Pre-operative diagnosis of alive twin tubal pregnancy.

A case of twin tubal pregnancy was reported. The patient presented with lower abdominal pain with some vaginal bleeding and was diagnosed with transvaginal sonography at approximately eight weeks of gestation. An uneventful salpingectomy was subsequently performed.

Maternal body mass index at term does not predict the severity of preeclampsia.

OBJECTIVE: Maternal pre-pregnancy weight is a risk of developing preeclampsia. Whether it is also associated with the disease severity is still elusive. This retrospective cohort was to determine the association between body mass index (BMI) at term and severity of preeclampsia. MATERIAL AND METHOD: BMIs on the delivery date of 229 patients were analyzed with various indicators of the disease severity. The corrected BMI (cBMI), calculated by an exclusion of feto-placental unit, was additionally analyzed. RESULTS: Neither maternal BMI nor cBMI correlated with the disease severity (p = 0.15 and 0.36). Patients who did and did not require MgSO4 do not have different BMI or cBMI (p = 0.12 and 0.23). Neonatal weight from severe disease arm does not differ from those with mild disease (p = 0.51). Counter-intuitively the correlations between birth weight and maternal BMI were stronger in the severe compared to the mild group (p = 0.0 and 0. 03). CONCLUSION: Neither BMI nor cBMI at the time of delivery predict the severity of preeclampsia or the need for seizure prophylaxis. Birth weight of the baby born from preeclamptic mother might be affected by multiple factors.

Relieving perineal pain after perineorrhaphy by diclofenac rectal suppositories: a randomized double-blinded placebo controlled trial.

BACKGROUND: Perineal pain after episiotomy is a common problem following vaginal birth. The pain affects either physical or mental function negatively. There are many methods in perineal pain relief such as local ice pack and a bath, ultrasound, oral anesthesia, and intravenous anesthesia. Analgesic rectal suppository is one of various methods in pain relief especially in drowsy patients, or when oral preparation causes gastric discomfort, nausea or vomiting. OBJECTIVE: To assess the effectiveness of diclofenac rectal suppositories for relief perineal pain after perineorrhaphy. DESIGN: A randomized double-blinded placebo controlled trial. MATERIAL AND METHOD: Seventy-two term, singleton, pregnant women who gave vaginal birth with second to third degree episiotomy tears were randomized with envelop concealment to either diclofenac or placebo rectal suppositories group. Each group received two tablets of 50 mg diclofenac or two tablets of look-alike placebo rectal suppositories. Visual analogue scale was used for scaling pain score before administration of the medications, and at 30 minutes, 1, 2, 12, and 24 hours after administration. RESULTS: No differences were found in the median pain scores before administration of medications and at 30 min, 1 hour and 2 hour after administration (p > 0.05), while the median pain scores were significantly reduced in the diclofenac group at 12 and 24 hours after administration compared to the control group (4.5 vs. 0.0; p < 0.001 and 2.0 vs. 0.0; p = 0.02 for 12 hours and 24 hours, consecutively). CONCLUSION: The present study suggested that diclofenac suppository was effective on reducing perineal pain after episiotomy, especially at 12 and 24 hours after administration.

Satisfaction of healthy pregnant women receiving short message service via mobile phone for prenatal support: A randomized controlled trial.

OBJECTIVE: The main objective was to compare the satisfaction levels of antenatal care between healthy pregnant women who received short message service (SMS) via mobile phone for prenatal support, and those who did not. The second objective was to compare the confidence, anxiety levels and also pregnancy outcomes. DESIGN: A randomized controlled trial. MATERIAL AND METHOD: 68 healthy pregnant women who attended the antenatal clinic and delivered at Siriraj Hospital, who met the inclusion criterias between May 2007 and October 2007, were enrolled and randomly allocated into two random groups. The study group received two SMS messages per week from 28 weeks of gestation until giving birth. The other group was pregnant women who did not receive SMS. Both groups had the same antenatal and perinatal care. The satisfaction, confidence and anxiety scores were evaluated using a questionnaire at the postpartum ward. The pregnancy outcomes were also compared in these two groups. RESULTS: The satisfaction levels of the women who received prenatal support in SMS messages, were significantly higher than those of who did not receive the messages both in the antenatal period (9.25 vs. 8.00, p < 0.001) and during labor (9.09 vs. 7.90, p = 0.007). In the SMS using group, the confidence level was'higher (8.91 vs. 7.79, p = 0.001) and the anxiety level was lower (2.78 vs. 4.93, p = 0.002) than the control group n the antenatal period, however no diference in pregnancy outcomes were found. CONCLUSION: The present study shows the higher satisfaction level of pregnant women who received SMS via mobile phone during their antenatal service when compared with the general antenatal care group. The study also show the higher confidence level and lower anxiety level in the antenatal period but no difference in pregnancy outcomes.

Prevalence and associate factors for striae gravidarum.

OBJECTIVE: To determine the prevalence and associate factors for striae gravidarum in Thai pregnant women. STUDY DESIGN: Cross-sectional study. MATERIAL AND METHOD: Two hundred and eighty women who gave first birth and were admitted to the postpartum wards in Siriraj Hospital were recruited. All of them were assessed during the immediate postpartum period for having striae gravidarum or not by the physician. The questionnaire was used to interview the participants for all of the information needed in the present study. The participants with striae gravidarum and the other without striae gravidarum were compared to characteristics of women using unpaired student t test and Chi-square tests. RESULTS: Seventy-seven percent of the study participants had developed striae gravidarum. Women who developed striae gravidarum were significantly younger (22.8 yr +/- 4.0 yr vs. 26.6 yr +/- 6.0 yr; p < 0.05), higher pre-pregnancy BMI (21.2 kg/m2 +/- 4.1 kg/m2 vs. 19.8 kg/m2 +/- 4.8 kg/m2; p < 0.05), higher maternal BMI at pregnancy (27.3 kg/m2 +/- 4.7 kg/m2 vs. 25.6 kg/m2 +/- 6.0 kg/m2; p < 0.05), higher gestational age at delivery (39.1 wk +/- 1.3 wk vs. 38.6 wk +/- 1.1 wk; p < 0.05), higher birth weight of baby (3,078.8 g +/- 411.4 g vs. 2,895.8 g +/- 339.2 g; p < 0.05), alcoholic drinker (91.4% vs. 8.6%; p < 0.05), had a little water intake (7.4 glasses +/- 2.7 glasses vs. 8.3 glasses +/- 3.1 glasses; p < 0.05), and had a family history of striae gravidarum (82.8% vs. 17.2%; p < 0.05) were associated with striae gravidarum. CONCLUSION: Maternal age, pre-pregnancy BMI, maternal BMI at delivery, gestational age at delivery, birth weight of baby, alcoholic drinking, water intake and family history were associated with striae gravidarum.

Three–dimensional prenatal ultrasonography of thanatophoric dysplasia: Initial experience at Siriraj Hospital.

Objective: To initially report the prenatal diagnosis of thanatophoric dysplasia (TD) by using both 2 dimensional (2D-US) and 3 dimensional (3D-US) ultrasonography. Methods: During January 2004 to December 2006, 10 pregnant women who were referred to our Maternal Fetal Medicine Unit due to abnormal skeletal sonographic findings have been extensively investigated by 2D-US and 3D-US. Results: 3 cases of TD (30%) have been identified with an average gestational age of 26 weeks. Sonographic findings demonstrated short limbs, severe micromelia, telephone receiver like femoral bone, bell shaped small thorax, platyspondyly of vertebrae and normal shaped skull in all cases. Prenatal diagnosis was made earlier by 2D-US analysis and then was confirmed by 3D-US. Conclusion: 3D-US provides additional findings and increases interpreter confidence, It provides additional information in the evaluation of fetal skeletal dysplasia, including thanatophoric dysphasia, compared with 2D-US.

Trends in modes of delivery in Siriraj Hospital.

Objective: To determine the changing of trend in methods of delivery in a university hospital, the correlation among each method of delivery as well as the correlation of the cesarean section rates and the perinatal mortality rates. Methods: The medical records of birth in Siriraj Hospital during 1979-2006 were collected and analyzed. The methods of delivery from these data were grouped and categorizes as following : vaginal delivery, cesarean section, forceps extraction, vacuum extraction, vaginal breech delivery and others. Each method of delivery was studied separately in detail for time and accordingly trend and comparatively to the others to find interaction among them. The changing of trend of perinatal mortality rates were also demonstrated to identify the correlation with the cesarean section rate. Results: There were totally 442,635 births for this study. It was found that the percentage of vaginal delivery was decreased from 82.35 % in 1979 to 58.44 % in 2006 while the cesarean section rates was increased steadily from 7.06% in 1979 to 37.77 % in 2006. The other methods of delivery such as forceps extraction, vacuum extraction and vaginal breech delivery do not play significant roles in this changing trend since they have only small proportions ranging from about 2-5% of all deliveries. In the view of perinatal mortality rate , it continuously declined and has been less than 10% in the last 10 years. Conclusion: Regarding to 28-year review, it is clearly established that methods of delivery are now changing. Cesarean section rate rises steadily with unpromising sign of stabilization and is now far beyond the rate suggested by WHO. It directly effects the downward trend of vaginal delivery and also may be to the other methods of delivery such as vaginal breech delivery, forceps extraction and vacuum extraction, approaching the extinction. This study found no significant correlation between the increasing cesarean rates and the perinatal mortality rates.

The effect of pre-pregnancy weight on delivery outcome and birth weight in potential diabetic patients with normal screening for gestational diabetes mellitus in Siriraj Hospital.

OBJECTIVE: To investigate the influence of pre-pregnancy weight on delivery outcome and birth weight in potential diabetic women with normal glucose tolerance. DESIGN: Retrospective Cohort study. MATERIAL AND METHOD: The medical records of 660 pregnant women, who attended the antenatal clinic and delivered at Siriraj Hospital between January 2003 and December 2005, were reviewed and analyzed. They all had the known pre-pregnancy weight and were at risk of gestational diabetes with the normal glucose tolerance. Any pregnant women without pre-pregnancy weight recorded were excluded from the present study. They were classified into two groups according to the pre-pregnancy BMI, one was the overweight group (BMI > or = 27 kg/m2) and the other was the normal weight group (BMI 20-25 kg/m2). Information of the complications of pregnancy, the route of delivery, birth weight, and neonatal outcomes were collected and analyzed. RESULTS: The risks of adverse pregnancy outcomes in overweight women, after adjusting for the confounding factors, were significantly increased, including pre-eclampsia (OR 3.87, 95% CI 2.09-7.25, p < 0.001), cesarean delivery (OR 2.22, 95% CI 1.45-3.39, p < 0.001), cephalopelvic disproportion (OR 2.15, 95% CI 1.35-3.42, p = 0.001), and macrosomia (OR 7.59, 95% CI 1.98-29.09, p < 0.001). CONCLUSION: Even though the screening test for gestational diabetes mellitus is normal, the overweight women still have several adverse pregnancy outcomes.

Reference centile chart for transverse cerebellar diameter (TCD) in Thai fetuses throughout gestation.

Objective: To create a reference centile chart for transverse cerebellar diameter in Thai fetuses throughout gestation. Methods: A total of 780 pregnant women between 13-40 weeks gestation, who attended at the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited. Each fetus was measured only once for the purpose of this study. The mean and fitted centiles were estimated at each week of gestation using linear regression modeling. Results: A total of 752 fetuses were measured for fetal transverse cerebellar diameter. Linear regression models were fitted to estimate the meant 95% confidence interval for transverse cerebellar diameter at each gestational age. The centile chart of this parameter was also presented. Conclusion: Reference centile chart for fetal transverse cerebellar diameter of Thai fetuses was created.

Menopausal symptoms and knowledge towards daily life and hormone replacement therapy among menopausal women in Bangkok.

OBJECTIVE: To evaluate prevalence and intensity of menopausal symptoms, knowledge towards daily life and hormone replacement therapy (HRT) among natural menopause women in Bangkok. DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHOD: One hundred and sixty two natural menopause women who attended the health seminars or exhibitions except topics about menopause and HRT in Siriraj Hospital from March - June 2005. Targeting women were asked to fill out the structured questionnaires. Data concerning personal history, menopausal symptoms, knowledge of menopause, HRT and daily life in menopause were collected. RESULTS: A total of 148 questionnaires (91.4%) were completed for the analyses. Of 148 women, 141 (95.3%) had menopausal symptoms. The most common and most severe menopausal symptom was muscle and joint pains (84.5% and 23.0%, respectively). The majority of the women understood correctly regarding knowledge about menopause issue and daily life during menopause (80.6% and 89.2%, respectively). Although 51.1% of the women showed their knowledge about HRT correctly, only 8.1% were currently using HRT. The main reasons for this low percentage of HRT use were ability to tolerate the menopausal symptoms (49.0%) and lack of correct knowledge about HRT (48.9%). CONCLUSION: The most common and also the most severe menopausal symptom in natural menopause women was muscle and joint pains. Most of them demonstrated their correct understandings about menopause issue and daily life in menopause and half of them demonstrated their correct understandings about HRT.

Double-blind randomized comparison of xylocaine and saline in paracervical block for diagnostic fractional curettage.

Comparative study of the level of the reported pain between patients who received xylocaine and normal saline for paracervical block during fractional curettage was carried out in 70 patients in a double blind randomized controlled trial. One group of patients received xylocaine for paracervical block just before the procedure was performed while the other group received normal saline in the same manner. Self-reported pain intensity using visual analog scale was assessed at four time points including the first time point when Allis tissue forceps was applied on the cervix, the second and third time points when curettage was done on the endocervix and in the endometrial cavity respectively. The last time point was evaluated at 30 minutes after the procedure. The results of the study revealed pain occurring in patients in the normal saline group was more severe than those in the xylocaine group with statistically significant difference at the second time point (visual analog scale 4.80 +/- 2.7 in the normal saline group compared to 3.20 +/- 2.4 in the xylocaine group, p < 0.05) and third time point (visual analog scale 8.17 +/- 2.0 in the normal saline group compared to 4.94 +/- 3.1 in the xylocaine group, p < 0.05 ). On the contrary, pain occurring in patients in the normal saline group and xylocaine group was not statistically significantly different at the first time point (visual analog scale 3.62 +/- 2.7 in the normal saline group compared to 3.97 +/- 2.8 in the xylocaine group, p > 0.05) and the fourth time point (visual analog scale 1.34 +/- 2.0 in the normal saline group compared to 1.57 +/- 2.6 in the xylocaine group, p > 0.05). Before this study, there was an idea that normal saline solution could be considered for the paracervical injection solution. The explanation for this was the local anesthetic mechanism may be from distension of nerve capsules rather than blockage of specific autonomic nerves. However, this study showed that nerve capsule distension is not the only factor for pain control in paracervical block. An analgesic agent is still an important factor.

Morbidity and mortality from birth before arrival at Siriraj Hospital.

OBJECTIVE: To identify maternal and infant morbidity and mortality from birth before arrival at Siriraj Hospital. STUDY DESIGN: Prospective case-control study. Setting: Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECTS: Three hundred and twenty patients, who had delivered at Siriraj Hospital, were divided into two groups. The study group consisted of 160 patients, who gave birth before admission to the labour room of Siriraj Hospital. The control group consisted of 160 patients, who had normal deliveries in the labour room of Siriraj Hospital at the same period of time. INTERVENTION: Interviewing the patients and reviewing the medical records of the mothers and infants from both groups. The data were analyzed by using the EpiInfo program. MAIN OUTCOME MEASURE: Maternal and infant characteristics after delivery, maternal and infant outcomes including puerperal morbidity, low birth weight, perinatal death and infant morbidity. RESULTS: The study showed that the mothers in the study group had to stay in the hospital longer than the control group (3.9 +/- 2.5 days and 3.6 +/- 1.3 days respectively, p < 0.05). The infants in the study group also had to stay in the hospital longer than the control group (5.1. +/- 6.5 days and 3.3 +/- 1.7 days respectively, p < 0.001). The birth weights of infants in the study group were significantly lower than in the control group (2,753.4 +/- 594.1 grams and 3,016.6 +/- 405.0. grams respectively, p < 0.001). The body temperature of the newborns in the study group were also lower than in the control group (36.2 +/- 0.6 degree Celsius and 37.0 +/- 0.4 degree Celsius respectively, p < 0.05). Concerning maternal and infant outcomes, all variables including low birth weight,perinatal death and infant morbidity were better in the control group significantly (p < 0.05) except for puerperal morbidity that had no significant difference (p = 0.77). CONCLUSION: From the present study, the authors confirmed the higher mortality and morbidity rate of infants who were born unexpectedly before hospital admission. However, there was no difference in morbidity between the mothers of both groups.

Risk factors for birth before arrival at Siriraj Hospital.

OBJECTIVE: To assess the potential risk factors for birth before arrival at Siriraj Hospital. STUDY DESIGN: Prospective case-control study. SETTING: Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECTS: The subjects were 320 patients who had delivered at Siriraj Hospital and were divided into two groups. One hundred and sixty patients, who gave birth before admission to the labor room of Siriraj Hospital, were assigned as the study group. The control group consisted of 160 patients who had normal deliveries in the labor room of Siriraj Hospital at the same period of time. INTERVENTION: Information was obtained by interviewing the patients. Both the interviewer and the subjects were blinded to each other. The data were analyzed by using logistic regression model and EpiInfo program. MAIN OUTCOME MEASURE: Information of antenatal care, socio-economic data, past obstetric history and present data of delivery. RESULTS: The six significant risk factors were identified; education level of the patients (odds ratio 6.11), past history of previous delivery (odds ratio 6.18), past history of preterm delivery (odds ratio 4.03), no antenatal care (odds ratio 8.55), unawareness of true labor symptoms (odds ratio 1.89) and present preterm delivery (odds ratio 2.99). CONCLUSION: The risk factors identified from this study were low education level, past history of previous delivery, past history of preterm delivery, no antenatal care, unawareness of symptoms of true labor and present preterm delivery. The risk factors from this study should have further study to get more information that can apply to control birth before arrival.

Prevalence of overactive bladder among nurses at Siriraj Hospital.

Objective : To determine the prevalence of overactive bladder among nurses at Siriraj Hospital. Study Design : Descriptive study. Subjects : 300 nurses working at Siriraj Hospital. Intervention : Each subject was randomly selected and interviewed regarding symptoms of overactive bladder using a standardized questionnaire. Results : Of 300 nurses included in this study, the prevalence of overactive bladder was 21.3% (95% CI 16.9-26.5). Urgency, the main symptom, was found to occur in 32.8%.The common associated symptoms were frequency and urge incontinence which were found in 23.4% and 11.4% respectively. Concerning the impact of the disease on various aspects of quality of life , we found there was no affect in 40-95% of cases, in 4-50 % there was a moderate effect and a strong effect on the quality of life in 0-12%. Surprisingly, only 10.9% of affected subjects had sought medical treatment for their symptoms, The remaining women appeared unconcerned by their problems. Conclusion : The prevalence of overactive bladder among nurses working at Siriraj Hospital was 21.3% which was very high. However, only a few cases sought medical help. This study provides baseline information concerning this condition in Thai women. Promotion of knowledge and awareness of this condition should be provided, as well as further research concerning various aspects should be conducted, in order to assess how interaction might improve the quality of life of affected women.

Increasing trend of illicit drug abuse in Thai parturient at Siriraj Hospital.

OBJECTIVE: To report the magnitude of the problem and to evaluate the outcome of maternal illicit drug use in Thai parturients. DESIGN: Retrospective case-control study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECT: The subjects were 44,640 parturients who had deliveries at Siriraj Hospital from January 1998 to December 2001 and were divided into two groups. The study group consisted of 66 parturients with a history of illicit drug use and the control group consisted of 44,574 parturients without a history of illicit drug use. INTERVENTION: Medical records of 66 parturients with a history of illicit drug use were reviewed. Obstetric statistics of the department were retrieved from the computerized database in the Division of Obstetric and Gynecologic Registry. The data were analyzed using descriptive statistics. MAIN OUTCOME MEASURE: Characteristics of parturients, pregnancy outcome, type and incidence of illicit drug. RESULTS: Within the study period, 66 cases of maternal illicit drug use were identifiable during the intrapartum period; 65 cases used amphetamine or derivatives and 1 case used an opioid derivative. The number had risen from 1 case in 1998 to 58 cases in 2001. Mean age of the patients was 23.30 +/- 6.04 years. Compared to the control group which included 44,574 parturients, the patients had a lower incidence of antenatal care (ANC rate = 21.21% vs 94.35%; RR = 0.23, 95% CI = 0.14-0.26), a higher incidence of HIV infection (10% vs 2%; RR = 6.09, 95% CI = 2.83-13.12), a higher incidence of birth before arrival (BBA rate = 9.09% vs 1.06%; RR = 8.59, 95% CI = 3.98-18.51), and a lower cesarean section rate (10.60% vs 26.36%; RR = 0.40, 95% CI = 0.20-0.81). There were no serious intrapartum, immediate postpartum and neonatal complication. Fetal outcome included a higher incidence of low birth weight infants (22.73% vs 10.23%; RR = 2.22, 95% CI = 1.42-3.46) and a smaller head circumference than the normal range of Thai fetal biometry (31.85 +/- 1.47 cm). CONCLUSION: There is an increasing trend of illicit drug use in Thai parturients. Although the present case series of drug abuse in Thai parturients cannot give the whole picture of maternal drug abuse in the Thai population, the dramatic increase in the identifiable cases during the past 4 years is very alarming. Currently, the outcome of pregnancy in case detected during intrapartum is not much different from that in the general population. However, there are potential risks for the patients and their babies. All medical staffs should be aware of this condition. Careful clinical data gathering and laboratory testing are suggested for prevention of complications and the potential hazards of this problem.

Placental ratio and fetal growth pattern.

INTRODUCTION: Placental hypertrophy and reduced fetal growth have been postulated to be an adaptation to maintain placental function in pregnant women with complications such as malnutrition. If this is true, a pregnancy with impaired fetal growth, resulting in a small for gestational age (SGA) infant, should have an increased placental weight to birthweight ratio (placental ratio) compared to those with appropriate for gestational age (AGA) or large for gestational age (LGA) infants. OBJECTIVES: To determine the relationship between placental ratio and fetal growth pattern. MATERIAL AND METHOD: Labour and delivery data of 1000 deliveries in the Department of Obstetrics & Gynecology, Siriraj Hospital from January 2001 to June 2001 were retrospectively studied to compare the placental ratios among pregnancies with SGA, appropriate for gestational age (AGA) and large for gestational age (LGA) infants. RESULTS: From 96 SGA, 804 AGA and 100 LGA cases, a higher placental ratio was found in the SGA group compared to AGA (0.2074 and 0.1985 respectively, p = 0.013). However, actual placental hypertrophy was not found as demonstrated by a lower placental weight in SGA compared with AGA pregnancies of the same birthweight range. There was no significant difference in placental ratio between the LGA and AGA group, the ratios being 0.2020 and 0.1985 respectively (p = 0.260). Although a positive correlation between placental weight and birthweight was observed in the AGA and LGA groups, it was not demonstrated in the SGA infants. This might influence the placental ratio in the SGA group. CONCLUSION: SGA pregnancies are associated with an increased placental ratio which appears not to be due to placental hypertrophy. As reduced birthweight has been shown to be correlated to diseases in adult life, whether this association between SGA and an increased placental ratio will have an implication in future obstetric care and prediction of diseases in adult life remains to be elucidated.

Effect of a newly developed abdominal webbing strap for pain relief after exploratory laparotomy in gynaecological patients.

The effect of a newly developed abdominal webbing strap for pain relief after exploratory laparotomy in gynaecological patients was studied using a quasi-experimental method. The subjects consisted of 60 patients in gynaecological wards and were randomly allocated into 2 groups as a control group and an experimental group. The experimental group was given the webbing strap when they gained consciousness after operation until 72 hours later while the control group was not. A visual analogue scale was used to evaluate the pain level experienced by the patient. The percentage changes in pain level while resting, coughing and walking were evaluated in both groups at 24, 48, and 72 hours after operation. The data were then analysed using the Student t-test. The results of the study showed no statistical difference in the decrease of pain level for either group while they were resting (P > 0.05) at every time of evaluation. On the contrary, at every time of evaluation, the pain level of the experimental group showed a greater decrease than the control group when coughing or walking which was statistically significant (P < 0.001). The quantity of analgesic usage was also not statistically different for either group (P > 0.05). As a result of this, we suggest our new developed webbing strap should be used routinely in gynaecological patients after exploratory laparotomy.

Clinical experience of the use of tolterodine in patients with overactive bladder at Siriraj Hospital.

Objective : To determine the efficacy of Tolterodine in patients with overactive bladder. Design : Open study. Setting : Gynaecological Outpatient Clinic, Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. Subjects : From August 2000 to June 2001, thirty patients who met the symptomatic definition of overactive bladder without local or metabolic causes were enrolled in this study. Intervention : Tolterodine 2 mg bid were given to the patients for 12 weeks. Main outcoem measurement : Patients' global opinion on results of treatment , change in voiding frequency, urgency episodes, urge incontinence episodes, and adverse events from medication. Results : Patients' global opinion showed a marked improvement in the condition in 6 cases (4 cases showed improvement in 2 weeks while the other 2 cases within 4 weeks of treatment), some improvement in 20 cases and failure of treatment in 4 cases (1 case discontinued at 2 weeks due to severe headache, 2 cases at 4 and 8 weeks due to lack of improvement and 1 case at 4 weeks due to economic problems). The mean number of voids per 24 hours showed a trend to decrease since the start of treatment from 12 times per 24 hours to 6 times per 24 hours after 12 weeks of treatment. The mean number of days with urgency per week showed a decreasing trend since the start of treatment from 2.8 days per week to less than 1 day per week after 12 weeks of treatment. The mean number of days with incontinence per week decreased from 3.5 days per week at the start of treatment to less than 1 day per week after 12 weeks of treatment. The adverse events from medication included a dry mouth in 15 cases (12 cases with mild degree and 3 cases with moderate degree ), 5 cases had flatulence, 5 cases had a slow urinary stream and 5 cases had a headache ( including 1 case who discontinued the treatment after 2 weeks). Conclusion : Tolterodine is effective in improving patient's view of their bladder condition, decreasing urinary frequency, urgency episodes and urge incontinence episodes. It is also well-tolerated by the patients.

Assessment of fetal lung maturity by free-floating particles in amniotic fluid and biparietal diameter by ultrasonography.

The accuracy of Free-floating particles (FFPs) and biparietal diameter (BPD) detected and measured by ultrasonography for assessment of fetal lung maturity were compared with the lecithin/sphingomyelin (L/S ratio) which was used as the gold standard. One hundred pregnant women in the lately third trimester who required amniocentesis for fetal lung maturity testing, from July 1998 to August 1999 at Siriraj Hospital, were included in this study. Ultrasonography was performed to evaluate the presence of FFPs in the amniotic fluid and the BPD was measured. Amniotic fluid for L/S ratio was obtained by amniocentesis. The presence of FFPs had a 58.3% specificity and a 41.7% false positive rate. A BPD value of at least 94 millimeters had 100% specificity and no false positives. When the presence of FFPs and a BPD value of at least 93 millimeters were used in combination, the test gave 100% specificity and no false positives. The presence of FFPS and a BPD value of at least 93 millimeters detected by real time ultrasonography may be used as predictive parameters to indicate fetal lung maturity.

Actinomyces colonization in IUD users.

The objective of this study is to assess the incidence of Actinomyces colonization in the Papanicolaou smears of IUD users at the Family Planning Research Center, Siriraj Hospital. IUD users who attended the center from January 1997- April 1997, regardless of how long they have been using the IUDs were screened for Actinomyces colonization at the time of enrollment. 342 IUD users with a negative Papanicolaou smear for Actinomyces colonization were included in the study and basic characteristics, type and duration of IUD use were recorded. Papanicolaou smears to detect Actinomyces colonization were repeated again 12 months later. Abnormal signs and symptoms were recorded. The main outcome measurement was a positive papanicolaou smear for actinomyces colonization. The incidence of Actinomyces colonization was 9.9% in IUD users regardless of type of IUDs (N= 34). Inert IUDs produced a significantly higher colonization rate as compared with metallic IUDs, (P<0.05). The colonization rates for Lippes D, Lippes C, ML Cu 250, and Cu T 380 A were 28.6%, 25.0%, 14.1% and 2.1%, respectively. The colonization rates appeared to increase with the duration of IUD use before the study and 62% of them were detected after 48 months of IUD use before the study. Almost all positive smears in IUD users (91.2%) were asymptomatic. The incidence of Actinomyces colonization is related to type and duration of IUD use. For this reason, all patients with IUDs should undergo annual Papanicolaou smears for diagnosis and appropriate treatment including removal IUDs and oral penicillin which were effective in this study.