Indications for cesarean section at Thammasat University Hospital.

OBJECTIVE: To present the indications associated with the increase in cesarean section rate at Thammasat University Hospital during the past three years. MATERIAL AND METHOD: This was a cross-sectional study. Pregnant women who underwent cesarean section between January 2003 and December 2005 at Thammasat University Hospital were recruited for the present study. Cases of fetal anomaly or intrauterine fetal death were excluded. Demographic and obstetric data including indications of cesarean section and pregnancy outcomes were collected and analyzed RESULTS: Among the 1328, 1402, and 1522 cases of cesarean section (27.31, 27.94, and 29.26%) in 2003, 2004 and 2005 respectively, the major indication was previous cesarean section (29%). Cephalopelvic disproportion (CPD), and elective cesarean section were second, and third most common indication (24.64%, 11.23%) respectively. CONCLUSION: The increasing cesarean section rate was due to rising of elective cesarean section or patient's request. Cesarean section without obstetric indication should be reconsidered to lower the cesarean section rate.

Reducing cesarean delivery rates: an active management labor program in a setting with limited resources.

OBJECTIVE: To determine the effect of an active management of a labor program on the rate of cesarean section and labor outcomes in low-risk nulliparous pregnancies in a setting with limited resources. MATERIAL AND METHOD: Nine hundred and seventy-five low risk nulliparous pregnant women were randomized to receive either active management of a labor program (n = 325) or conventional management (n = 650). The rate of cesarean section and labor outcomes were compared between the two groups using Chi-square and t-tests. RESULTS: The subjects in the active management program had significantly shortened first stage of labor and total duration of labor compared with the conventional group (538.0 +/- 242.9 min vs 589.4 +/- 263.8 min, p < 0.05, 539.3 +/- 261.4 min vs 610.3 +/- 264.4 min, p < 0.001, respectively). There was no statistical difference found in the rate of cesarean section and other labor outcomes. CONCLUSION: The active management program shortened the first stage and duration of labor in low-risk nulliparous pregnant women.

Normal value of bone mineral density of lumbar spine, proximal femur, and distal forearm of women in different age groups.

The cross sectional, descriptive study was conducted to find the reference data for bone mineral density (BMD) in normal women in the area around Thammasat University Hospital. The study population consisted of 806 women aged 15-80 years. BMD of different parts of the body were measured by dual energy photon absorptiometer. The results showed that mean (+/- SD) BMD of the lumbar spine 2, 3, 4, neck of femur, Ward's triangle of femur, greater trochanter of femur, ultradistal part of radius, and distal ulnar averaged from all age groups were 0.954 +/- 0.144, 1.027 +/- 0.151, 1.059 +/- 0.147, 0.898 +/- 0.114, 0.774 +/- 0.165, 0.777 +/- 0.103, 0.412 +/- 0.073, and 0.585 +/- 0.096 g/cm2 respectively. Overall, the peak BMD was between the age of 40-44 years old. It started decreasing from the age of 45 and decreased remarkably after the age of 50. The data is shown to be a database for our hospital's health policy, but the authors believe that it could also be used as reference data for future studies in Thailand. It is suggested that normal values in different areas should be available in the future in order to provide more specific and better health care according to demographic variation.