Hemostatic defects in Thai adolescents with menorrhagia.

Twenty-eight adolescents with menorrhagia by pictorial blood loss assessment chart (PBAC) criteria were investigated for underlying hemostatic defect. CBC, ABO blood group, bleeding time, APTT, PT, TT FVIII:C, VWF:Ag, RiCoF and platelet aggregation study were evaluated. Six patients (21.4%) were addressed with underlying hemostatic defect. Of these, severe aplastic anemia (n=1) and thrombotic thrombocytopenicpurpura (n=1) were identified in 2 patients with low platelets after an initial CBC. Four patients with prolonged bleeding time demonstrated inherited hemostatic defect: von Willebranddisease (VWD) type 3 (n=1), Glanzmann thrombasthenia (n=1) and Bernard-Soulier syndrome (n=2). Median PBAC score of patients with hemostatic defect was significantly higher than that of patients with unknown cause of menorrhagia (436.5 vs. 251.3, p = 0.01). After the exclusion of six patients with well-identified bleeding risks, isolated abnormal platelet aggregation response to adrenaline was detected in 11 (50%) adolescents using platelet aggregation study. No significant difference of median PBAC score was noted among patients with and without evidence of this impaired responsiveness to adrenaline. In addition, the authors also found an abnormal platelet aggregation with adrenaline stimulant in 15 (75%) among 20 healthy female controls who had no history of bleeding diathesis. No significant difference infrequency of abnormal platelet aggregation to adrenaline was observed between affected cases and controls. In summary, an impaired responsiveness of platelets to adrenaline in the present study is insufficient to support its risk of bleeding. On the contrary, the simple test such as CBC and bleeding time revealed a worthy contribution to investigate coexisting coagulopathy in adolescents with menorrhagia.

Impact of bottle feeding prohibition on exclusively breastfeeding.

OBJECTIVE: To compare the time of colostrum expression and quantity of breast milk between early postpartum women who practiced exclusively breastfeeding and who had combined breast and bottle feeding. MATERIAL AND METHOD: Seventy mothers who delivered term normal, singleton infants were voluntarily recruited during immediate postpartum period and allocated into two groups. Study group was 35 mothers who practiced exclusively breastfeeding and 35 mothers who practiced combined breast and bottle feeding were control group. Expression of colostrum at 12, 24, and 48 hours and quantity of breast milk at 48 hours after delivery were evaluated and compared between two groups. RESULTS: At 12 and 24 hours after delivery, 65.7% and 88.6% of study group had colostrum compared to 37.1% and 68.6% in control group, respectively. The difference was significantly higher in study group. However, at 48 hours after delivery, there was no statistical difference in both groups. Quantity of breast milk at 48 hours after delivery was 5 mL (2, 10) in the study group compared to 2 mL (0, 8) in the control group, which was significantly different. CONCLUSION: Exclusively breastfeeding since immediate postpartum significantly promote earlier expression of colostrum and higher quantity of breast milk.

Oral etoricoxib for pain relief during fractional curettage: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of oral etoricoxib and placebo combined with paracervical block for pain relief during fractional curettage MATERIAL AND METHOD: A double-blind, randomized controlled trial that included 220 women who underwent fractional curettage and received paracervical block for pain relief was done at Ramathibodi Hospital between September 2005 and June 2006. One hundred and ten women were randomly allocated to the etoricoxib group (90 mg, tablet) and 110 to the placebo group. The main outcome was the patient's assessment of intensity of pain measured by verbal rating scales after speculum insertion, during fractional curettage, immediately after curettage, and 30 minutes after curettage. RESULTS: Demographic data including age, previous vaginal deliveries, and history of curettage were not significantly different between etoricoxib group and placebo group. Most common indication for fractional curettage was menometrorrhagia in both groups. Pain score in etoricoxib group was significant lower during fractional curettage (5 vs. 6, p = 0.04), immediately after curettage (2 vs. 3, p = 0. 009), and 30 minutes after curettage (0 vs. 1, p = 0.003). Comparing the number of patients with mild pain (score 0-3), there were significant higher number of mild pain patient at the time during curettage (39 vs. 20 cases), immediate after curettage (78 vs. 60 cases), and 30 minutes after curettage (107 vs. 100 cases) in etoricoxib group. CONCLUSION: Combination of etoricoxib with paracervical block for reduction of pain during fractional curettage had statistically significant lower pain scale when compared with placebo with paracervical block. However the difference was small and may have questionable clinical significance.

Trends of perinatal deaths at Ramathibodi Hospital: 1995-2005.

OBJECTIVE: To study the trends in perinatal mortality rate and causes of perinatal deaths at Ramathibodi Hospital from 1995 to 2005. DESIGN: Retrospective descriptive study. MATERIAL AND METHOD: Review of medical records and reports during academic activities. RESULTS: 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. CONCLUSION: 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.

A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial.

OBJECTIVE: To compare repeated doses of sublingual with oral misoprostol in the medical management of early pregnancy failure. MATERIAL AND METHOD: One hundred and thirty eight women with a period of gestation less than 20 week calculated by her last menstrual period and less than 12 weeks by size were sequentially allocated to two groups to receive either 400 microg of misoprostol orally or sublingually every 4 hours until termination of pregnancy was completed. RESULTS: There is no difference in the mean induction to abortion interval. Fever and chill were more common in sublingual group compared with oral group. The other adverse effects were similar and included nausea, vomiting, diarrhea, abdominal pain, and headache. CONCLUSION: Sublingual misoprostol is as effective as oral route. Most adverse effects are similar in both groups except fever was more common in sublingual group.

Increase accuracy of visual estimation of blood loss from education programme.

OBJECTIVE: To study the increase accuracy of visual estimation of blood loss after an education program. MATERIAL AND METHOD: Seven simulated scenarios with known measured amount of blood were created by using expired packed red cell from blood bank and common surgical materials. Ninety nurses were randomized into two groups. The experimental group attended blood loss estimation course while the control group did not. The percentage of errors in blood loss estimation were calculated and compared between both groups. The main outcome of this study was percentage of nurses who had accurate estimation. We assumed that if the estimated blood volume is within twenty percentage of actual volume it is accurate. RESULTS: There were no difference in age group (p = 0.08), clinical experiences (p = 0.95) and type of work (p = 0.47) between both groups. Educational program significantly increase accuracy in blood loss estimation (p < 0.05) in all seven scenarios. CONCLUSION: Educational program increased the accuracy of visual estimation of blood loss.

Adnexal masses in pregnancy.

OBJECTIVE: To determine incidence and maternal and fetal outcomes of pregnant women undergoing surgical management for adnexal mass. MATERIAL AND METHOD: A cohort study was performed in patients who presented with adnexal masses in pregnancy that required surgical management during April, 1986 to March, 2001. The maternal and fetal outcomes were analyzed. RESULTS: One hundred eighteen patients of 116,323 deliveries were identified with adnexal masses that required surgical management. The incidence was 1 in 986 deliveries. One hundred and three cases had complete data for analysis. A malignant tumor or a tumor of low malignant potential was found in 3 cases (2.9%). In 4 patients, the only finding at the time of operation were leiomyomas. Eighty-four of 103 cases (81.6%) had an elective operation and 19 cases (18.4%) had an emergency operation. There were 3 spontaneous abortions, 3 preterm deliveries, and 1 intrauterine growth restriction in all patients. Patients who underwent elective and emergency operation had the same adverse pregnancy outcome. CONCLUSION: The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. The percentage of malignant tumors or tumors of low malignant potential was 2.9%. Patients who underwent elective operation had the same adverse pregnancy outcome compared with those who underwent emergency operation.

Sexual behavior of secondary school students in Bangkok metropolis.

OBJECTIVE: To explore sexual behavior in terms of masturbation, homosexual contact and coitus in secondary school students in Bangkok. MATERIAL AND METHOD: This was a cross-sectional survey research from December, 2002 to January, 2003. 362 students were selected by the multistages simple random sampling technique. A self administered questionnaire was used to collect data on baseline characteristics and sexual behavior of the students. RESULTS: 197 male and 165 female students were enrolled in the present study. The mean age was 16.5 years, and 65.7 percent of the students were exposed to sexually explicit contents via the internet. 58.0 percent of the students used the internet for pornographic viewing. According to the sexual behavior of the students, 79.2 percent of the males and 9.1 percent of the females had experience in masturbation (p < 0.05). The male had a slightly higher in homosexual contact than the females (10.2% vs 9.1%) but coital experience of the males was markedly significance higher than the females (25.4% vs 7.9%) (P < 0.05). CONCLUSION: It was concluded that sexual behavior in the internet era; males had more experience in all these categories than females. Sexual education via the internet should be improved in order to make adolescents understand appropriate sexual behavior and practice safer sex.

Comparison of oral and vaginal misoprostol for induction of labor at term: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of oral with vaginal misoprostol for induction of labor at term. METHODS: One hundred and fifty-three pregnant women at term with indications for induction of labor and Bishop score < or = 6 were randomly assigned to receive misoprostol either 100 microg orally or 50 microg vaginally every 6 h for 48 h. Repeated doses were given until Bishop score > or = 8 was achieved or spontaneous rupture of membranes occurred. Those who were not in labor after 48 h had labor induced with amniotomy and oxytocin. The main outcome measure was induction to delivery time. RESULTS: The median induction to vaginal delivery time in the oral group (14.3 h) was not significantly different from that of the vaginal group (15.8 h). The median number of doses was also not significantly different in the oral group compared with the vaginal group. There was a significant higher incidence of uterine tachysystole in the vaginal group compared to the oral group (17.1% vs 5.3%, P = 0.032). There was no hyperstimulation in either group. There were no significant differences between the groups with respect to oxytocin augmentation, cesarean section rate, analgesic requirement, and neonatal outcomes. CONCLUSION: Oral administration of 100 microg misoprostol has similar efficacy to intravaginal administration of 50 microg misoprostol for labor induction with less frequent abnormal uterine contractility. 100 microg of misoprostol orally can be used as an alternative to the vaginal route for labor induction.

Vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women: a randomized controlled trial.

AIM: To investigate the efficacy of vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women. METHODS: Forty-four postmenopausal women with indication for dilatation and curettage were randomly assigned to receive either 400 micro g of misoprostol or placebo vaginally 6 h before dilatation and curettage. The main outcome measures were the number of women who required cervical dilatation, cervical width, time taken to dilate to Hegar 6 and other complications. RESULTS: The mean cervical diameter (4.59 millimeters in the misoprostol group vs 4.41 millimeters in the placebo group) was comparable between the two groups. A similar number of women in the misoprostol group and in the placebo group required cervical dilatation (12 vs 16, P = 0.35). The operative times for both groups were similar. The incidence of side-effects was comparable in both groups. There were two uterine perforations in the misoprostol group (2 vs 0). CONCLUSION: There was no significant benefit from applying 400 micro g vaginal misoprostol 6 h prior to dilatation and curettage in postmenopausal women.

Hands-on is better than look-on: condom use.

OBJECTIVES: To compare knowledge about condoms, attitude towards condom use and skill in condom application between the experimental group who received hands-on and the control group who had look-on demonstrations of condom application onto the penile model of third year male primary vocational students. METHOD: Self administered questionnaire was used to collect data about knowledge and attitude. Skill was separately evaluated by a skill evaluation form. Pretest and posttest of knowledge, attitude and skill were done separately at 2 week intervals in the same subjects. The pretest and posttest scores were expressed as the mean and standard deviation. Statistic analysis used unpaired t-test for comparing scores between the two groups using SPSS. RESULTS: Comparison of pretest with pretest, posttest with posttest and the different mean score of posttest with pretest between the two groups of knowledge and attitude about condoms were not significantly different in both groups but the skill in condom application score was significantly different (p-value < 0.001). However, the skill score increased in the experimental group more than in the control group. CONCLUSIONS: This study suggested that condom application skill increased with the hands-on than look-on instructional model. It was concluded that hands-on should be used to improve skill to prevent condom user failure and nonuse.