Outcome of intra-amniotic hypertonic saline instillation for second-trimester abortion.

Objective: To evaluate the efficacy and safety of intra-amniotic hypertonic saline instillation for second trimester abortion. Methods: The pregnant women whose pregnancies were complicated by serious fetal abnormalities, trisomy 21 and thalassemia HbE disease, were admitted at Siriraj Hospital from January 1, 2009 to April 30, 2010. The patients were legally induced abortion by intra-amniotic hypertonic saline instillation. Results: A total of 42 pregnant women were retrospectively studied. The average gestational age was 22.4 ± 2.2 weeks. The average instillation-abortion time was 34.8 ± 18.2 hours. All abortuses were dead at the time of abortion. The number of complete abortions were 39 cases (92.9%). There were no serious complications in this study. Conclusion: Intra-amniotic hypertonic saline instillation for second trimester abortion should be considered as a good method in terms of efficacy and safety.

Pregnancy outcomes in methamphetamine abuse mothers.

Objective: The objective of this study was to determine the outcomes of pregnancy in methamphetamine abuse mothers. The history of methamphetamine abuse, other abused drugs and some abuse behaviors of mothers were also studied. Methods: Cross sectional analytical study of 182 mothers with a history of methamphetamine abuse during pregnancy and the outcomes were reviewed. Data was collected from in-patient files of Siriraj Hospital between 1 January 2000 and 31 December 2003. Those mothers who miscarried were excluded from the study. Characteristics of the patients, antenatal care records, histories of methamphetamine abuse, modes and outcomes of delivery such as preterm labor, birth weight, Apgar score, length and head circumferences were recorded. Subsequent analysis of 50 teenage mothers and 100 mothers over 20 years were compared. Data was analyzed and descriptive statistics, Chi-square test and unpaired t-test were used where appropriate. Results: Of all 182 mothers, 65.9% did not attend ANC and 43% were nulliparous. Percentages of preterm and low birth weight were 6.6% and 24.2% respectively. Sexually transmitted diseases were quite prevalent. There was a high positive anti-HIV rate of 6.6% in this group. Neonatal asphyxia (Apgar < 7) at 1 min was found in 4.9% of the infants. The average birth weight, head circumference and fetal length were 2813.5 + 456.3 gm., 32.0 + 2.1cm. and 48.4 + 2.7 cm. respectively. Most of the mothers abused methamphetamine less than one year with a dose of 1 tab per day. Multiple substance abuse was noticed. 47.9% of the patients smoked cigarettes and 12.7% consumed alcohol during pregnancy. Maternal characteristics and pregnancy outcomes were not different when subsequent analysis was performed to compare between 50 teenage mothers and 100 mothers over 20 years of age. Conclusion: The results showed some adverse outcomes of pregnancy from mothers with methamphetamine abuse. Poor ANC, high positive anti-HIV rates, high percentage of low birth weights and smaller head circumferences of the newborns were observed in this study. The prevalence of preterm was low without clear explanation. The age of the mothers had no additional role on these adverse outcomes although there was a trend of higher low birth weight and preterm among teenage mothers.

The comparative study of different contraceptive methods between copper T 380A and norplant 6, Siriraj experience.

Objective: To evaluate and study the demographic and clinical profile among the users of these 2 different contraceptive methods, to assess the continuation rates of these 2 methods as well as the frequency of Pap smear screening plus the resultsof Pap smears in each contraceptive method. Methods: This was a case note-based study in which the data were transferred to a standardized pre-tested proforma. Results: During 1 January - 31 December 2001 There were 162 Copper T 380 A users and 307 Norplant 6 users. The age group of IUD users were found higher than Norplant-6 users with a statistical difference. The continuation rates after 5 years were 39.5% for copper T 380 A and 11.4% for Norplant users. The frequency of Pap smear screening as well as the follow up rate was found much higher in copper T 380 A. The results of Pap smear of these two groups using long-acting contraception were statistically different : IUD users had a higher infection rate but Norplant users had higher abnormal cells. After treatment all users return to normal Pap smear. Conclusion: This contraceptive study was conducted in 2001. The continuation rate for copper T 380 A was significantly higher than Norplant 6 and encouraged the participants to have Pap smear screening as well as keeping the appointment for follow up. The report of Pap smear screening was found abnormally higher in the Norplant users. Actinomyces infection was commonly found with copper T 380 A.

Breastfeeding pattern in mothers who delivered at Siriraj Hospital.

This is a study of patients who attended the antenatal clinic and were admitted to the service ward, Siriraj Hospital. There were 2,503 mothers who were contacted by phone. The rate of exclusive breastfeeding at 7 days, 1 months, 4 months and 6 months postpartum in this group was 83.4%, 69.5%, 33.1% and 18.6%, respectively. Some mothers stopped breastfeeding: 2.3% at 7 days, 6.1% at 1 month, 36.1% at 4 months and 61.3% at 6 months. The reasons for using artificial feeding or breastfeeding plus artificial feeding were classified into two periods. The reasons for the 7 day and 1 month periods were insufficient milk production (8.9% and 13.1%, respectively) and mothers having to work (4.6% and 14.8%, respectively). Reasons for the 4 month periods were 51.6% and 69.0% of mothers having to work. All mothers in this group were willing to breastfed their babies because they received knowledge and nipple preparation from the antenatal clinic. Some mothers stopped breastfeeding during early postpartum because of socioeconomic and social problems. However, 38.7% of mothers practiced full or partial breastfeeding at 6 month postpartum.

HLA class II (DRB1, DQA1 and DQB1) allele and haplotype frequencies among HIV-infection discordant Thai couples.

We investigated the association of HLA-DRB1, -DQA1 and -DQB1 alleles and haplotypes in 33 Thai HIV discordant couples. A significantly lower frequencies of DRB1*14 (3.0% vs 11.3%, p = 0.048) and DQA1*0103 (0.0% vs 5.63%, p = 0.042) alleles were found in the seropositive individuals when compared with HIV-negative controls. In contrast, there was no significant difference in HLA-DQB1* allele frequencies. The haplotype analysis revealed that DRB1*1501-DQA1*0102-DQB1*0601 (7.6% vs 0.0%, p = 0.002), DRB1*0405-DQA1*0302-DQB1*0401 (7.6% vs 1.3%, p = 0.024) and DRB1*1401-DQA1*0104-DQB1*05031 (6.1% vs 0.0%, p = 0.007) were found to be significantly higher frequencies when compared between HIV seronegative partners and HIV negative controls, but DRB1*1501-DQA1*0102-DQB1*0502 (0.0% vs 8.1%, p = 0.01) was significantly lower. The DRB1*1602-DQA1*0101-DQB1*0502 (4.6% vs 0.0%, p = 0.024) haplotype was found to be significantly higher frequencies in HIV seropositive individuals when compared to HIV negative controls but the DRB1*1502-DQA1*0101-DQB1*0501 (1.5% vs 8.1%, p = 0.049) haplotype was lower.

The combined oral contraceptive pill versus bromocriptine to suppress lactation in puerperium: a randomized double blind study.

A randomised double blind comparative study of 230 HIV infected mothers who had a normal delivery at 37-42 weeks' gestation were divided into two groups; 116 combined pill users and 114 bromocriptine users to suppress lactation. There were 33 cases (28.5%) of combined pills users and 29 cases (25.4%) of bromocriptine users who had breast engorgement without statistical difference. All of them had mild breast engorgement without any treatment except one case (0.9%) in the bromocriptine group had severe breast engorgement with puerperal fever and needed an analgesic drug. There were no side effects of the drugs. This study showed that combined pills were beneficial to suppress lactation in HIV infected mothers to prevent postnatal mother-to-child transmission because of low risk and low cost.

Cervical cancer in elderly Thais.

BACKGROUND : Neoplasm is the second most common cause of death in Thai women and cervical cancer is the most common. The prevalence of cervical cancer in Thai elderly women is unknown. What is the optimum time for a regular Papanicolaou smear check up. METHOD: A cross-sectional study of healthy elderly women (age >60 years) who lived within a 10-kilometer radius of Siriraj Hospital was carried out. All had their history taken and were examined by vaginal examination and Papanicolaou smear for cancer screening three times; on the day of enrollment, at one-year and two-years. RESULTS: Six hundred and eighty two women aged 60-88 years were recruited. There were 7 cases (1.0%) who had a positive Papanicolaou smear on the day of enrollment. Six cases (0.9%) had complete investigations: 2 cases (33.3%) had invasive cervical cancer stage III b, 4 cases had CIN III. There was one case out of 268 (0.4%) at one-year and one case out of 342 (0.3%) at two-years who had a positive Papanicolaou smear and the final diagnosis was CIN III. CONCLUSION : The prevalence of cervical cancer in Thai elderly women in this study was 1 per cent. Thai elderly women need a yearly Papanicolaou smear check up.

Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women.

BACKGROUND: Genital prolapse is a common health problem in elderly women. It is prevalent among elderly females and affects their quality of life. Those with a severe degree of genital prolapse may need operative treatment which may be risky due to co-morbid conditions such as hypertension, respiratory disease, cardiovascular disease and diabetes mellitus. The aim of this study was to determine the prevalence of genital prolapse and the effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly females. METHOD: The authors conducted a cross sectional study to determine the prevalence of genital prolapse in 682 elderly women (aged > or = 60 years) who lived within a 10-kilometer radius of Siriraj Hospital. 654 subjects were eligible for the controlled trial to determine the effectiveness of pelvic floor exercise to prevent worsening of genital prolapse. There were 324 subjects in the control group and 330 subjects in the experimental group. The experimental group received training in pelvic floor exercise and were asked to perform the exercise 30 times after one meal, every day for 24 months. The subjects were followed-up every 6 months for 24 months to assess worsening of genital prolapse. RESULTS: The prevalence of genital prolapse was 70 per cent. There were 324 subjects in the control group and 330 subjects in the experimental group. After 24 months of pelvic floor exercise, the rate of worsening of genital prolapse was 72.2 per cent in the control group and 27.3 per cent in the experimental group (p = 0.005). The rate of worsening of genital prolapse was not significantly different between the control group and the study group in those who had a mild degree of genital prolapse. CONCLUSION: The prevalence of genital prolapse in elderly Thai women was 70 per cent. A 24 months pelvic floor exercise program was effective to prevent worsening of genital prolapse in the women who had severe genital prolapse.

Sexual risk of adolescent in school.

There were 2,098 school boys and girls who answered questionnaires aged 11-20 years, 9.1% had had sexual intercourse and 0.3% had become pregnant. About 5.3% of girls and 7.2% of boys were homosexual. There were 37.8% of this group had seen pornographic pictures at their friends' house, 42.7% went to discotheques and 4.9% had experience of drug abuse. Most of them knew of at least one contraceptive method as a result of their teachers' education and the condom was the most popular one. When asked if they had any sexual health problems who would they consult, most of them consulted their parents and friends. Comparing the group that had had sexual intercourse with the group that had not, the sexual intercourse group had had more experience of pornographic pictures; had attended discotheques and used drugs which was statistical significant (p < 0.05). This result shows that the risks for having sexual intercourse in this group were viewing pornographic pictures, attending discotheques and drug abuse. Sexual intercourse started in the 12-year old group. Increasing age lead to increased discotheque attendance, drug abuse, use of pornographic pictures and increased sexual intercourse. We conclude that sex education should be started at 12 years. Parents and teachers should be both consultant and educator for sexual health and sex education. Well educated boys and girls will be good counselors or consultants for their friends. Drug abuse, pornographic pictures and discotheques were the risk factors for premarital sexual intercourse.

Venous thromboembolism and combined oral contraception in Thai women.

Hospital-based case-control study risk of venous thromboembolism (VTE) associated with combined oral contraceptives (OC) in Thai women aged 20-44 years was 7.6. Body mass index (BMI) of cases were significantly higher than controls. The risk of VTE in women having BMI more than 25 kg/m2 was 5.8. Cigarette smoking and alcoholic used did not the risk of VTE in OC user. The OC prevalence in this study in cases and controls were 39.5% and 7.9% respectively. All combined pills composed of 0.05 mg. Or less estrogen and second generation progestogen. This study suggested that the prescription of combined oral contraception to Thai overweight women should be avoided because it increased the risk of venous thromboembolism by two risk factors.

Prevalence of Hepatitis B carriers in pregnant women.

This study aimed to detect the prevalence of HBV carriers in pregnant woman by two blood tests, 3-month interval for HBsAg. At Siriraj antenatal clinic, there were 6.3% HBsAg positive and 37.6% HBsAg positive in 17,652 pregnant women who first visit ANC. Second blood test showed that 17.6% was HBsAg negative. HBV carrier pregnant women who were HBsAg positive twice were younger than HBV carriers who were HBsAg negative twice with P=0.00006. There were 1.2% high SGPT in HBV carriers. In sub-group who were HBsAg negative and turn to positive, 9.1% of them had high SGPT. This result indicates that in high prevalence of HBV carrier pregnant women blood test for SGPT in this sub-group is beneficial and cost-effective.

A study of amphetamine users in vocational school boy.

In Thailand, amphetamine locally called “YAMAH” are wrongly used as stimulants. They are widely available among teenagers in vocational schools. In a urinary amphetamine test conducted on three hundred and fifty vocational students aged 18-20 years 13.7% proved positive. Significantly half of the students testing positive were aged only 18 years, maybe because, being younger they are easily led which might have caused by their own inexperienced behavior. It was also found that 42.9% of these students had sex-related diseases, though most had sexual intercourse with their girl friends and only a few with prostitutes. On comparing the sexual histories, we found 62.5% of the positive group always used condom during sexual intercourse, while only 19.4% in the negative group did, a marked statistical difference. On proving deeper with the students test up positive we found that themselves male and female, are agents for the “YAMAH” are family problems and friends. All students realize the danger “YAMAH” poses to their health and the waste of money it causes. Yet, they would be able to stop taking “YAMAH” only if it were not still available in their own schools.