Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVES: To compare the effects of estradiol vaginal tablet with conjugated estrogen cream on urogenital symptoms, vaginal health index, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women. METHODS: Fifty-three women with urogenital symptoms were randomized to local vaginal treatment of 25 microg estradiol tablet or 1 g of conjugated estrogen cream for 12 weeks. They were assessed for urogenital symptoms, vaginal health index, vaginal cytology, endometrial thickness and estradiol level. RESULTS: Forty-eight women completed the treatment. Both groups showed improvement of urogenital symptoms, vaginal health index, and vaginal cytology after the first 4 weeks of treatment. Conjugated estrogen cream showed superior efficacy in alleviating vaginal dryness and dyspareunia. Two cases of endometrial proliferation were noted. CONCLUSIONS: Estradiol vaginal tablet and conjugated estrogen cream were effective in treating urogenital symptoms, the restoration of normal vaginal epithelium and reduction of vaginal pH in postmenopausal women. However, 2 cases of endometrial proliferation were noted.

Asunto(s)

RESUMEN

Previous studies have shown that sweeping between the membranes and lower uterine segment was an effective procedure for reducing prolonged pregnancy. However, there has been no study to show the effect of lower uterine segment sweeping to the progress of the active phase of labor. This study was to determine the effect of lower uterine segment sweeping on the progress of the active phase of labor in nullipara. A total of four hundred nulliparous term pregnant women with spontaneous labor were randomized to one of two groups; the control group had routine vaginal examination while the study group had lower uterine segment sweeping at the time of each examination. Oxytocin infusion was given if there was dysfunctional labor. Progression of labor and the need for oxytocin augmentation were reviewed. Data were analyzed by chi square and Student t-test. Oxytocin was used in 67 per cent of the sweeping group and 62 per cent of the control group (p=0.3). The duration of the first stage (0.46), the second stage (0.38), and the third stage (0.28) of labor were not significantly different between the two groups. In conclusion, lower uterine segment sweeping did not reduce the need for oxytocin augmentation or lessen the duration of labor in nullipara.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: To determine the relationship between maternal perception of sound-provoked fetal movement in the early intrapartum period and perinatal outcome. METHOD: 739 singleton pregnant women of at least 32 weeks gestation who were admitted to the labor ward, underwent the maternal perception of sound-provoked fetal movement test. All were in the latent phase of labor with singleton cephalic presentation. The result of maternal perception of sound-provoked fetal movement was compared with the perinatal outcome using sensitivity, specificity, negative predictive value, positive predictive value and accuracy. RESULTS: When 739 pregnant women were compared to the perinatal outcome, maternal perception of sound-provoked fetal movement had sensitivity 100%, specificity 98.9%, positive predictive value 15.1%, negative predictive value 100%, and accuracy 90.1%. CONCLUSION: The finding suggested the usefulness of maternal perception of sound-provoked fetal movement as an effective screening test to identify fetuses at risk in the early intrapartum period because of its high sensitivity and specificity. This is a simple and inexpensive test for evaluating fetal well-being in a primary health care setting.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the reliability and application of maternal perception of sound provoked fetal movement for antepartum assessment of fetal well-being. METHODS: Six hundred singleton high risk pregnant women of at least 32 weeks gestation were studied on 684 occasions. The response was compared with a nonstress test (NST) performed before a 3 second vibroacoustic stimulation with an electronic artificial larynx. The result of maternal perception of sound provoked fetal movement was compared to the NST and the perinatal outcome using sensitivity, specificity, negative predictive value, positive predictive value, and accuracy. RESULTS: On 684 occasions, a positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 642 occasions (93.9%) and was accompanied by a reactive NST on 630 occasions; giving a specificity of 97.1% and a negative predictive value of 98.1%. Results of maternal perception of sound provoked fetal movement and NST, performed within a week of delivery, in 560 women were compared with perinatal outcome. The maternal perception of sound provoked fetal movement test had better sensitivity (64.7%) for poor perinatal outcome than the NST (58.8%). Both tests were not different in specificity (96.3% vs 96.5%), positive predictive value (35.5% vs 34.5%), negative predictive value (98.9% vs 98.7%), and accuracy (95.4% vs 95.4%). CONCLUSION: The findings suggested that maternal perception of sound provoked fetal movement may be an effective screening test to identify fetal compromise in antepartum period. This test is a simple and inexpensive test for evaluating fetal well-being in primary health care setting.

Asunto(s)

RESUMEN

OBJECTIVE: To study the incidence of spontaneous abortion and relationship between incidence and maternal age profession, education level and income. STUDY DESIGN: Prospective cohort study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. SUBJECTS: 999 patients registered at antenatal care unit, Department of Obstetrics and Gynecology from July 1, 1992. MAIN OUTCOME: Number of spontaneous abortion measures. RESULTS: From 999 patients, 69 were excluded from the study (8 had induced abortion, 61 could not be contacted). Most of patients aged 20-34 (85.5%) with the mean of 27 years. Spontaneous abortion occurred in 64 patients, incidence of 6.9 per cent. The analysis of data showed no relationship between the incidence of spontaneous abortion and age, profession, education level and income. CONCLUSION: Compared with previous studies, the incidence of spontaneous abortion is this study was quite low. With regard to the relationship of socioeconomic, further study with larger population should be performed to draw suitable conclusion.

Asunto(s)

RESUMEN

Catheterization, which is widely accepted as an important factor to urinary tract infection, is routinely done during cesarean section. This randomized study was conducted to compare the incidence of urinary tract infection between patients who underwent cesarean section using intermittent catheterization and indwelling catheterization, at the Department of Obstetrics and Gynecology, Ramathibodi Hospital from August 1991 to December 1991. Sixteen of 51 patients (31.4%) of the intermittent group and 9 of 47 patients (19.1%) of the indwelling group developed urinary tract infection. The difference was not statistically significant. Of the patients in the intermittent group 39.2 per cent were found to have postoperative urinary retention requiring recatheterization, whereas all cases in the indwelling group could void after its removal. Klebsiella pneumoniae was the commonest isolated organism. Indwelling catheterization was concluded to be the favourable method.

Asunto(s)

RESUMEN

Papanicolaou (Pap) smear test is an established method of cervical cancer screening. However, most women in Thailand are still reluctant to undergo pelvic examination. A prospective study was carried out on the use of self inserted vaginal tampon to collect specimens for Pap test in 126 patients at Ramathibodi Hospital from September to October 1990. The tampons which were inserted overnight and removed by the patients themselves were smeared across a glass slide and immediately fixed in 95 per cent ethyl alcohol. Ninety-six point two per cent of the slides had adequate cells of good quality to be interpreted. The remaining 3.98 per cent could not be interpreted due to the lack of cells and poor cell fixation. It is concluded that the smears obtained by this method are satisfactory for cytologic evaluation.

Asunto(s)

RESUMEN

In obstetrics, the need to perform manual removal of placenta is not infrequent. This was a retrospective study of placental removal among all vaginal deliveries at Ramathibodi Hospital from 1985 to 1988. The incidence of manual removal of placenta was 2.1 per 100 parturients which was higher than other reports. The reason for this is still unclear. The patients' age was mostly 26-30 years with multiparity accounting for 73.1 per cent and most deliveries occurred between 38-40 weeks of gestational age. The indication for manual removal of placenta was mostly placental retention. Previous history of curettage in the last gravida accounted for 34.7 per cent of cases. In two cases (0.5%), the procedure failed due to placenta accreta and hysterectomy was required.

Asunto(s)

RESUMEN

In this prospective study, comparisons were made between the results of fetal movement count as performed by either the attending staff or by the patients using the non stress test (NST). A total of 283 NSTs were performed in 200 patients who had singleton pregnancy of at least 32 weeks gestation with indications for assessment of fetal well-being. Fetal movement counts performed by the attending staff and by the patients were recorded on 241 and 170 occasions, respectively. The results showed that the best correlation between fetal movement count by the attending staff with NST was when the criteria of three or more fetal movements within 10 min was used. Likewise, the best correlation between fetal movement count by patients with NST was found when ten fetal movements within 2 h was used as a cut off point. The result of this study suggests the usefulness of fetal movement count performed either by attending staff or patients as a cheap and effective method of screening for good fetal well-being in places where NST is not readily available and may also be used as a screening for patients prior to further evaluation.

Asunto(s)

RESUMEN

This was a retrospective case-control study of hydrops fetalis due to Bart hemoglobinopathy at Ramathibodi Hospital between 1978-1987. The incidence was 0.61 per 1,000 deliveries. Hydrops fetalis tend to go into labour prematurely with smaller fetuses and larger placentae. When compared with the control group there were statistically significant differences in the history of previous perinatal loss and obstetric complications i.e. hypertensive disorder in pregnancy and postpartum hemorrhage. Early diagnosis and termination of pregnancy will avoid these complications.

Asunto(s)

RESUMEN

In birth certificate data for Massachusetts resident births from 1978 to 1982, 12-27% of births purportedly under 31 weeks of gestation were probably misclassified, i.e. had birthweight greater than or equal to 2500 g. Correcting for maldistribution of births removed 34% and 23%, respectively, of black and white births with reported gestational ages less than 36 weeks but with implausible weights. Percentages of unknown and incomplete reports of last menstrual period were also significantly higher for blacks. After adjustment, preterm black infants weighed less than whites at each gestational age. The proportion of infants less than 2500 g born at term (greater than or equal to 37 weeks gestation) was higher (although not significantly) among blacks. These findings are consistent with hypotheses that low socioeconomic status negatively affects the rate of intrauterine growth.

PIP: In birth certificate data for Massachusetts, US resident births from 1978 to 1982, 12 to 27% of births purportedly under 31 weeks of gestation were probably misclassified, i.e. had birthweight or = 2500 grams. Correcting for maldistribution of births removed 34% and 23%, respectively, of black and white births with reported gestational ages 36 weeks but with implausible weights. % of unknown and incomplete reports of last menstrual period were also significantly higher for blacks. After adjustment, preterm black infants weighed whites at each gestational age. The proportion of infants 2500 grams born at term ( or = 37 weeks gestations) was higher (although not significantly) among blacks. These findings are consistent with hypotheses that low socioeconomic status negatively affects the rate of intrauterine growth. Future studies of fetal growth patterns from birth certificate data should adjust for both probably misclassified birthweight and cases of implausible gestational ages. These adjusted cases should also be considered separately in terms of morbidity and mortality, as they may derive from different populations.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

PIP: A retrospective study of 9300 deliveries occurring at Bangkok's Ramathibodi Hospital in 1977-79 was undertaken to identify the maternal factors associated with low birthweight. 65 of the deliveries resulted in twins. Overall, there were 641 (6.9% incidence) low birthweight (under 2500 grams) deliveries. The incidence of low birthweight was above the average in mothers with the following demographic attributes: age less than 20 years, 12.3%; no formal education, 11.9%; divorced, separated, or widowed marital status, 8.5%; and 1-4 years of education, 8.3%. Both maternal age over 35 years and rural residence were associated with a 7.7% rate of low birthweight, but this rate was not significantly different from that of the total sample. Of all of the demographic characteristics analyzed, maternal education of 13 or more years was associated with the lowest incidence of low birthweight infants (5.5%). In terms of reproductive history, the highest percentages of low birthweight infants occurred in mothers whose last pregnancy was premature (13.9%) or resulted in a stillbirth (9.3%). An interpregnancy interval of 13-24 months was associated with a 7.0% incidence of low birthweight. In terms of breastfeeding patterns, women who did not breastfeed or who breastfed for 1 year or more were most at risk (7.3% and 8.6%, respectively). Finally, the incidence of low birthweight was significantly elevated in mothers with the following pregnancy-related variables: no prenatal visits, 43,5%, or only 1-3 prenatal visits, 26.3%; twin pregnancy (60.0%); and breech presentation, 19.9%. The findings of this study can be used to plan special interventions for pregnant women who possess characteristics associated with a higher risk of low birthweight infants.^ieng

Asunto(s)