Risk factors for cesarean hysterectomy in cesarean delivery.

OBJECTIVE: To identify the risk factors for cesarean hysterectomy. MATERIAL AND METHOD: A case-control study was conducted by reviewing the medical records of pregnant women delivered in King Chulalongkorn Memorial Hospital between January 1994 and December 2004. Cases included pregnant women who underwent hysterectomy immediately or within 24 hours after cesarean delivery, whereas control referred to pregnant women who underwent cesarean section at the same period. RESULTS: Of the 109,005 deliveries, twenty-seven women (0.25/1000-delivery) underwent cesarean hysterectomy. With multivariate analysis, the risk factors significantly associated with peripartum hysterectomy were placenta previa (adjusted OR = 67.96, 95% CI = 15.32, 301.46) and multiparity (adjusted OR = 7.30, 95% CI = 1.24, 43.19). When compared to controls, cases with cesarean hysterectomy had higher incidence of maternal and neonatal morbidities, needed more blood transfusion and required longer hospital stays. Operation performed in daytime found to have less mean blood loss (1,766 ml) compared to operation at nighttime (5,730 ml). CONCLUSIONS: Placenta previa and multiparity were significant risk factors of cesarean hysterectomy. Cesarean section in these cases should be done by experienced obstetricians with good preoperative care and if possible, during the daytime. Before an operation, each patient and her family should be counseled and informed regarding the risk for complications included hysterectomy.

Randomized comparison of lower and standard dosages of transdermal estradiol on serum estradiol levels and vaginal maturation index.

OBJECTIVE: To evaluate serum estradiol (E2) in postmenopausal women who received 0.025 mg/d or 0.05 mg/d transdermal estradiol, in an equivalent trial. MATERIAL AND METHOD: One hundred and eight postmenopausal women were randomized into 0.025 mg/d and 0.05 mg/d of transdermal E2 matrix patch. After 12 weeks, serum E2 and vaginal maturation index (VMI) were checked in both groups. Adverse effects, such as breast tenderness, application site reaction, weight gain, and headache, were also assessed. RESULTS: Serum E2 in 0.025 mg/d and 0.05 mg/d groups were 42.43 +/- 35.11 and 48.41 +/- 22.36 pg/mL, respectively. There was no statistically significant difference between the groups. Equivalence was found under CI of +/- 14 pg/mL. Mean value of superficial cells and vaginal maturation index (VMI) were comparable between both groups. Adverse effects seem to be less in the lower dosage group compared to the standard dosage group. CONCLUSION: The lower dosage (0.025 mg/d) of the transdermal E2 matrix system is probably an appropriate treatment option for postmenopausal women who need minimal effective and minimal adverse effects.

Laparoscopic finding in Thai women with chronic pelvic pain.

OBJECTIVE: To study the laparoscopic findings in Thai women with chronic pelvic pain. SETTING: The Gynecology Endoscopy unit, Department of Obstetrics and Gynecology, Faculty of Medicine, King Chulalongkorn Memorial hospital. DESIGN: Descriptive study. MATERIAL AND METHOD: The medical records of Thai women with chronic pelvic pain undergoing laparoscopic diagnosis from January 1996 to December 2001 at King Chulalongkorn Hospital were reviewed. Patients' characteristics and laparoscopic findings were reviewed and analyzed. RESULTS: One hundred and ten eligible women were enrolled in this study. The mean age was 33.9 +/- 7.2 years old (16-54 years old). Sixty-seven (60.90%) women had endometriosis, 14 (12.73%) women had pelvic adhesion, 4 (3.64%) women had myoma uteri, 4 (3.64%) women had tubal occlusion and 13 (11.81%) women had normal findings. The majority (38.15%) of endometriosis findings were in minimal stage of American Fertility Society (AFS) scores. CONCLUSIONS: The vast majority of causes of chronic pelvic pain in women in this study was pelvic endometriosis. Laparoscopic diagnosis was an important tool for identifying the causes in Thai patients.

Bilateral tubal pregnancies after tubal sterilization in a human immunodeficiency virus seropositive woman.

Bilateral tubal ectopic pregnancies are rare occurrences. Bilateral tubal ectopic pregnancy in a patient who had undergone tubal sterilization is also very rare. The authors report a case of a 32-year-old, gravida 2, parity 1, human immunodeficiency virus seropositive who had previously undergone tubal sterilization. She presented with abdominal distention and vaginal bleeding after 12 weeks of amenorrhea. Pre-operative diagnosis was ruptured ectopic pregnancy. Emergency exploratory laparotomy and bilateral salpingectomy were performed. The pathology report confirmed bilateral tubal pregnancies. She was well at the fifth day of discharge and four-week follow-up. Ectopic pregnancy should always be suspected in reproductive-age patients presenting with amenorrhea even if they have undergone tubal sterilization. To the authors' knowledge, there has been no report of bilateral tubal pregnancy in a patient with human immunodeficiency virus seropositive after tubal sterilization.