The use of low dose 1.5 mg prostaglandin E2 gel for cervical ripening and induction of labor at term with unfavorable cervix.

A prospective study was undertaken to evaluate the efficacy and safety of a 1.5 mg prostaglandin E2 gel applied intracervically for the initiation of cervical ripening before the induction of labor. All patients were required to have an initial Bishop score of four or less. There was a total of 220 pregnant women in this study and primipara accounted for 175 or 80 per cent of the pregnant women. The 1.5 mg PGE2 gel was found to be an effective means of cervical ripening in both primipara and multipara with a success rate of 77.7 and 93.3 per cent after the first application to 96 and 100 per cent in the second application, respectively. The mean induction to delivery time was 25.17 hours in primipara and 13.57 hours in multipara. The mean amniotomy to delivery time was 7.55 and 4.65 hours in primipara and multipara, respectively. The cesarean section rate was 48 per cent and 18 per cent in primipara and multipara, respectively. The side-effects were minimal. These results compare well with other reported studies using different dosages and routes.

Mid-trimester abortion using hypertonic saline or prostaglandin E2 gel: an analysis of efficacy and complications.

A total of 149 mid-trimester termination of pregnancies using hypertonic saline infusion (125) or prostaglandin E2 gel (24) have been analyzed for efficacy and complications. The mean induction to abortion time (I-A) was 31.7 +/- 9.2 hours in hypertonic saline (HSI) group and 28.4 +/- 27.7 hours in prostaglandin (PGE2) group. Retained placenta occurred in 76 (63.3%) in HSI group and 6 (25%) in PGE2 group. Four (3.3%) in HSI group had pyrexia over 38.5 degrees C and the only one case with proven sepsis developed disseminated intravascular coagulation defect (DIC) which accounted for one case (0.8%) of blood loss of more than 500 ml. There was also one case of mildly disturbed electrolytes in HSI group occurring during the instillation. Minor side-effects of nausea and vomiting occurred in 4 (16.7%) in the PGE2 group only.

Operative obstetrics at Ramathibodi Hospital, 1970-1990.

A 21-year retrospective review of operative obstetrics at the Department of Obstetrics and Gynaecology, Ramathibodi Hospital was reported from January 1, 1970 to December 31, 1990. There were a total of 128,630 deliveries, of which 41,724 (32.4%) were abnormal deliveries. Forceps, vacuum and cesarean section still increased, but vaginal breech deliveries have lost their popularity in this institution.

Control of uterine hyperactivity caused by prostaglandin with intravenous terbutaline: a case report.

Prostaglandin E2 is beginning to be used more widely for the induction of labor in this country. The main concern with vaginal administration is the difficulty in stopping uterine hyperactivity. This report is a case where intravenous terbutaline was given as soon as hyperactivity and fetal heart rate deceleration were detected. Using this treatment, hyperactivity was controlled and the fetal heart rate returned to normal. Unfortunately, cesarean section was necessary for fetal distress which developed two and a half hours later when syntocinon was started intravenously to augment the labor.

Ripening of the unfavorable cervix with prostaglandin E2: intracervical versus intravaginal route.

Forty-eight term primiparae women with unripe cervix (Bishop score of 4 or less) were randomly given either 1.5 mg of prostaglandin E2 in 3 ml of gel intracervically or 3 mg prostaglandin E2 tablet intravaginally to ripen the cervix. Intracervical administration caused favorable cervix in 36 per cent compared with 12 per cent in the intravaginal group, and induced spontaneous labor in 41 per cent compared with 69 per cent in the intravaginal group. Oxytocin augmentation was required in 88 per cent in the intracervical group compared to 62 per cent in the intravaginal group. The only significant difference statistically was the mean duration of the insertion of PGE2 to delivery being 16 hours and 23.5 hours in the intracervical and intravaginal routes respectively (P = 0.02). There was one case of hyperstimulation and one case of maternal death from amniotic fluid embolism in this study.

Coitus, oral-genital sex and anal intercourse.

Current evidence suggests that there is a change of attitude towards more permissive sex among the young and educated people in Thailand compared to other oriental countries. This study aimed to find the frequency of coitus, oral-genital sex and anal intercourse among new female patients who attended the sexual health clinic, Ramathibodi Hospital in 1990. The gynecologist in charge interviewed the patients using a questionnaire. The total number of participants was 408. Coital frequency ranged from < 1 to 7 times per week with 1, 2, 3 as the first three leading rate. There were 107 women (26.2%) and 150 men (36.8%) who had experienced fellatio and cunnilingus, respectively. Only 5.6 per cent had anal intercourse. These findings add more knowledge about the sexual behavior among Thais and that a certain group of people are not strictly conservative in their attitude towards sex and that males are more permissive than females.

Low birthweight in Thailand: 1982.

Birthweight is sensitive index of social and economic change. The objectives of this study are to establish baseline birthweight, per cent of low birthweight and to determine maternal characteristics on LBW among Thai mothers. The study was based on data from birth records which was collected in 1982. The total number of samples used was 28,952. The lowest mean birthweight occurred in the North and Northeastern regions. These two regions had a mean birthweight of less than 3,000 g. The incidence of LBW was highest in the North at 12.8 per cent. The per cent of birthweight showed the highest with maternal age less than 20 years or parity equal to zero. Unskilled workers showed the highest per cent of LBW in the Northeast, North and the East and housewives in the West and South and farmers in the North.

Induction of labor using intracervical prostaglandin E2 gel: the outcome.

A prospective study was undertaken to evaluate the safety and efficacy of a 3 mg prostaglandin E2 (PGE2) gel applied intracervically for the initiation of cervical ripening before the induction of labor. All patients were required to have an initial Bishop score of 4 or less. The 3 mg PGE2 gel was found to be an effective method of cervical ripening in primigravida and multigravida with a success rate of 76 and 86.8 per cent after the first application to 96.4 and 97.4 per cent after third application respectively. The mean induction to delivery time was 22 hours in primigravida and 13 hours in multigravida. The mean amniotomy to delivery time was 6 hours and 4 hours in primigravida and multigravida respectively. However, the incidence of cesarean section was not improved as expected and there was one instance of uterine hyperstimulation. The only serious complication was one uterine rupture that occurred in multigravida with the prolonged use of oxytocin.

Comparison of intravenous oxytocin with and without vaginal prostaglandin E2 gel in term pregnancy with premature rupture of membranes and unfavorable cervix.

Forty-seven nulliparous term pregnant women with PROM and unfavorable cervix, were randomly divided into 23 patients who were observed for four hours then followed by intravenous oxytocin, and 24 patients who were given 3 mg PGE2 gel intravaginally then followed by intravenous oxytocin four hours later. No statistically significant difference was observed between the two treatment groups with regard to Bishop score four hours after observation, intravenous oxytocin to delivery time, Apgar score at 1 and 5 minutes and maternal puerperal complications in both groups. It can be concluded that PGE2 did not significantly improve Bishop score or shorten the induction to delivery time in cases of PROM with unfavorable cervix. Intravenous oxytocin is still preferable both in terms of cost and effectiveness.

Hydrops fetalis due to Bart hemoglobinopathy at Ramathibodi Hospital (1978-1987): a 10-year review.

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.

Fetal outcome in term frank breech primipara delivered vaginally and by elective cesarean section.

A retrospective study was carried out over a 3-year period comparing the fetal outcome of primiparous term frank breech delivered vaginally with those by elective cesarean section. There were 87 patients delivered by vaginal route and 176 by abdominal route. The staff delivered 13 per cent by vaginal route against 57 per cent by residents. There were no statistical differences in apgar score at 1 and 5 minutes with regard to the routes of delivery, different fetal birthweights and obstetrical experience of the accoucheur. There were no perinatal deaths. The concept of elective cesarean section in all primiparous term frank breech should be reconsidered.