Success rate of second-trimester termination of pregnancy using misoprostol.

OBJECTIVE: To evaluate the efficacy and maternal side effects of misoprostol usage for second trimester termination in Siriraj Hospital. STUDY DESIGN: Descriptive cross sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: The medical records of 94 pregnant women, between 14-28 weeks of gestation, who were admitted for medical termination of pregnancy, were reviewed. Each patient received 400 microg of misoprostol vaginally every 12 hours as recommended by RTCOG for termination of pregnancy. Main outcome measures included success rate of abortion within 48 hours, induction to abortion interval and maternal side effects. RESULTS: The success rate of abortion within 48 hours was 89.46%. Mean induction to abortion interval was 22.1 hours. The most common maternal side effect was fever (24.5%). The rate of incomplete abortion was 28.6% of successful cases. No factor, including age, parity and viability of fetus affected the success rate significantly. No serious maternal complication was detected. CONCLUSION: Misoprostol 400 microg vaginally every 12 hours can be used effectively and safely for second trimester pregnancy termination.

Incidence of gestational diabetes mellitus among pregnant women with one abnormal value of oral glucose tolerance test.

OBJECTIVE: To compare the incidence of Gestational Diabetes Mellitus (GDM) between pregnant women with one abnormal value of oral glucose tolerance test (Study group) and those with normal screening test (Control group) and compare their pregnancy outcomes. DESIGN: Retrospective cohort study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. MATERIAL AND METHOD: Two hundred and twenty eight at-risk pregnant women were enrolled from January 2003 to November 2004. They were divided equally with 114 each in study and control group. All received GDM screening before 24 weeks of gestation following the guidelines used at Siriraj Hospital. Data collection included baseline characteristics, data on clinical risks and screening results, final diagnosis, maternal and neonatal complications. Incidence of GDM and pregnancy outcomes was compared between the two groups. RESULTS: Both groups' baseline characteristics and clinical risks were comparable, except that the mean age of women in the study group was significantly greater than in the control group (32.8 +/- 4.9 and 29.7 +/- 5.5 years, p < 0001). The incidence of GDM was significantly higher among in study group compared with the control group (21.9% and 1.8% respectively, RR 12.5, 95%CI 3.0-51.5). After adjusting for maternal age, abnormal one OGTT value was the only independent risk for developing GDM (adjusted OR 16.3, 95%CI 3.7-71.9, p < 0.001). Infants of the study group had significantly higher birth weight than those of the control group (3203.6 +/- 563.9 and 3050.7 +/- 457.8 g respectively, p = 0.026). Rate of primary cesarean section, asphyxia, macrosomia, low birth weight, and other neonatal complications were comparable between the two groups. CONCLUSION: Pregnant women with one abnormal value of oral glucose tolerance test had a significantly greater risk of developing GDM compared to women with normal screening test. Pregnancy outcomes between the two groups were not significantly different.

Incidence of vaginal breech delivery in singleton in Siriraj Hospital.

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.