpose of identifying intricate organ sharing. Because of the rarity of this condition, and the heterogeneity of fetal fusion, added benefits of either 3DUS or MRI for prenatal diagnosis and perinatal management of conjoined twins have not been demonstrated by well-conducted clinical trials. This article aims to review clinical application of various 3DUS display modes in prenatal assessment of conjoined twins, focusing on their potential additional benefits, risks and misuses. 3DUS may help detecting additional findings that are not possible with 2DUS, but, it has not been scientifically shown to improve the survival rate of the twins or reduce maternal morbidity.

Aim: The aim of this study was to demonstrate the changes of right and left myocardial performance indices (MPI) in small-for-gestational age (SGA) fetuses during 28-40 weeks of gestation., Material and Methods: Singleton pregnant women during 28-40 weeks of gestation were enrolled. Estimated fetal weight was used to classify the subjects into appropriate-for-gestational age (AGA) and SGA groups. The Doppler indices of umbilical and middle cerebral arteries, including amniotic fluid index, were used to distinguish constitutional SGA (both normal Doppler indices and amniotic fluid index) from intrauterine growth restriction (IUGR) fetuses (abnormal Doppler indices and/or oligohydramnios). MPI was obtained and compared between the groups. Inter- and intra-observer variations were also assessed., Results: Fifty women had AGA fetuses whereas another 50 cases had SGA fetuses (41 constitutional SGA and nine IUGR). Right MPI in AGA fetuses was constant whereas left MPI was slightly increased. The MPI of SGA fetuses were significantly greater than those of AGA fetuses starting from 30 weeks gestation until delivery (P < 0.01 and <0.05 in right and left side, respectively). Subgroup analysis demonstrated right and left MPI of IUGR fetuses increased with advancing gestation and were significantly greater than those of constitutional SGA and AGA fetuses, which appeared to be similar. The reproducibility of the test was high., Conclusions: In SGA fetuses, the MPI of right and left ventricles was significantly increased with advancing gestation compared to AGA cases., (© 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.)

Objective: To compare the efficacy and safety of titrated oral misoprostol and a conventional oral regimen for cervical ripening and labor induction., Methods: A randomized double-blind trial of women with term singleton pregnancies with indications for labor induction. Participants were allocated to receive 20 mL of misoprostol solution (1 μg/mL) orally every 1 hour for 4 doses then titrated to 40 μg every 1 hour (titrated group) or 50 μg of misoprostol orally every 4 hours up to 12 hours (conventional group). Primary outcomes were success rate of cervical ripening within 12 hours, interval from first dose until more favorable cervix or active labor occurred, and total dose of misoprostol., Results: Sixty-four participants were included. Mean total dose of misoprostol and incidence of tachysystole were significantly higher in the titrated compared with the conventional group (236.2±110.1 μg vs 103.1 ± 35.7 μg; P=0.001 and 25.0% vs 6.3%; P=0.03), whereas success rate, interval from drug administration to more favorable cervix and delivery, proportion of patients delivered vaginally within 12 hours and 24 hours, need for oxytocin augmentation, cesarean delivery rate, maternal adverse effects and complications, and neonatal outcome were not significantly different (P>0.05)., Conclusion: Conventional oral misoprostol is as effective as titrated misoprostol for cervical ripening and labor induction, but has a lower incidence of tachysystole and a lower total dose of misoprostol is required. ClinicalTrial.gov: NCT00886860., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy., Material and Method: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization., Results: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml., Conclusion: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.

Objective: To evaluate the efficacy and maternal side effects of misoprostol usage for second trimester termination in Siriraj Hospital., Study Design: Descriptive cross sectional study., Setting: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University., Material and Method: The medical records of 94 pregnant women, between 14-28 weeks of gestation, who were admitted for medical termination of pregnancy, were reviewed. Each patient received 400 microg of misoprostol vaginally every 12 hours as recommended by RTCOG for termination of pregnancy. Main outcome measures included success rate of abortion within 48 hours, induction to abortion interval and maternal side effects., Results: The success rate of abortion within 48 hours was 89.46%. Mean induction to abortion interval was 22.1 hours. The most common maternal side effect was fever (24.5%). The rate of incomplete abortion was 28.6% of successful cases. No factor, including age, parity and viability of fetus affected the success rate significantly. No serious maternal complication was detected., Conclusion: Misoprostol 400 microg vaginally every 12 hours can be used effectively and safely for second trimester pregnancy termination.