Comparison of pain during postpartum tubal sterilization between patient premedicated with intramuscular morphine and sublingual buprenorphine.

A randomized double blind clinical trial was carried out at Siriraj Hospital in order to compare pain level during postpartum tubal sterilization between patient premedicated with intramuscular morphine and sublingual buprenorphine. Eighty postpartum women were randomly assigned to one of the two studied groups. The first group was premedicated with intramuscular morphine and oral placebo, the other received sublingual buprenorphine and intramuscular tetanus toxoid. Recorded pain level in abdominal cavity at 5 minutes before drug administration, 30 minutes after drug administration and immediately after surgery. AII side effects were observed, recorded and compared between two groups. There were no significant differences between two groups in the pain relief in postpartum tubal sterilization. Major side effects are nuasea, vomiting and dizziness. Sublingual buprenorphine can be used as a premedication in a normal postpartum women who plan to receive postpartum tubal sterilization instead of intramuscular morphine.

Bupivacaine plus fentanyl for intrapartum continuous epidural analgesia.

Labour pain relief using 0.125% bupivacaine plus fentanyl for intrapartum continuous epidural analgesia and intravenous pethidine plus phenergan were evaluated by randomized clinical trial in 40 patients seen at the labour room of Siriraj Hospital. The progression of labour, pain levels at 15 minutes before and after drug administration and in the second stage, the method of delivery and all side effects within two groups were observed and compared. From the study, it was found that continuous epidural analgesia with the new drug combination was more effective in relieving labour. There was no significant difference in the progression of labour and the frequency of instrumental delivery. The main side effects of nausea, vomiting and somnolence were observed to be less in the study group less than other patient but one parturient was found to have developed hypotension.

Evaluation of fetal lung maturity by using free-floating particles in amniotic fluid ultrasonography.

The examination of amniotic fluid for the presence or absence of free-floating particles (FFPs) by real-time ultrasound was performed in 100 non-diabetic patients undergoing amniocentesis for maturity testing. A modified lecithin to sphingomyelin ratio (L/S ratio) was the gold standard of the test. The sensitivity and specificity were 97.6% and 62.5% respectively. The presence of FFPs had 93.2 positive predictive value and 83.3% negative predictive value. FFPs grade 2, 1, 0 had 100%, 70% and 16.7 positive predictive value respectively. The mean value of L/S ratio varied with the FFPs grading, with the mean of 5.09+ 2.48, 2.84 + 0.71, 2.02+ 0.01 in grade 2, 1 and 0 respectively. This study suggests that the presence of FFPs especially FFPs grade 2 on real-time ultrasound may be used to confirm fetal lung maturity.

A study of menopausal symptoms in women attending the menopausal clinic at Siriraj Hospital.

The study of menopausal symptoms leading women to attend the menopausal clinic at Siriraj Hospital was carried out between January 1993 and December 1994. These 310 women, with the mean age of 49.7+ 7.0 years, were interviewed. Surgical menopausal, natural menopausal and perimenopausal women were encountered in 40.6%, 31.3% and 28.1% respectively. The mean age of menopause, as recalled memory was 47.5+ 5.3 years. The three most common symptoms presented were hot flushes (46.8%), muscle/bone pain 34.5%), and nervous (24.8%) while the least common one was dry skin (2.6%). Symptoms, with statistically significant difference (P<0.05) encountered among the three groups were headache/dizziness which mostly presented among perimenopausal women (32.2%), vaginal dryness and dyspareunia which mostly presented among natural menopausal women (39.2% and 30.9% respectively).

Relationship between cervical cone margins and residual lesions in subsequent hysterectomy.

A cross-sectional study was performed to assess the relationship between cervical conization specimens (pathological diagnosis of CIN III or MIC) and subsequent hysterectomy specimens from 140 patients at Siriraj Hospital. It was found that the pathological diagnosis of CIN III and MIC were related significantly to the lesions found at cervical cane margins (29.8% and 57.7% respectively, P < 0.01) but no relationship to the residual lesions in subsequent hysterectomy (P > 0.05). 98.9% of cone specimens with margin-free have been found absent of residual lesions in subsequent hysterectomy whereas 61.2% of involved margins have been present. Lestions at cervical cone margins were related significantly (P <0.01) to residual lesions in subsequent hysterectomy and could be an appropriate guideline in further management for patients undergone cervical conization.

Incidence and associated risk factors of peripartum hysterectomy.

We present a descriptive study of 86 pregnant women, who underwent peripartum hysterectomy at Siriraj Hospital between 1982 and 1992. The incidence was 0.5 per 1,000 deliveries. The indications leading to hysterectomy were uterine atony, uterine rupture, placenta previa, placenta accrete, tear bleeding, and uterine infection. Common complications were haemorrhage and infection. There were 6 maternal deaths (7%) from severe hemorrhage and all of them evinced coagulopathy. Furthermore, there were 9 fetal deaths (10.5%), 2 of them having congenital anomalies. This study indicates that lack of antenatal care, advanced maternal age multiparity, and abnormal delivery are the risk factors for peripartum hysterectomy. To reduce the prevalence and risk of peripartum hysterectomy; parity, appropriate maternal age at pregnancy, high quality antenatal care and good intrapartum care are factors to consider.

Rudimentary horn pregnancy.

A case of pregnancy in rudimentary horn is presented, and a discussion of this rare and potentially catastrophic phenomenon follows. The correct diagnosis was only made at laparotomy for acute abdominal pain when the patient was 16 weeks pregnant. Definite clinical palpation of the pregnant uterus together with ultrasonographic evidence of a viable fetus misled the diagnosis. When this condition is suspected the diagnosis may be aided by ultrasound searching of the uterus.