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Objective: To determine the preterm birth rate, neonatal birth weight and causes of early neonatal death at Siriraj Hospital over a 9-year period (2002-2010). Methods: The medical records of preterm birth, threatened preterm labor and neonatal birth weight at Siriraj Hospital from 2002 to 2010 were retrospectively collected and reviewed. The data was analyzed by SPSS version 13. Results: During a 9-year period, 2002-2010, the birth rate decreased steadily from 2002 to 2006, but increased suddenly from 2007 to 2010. The rate of preterm birth was increased steadily from 2004 to 2010 (9.44%-13.70%). The rate of threatened preterm labor was constantly between 6.0 and 8.9%. Among preterm births, low birth weight infants were mostly found except in the year 2003. Early neonatal death was mostly caused from fetal abnormality. The trend of neonatal death from prematurity had continuously declined and there was no early neonatal death from 2008 to 2010. Conclusion: Regarding this 9-year review, the preterm birth rate increased from 2007 to 2010 while premature babies mostly survived.
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Objective: To determine the prevalence of ovarian cancer, staging, presenting symptoms, gestational age of diagnoses, screening and diagnostic methods and pregnancy outcomes during pregnancy at Siriraj Hospital over a 13-year period (1998-2010). Methods: Medical records of pregnant women diagnosed with ovarian cancer at Siriraj Hospital from 1998 to 2010 were reviewed. Results: During the 13-year period, 1998-2010, eight cases of pregnant women with ovarian cancer were detected. Six cases of ovarian cancer stage I and 2 cases of ovarian cancer stage II were recorded. All of the patients presented with the symptom of abdominal mass. Two cases presented with abdominal pain. Ultrasonography was performed in all cases to confirm the diagnosis. Two patients with stage II ovarian cancer which was diagnosed in early pregnancy, subsequently had abortions. Five cases from 6 cases of those patients with stage I ovarian cancer underwent caesarean delivery while one case had a normal vaginal delivery. Conclusion: Regarding to this 13-year review, the prevalence of ovarian cancer in pregnancy was low. The management of pregnant patients with ovarian cancer depended on the gestational age and the staging of malignancy.
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Objective: To predict fetal intrauterine growth retardation (IUGR) by using the centile chart for the ratio of transverse cerebellar diameter to abdominal circumference (TCD/AC) throughout pregnancy from 13-40 weeks. Methods: A total of 643 pregnant women were recruited in this study. The exclusion criteria of 643 normal pregnant women were uncertain date of last menstrual period, multiple pregnancies, fetal abnormalities and maternal conditions which could affect fetal growth. The known 20 small IUGR infants were also tested. Transverse cerebellar diameter and abdominal circumference of all the subjects were measured out by gestational age. The approximately equal numbers of fetuses were measured at each week of gestation. The mean and standard deviation of TCD/AC ratio is estimated at each week of gestation. In addition the 5th, 10th, 50th, 90th and 95th percentiles were calculated at each week of gestation. Results: Of 643 pregnant women, 149 (23.1%) were scanned before 20 weeks of gestation and 286 (44.5%) were scanned between 20 and 30 weeks of gestation. The last group was rechecked after 30 weeks of gestation. TCD/AC ratio slowly declined from early pregnancy until about 20 weeks then remained stable. After 30 weeks of gestation it started to decline again. A TCD/AC ratio greater than the 90 th centile was present in 80% (16/20) known small for gestational age (SGA) infants. (SGA has not been defined). Conclusion: The normal reference value of TCD/AC ratio in Thai fetus were shown in this study. The TCD/AC ratio is a stable, gestational age independent parameter during 20-30 weeks of gestation that may be useful in the early detection of fetal intrauterine growth retardation (IUGR).
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Objective: To investigate the relationship between the Nuchal thickening (NT) and crown–rump length (CRL) in normal Thai fetuses during 10-14 weeks of gestation. Methods: A prospective observational study was conducted. Ultrasound measurement of NT and CRL was offered for 1,000 consecutive Thai fetuses between 10-14 weeks of gestation. Regression analysis was used to analyze the relationship between the NT and CRL. Results: The mean maternal age was 28.03 ± 5.8 yr (range 14-47 yr). The mean CRL was 54.7 ± 12.7 mm (range 10.0-82.0 mm), and the mean NT was 1.6 ± 0.60 mm (range 0.3-6.9 mm), respectively. The median gestational age was 12.0 weeks. The regression equation relating median NT to CRL was described as follows: expected Nuchal thickening (mm) = 0.437 + (0.01764 × CRL) (mm) (R2 = 0.134, p <0.001). Conclusion: The present study offers normative data of the fetal NT in Thai fetuses, which may improve the performance of NT measurement during the first-trimester as a screening tool for chromosomal abnormalities or other congenital abnormalities in the first trimester. The present study shows that NT measurements increase with increasing CRL.
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Objective: To create a reference centile chart for transverse cerebellar diameter in Thai fetuses throughout gestation. Methods: A total of 780 pregnant women between 13-40 weeks gestation, who attended at the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited. Each fetus was measured only once for the purpose of this study. The mean and fitted centiles were estimated at each week of gestation using linear regression modeling. Results: A total of 752 fetuses were measured for fetal transverse cerebellar diameter. Linear regression models were fitted to estimate the meant 95% confidence interval for transverse cerebellar diameter at each gestational age. The centile chart of this parameter was also presented. Conclusion: Reference centile chart for fetal transverse cerebellar diameter of Thai fetuses was created.
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Objectives : To determine the effectiveness of ultrasound screening for fetal anomalies at different gestational ages and to define an appropriate cost for each ultrasound screening. Materials and methods: 470 pregnant women participated in our ultrasound screening programme from October 1st, 2002 to September 15th, 2003. 757 scans were appointed throughout the first, second and third trimesters, numbering 240,257 and 260 scans, respectively. The ultrasound cost were reduced to about 30% of the normal price (800 baht for 2-3 scans). Results : out of757 scans, 7 abnormal fetuses were found. All abnormalities were detected around 18-20 weeks of gestation No abnormalities were found at other gestational ages. The abnormalities included infantile polycystic kidney, cleft lip, trisomy 13,gastroschisis and 3 cases of echogenic foci of hearts. Using this reduced cost, these pregnant women were easily able to participate in this research Programme. Conclusion: In order to reduce perinatal morality and morbidity, ultrasound screening for fetal anomalies can be performed between 18-20 weeks gestation. If the fetus is found to be abnormal, proper management and care can be planned before delivery. An important obstacle is the high cost of having a scan performed. Therefore, a reduced cost should be considered to recruit more pregnant women to participate in this policy. A reasonable cost for each ultrasound was found to be 425 baht.
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The objectives of this study were to determine the prevalence of and factors associated with postpartum psychological distress. This study was designed as a descriptive, prospective study set in the postpartum wards of the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. A total of 275 postpartum woman were admitted to the postpartum wards at Siriraj Hospital. The 12-item Thai GHQ score was > 2. Of 275 postpartum woman included in this study, the prevalence of psychological distress was found to be 34.2% (95% CI 28.7–40.2). Significant associated risk factors, as determined by logistic regression analysis, included age > 35 years old (adjusted OR 8.58, 95% CI 2.24-32.84), fair husband relationship (adjusted OR 2.00, 95% CI 1.11-3.57), poor husband relationship (adjusted OR 4.00, 95% CI 1.76-9.08), and poor family support (adjusted OR 5.40, 95% CI 1.34-21.70. Our findings indicated that the prevalence of postpartum psychological distress in Siriraj Hospital was 34.2%. Significant risk factors included age over 35 years old, fair to poor husband relationship and poor family support during pregnancy. Understanding such risks might lead to the development of preventive measures for the condition, as well as early diagnosis and treatment to reduce the severity among high-risk or affected woman. Further studies are required for more extensive exploration of this condition.
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Comparative study of the level of the reported pain between patients who received xylocaine and normal saline for paracervical block during fractional curettage was carried out in 70 patients in a double blind randomized controlled trial. One group of patients received xylocaine for paracervical block just before the procedure was performed while the other group received normal saline in the same manner. Self-reported pain intensity using visual analog scale was assessed at four time points including the first time point when Allis tissue forceps was applied on the cervix, the second and third time points when curettage was done on the endocervix and in the endometrial cavity respectively. The last time point was evaluated at 30 minutes after the procedure. The results of the study revealed pain occurring in patients in the normal saline group was more severe than those in the xylocaine group with statistically significant difference at the second time point (visual analog scale 4.80 +/- 2.7 in the normal saline group compared to 3.20 +/- 2.4 in the xylocaine group, p < 0.05) and third time point (visual analog scale 8.17 +/- 2.0 in the normal saline group compared to 4.94 +/- 3.1 in the xylocaine group, p < 0.05 ). On the contrary, pain occurring in patients in the normal saline group and xylocaine group was not statistically significantly different at the first time point (visual analog scale 3.62 +/- 2.7 in the normal saline group compared to 3.97 +/- 2.8 in the xylocaine group, p > 0.05) and the fourth time point (visual analog scale 1.34 +/- 2.0 in the normal saline group compared to 1.57 +/- 2.6 in the xylocaine group, p > 0.05). Before this study, there was an idea that normal saline solution could be considered for the paracervical injection solution. The explanation for this was the local anesthetic mechanism may be from distension of nerve capsules rather than blockage of specific autonomic nerves. However, this study showed that nerve capsule distension is not the only factor for pain control in paracervical block. An analgesic agent is still an important factor.
Subject(s)
Adult , Anesthesia, Conduction , Chi-Square Distribution , Dilatation and Curettage/methods , Double-Blind Method , Female , Humans , Lidocaine , Middle Aged , Nerve Block/methods , Pain Measurement , Probability , Reference Values , Sodium Chloride , Thailand , Uterine Hemorrhage/diagnosisABSTRACT
Objective : To determine the prevalence of overactive bladder among nurses at Siriraj Hospital. Study Design : Descriptive study. Subjects : 300 nurses working at Siriraj Hospital. Intervention : Each subject was randomly selected and interviewed regarding symptoms of overactive bladder using a standardized questionnaire. Results : Of 300 nurses included in this study, the prevalence of overactive bladder was 21.3% (95% CI 16.9-26.5). Urgency, the main symptom, was found to occur in 32.8%.The common associated symptoms were frequency and urge incontinence which were found in 23.4% and 11.4% respectively. Concerning the impact of the disease on various aspects of quality of life , we found there was no affect in 40-95% of cases, in 4-50 % there was a moderate effect and a strong effect on the quality of life in 0-12%. Surprisingly, only 10.9% of affected subjects had sought medical treatment for their symptoms, The remaining women appeared unconcerned by their problems. Conclusion : The prevalence of overactive bladder among nurses working at Siriraj Hospital was 21.3% which was very high. However, only a few cases sought medical help. This study provides baseline information concerning this condition in Thai women. Promotion of knowledge and awareness of this condition should be provided, as well as further research concerning various aspects should be conducted, in order to assess how interaction might improve the quality of life of affected women.
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In order to reduce perinatal morbidity and mortality rates, a Fetal Anomaly Clinic has been set up at Siriraj Hospital. The aims are to identify abnormal fetuses and manage them in an appropriate way before delivery. From 1st May, 2000 to 30th April, 2002, 142 pregnancies with fetal abnormalities out of 10,386 pregnant women examined were found at the Fetal Anomaly Clinic, Siriraj Hospital. There were 32 fetuses (22.5%) with CNS abnormalities and neural tube defects with a mean gestational age at diagnosis of 18.6 weeks, 12 fetuses (8.5%) with gastrointestinal abnormalities with a mean gestational age at diagnosis of 17.1 weeks, 12 cases (8.5%) with cardiovascular and pulmonary abnormalities with a mean gestational age at diagnosis of 24.8 weeks, 10 cases (7%) with skeletal abnormalities with mean gestational age at diagnosis of 26.7 weeks,15 cases (10.6%) with chromosome abnormalities with a mean gestational age at diagnosis of 21.7 weeks, 18 cases (12.6%) of KUB abnormalities with a mean gestational age at diagnosis of 25.6 weeks and 43 cases (30.3%) of other abnormalities with a mean gestational age at diagnosis of 24.5 weeks. Counsellings was given before making a decision and all abnormalities were confirmed by autopsy, amniocentesis, paediatric neonatologists or paediatric surgeons.
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Objective : To determine the efficacy of Tolterodine in patients with overactive bladder. Design : Open study. Setting : Gynaecological Outpatient Clinic, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. Subjects : From August 2000 to June 2001, thirty patients who met the symptomatic definition of overactive bladder without local or metabolic causes were enrolled in this study. Intervention : Tolterodine 2 mg bid were given to the patients for 12 weeks. Main outcoem measurement : Patients' global opinion on results of treatment , change in voiding frequency, urgency episodes, urge incontinence episodes, and adverse events from medication. Results : Patients' global opinion showed a marked improvement in the condition in 6 cases (4 cases showed improvement in 2 weeks while the other 2 cases within 4 weeks of treatment), some improvement in 20 cases and failure of treatment in 4 cases (1 case discontinued at 2 weeks due to severe headache, 2 cases at 4 and 8 weeks due to lack of improvement and 1 case at 4 weeks due to economic problems). The mean number of voids per 24 hours showed a trend to decrease since the start of treatment from 12 times per 24 hours to 6 times per 24 hours after 12 weeks of treatment. The mean number of days with urgency per week showed a decreasing trend since the start of treatment from 2.8 days per week to less than 1 day per week after 12 weeks of treatment. The mean number of days with incontinence per week decreased from 3.5 days per week at the start of treatment to less than 1 day per week after 12 weeks of treatment. The adverse events from medication included a dry mouth in 15 cases (12 cases with mild degree and 3 cases with moderate degree ), 5 cases had flatulence, 5 cases had a slow urinary stream and 5 cases had a headache ( including 1 case who discontinued the treatment after 2 weeks). Conclusion : Tolterodine is effective in improving patient's view of their bladder condition, decreasing urinary frequency, urgency episodes and urge incontinence episodes. It is also well-tolerated by the patients.
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The accuracy of Free-floating particles (FFPs) and biparietal diameter (BPD) detected and measured by ultrasonography for assessment of fetal lung maturity were compared with the lecithin/sphingomyelin (L/S ratio) which was used as the gold standard. One hundred pregnant women in the lately third trimester who required amniocentesis for fetal lung maturity testing, from July 1998 to August 1999 at Siriraj Hospital, were included in this study. Ultrasonography was performed to evaluate the presence of FFPs in the amniotic fluid and the BPD was measured. Amniotic fluid for L/S ratio was obtained by amniocentesis. The presence of FFPs had a 58.3% specificity and a 41.7% false positive rate. A BPD value of at least 94 millimeters had 100% specificity and no false positives. When the presence of FFPs and a BPD value of at least 93 millimeters were used in combination, the test gave 100% specificity and no false positives. The presence of FFPS and a BPD value of at least 93 millimeters detected by real time ultrasonography may be used as predictive parameters to indicate fetal lung maturity.
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The objective of this study is to assess the incidence of Actinomyces colonization in the Papanicolaou smears of IUD users at the Family Planning Research Center, Siriraj Hospital. IUD users who attended the center from January 1997- April 1997, regardless of how long they have been using the IUDs were screened for Actinomyces colonization at the time of enrollment. 342 IUD users with a negative Papanicolaou smear for Actinomyces colonization were included in the study and basic characteristics, type and duration of IUD use were recorded. Papanicolaou smears to detect Actinomyces colonization were repeated again 12 months later. Abnormal signs and symptoms were recorded. The main outcome measurement was a positive papanicolaou smear for actinomyces colonization. The incidence of Actinomyces colonization was 9.9% in IUD users regardless of type of IUDs (N= 34). Inert IUDs produced a significantly higher colonization rate as compared with metallic IUDs, (P<0.05). The colonization rates for Lippes D, Lippes C, ML Cu 250, and Cu T 380 A were 28.6%, 25.0%, 14.1% and 2.1%, respectively. The colonization rates appeared to increase with the duration of IUD use before the study and 62% of them were detected after 48 months of IUD use before the study. Almost all positive smears in IUD users (91.2%) were asymptomatic. The incidence of Actinomyces colonization is related to type and duration of IUD use. For this reason, all patients with IUDs should undergo annual Papanicolaou smears for diagnosis and appropriate treatment including removal IUDs and oral penicillin which were effective in this study.
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A prospective clinical study was performed to determine an appropriate cut-off point value of endometrial thickness for the detection of endometrial abnormalities among women with abnormal uterine bleeding. Two hundred and forty nine women with abnormal uterine bleeding who had indication for fractional uterine curettage were enrolled. Endometrial thickness was measured by transvaginal ultrasonographic examination in each patient before performing fractional uterine curettage on the same day. The results were compared with the final histological diagnosis from fractional uterine curettages. Endometrial abnormalities were identified in 69 out of 249 cases (27.7%) as hyperplasia in 57 cases(22.9%) and endometrial cancer in 12 cases (5.0%). The appropriate cut off point value of endometrial thickness was 4 mm below which no abnormal endometrial was found. This cut-off point yielded a sensitivity of 100%, a specificity of 18.3%, a positive predictive value of 31.9%, a negative predictive value of 100%, a false positive rate of 68.2%, a false negative rate of 0% and an accuracy of 40.5%. In conclusion, endometrial thickness measurement by transvaginal ultrasonography is a simple diagnostic method for identifying endometrial abnormalities in women with abnormal uterine bleeding. The cut-off point value of below 4 mm can identify endometrial abnormalities, thus unnecessary fractional uterine curettage can be avoided.
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Erythema multiforme is a mucocutaneous disorder which may correlate with many causes. We report here on a pregnant patient with erythema multiforme which was induced by herpes simplex genitalis. After confirmation of a herpes simplex viral infection, the patient was treated with steroids, antiviral and antibacterial agents. Finally, the patient was treated with steroids, antiviral and antibacterial agents. Finally, the patient showed improvement and delivered a healthy baby. History, investigations, diagnosis and treatments are discussed.
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Dengue, an important mosquito-borne flavivirus infection, is endemic in South-East Asia. We report here on a pregnant patient with an unusual presentation of dengue haemorrhagic fever. After diagnosis of dengue haemorrhagic fever, the patient was given platelets and antiplatelet transfusion was occurred. Labor was delayed by conservative, symptomatic and supportive management. The condition of the patient improved and she gave birth to a healthy baby. The history, investigation, diagnosis and treatment of the patient are discussed.
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Aortic dissection during pregnancy is rare, but should be kept in mind by every physician in charge of pregnant women. A case of aortic dissection is reported here without any evidence of dissection during the early antenatal period. The patient had sudden chest pain during thirty-fourth week of gestation, medical and surgical management were undertaken. Delivery by emergency Caesarean section was performed, and both the patient and the foetus were saved. The etiology, association with pregnancy, diagnosis and managements of acute dissection of the aorta are discussed.