The pregnancy rates--a retrospective comparison of tubal and uterine embryo transfers.

Tubal embryo transfer (TET), which involves an embryo transfer via the uterine tube, has a possible advantage over uterine embryo transfer (UET) due to more natural timing of embryo exposure to the uterine cavity. This study was carried out to evaluate the pregnancy rate of TET versus UET. Eight hundred and ninety-seven consecutive patients who underwent embryo transfers from July 1997 to June 1999 in Bielefelder Institut fuer Fortpflanzungsmedizin (BIF.), Germany were included in this study. Two hundred and eighty-six pregnancies were achieved in 167 cases (31.4%) after TET and 119 cases (24.6%) after UET. The abortion rate of the TET group was 12.0 per cent while that of the UET group was 23.3 per cent. Our results showed that TET has a significantly increased clinical pregnancy rate and significantly decreased abortion rate. There is an advantage in transferring embryos to the fallopian tube in infertile couples with male factor infertility and unexplained infertility. We recommend TET as the first choice for embryo transfer in infertile couples with patent fallopian tubes and with no evidence of pelvic adhesion and/or endometriosis.

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.

Cesarean hysterectomy in Siriraj Hospital: a 5-year review.

Cesarean hysterectomy remains a necessary procedure for life saving during abdominal delivery. The procedure itself is usually associated with considerable perioperative morbidity, especially when performed under emergency conditions. Obstetricians should identify patients at risk and anticipate the procedure and its complications. Knowledge of this operation and skill at its performance can be very helpful in reducing perioperative maternal and perinatal morbidity.