Organochlorine compoundes in perinatal blood samples ; maternal and neonatal measurements at Siriraj Hospital.

Seventy four percent of 50 normal term pregnant woman, delivered at labour room Siriraj Hospital during August to October 1993, were found to be contaminated by organochlorine compounds in their blood samples. The main contaminants were p,p’ –DDE, α –BHC, heptachlor, γ –BHC, dieldrin, p,p’ –DDT, o,p’ – DDE and hepta-opex. The mean blood level were 10.15, 1.21, 1.61, 0.80, 6.95, 3.56, 1.03 and 1.47 ppb respectively. The main contaminants, found in 54 percent of the newborns, were α –BHC, p,p’ –DDE and dieldrin and the mean blood level were 0.62, 5.05 and 1.24 ppb respectively. However, the contaminants found were below the acute toxic level in both groups.

Rudimentary horn pregnancy.

A case of pregnancy in rudimentary horn is presented, and a discussion of this rare and potentially catastrophic phenomenon follows. The correct diagnosis was only made at laparotomy for acute abdominal pain when the patient was 16 weeks pregnant. Definite clinical palpation of the pregnant uterus together with ultrasonographic evidence of a viable fetus misled the diagnosis. When this condition is suspected the diagnosis may be aided by ultrasound searching of the uterus.

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.

Twin pregnancy with single fetal death.

The antepartum death of one twin during late second trimester is a rare obstetric complication. Reported herewith a case of twin primigravuda whose death of one twin occurred at 26 weeks gestation. Delivery was postponed for 9 weeks as lung maturity was anticipated, since previous experience of preterm and neonatal death rates were high in the surviving twins.

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.

Clinical significance of atypical cells in papanicolaou smears.

A retrospective study was done on 120 patients with atypical cells in Papanicolaou smears obtained during a five-year period (1982-1986) at the Cytology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University. The patients were divided into three groups according to diagnostic procedures. Each group consisted of 44, 46 and 30 patients respectively. Group I had normal cervices on examination and were referred for colposcopy. Group II had suspicious cervices, and biopsies were done on grossly visible lesions. Group III had histories of abnormal uterine bleeding and underwent diagnostic fractional curettages. Of group I, 11 (25%) were found to have CIN 1-3 and 4 (9.1%) had invasive carcinoma. Of group II, 4 (8.7%) were found to have CIN 2-3, 13 (28.3%) had invasive carcinoma. Of group III, 12 (40%) were found to have endometrial hyperplasia and 6 (20%) had endometrial carcinoma. It appears that a Papanicolaou smear report of atypical cells should be considered abnormal, further evaluation is required according to the clinical presentation of the patient.

Rupture of the gravid uterus.

Rupture of the gravid uterus, the most tragic obstetric emergence, is said to occur infrequently nowadays due to efficient antenatal and intranatal intensive care. Forty-six incidents of uterine rupture were reviewed among 197, 254 deliveries during 1978-1987, that is 1 per 4288 deliveries. There were 20 cases of previous scarred rupture, 18 traumatic, and 8 cases of spontaneous ruptures. A rupture of a previously scarred uterus had an approximately equal number of classical and low transverse scars. Maternal and fetal prognoses were much better with low transverse scars. A rupture of the previously unscarred uterus was a more dramatic event. It tended to be longitudinal and complete, and fetal prognoses were relative poor. About 28% of the ruptures were diagnosed prior to delivery, 33% were noticed at operation, and 39% were observed only after delivery and diagnosed by manual uterine exploration. The majority of cases were managed by hysterectomy rather than repair. Under special circumstances, the uterus may be repaired for subsequent reproduction. Maternal mortality was 2.2% and fetal loss 42.6%, 37% suffering from asphyxia at birth. Preventative measures, early diagnosis, and prompt treatment are emphasized.

Acute appendicitis in pregnancy and puerperium : A review of 30 cases.

The diagnosis of appendicitis is frequently difficult in the pregnant woman. As the pregnancy progresses, the difficulties in the diagnosis increase so much that treatment is delayed. This causes danger to both mother and fetus. A review of 30 cases of appendicitis in pregnancy and the puerperium over a 5-year period (1982-1986), at Siriraj Hospital is presented. There was no maternal mortality nut some morbidity. As for the fetus, an adoration rate of 22.2% was found in the second trimester, where as the cases in the third trimester had a prematurely rate of 41.6%. It is considered that early operation will decrease complications and is the treatment of choice at all stages of pregnancy and the puerperium. Tocolytic agents may have a beneficial effect on the course of the pregnancy and should be given prophylactically to all patients beyond 16 weeks to prevent uterine contractions and premature labour.

Multifoetal pregnancy: Time interval between birth of the twins.

A prospective study was carried out on 276 live-born twins at 34 or more weeks gestation (or birth weight > 2,000 gm) delivered between the years 1982 – 1984, at Siriraj Hospital. Apgar scores, presentations, birth weights, and methods of delivery of the second twin were reviewed according to the time interval between delivery of the first and second twins. The study revealed the favourable outcome of the second child despite a delayed time interval beyond 15 minutes.