Long-term compliance with hormonal replacement therapy: Experience of Siriraj menopause clinic.

A retrospective analysis of women who registered for treatment at Siriraj Menopause Clinic in the year 1995 was performed to assess long-term compliance with hormonal replacement therapy (HRT). There were 217 women who registered that year and all were followed up for the following four years. Of these 217 women, 195 commenced HRT and were divided into two groups. The first group of 1,105 women (natural menopause, N) comprised 25 menopause transition and 80 postmenopause cases. The second one of 91 women (surgical menopause, S) was the group who previously underwent total hysterectomy with bilateral salpingooophorectomy. The average age at first consultation in the N group was 52.1 + 6.5 year which was significantly higher than 46.7 + 7.7 year in the S group (P<0.0001). In the N group, compliance was 61.9% at 1 year and 56.1%, 50.4%, 43.8% at 2,3 and 4 years while in the S group compliance was 74.7% at 1 year and 64.8%, 58.2%, 47.2% at 4 years respectively. Compliance with HRT was not statistically different between both groups (P>0.05). Drop out cases were maximum in the first years in both groups and total drop out cases increased slowly and steadily every year for the next four years. Ages at first consultation of compliant and non compliant women in each group were also not statistically different (P>0.05). Long-term compliance with HRT in this study was comparable with previously reported data. Main reasons for non compliance at 4 years were breast symptoms including breast masses and mastalgia, abnormal vaginal bleeding or irregular menses, weight gain and skin problems including acne, melasma and hair loss. These problems are different from other reports. Factors affecting long-term compliance with HRT should be further studied especially in those women who have undergone a surgical menopause.

Heterotopic pregnancy: A case report.

The incidence of heterotopic or combined pregnancy has risen in recent years. A case of heterotopic pregnancy is reported here without any risk factors, e.g., ovulation induction or assisted reproduction. The patient may fit in with superfecundation hypothesis. The diagnosis was made by transvaginal sonography after left salpingectomy and continuation of persistent HCG titer. The etiology, incidence, diagnosis and management of this condition were reviewed.

Cesarean section rate and perinatal mortality rate at Siriraj Hospital during 1980-1990.

Cesarean section rates have increased markedly in many centers all over the world in the past 20 years. A retrospective analysis was made using the obstetrics data from one teaching hospital in Bangkok in order to see trends in cesarean section and perinatal mortality during the years 1980-1990. We analysed the annual cesarean section rate, the perinatal mortality rate, and the major indications for cesarean section. Z-test was used to investigate statistical significance. There was a significant increase in the primary cesarean section rate, the repeated cesarean section rate and the total cesarean section rate in the year 1980-1987. After 1987, the rates reached a plateau until December, 1990. Cephalo-pelvic disproportion, breech presentation and fetal distress were the three leading causes of cesarean section in this study. There were significant increase in cephalopelvic disproportion and fetal distress in the second half of the decade compared with the first half. Breech presentation at the time of delivery slightly increased during this time without statistical significance. Perinatal mortality rate decreased significantly from an average of 13.53 between 1980-1984 to 11.12 between 1985-1990. Increasing vaginal birth after cesarean section may be an important means to reduce the cesarean section rate by decreasing the repeated cesarean section rate. This practice has been reposted to lower cesarean section rates in many centers.

Pregnancy complicated with SLE and RPGN : A case report.

Pregnancy complicated with systemic lupus erythematosus (SLE) is notoriously variable in its presentation, course, and outcome. Renal involvement is demonstrated in half of patients. Exaggerated by pregnancy on renal function is not concluded. But renal failure is one of the leading causes of death. We report a case of lupus complicating pregnancy that no prepregnancy remission. She developed clinically pre-eclampsia and lupus nephritis in 17 weeks gestation. Flares of disease with deterioration of renal function despite corticosteroid therapy lead to stop pregnancy. Although pregnancy has been terminated, she became worse and died before starting hemodialysis. Histologic study from renal necropsy and clinical manifestation consistented with rapidly progressive glomerulonephritis (RPGN).

Pregnancy in a salpingectomised stump.

Ectopic pregnancy after homolateral salpingectomy is a morbid condition rarely encountered nowdays. The explanation of its pathogenesis remains controversial. In this report, one such case is described. The operative treatment included cornual wedge resection to prevent a future ipsilateral tubal pregnancy.

Eclampsia in Siriraj Hospital: Fifteen years analysis.

The study of the epidemiological characteristics of eclamptic patients was carried out among patients admitted to Siriraj Hospital from January 1972 to December 1986. Particular attention was paid to antenatal care patterns, maternal and perinatal mortalities. Three hundred and eleven eclamptic patients were encountered among 301,533 deliveres, a prevalence of 103.1/100,000 deliveries. The majority of eclamptic patients had no antenatal care, only 14.74% of these patients had good antenatal supervision. There were 9 maternal deaths encountered during the whole period of study with no death encountered during the last 5 years. Twenty seven perinatal deaths were encountered of which intrapatum deaths were frequently found. Most of the deaths were due to prematurity. However, there has been no perinatal death among eclampic patients during the last 5 years.