The use and maintenance of instruments for large loop excision of transformation zone at Ramathibodi Hospital.

The average use of LLETZ in Ramathibodi Hospital from 1993 to 1998 was 73.3 cases per year (range 26-116 cases). The endocervical box (F2) loop electrode was the most frequently damaged at the rate of 4 pieces per 100 procedures. The damage rate of the 25 mm loop electrode was 3 pieces per 100 procedures and 20 mm loop electrode was 2 pieces per 100 procedures. The life of the instrument can be prolonged through proper care and continuous maintenance as well as by experienced operators and the assisting team.

Bone density in women receiving Norplant implants for contraception.

The aim of this study was to determine whether long-term Norplant uses is associated with changes in bone density. The study group consisted of forty one healthy women aged 19-42 years who had used Norplant for 31.1 +/- 11.2 months with a minimum period of 12 months. Fifty current IUD users constituted the control group. The bone density was measured by dual energy X-ray absorptiometry (DEXA) at the non dominant distal and ultradistal forearm. Serum estradiol was measured by microparticle enzyme immunoassay technique. Age, parity, income, weight, height and body mass index (BMI) of both groups were no differences. Our analysis did not find any differences in bone mineral density of distal forearm and ultradistal forearm between Norplant and IUD users (95% CI -0.01, -0.03 and -0.02, 0.02 respectively). Serum estradiol was not different in the two groups (95% CI -24.9, 110). This study revealed that the Norplant implants do not have any adverse effect on bone mineral density.

Female sterilization in Ramathibodi Hospital: 1987-1993.

A 7 year (1987-1993) restropective review of female sterilization in the Department of Obstetrics and Gynecology, Ramathibodi Hospital was reported. This paper is part of a continuing study of female sterilization in Ramathibodi Hospital. A total of 9,968 cases of female sterilization was done from January 1987 to December 1993. Post partum acceptors accounted for 63 per cent of total female sterilization, the overall postpartum female sterilization rate was 117.4 per 1,000 deliveries. 37 per cent was interval sterilization. The peak of interval sterilization was in March. 69.8 per cent of interval sterilization was performed by minilaparotomy technique, the remainder were by laparoscopy.

Adolescent pregnancy with HIV-1 positive in Ramathibodi Hospital 1991-1995.

In summary, the level of HIV infection among teenagers will increase in our community because of their risky behaviour. Education and counselling should be the effective strategies to overcome this problem.

Prophylactic oophorectomy of benign uterine disease in premenopausal women: 11 years review.

Between 1982 and 1992, 695 consecutive abdominal hysterectomies and prophylactic oophorectomies in premenopausal women for benign uterine diseases were performed in our department. The trend of prophylactic oophorectomy has declined since 1988 to a minimum in 1990. 60 per cent were 41-45 years of age, 28 per cent were more than 46 years, 12 per cent were 36-40 years. Uterine fibroid was the most frequent indication (77.7%), followed by adenomyosis (21.0%). Ovarian histologies revealed abnormalities only in 1.3 per cent of the removed ovaries, the remainder appeared to be normal.

Maternal and umbilical cord blood lead levels in Ramathibodi Hospital, 1993.

A prospective cross-sectional study of maternal and umbilical cord blood lead levels was conducted in a total of 500 deliveries at Ramathibodi Hospital. The mean concentrations of lead in maternal and cord blood were 6.2 +/- 2.0, 1.6 +/- 0.5 microgram/dl respectively. There was direct relationship between maternal and umbilical cord blood lead level. Maternal occupation and length of stay in Bangkok were related to maternal blood lead levels. There was no association between adverse pregnancy outcomes and maternal blood lead levels. A large scale study and periodic surveillance of blood lead levels in pregnancy is advocated.

Risk factors for neonatal hyperbilirubinemia.

The purpose of this Historical Prospective Study was to analyze factors associated with neonatal hyperbilirubinemia. Data were collected from summary labour records and individual patients' records at Ramathibodi Hospital between January 1, 1988 and December 31, 1988. Of the 7,644 livebirths, neonatal hyperbilirubinemia (> or = 15 mg/100 ml) occurred in 638 cases. There was a statistically significant positive relationship between hyperbilirubinemia and vacuum extraction (RR 2.7), preterm delivery (relative risk, RR 2.1), low birthweight (RR 2.0), antepartum complication (RR 1.7), intrapartum complications (RR 1.5), forceps delivery (RR 1.4), and oxytocin infusion (RR 1.3). No significant relationship emerged between hyperbilirubinemia and fetal sex, cesarean section, breech delivery and the 5 min Apgar score. From 1984 to 1988 there was a pronounced increase in the incidence of neonatal hyperbilirubinemia in Ramathibodi Hospital. This increase was consistent with the increase in use of oxytocin infusion which reflects changes in obstetric practice. Provision of information, education and communication about this adverse effect to obstetricians and auditing their use are suggested solutions.

Operative obstetrics at Ramathibodi Hospital, 1970-1990.

A 21-year retrospective review of operative obstetrics at the Department of Obstetrics and Gynaecology, Ramathibodi Hospital was reported from January 1, 1970 to December 31, 1990. There were a total of 128,630 deliveries, of which 41,724 (32.4%) were abnormal deliveries. Forceps, vacuum and cesarean section still increased, but vaginal breech deliveries have lost their popularity in this institution.

Diagnostic laparoscopy at Ramathibodi Hospital: 1979-1988.

A 10-year review of diagnostic laparoscopy at Ramathibodi Hospital was presented. There was a total of 6,033 laparoscopies performed from 1979 to 1988, of which 1,416 (23.5%) were diagnostic. The three most frequent indications were suspected ectopic pregnancy (459 cases, 32.4%), endometriosis (409 cases, 28.9%) and infertility (308 cases, 21.8%). The trend in performing diagnostic laparoscopy has been increasing from 79 procedures in 1979 to 230 in 1988. Laparoscopy plays a major role in making definitive diagnosis in many cases. Complications were found in only 4 cases (2.8/1,000 procedures).

Elective induction of labor: Ramathibodi Hospital (Jan-Jun, 1990).

To assess the outcome of elective induction of labor, 262 deliveries were studied retrospectively and compared with 249 controlled cases whose labor began spontaneously. Elective induction accounted for 61 per cent of all patients induced with the overall induction rate of 11 per cent. Sixty-two per cent of the private cases as opposed to 24 per cent of the nonprivate cases were induced before the expected date of confinement. Among private cases, the cesarean section rate was similar whether the patients were induced or admitted in spontaneous labor. However, when considering the nonprivate cases the cesarean section rate was twice as high if the patients were induced. Mean maternal height and fetal birth weight were similar in both the study and control groups but there were more cases of low birth weight infants in the study group. The fetal outcome as indicated by 5-minute Apgar score was not less than five in both groups.

Low birthweight in Thailand: 1982.

Birthweight is sensitive index of social and economic change. The objectives of this study are to establish baseline birthweight, per cent of low birthweight and to determine maternal characteristics on LBW among Thai mothers. The study was based on data from birth records which was collected in 1982. The total number of samples used was 28,952. The lowest mean birthweight occurred in the North and Northeastern regions. These two regions had a mean birthweight of less than 3,000 g. The incidence of LBW was highest in the North at 12.8 per cent. The per cent of birthweight showed the highest with maternal age less than 20 years or parity equal to zero. Unskilled workers showed the highest per cent of LBW in the Northeast, North and the East and housewives in the West and South and farmers in the North.

Outcome of premature rupture of membranes (PROM) at term: Ramathibodi Hospital, 1988.

Management of PROM at term is still controversial and varies between immediate induction and awaiting a certain length of time. In this retrospective study, mode of delivery of 202 patients who presented at term with premature rupture of membranes were reviewed. Of these, 77 went into spontaneous labour while awaiting induction. The caesarean section rate among such patients (16%) was significantly lower than that of the remaining 125 patients (46%) whose labour was induced. There was no neonatal infection in either group. Further prospective randomized study is needed to confirm this finding.

Female sterilization in Thailand: past, present and future.

Female sterilization is the most effective contraception and has a very high demographic effectiveness. In the past, there have been developments in technological aspects. At present, the minilaparotomy and laparoscopic sterilization have been well developed and widely used, but the number of new acceptors is declining, and there is still a large number of unmet demands. Social action rather than technological action is needed. In the future, steps to increase the number of acceptors, are, proper management of the sterilization services, including adequate monitoring and a good surveillance system.

Failure of female sterilization at Ramathibodi Hospital: a 20-year review (1969-1988).

The Department of Obstetrics and Gynaecology, Ramathibodi Hospital, has offered female sterilization services since 1969. There were 30,856 cases of sterilization in the last 20 years. Thirty-seven women became pregnant following sterilization (0.12%). The failure rate after laparoscopic and minilaparotomy technique was 0.19 per cent and 0.20 per cent respectively, and the failure rate of postpartum sterilization was only 0.02 per cent. The failure occurred from 3 to 106 months after sterilization. The majority of intrauterine pregnancies occurred within 12 months, while ectopic pregnancy occurred at different periods. Ectopic pregnancies occurred in 18.9 percent of the failure cases. The ectopic pregnancy rate following laparoscopic and minilaparotomy technique was 0.05 and 0.03 per cent respectively. No ectopic pregnancy was found after failure of postpartum sterilization in this series.

Rupture of the pregnant uterus: Ramathibodi's experience 1981-1990.

A total of seven women had uterine rupture at Ramathibodi Hospital, Bangkok, between 1981-1990. The incidence was 1 per 9,908 deliveries or 1.009 per 10,000 deliveries. All were related to oxytocic drug administration and two of them had induction with prostaglandins. The intraoperative and postoperative problems were intraoperative hypotension (57%), febrile morbidity (28%) and wound dehiscence (12.5%). Fetal mortality was 43 percent and there was no maternal death.

The relationship between head level on admission and mode of delivery in primigravidae.

Controversy still exists over the significance of the fetal head level in early labor, whether it bears any relationship with mode of delivery. In this prospective study, correlation was made between fetal head level on admission of 98 primigravidae and mode of delivery. Contrary to the findings of recent reports the result of this study seems to show a higher cesarean section rate among patients who presented with high head (> or = 4/5 in early labor).

Hydrops fetalis due to Bart hemoglobinopathy at Ramathibodi Hospital (1978-1987): a 10-year review.

This was a retrospective case-control study of hydrops fetalis due to Bart hemoglobinopathy at Ramathibodi Hospital between 1978-1987. The incidence was 0.61 per 1,000 deliveries. Hydrops fetalis tend to go into labour prematurely with smaller fetuses and larger placentae. When compared with the control group there were statistically significant differences in the history of previous perinatal loss and obstetric complications i.e. hypertensive disorder in pregnancy and postpartum hemorrhage. Early diagnosis and termination of pregnancy will avoid these complications.

The use and maintenance of laparoscope in gynecology at Ramathibodi Hospital.

The average use of laparoscope in Ramathibodi Hospital during 1974-1986 was 656.9 cases per year (range = 394-830 cases). The light bulb was the most frequently damaged at the rate of 5 bulbs per 1,000 procedures. The life of the instrument can be prolonged through proper care and continuous maintenance as well as experienced operators and assisting team.