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.

Pregnancy outcome of twin pregnancy in Ramathibodi Hospital.

OBJECTIVES: To evaluate maternal and neonatal complications and pregnancy outcomes of twin pregnancies. MATERIAL AND METHOD: The retrospective analysis included data on the twin pregnancies delivered at Ramathibodi Hospital between January 1995 and December 2000. The data retrieved from the medical records included demographic data, complications of pregnancy, and maternal and neonatal outcomes. Statistical analysis was performed. RESULTS: Of 374 twin pregnancies, 321 cases had completed medical records. Incidence of twin pregnancies was 8.6 per 1,000 births. Most common maternal complication was preterm delivery (49.2%). Other maternal complications were anemia (21.5%), pregnancy induced hypertension (13.4%), premature rupture of membranes (10%), postpartum hemorrhage (5.6%) and antepartum haemorrhage (1.9%), respectively. Median gestational age at delivery was 37 weeks. Most common route of delivery was caesarean section (58.3%). Most common neonatal complication was low birth weight (62.3%). Perinatal mortality rate was 45 per 1,000 births. Prematurity was the most common cause of neonatal death. No neonatal death was found after 34 weeks of gestation. CONCLUSION: Twin pregnancy has high maternal and neonatal complications, especially preterm delivery that increases risk of significant neonatal morbidity and mortality.

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.