Effect of lower uterine segment sweeping on progress of labor in nullipara.

Previous studies have shown that sweeping between the membranes and lower uterine segment was an effective procedure for reducing prolonged pregnancy. However, there has been no study to show the effect of lower uterine segment sweeping to the progress of the active phase of labor. This study was to determine the effect of lower uterine segment sweeping on the progress of the active phase of labor in nullipara. A total of four hundred nulliparous term pregnant women with spontaneous labor were randomized to one of two groups; the control group had routine vaginal examination while the study group had lower uterine segment sweeping at the time of each examination. Oxytocin infusion was given if there was dysfunctional labor. Progression of labor and the need for oxytocin augmentation were reviewed. Data were analyzed by chi square and Student t-test. Oxytocin was used in 67 per cent of the sweeping group and 62 per cent of the control group (p=0.3). The duration of the first stage (0.46), the second stage (0.38), and the third stage (0.28) of labor were not significantly different between the two groups. In conclusion, lower uterine segment sweeping did not reduce the need for oxytocin augmentation or lessen the duration of labor in nullipara.

Spontaneous abortion rate.

OBJECTIVE: To study the incidence of spontaneous abortion and relationship between incidence and maternal age profession, education level and income. STUDY DESIGN: Prospective cohort study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. SUBJECTS: 999 patients registered at antenatal care unit, Department of Obstetrics and Gynecology from July 1, 1992. MAIN OUTCOME: Number of spontaneous abortion measures. RESULTS: From 999 patients, 69 were excluded from the study (8 had induced abortion, 61 could not be contacted). Most of patients aged 20-34 (85.5%) with the mean of 27 years. Spontaneous abortion occurred in 64 patients, incidence of 6.9 per cent. The analysis of data showed no relationship between the incidence of spontaneous abortion and age, profession, education level and income. CONCLUSION: Compared with previous studies, the incidence of spontaneous abortion is this study was quite low. With regard to the relationship of socioeconomic, further study with larger population should be performed to draw suitable conclusion.

Post-cesarean section urinary tract infection: a comparison between intermittent and indwelling catheterization.

Catheterization, which is widely accepted as an important factor to urinary tract infection, is routinely done during cesarean section. This randomized study was conducted to compare the incidence of urinary tract infection between patients who underwent cesarean section using intermittent catheterization and indwelling catheterization, at the Department of Obstetrics and Gynecology, Ramathibodi Hospital from August 1991 to December 1991. Sixteen of 51 patients (31.4%) of the intermittent group and 9 of 47 patients (19.1%) of the indwelling group developed urinary tract infection. The difference was not statistically significant. Of the patients in the intermittent group 39.2 per cent were found to have postoperative urinary retention requiring recatheterization, whereas all cases in the indwelling group could void after its removal. Klebsiella pneumoniae was the commonest isolated organism. Indwelling catheterization was concluded to be the favourable method.

Cytologic evaluation of smears obtained by self-collection vaginal tampon.

Papanicolaou (Pap) smear test is an established method of cervical cancer screening. However, most women in Thailand are still reluctant to undergo pelvic examination. A prospective study was carried out on the use of self inserted vaginal tampon to collect specimens for Pap test in 126 patients at Ramathibodi Hospital from September to October 1990. The tampons which were inserted overnight and removed by the patients themselves were smeared across a glass slide and immediately fixed in 95 per cent ethyl alcohol. Ninety-six point two per cent of the slides had adequate cells of good quality to be interpreted. The remaining 3.98 per cent could not be interpreted due to the lack of cells and poor cell fixation. It is concluded that the smears obtained by this method are satisfactory for cytologic evaluation.

Manual removal of placenta at Ramathibodi Hospital 1985-1988.

In obstetrics, the need to perform manual removal of placenta is not infrequent. This was a retrospective study of placental removal among all vaginal deliveries at Ramathibodi Hospital from 1985 to 1988. The incidence of manual removal of placenta was 2.1 per 100 parturients which was higher than other reports. The reason for this is still unclear. The patients' age was mostly 26-30 years with multiparity accounting for 73.1 per cent and most deliveries occurred between 38-40 weeks of gestational age. The indication for manual removal of placenta was mostly placental retention. Previous history of curettage in the last gravida accounted for 34.7 per cent of cases. In two cases (0.5%), the procedure failed due to placenta accreta and hysterectomy was required.

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.