ABSTRACT
A randomized single blind clinical trial was carried out in order to compare the effectiveness of oral morphine syrup and injected morphine in premedication of postpartum tubal sterilization by local anaesthesia. A total of 200 postpartum patients were divided into two groups by systemic random sampling. The first group of 100 patients was premedicated with 30 mgs of syrup morphine orally 90 minutes before operation, and the second group of 100 patients was premedicated with 10 mgs of morphine hydrochloride via the intramuscular route 15 minutes before operation. All patients were given tubal sterilization by first- and second- year residents, using the modified Pomeroy technique. The pain experienced by each patient during the operation was evaluated by verbal and numerical rating scales. The pain scores and the operating time of both groups were analysed by the Mann Whitney U test and pair t test, respectively. The pain scores of the first and second group were 3.644 + 1.802 and 3.570 + 1.470, respectively, with no significant difference. The operating time was 10.300 + 1.904 and 11.200+ 2.543 minutes in the first and second group, respectively. The effectiveness of oral morphine syrup and intramuscular morphine in premedication for postpartum tubal sterilization was found to give the same results. The cost-effectiveness of oral morphine syrup is greater and it can therefore replace intramuscular morphine in premedication for postpartum tubal sterilization.
ABSTRACT
To identify risk factors associated with emergency cesarean hysterectomy at Siriraj Hospital, medical records of 93 patients who underwent emergency cesarean hysterectomy from January 1986 through December 1995 were retrospectively compared with those of 372 selected controls who underwent cesarean section at the time close to the first group (case : control = 1:4). The incidence of emergency cesarean hysterectomy during the period was 4.07 / 1,000 cesarean sections. Multivariable analysis revealed that age > 35 years (OR=9.7,95% CI : 3.7-24.9), placenta preview (OR = 4.8, 95% CI : 2.2-10.6), age 31-34 years (OR=4.3,95% CI : 1.7-11.3) and parity >3 (OR=3.4,95% CI : 1.6-7.1) were independent factors significantly associated with emergency cesarean hysterectomy (P<0.01). Emergency cesarean hysterectomy remains a necessary procedure for life saving during abdominal delivery. Identification of patients at risk, knowledge of this operation and skill at its performance can be very helpful in reducing maternal morbidity and mortality.
ABSTRACT
From May 1995 to June 1996, a total of 256 patients with associated gynecologic conditions requiring further cervical biopsy, cervical conization or total abdominal hysterectomy at Siriraj Hospital underwent examination for cervical neoplasia by speculoscopy without prior knowledge of the results of previous Pap smears. Compared with the histological results for the cervix, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate of speculoscopy in the detection of cerical neoplasia were 82.0, 84.6, 79.2, 82.1, 81.9, 20.8 and 15.4 per cent respectively. When speculoscopy and Pap smear were combinded, sensitivity increased and the false negative rate decreased. In places where cervical cancer screening by Pap smear are not well established, speculoscopy could be an alternative method offering fair to good results compared with Pap smear.
ABSTRACT
A cross-sectional study was performed to assess the relationship between cervical conization specimens (pathological diagnosis of CIN III or MIC) and subsequent hysterectomy specimens from 140 patients at Siriraj Hospital. It was found that the pathological diagnosis of CIN III and MIC were related significantly to the lesions found at cervical cane margins (29.8% and 57.7% respectively, P < 0.01) but no relationship to the residual lesions in subsequent hysterectomy (P > 0.05). 98.9% of cone specimens with margin-free have been found absent of residual lesions in subsequent hysterectomy whereas 61.2% of involved margins have been present. Lestions at cervical cone margins were related significantly (P <0.01) to residual lesions in subsequent hysterectomy and could be an appropriate guideline in further management for patients undergone cervical conization.