Pregnancy Outcomes of Healthy Parturients Delivered With or Without Episiotomy.

Background: The use of episiotomy, a previously popular obstetric procedure, has been declining for the last 25 years, falling from 65% of deliveries in 1979 to 18% in 2003. Some complications have been reported in terms of maternal side effects; however, many episiotomies are still performed in Rajavithi Hospital. Objective: To compare maternal and neonatal outcomes and complications in the 48-hour period after vaginal delivery in healthy parturients with and without episiotomy. Material and Method: A historical cohort study was conducted by reviewing the medical records of 920 healthy parturients who gave birth vaginally in Rajavithi Hospital between January 1st and December 31st 2012. Data were collected of 460 cases who delivered with episiotomy and another 460 vaginal-delivery patients who did not. Data collection included maternal characteristics, and maternal and neonatal outcomes. Results: Most parturients were parous cases (711/920, 77.3%). Gestational age, number of nulliparae, and duration of 2nd stage of labor were significantly higher in the episiotomy group. Third and fourth degree perineal tear was significantly higher in the episiotomy group than in the non-episiotomy group (21.0%: 0.0% and 20.2%: 0.0%; p<0.001) in nulliparous women, but there was no difference inparous patients. Wound infection within 48 hours postpartum was similar in parous parturients in the episiotomy and non-episiotomy groups while there was no wound infection in the nulliparous group. Mean birthweight in the episiotomy group was significantly higher than in the non-episiotomy groups (3,064.95±418.44 gm vs. 2,940.15±486.61 gm; p<0.001). Other neonatal outcomes and complications were similar in the two groups. Conclusion: Incidence of second, third and fourth degree perineal tear was significantly higher in the episiotomy group than in the non-episiotomy group.

Preferred Route of Delivery of Thai Pregnant Women.

Background: Pregnant women who prefer cesarean delivery may request it without any obstetric indication, and this could be one of the reasons for the high rates of cesarean deliveries. Objective: To determine the route of delivery preferred by Thai pregnant women. Material and Method: A cross-sectional study was performed of Thai pregnant women who attended the antenatal care (ANC) clinic in Rajavithi Hospital between February 1, 2011 and July 31, 2011. Participants were interviewed by one of the researchers using questionnaires relating to their preferred route of delivery assuming they were in the scenario of term pregnancy with uncomplicated singleton cephalic presentation. Results: Most cases (418/440, 95%) preferred vaginal delivery. The most common reason given for choosing vaginal delivery was faster recovery (49.8%) while the main motivation stated for cesarean delivery was fear of pain during vaginal delivery (68.2%). Dissatisfaction with previous birth experience was the only factor significantly associated with preference for cesarean delivery (p<0.05). Conclusion: Most Thai pregnant women (95%) attending the ANC clinic at Rajavithi Hospital preferred vaginal delivery. Dissatisfaction with previous birth experience was the only factor significantly associated with choice of the cesarean route.

Self-Preferred Route of Delivery of Thai Obstetricians and Gynecologists.

BACKGROUND: The attitude of Obstetricians and Gynecologists (OB-GYNs) towards performing cesarean delivery on maternal request (CDMR) together with their preferred route of delivery for themselves or their wives is considered as important responsible factors of increasing cesarean delivery. OBJECTIVE: To assess the attitudes of Thai Obstetricians and Gynecologists with regard to their self-preferred route of delivery, willingness to perform cesarean delivery on maternal request, and associated factors. MATERIAL AND METHOD: From July 1, 2013 to September 30, 2013, a cross-sectional study was carried out of 1,950 members of The Royal Thai College of Obstetricians and Gynaecologists who were randomized before being sent mailed questionnaires. The questionnaires requested details of the OB-GYNs' demographic data and asked about their self-preferred route of delivery for themselves or their wives (in the case of male doctors) and their willingness to perform cesarean delivery on maternal request (CDMR). The questionnaires were returned via mail. RESULTS: Three hundred and seventy OB-GYNs (18.9%) completed and returned the questionnaires via mail. In a scenario of uncomplicated singleton cephalic presentation pregnancy at term, vaginal delivery was chosen as the most preferred route of delivery (68.9%). The significant associated factors for preferred cesarean delivery were male, age < 40 years, experience in practice as OB-GYN < 10 years and prior cesarean delivery. Many (53.2%) were willing to perform cesarean delivery on maternal request. CONCLUSION: Most Thai Obstetricians and Gynecologists (68.9%) preferred vaginal delivery for themselves or their wives, but many (53.2%) were willing to perform cesarean delivery on maternal request.

Presence of Sperm in Pre-Ejaculatory Fluid of Healthy Males.

BACKGROUND: Coitus interruptus, a common contraceptive method, has a high failure rate. Two reasons have been proposed for this: delayed withdrawal after ejaculation and presence of sperm in the pre-ejaculatory fluid. OBJECTIVE: To determine whether sperm was present in the pre-ejaculatory fluid of healthy males. MATERIAL AND METHOD: A total of 42 healthy Thai men were enrolled in the study between August 1, 2009 and November 30, 2009 at the Department of Obstetrics and Gynecology, Rajavithi Hospital. They were asked to collect pre-ejaculatory fluid smears in two glass slides and then deposit a semen sample in a plastic bottle after masturbation. Microscopic examination of wet and air-dried preparations and routine semen analyses were done consecutively in the human genetics laboratory. RESULTS: Actively mobile sperm were found in 16.7% (7/42 cases) of the pre-ejaculatory penile secretions of subjects whose sperm counts were 2 in 2 cases, 3 in 3 cases and 4 per high power field in the other 2 cases of positive sperm. Semen analyses were normal in 41/42 volunteers (97.6%); there was one case of oligospermia (14 x 106/ml). CONCLUSION: Actively mobile sperm were discovered in the pre-ejaculatory fluid of 16.7% of healthy men.

Prevalence of Sexually Transmitted Infection in Teenage Pregnancy in Rajavithi Hospital, Thailand.

BACKGROUND: Behavioral and social changes in the modern era have triggered an increase in the incidence of early sexual contact and teenage pregnancy. Since there is no routine Gonococcal & Chlamydial (GC & CT) screening in teens in antenatal clinics in Thailand, the present study was performed to find the prevalence of STI, especially Chlamydial infection, in teenage pregnancy. OBJECTIVE: To evaluate the prevalence of sexually transmitted infections (STIs), especially Chlamydial infection (CT), in teenage pregnancy and its related factors. MATERIAL AND METHOD: One hundred and twenty-one teenage pregnancies were recruited at the ANC in Rajavithi Hospital from October 2006 to May 2007. After signing informed consent forms, they were asked to answer questionnaires about baseline data, sexual information and risk factors, after which urine specimens were collected for screening for GC and CT using the PCR technique (AMPLICOR by Roche). Later, pelvic examination was per formed by the gynecologist at the STD (sexually transmitted disease) clinic. All the data and LAB results were recorded and analyzed by the SPSS program. Numbers, percentages, means with SD, Chi-squared test, Fisher's exact test and odds ratio were used. Potential risk factors were analyzed using binary logistic regression. RESULTS: The prevalence of STI in pregnant teenagers was 28.1% (CT = 19.8%, GC = 1.7%, hepatitis B = 3.3%, trichomoniasis 1.7%, Herpes simplex = 0.8% and condyloma acuminata = 0.8%). No Syphilis, chancroid or HIV were found in the present study Other non-STI like candidiasis and bacterial vaginosis were found in 45.5% of participants (candidiasis and bacterial vaginosis at 19.0% and 24.8%, respectively). The risk of CT infection was significantly related (6.9 times higher) to having previous sexual contact before the current partner (95% CI, 1.8-27.0). CONCLUSION: STI, especially Chlamydial infection, was found in a significant number of teenage pregnancies. Measures should be taken to prevent this resulting in complicated outcomes in the future.

High pre-pregnancy body mass index and the risk of poor obstetrics outcomes among Asian women using BMI criteria for Asians by World Health Organization Western Pacific Region (WPRO): a large cohort study.

OBJECTIVE: To evaluate the effects of high pre-pregnancy body mass index (BMI) on the risk ofpoor obstetric outcomes among Asian women using BMI criteria by Regional Office for the Western Pacific Region of WHO (WPRO). MATERIAL AND METHOD: The present study was a retrospective cohort. Subjects of live birth singletons who had full term delivered atfour tertiary care centers, teaching university hospitals between January and December 2012 were enrolled. All pregnant women with pre-pregnancy BMI 18.5 kg/m2 or over were recruited and categorized into two groups, normal BMI and high BMI Level of BMI at 18.5-22.9 kg/m2 was defined normal BMI, and level at or over than 23 kg/M2 was defined as high BMI, respectively. The association between high pre-pregnancy BMI and poor adverse pregnancy outcomes were evaluated. RESULTS: Two thousands seven hundred and thirty-three pregnant women were recruited. Normal and high pre-pregnancy BMI women were 1,840 and 893, respectively. The average age was 2 7.81 +/- 5.67 and 29.48 +/- 13.03 years old respectively. Most ofsubject were primigravida. Mean BMI of normal group and high BMI group were 20.2 7 +/- 1.42 and 26.66 +/- 3.45 kg/ m2, respectively. In multivariate analysis, high pre-pregnancy BMI pregnant women have significantly higher adjusted risk ratio for gestational diabetes mellitus and preeclampsia, induction of labor prolong second stage of labor, including, caesarean delivery or obstetrics procedures (RR 1.54, 95% CI 1.30-1.84, RR 1.17, 95% CI 1. 12-1.23, RR 1.41, 95% CI 1. 04- 1.90, RR 1.28, 95% CI 1.11-1.48 and RR 1.17, 95% CI 1.05-1.27, respectively). In addition, the adjusted risk ratio of postpartum hemorrhage and neonatal macrosomia were significantly increased (RR 1.86, 95% CI 1.01-3.43 and RR 1.46, 95% CI 1.28-1.65, respectively). CONCLUSION: This evidence strongly suggested that high pre-pregnancy BMI using WPRO criteria increased the risk of pregnancy complications and adverse pregnancy outcomes. This study was one of the largest studies among Asian populations.

Standard intrauterine growth curve of Thai neonates delivered at Rajavithi hospital.

OBJECTIVE: To determine the distribution of Thai neonatal birthweights classified in gestational age and sex to create standard intrauterine growth curves of Thai neonates. MATERIAL AND METHOD: A retrospective study was performed in Thai singleton pregnant women with confirmed gestational age between 24 and 42 weeks (168-294 days), delivered at Rajavithi Hospital. Birthweights were graphed as 5th, 10h, 50th and 90th percentile, and classified in gestational age as male, female, and both sexes. RESULTS: In all 7,506 neonates: 3,973 male and 3,533 female, were included during the 4-year study period. The standard intrauterine growth curves at 5th, 10th, 50th, and 90th percentile in male neonates were higher in value but similar in shape than those in female neonates. CONCLUSION: Male birthweights were higher but similar in shape compared with those of female in all gestational ages (24-42 weeks).

Characteristics, risk factors, and outcomes related to Zika virus infection during pregnancy in Northeastern Thailand: A prospective pregnancy cohort study, 2018-2020.

BACKGROUND: In response to the 2015-2016 Zika virus (ZIKV) outbreak and the causal relationship established between maternal ZIKV infection and adverse infant outcomes, we conducted a cohort study to estimate the incidence of ZIKV infection in pregnancy and assess its impacts in women and infants. METHODOLOGY/PRINCIPAL FINDINGS: From May 2018-January 2020, we prospectively followed pregnant women recruited from 134 participating hospitals in two non-adjacent provinces in northeastern Thailand. We collected demographic, clinical, and epidemiologic data and blood and urine at routine antenatal care visits until delivery. ZIKV infections were confirmed by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Specimens with confirmed ZIKV underwent whole genome sequencing. Among 3,312 women enrolled, 12 (0.36%) had ZIKV infections, of which two (17%) were detected at enrollment. Ten (83%, 3 in 2nd and 7 in 3rd trimester) ZIKV infections were detected during study follow-up, resulting in an infection rate of 0.15 per 1,000 person-weeks (95% CI: 0.07-0.28). The majority (11/12, 91.7%) of infections occurred in one province. Persistent ZIKV viremia (42 days) was found in only one woman. Six women with confirmed ZIKV infections were asymptomatic until delivery. Sequencing of 8 ZIKV isolates revealed all were of Asian lineage. All 12 ZIKV infected women gave birth to live, full-term infants; the only observed adverse birth outcome was low birth weight in one (8%) infant. Pregnancies in 3,300 ZIKV-rRT-PCR-negative women were complicated by 101 (3%) fetal deaths, of which 67 (66%) had miscarriages and 34 (34%) had stillbirths. There were no differences between adverse fetal or birth outcomes of live infants born to ZIKV-rRT-PCR-positive mothers compared to live infants born to ZIKV-rRT-PCR-negative mothers. CONCLUSIONS/SIGNIFICANCE: Confirmed ZIKV infections occurred infrequently in this large pregnancy cohort and observed adverse maternal and birth outcomes did not differ between mothers with and without confirmed infections.

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.

Trend in mode of delivery in Rajavithi Hospital: a ten-year analysis (2002-2011).

OBJECTIVE: To create trends in mode of delivery both public and private service at Rajavithi Hospital. MATERIAL AND METHOD: The medical records of singleton pregnant women delivered between January 1, 2002 and December 31, 2011 were retrospectively analyzed for mode of delivery, indication of operative obstetrics, and modality of services (public and private service). RESULTS: During the study period, total singleton deliveries gradually decreased from 9,418 to 6,023 while the spontaneous vaginal delivery rate fluctuated, and the cesarean delivery rate increased from 25.48% to 34.70%. Vaginal operative deliveries steadily declined such as, forceps extraction 3.83% to 0.95%, vacuum extraction, 1.72% to 0.85%, and vaginal breech delivery 0.92 to 0.28%. CONCLUSION: The cesarean delivery rate increased in contrast with the decline of the vaginal operative delivery rate.

Risk factors related to heartburn in pregnant women attending the antenatal care clinic, Rajavithi Hospital.

OBJECTIVE: To determine the risk factors related to heartburn in pregnant women attending the antenatal care clinic, Rajavithi Hospital. MATERIAL AND METHOD: Self-reporting questionnaire about demographic data and risk factors related to heartburn in those pregnant women between May 1 and July 31, 2010. RESULTS: Heartburn was found in 55 out of 452 pregnant women (12.2%). There were no significant differences in demographic characteristics and risk factors between the heartburn and non-heartburn groups. Consumption of alcoholic drinks was a reversely significant risk factor of heartburn (OR 0.11, CI 0.01 to 0.78) (p = 0.005). CONCLUSION: Heartburn was not uncommon, and no associated factors were demonstrated.

Risk factors related to febrile morbidity after abdominal hysterectomy.

OBJECTIVE: To assess risk factors related to febrile morbidity (FM) after abdominal hysterectomy for non-malignant diseases. MATERIAL AND METHOD: Retrospective review and analysis of the data was carried out on the medical records of patients who had undergone total abdominal hysterectomy (TAH) with or without bilateral salpingo-oophorectomy (BSO) for non-malignant gynecological diseases during the period of January 1, 2006 to July 31, 2007. Patients who had had fever before surgery, had been treated with antibiotics within 1 week prior to surgery, had an emergency operation or incomplete data were excluded RESULTS: FM was found in 47 of the 450 patients (10.4%) and unexplained fever was the most common cause of febrile morbidity. Type of operation, operative time, estimated blood loss, indication for surgery, antibiotic therapy use, and surgeons' skill were all statistically significant risk factors when univariate analysis was used. After multiple logistic regressions were analyzed, however, only type of operation and skill of surgeons were still significant risk factors. CONCLUSION: The significant risk factors related to febrile morbidity were type of operation, and surgeons' skill.

Effect of antenatal education for better self-correct diagnosis of true labor: a randomized control study.

OBJECTIVE: To compare self-correct diagnosis of true labor between a special education group and routine education group. MATERIAL AND METHOD: A randomized controlled study was performed in 200 primigravida attending at antenatal care (ANC) clinic, Rajavithi Hospital between October 1, 2009 and March 31, 2010. They were randomly enrolled and divided into two equal groups, the first hundred cases were the special education group and the other hundred cases were the routine education group. Self-correct diagnosis of true labor onset was defined as coming to the labor room because of true labor pain and delivery in the same visit. RESULTS: There were 85 and 79 pregnant women in the special and routine education groups, respectively. There was no significant difference in mean maternal age, 25.20 years versus 25.54 years). The cesarean section rate was 35.3% versus 26 6%. There was higher significance of self-correct diagnosis of true labor onset between the special and routine education group (91.8% vs. 77.2%), respectively (p = 0.01). CONCLUSION: The special education group had significantly better self-correct diagnosis oftrue labor onset, compared with the routine education group.

Fetal echocardiography: a 9-year experience in Rajavithi Hospital (1999-2007 AD).

OBJECTIVE: To determine obstetric characteristics of pregnant women underwent fetal echocardiography (FE), details of FE and postnatal echocardiographic abnormality. MATERIAL AND METHOD: Between January 1, 1999 and December 31, 2007, pregnant women who had the indication for FE were examined at the Department of Obstetrics and Gynecology, Rajavithi Hospital. Standard obstetric ultrasonographic examinations such as fetal biometry, placental localization, and congenital anomaly were initially performed. Then, extensive fetal echocardiographic examination including conventional real time B-mode and Doppler color flow mapping were performed in the following views: four chamber five chamber right long axis, left ventricular long axis, aortic arch, ductal arch, and short axis view of great vessels and ventricles. RESULTS: Eight hundreds fifteen pregnant women were examined for FE (37 pairs of twin pregnancies but one pairs of them were single fetal demise and one triplet with a single fetal demise, so 852 fetuses were examined). The mean maternal and gestational ages at examination were 28.8 years and 27.3 weeks, respectively. The most common indication for FE was diabetes mellitus (25.6%). Percentages of abnormal and unsatisfied FE were 7.7% and 7.9%, respectively. The most common abnormal FE was generalized cardiomegaly (34.8%). Hypoplastic left heart syndrome (HLHS) was the most common cardiac abnormalities diagnosed by postnatal examination (16.6%). CONCLUSION: Percentage of abnormal FE were 7.7%, most of them were generalized cardiomegaly The most common indication for FE was diabetes mellitus (25.6%). The most common abnormal postnatal echocardiography was HLHS (16.6%).

Coitus interruptus in female patients seeking services at Obstetrics and Gynecology Department in Rajavithi Hospital.

OBJECTIVE: To study the using rate and demographic characteristic of female patients attending in Rajavithi Hospital who used coitus interruptus (CI) as a contraceptive method. MATERIAL AND METHOD: Two hundred sexually active, reproductive age (15-44 years) female patients attending family planning, postpartum or gynecologic clinic in Rajavithi Hospital between March 1, 2004 and May 31, 2004 were interviewed to obtain demographic data and CI using designed questionnaires. RESULTS: One hundred and forty out of 200 women were using CI as a choice of contraception (70%). The mean age of the CI groups was 27 years. Most were occupied as private sector employees (49.3%). Friend was the most common route for obtaining information about CI (46.4%). The women and their partners were satisfied with CI 68.6% and 34.3%, respectively. CONCLUSION: Seventy percent of the female patients seeking services at Obstetrics and Gynecology Department in Rajavithi Hospital used CI as a choice of contraception. Friends were the most common route for obtaining information regarding this contraceptive method (46.4%).

Outcome of teenage pregnancy in Rajavithi Hospital.

OBJECTIVE: To compare maternal and neonatal outcomes between pregnant teenage girls (age <20 yrs) and pregnant adults (age 20-34 yrs). MATERIAL AND METHOD: Seven hundred and fifty pregnant teenagers admitted and delivered at Rajavithi Hospital during November 8, 2006 and December 22, 2007 were enrolled in the study. A control group included 750 pregnant adults delivered during the same period. RESULTS: Preterm labor was the significant antepartum complication in the teenage mothers while diabetes mellitus was the significant one in the adult mothers as compared to those in the other groups. Teenage mothers had significantly higher incidence of cesarean delivery than that in the adult mothers. The neonates of the teenage mothers showed higher number of complications than those of the adult mothers. CONCLUSION: Pregnant teenage girls had more maternal and neonatal complications than those of pregnant adults.

Risk factors related to asymptomatic bacteriuria in pregnant women.

OBJECTIVE: To determine the risk factors related to asymptomatic bacteriuria (ABU) in pregnant women. MATERIAL AND METHOD: Three hundred and sixty asymptomatic pregnant women who attended their first antenatal appointment at Rajavithi Hospital from August 1 and October 31 2005 were enrolled. Those with symptoms of urinary tract infection within one month, those who had been prescribed antibiotics during the previous seven days, and those with medical or obstetric complications, vaginal bleeding, and history of urinary tract disease were excluded. Urine specimens were collected by clean-catched midstream urine technique for culture. Several risk factors related to ABU and obstetric and demographic characteristics were recorded. RESULTS: The prevalence of ABU in pregnant women was 10.0%. The significant risk factors related to ABU in pregnancy was lower education level < or = grade 6 (p < 0.05) with 2.17-time risk of ABU compared with higher education level > grade 6. Maternal and gestational age, occupation, monthly income, gravidity, previous history of urinary tract infection and anemia were not statistically associated with ABU. CONCLUSION: Lower education level (< or = grade 6) should be the only significant risk factor related to ABU in Thai pregnant women under limited sample size.

Reagent strip testing for antenatal screening and first meaningful of asymptomatic bacteriuria in pregnant women.

OBJECTIVE: To evaluate the diagnostic performance of reagent strip test as a screening test for asymptomatic bacteriuria (ABU) in pregnant women. MATERIAL AND METHOD: Three hundred and sixty asymptomatic pregnant women who attended their first antenatal appointment at Rajavithi Hospital from August 1st to October 31st, 2005 were enrolled Those with symptoms of urinary tract infection within one month, those who had been prescribed antibiotics during the previous 7 days, and those with medical or obstetric complications, vaginal bleeding and a history of urinary tract diseases were excluded Urine specimens were collected by clean-catched midstream urine technique for urine dipstick and culture. RESULTS: The prevalence of ABU was 10.0% The urine dipstick nitrite leukocyte esterase and combined test had a sensitivity of 16.7%, 75.0% and 16.7%, specificity of 99.1%, 67.9% and 99.4%, positive predictive value of 66.7%, 20.6% and 75.0%, negative predictive value of 91.5, 96.1% and 91.5%, accuracy of 90.8%, 68.6% and 91.1%, respectively. CONCLUSION: Reagent strip testing indicated a fair sensitivity for routine antenatal screening for asymptomatic bacteriuria in pregnant women

The accuracy of late antenatal screening cultures in predicting intrapartum group B streptococcal colonization.

OBJECTIVE: To determine the accuracy of late antenatal (35-37 weeks) screening cultures in predicting intrapartum group B streptococcal (GBS) colonization in Rajavithi Hospital (RH). MATERIAL AND METHOD: From the September 1st, 2006 to November 30th, 2006 at RH, 360 pregnant women who fulfilled the specified criteria were selected from antenatal clinic. Swabs were cultured from the lower vagina and anorectum for GBS using Todd-Hewitt broth with 15 mcg/ml nalidixic acid and 8 mcg/ml gentamicin. When they were admitted in the labor room (LR) for labor; the cultures were repeated in the same way. RESULTS: 302 out of 360 cases had been cultured in LR. The prevalence of GBS in pregnant women at 35-37 weeks and delivery were 13.05% and 13.58% respectively. Fifty-three out of 302 cases were colonized with GBS from at least ANC and/or LR. So the overall prevalence of GBS colonization in pregnant women in this study was 17.55% (53/302). The sensitivity, specificity, positive and negative predictive values of late antenatal GBS culture were 70.73%, 95.40%, 70.73% and 95.40% respectively. There was no significant difference between PPV and NPV in any interval between antenatal and intrapartum cultures. CONCLUSION: Late antenatal screening cultures were not sensitive in predicting intrapartum GBS colonization status.

Outcome of pregnancy among parturients complicated with heart disease in Rajavithi Hospital.

OBJECTIVE: To compare the maternal and perinatal outcomes at Rajavithi Hospital from January 1st, 2000 to December 31st, 2004, (5 years), (3rd period) with those occurring in the previous two periods:1st and 2nd (1965-1970, (6 years) and 1985-1990, (6 years) respectively. MATERIAL AND METHOD: Retrospective analysis of various medical records of 196 cases diagnosed pregnancy with heart disease. RESULTS: The prevalence of parturients complicated with heart disease was 0.41%, an increase of 2 and 5 times compared with the first and second period, respectively. Congenital heart disease was the most common type of disorder in the second and third period (64.28% and, 49.49%, respectively) while rheumatic heart disease was the most common disorder in the first period (54.86%). Most of the cases in the 2nd and 3rd periods were delivered by operative vaginal delivery (46.43% and 44.90%, respectively), while spontaneous vaginal delivery was the most common mode of delivery in the first period (78.99%). All of the postpartum and perinatal complications except postpartum hemorrhage were significantly higher in the worse class of NYHA (class III/IV) than those in the better class of NYHA (class I/II). The maternal death rate in the third period increased 1.81 times and 13.66 times compared with those in the first and second periods, respectively. CONCLUSION: Congenital heart disease was the most common heart disease in pregnancy from 1985 to 1990 and 2000 to 2004. Patients in the NYHA class III/IV had worse maternal and fetal outcomes than those in the NYHA class I/II except for postpartum hemorrhage. Maternal mortality rate was highest from 2000 to 2004 (12.57 per 100,000 live births).