Graves' disease complicating pregnancy.

During the 12-yr period from 1981 to 1992, over 85,000 deliveries at Ramathibodi Hospital from 114 pregnancies (prevalence 0.1%) in 110 patients were complicated by Graves' disease. The diagnosis was made following conception in 52 per cent. Medical treatment with propylthiouracil was the main regimen. Maternal and perinatal outcome were related with thyroid status at delivery including thyrotoxic crisis, preeclampsia and preterm deliveries. There was no case of fetal goitre, hyperthyroidism, but fetal hypothyroidism occurred in 12.2 per cent which calls for close monitoring of antithyroid drug dosage and close neonatal-infant follow-up.

Treatment of atonic postpartum hemorrhage with a prostaglandin E2 analogue.

Atonic postpartum hemorrhage constitutes a dramatic clinical situation, with acute danger to the life of the mother. The present report is a 3 yrs prospective study using a Prostaglandin E2 analogue (Sulprostone) in the management of 22 cases with severe postpartum hemorrhage due to uterine atony unresponsive to conventional therapy. Successful control of hemorrhage in cases of blood loss more than 1,500 ml occurred in 83 per cent. Precipitated labour was the most common predisposing factor encountered in this group of atonic postpartum hemorrhage. Side effects of the prostaglandin therapy was tolerable and self-limited. The use of intramuscular administered Sulprostone appears to be an adjunctive treatment in uncontrollable atonic postpartum hemorrhage.

Diabetic ketoacidosis in pregnancy.

Diabetic ketoacidosis, though uncommon, is a very serious complication in obstetrics. We reported 5 cases, which in retrospect could all have been prevented from occurring. Either a strong family of diabetes mellitus or presence of glycosuria were present in 4 cases. In 3 cases, the use of sympathomimetic and corticosteroid was the predisposing factor. Clinicians should have an index of suspicion in patients at risk and it might be prudent to screen for diabetes where the use of sympathomimetic and corticosteroid.

Uterine rupture and labor induction with prostaglandins.

Uterine rupture in patients with labor induction with prostaglandin E2 application though uncommon is a very serious complication and preventable in obstetrics. We reported three cases of spontaneous uterine rupture following induction of labor with intracervical PGE2 gel administration in a dosage of 3-6 mg and two in whom labor was augmented with oxytocin infusion. To avoid such a complication, intracervical PGE2 gel administration should be started with a smaller dose and should augmentation with oxytocin be required careful evaluation and monitoring by a specialist is desirable.

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).

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.

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.