ABSTRACT
Objective: To determine the prevalence of pregnancy with placenta previa in Siriraj Hospital. Methods: This study conducted a retrospective review of in-patients medical records of a total of 843 singleton deliveries in Siriraj Hospital with gestational age ≥28 weeks during January to February 2009. Data on baseline characteristics of pregnant women, pregnancy course and the outcomes during delivery were collected. Placenta previa was diagnosed by ultrasonographgy and /or direct visualization of placental location during cesarean section. Results: The mean age of the population was 28.4 ± 6.0 years old. Most of these delivered at term gestation (87.4%). The modes of delivery were normal vertex delivery, emergency cesarean section and elective cesarean section which presented in 60.5%, 26.5% and 12.1% of pregnancies respectively. The prevalence of placenta previa was 0.7% (6/843). The factor significantly associated with placenta previa was previous uterine curettage (p = 0.001). The significant outcomes of pregnancy with placenta previa were maternal blood loss >500 mL (P = 0.008) and baby’s APGAR score at 1st minute ≤7 (p = 0.006). Conclusion: The prevalence of pregnancy with placenta previa in Siriraj Hospital was 0.7%.
ABSTRACT
Nowadays, the majority of breech deliveries are by cesarean section. In Siriraj Hospital, planned vaginal breech delivery is not our current practice. Compared with vaginal breech delivery, cesarean section can significantly reduce neonatal complications, with a trivial increase in maternal complications. However, cesarean section cannot alleviate all of the complications. In the present report, a case with entrapment of after-coming head in cesarean breech delivery of a term fetus was described, and the management of this emergency condition was reviewed.
ABSTRACT
A Thai woman 36 year old with post tubal sterilization. She was performed for Tuboplasty to restore fertility on new marriage. Both fallopian tubes functioned post correction. She tried natural conception, but was not successful. The doctor treated her by the way of ovarian induction with Clomiphene Citrate and intrauterine insemination. She conceived in the 4th cycle, but she had an heterotopic pregnancy. Gestational sac, fetal echo and positive fetal heart beat were detected at both the intrauterine cavity and the right adnexa, and she had no abnormal symptoms. The Diagnostic Laparoscopy was performed. Following the operation an unruptured right tubal pregnancy was found. Right salpingectomy was done and the pathological report confirmed tubal pregnancy. Post operative time, she had no signs of abortion, and normal intrauterine growth was detected.
ABSTRACT
Objective: The main purpose of this study was to determine the exclusive breastfeeding rate in mothers who had problems in breastfeeding and were closely taken care by the well-trained breastfeeding team. The second purpose was to define the causes of non-exclusive breastfeeding. The third purpose was to compare the exclusive breastfeeding rate with the previous study of routine postpartum care. Methods: A prospective observational study was conducted. From January to July 2005, there were 4,344 mothers delivered at Siriraj Hospital. 847 of them, mothers (19.5%) had the problems in breastfeeding, therefore, they were cared and supported to breastfeed their babies by well-trained clinicians either at a service ward or at a Lactation clinic. To obtain the data of method of feeding and the problems in breastfeeding, the subjects were contacted by phone during 7 days, 1, 4 and 6 months postpartum period. Results: The rates of the exclusive breastfeeding in 7 days, 1, 4 and 6 months during postpartum period in this study were 84.6%, 76%, 41% and 27.7%, respectively. The important problems of the breastfeeding were tongue tie of the infants and the short maternal nipples (57.5% and 31.6%, respectively). Compared with the previous study, in this study, breastfeeding lasted longer and had a higher rate. Conclusion: Successful breastfeeding would be achieved if mothers receive the continuous support from the care team and their families in detecting and solving the problems of breastfeeding in early period.
ABSTRACT
OBJECTIVE: To determine the incidence of vaginal breech delivery at Siriraj Hospital and to evaluate factor affecting mode of delivery. DESIGN: Cross-sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECT: A total of 317 women with singleton breech presentation, > or =28 weeks of gestation, who had their deliveries at Siriraj Hospital during January 1st to December 31st 2003. MATERIAL AND METHOD: The medical records of these women were reviewed to determine the incidence of vaginal breech delivery. Characteristics regarding current pregnancy and delivery and maternal and fetal outcomes were evaluated, including parity, gestational age, estimate fetal weight, cervical dilation, membranes status, maternal complications, types of breech presentation, and being a private case. RESULTS: The incidence of vaginal breech delivery among these women was 17.7%. Univariate analysis showed that multiparity, gestational age of <32 weeks, estimate fetal weight of < or =2500 grams, advanced cervical dilatation, ruptured membranes, and not being a private case increased the risk of vaginal breech delivery. Multiple logistic regression analysis demonstrated that only advanced cervical dilatation (4-7 cm, adjusted OR 10.7, 95% CI 3.5-33.0; >7 cm adjusted OR 40.4, 95% CI 12.6-129.2), ruptured membranes (adjusted OR 2.9, 95% CI 1.3-6.3), multiparity (adjusted OR 6.4, 95% CI 2.6-15.7), and gestational age <32 weeks (adjusted OR 9.7, 95% CI 2.7-35.7) were independently associated with vaginal breech delivery. However, lower apgar scores and neonatal complications, especially prematurity, were more frequent in vaginal than cesarean delivery. CONCLUSION: Vaginal breech delivery was found in 17.7% of singleton breech presentation in Siriraj Hospital. Certain characteristics during labor and delivery were associated with mode of delivery including advanced cervical dilatation, ruptured membranes, multiparity, and preterm gestational age.