Maternal mortality in Rajavithi Hospital 1984-1998: analysis of the causes of death.

From January 1st, 1985 to December 31st, 1998 there were 49 maternal deaths. The completed data of 45 cases were reviewed to evaluate the causes of death including direct, indirect and non maternal death. The mean maternal mortality ratio was 19.18 per 100,000 live births. The leading causes of death were hemorrhage, infection, pregnancy induced hypertension and amnionic fluid embolism. The maternal mortality ratio can be reduced because the most common cause of death was hemorrhage which is preventable.

Aerobic microbiological study in term pregnant women with premature rupture of the membranes: a case-control study.

To determine the aerobic microorganisms related to premature rupture of the membranes (PROM) in term pregnant women, a case-controlled study was performed on pregnant women delivered at Rajavithi Hospital between November 1, 1996 and July 30, 1997. Two hundred and twenty pregnant women with PROM and 220 pregnant women without PROM were recruited by simple random sampling. The diagnosis of rupture of the membrane was made by history and by positive microscopic ferning and pH testing performed during speculum examination. The demographic characteristics were not statistically significantly different between both groups. We could not isolate any organisms (35.9% in the study group and 49.5% in the control group). Candida albicans and Klebsiella pneumoniae were the only two significant differences demonstrated between the study and control group (p<0.05). Candida albicans, the most prevalent organism in the study group, demonstrated significant difference between the study and control group (14.5% and 7.7% respectively) (p<0.05). Klebsiella pneumoniae demonstrated significant difference between the study and control group (7.30% and 4.10% respectively) (p<0.05). Gardnerella vaginalis, the most prevalent organism in the control group, showed no significant difference between the control and study group (16.40% and 14.10% respectively) (p=0.547).

Intra- and extra-uterine pregnancies following repeated sterilization in a case of HIV seropositive patient.

A 24-year-old woman, HIV seropositive, LMP ten weeks previously, para 2-0-0-2, presented with complaints of left sided pelvic pain. Her previous pregnancies were terminated by cesarean section with tubal sterilization (Pomeroy technique) in the first pregnancy and by cesarean section with repeated tubal sterilization (Pomeroy technique) in the second one. The pelvic examination revealed cervical motion tenderness and a tender sausage-like mass of about 3 x 4 cm in the left adnexa. Both previously ligated fallopian tubes and a hematosalpinx lying distal to the ligated site of the left tube were revealed in the exploratory laparotomy after a positive culdocentesis. Bilateral salpingectomy was performed. The histological examination confirmed the diagnosis of tubal pregnancy in the left tube and the status post tubal sterilization in the right one. The postoperative course was uneventful.

Risk factors of delivery of low apgar score newborn below 7 at 1 minute: a case-control study.

To determine the significant risk factors of delivery of low Apgar score newborns below 7 at 1 minute, a case-control study was analysed in pregnant women delivered at Rajavithi Hospital between December 1, 1995 and June 30, 1996. Two hundred and two pregnant women who delivered low Apgar score newborns below 7 at 1 minute and four hundred and four pregnant women who delivered normal Apgar score newborns > or = 7 at 1 minute were recruited in the study by simple random, sampling. Risk factors which were significantly associated with low Apgar scores below 7 at 1 minute were gestational age less than 37 weeks or more than 42 weeks, birth weight less than 2,500 g or more than 4,000 g, meconium passage in the amnionic fluid, narcotic analgesic use and breech presentation. The non-significant risk factors were maternal medical or obstetric complications and oxytocin use.

Neonatal and maternal complications among pregnant women delivered by vacuum extraction or forceps extraction.

A historical cohort study was used to analyse the maternal and neonatal complications among pregnant women delivered by vacuum or forceps extraction at Rajavithi Hospital, 1994. The maternal complications (third and fourth degree of perineal tear and postpartum hemorrhage) were statistically significant more often in the forceps group than in the vacuum extraction group. But fetal complications (neonatal hyperbilirubinemia, low Apgar scores (< 7) at 1 and 5 minutes and the transfer to NICU) were statistically significant more often in the vacuum extraction group than in the forceps group.

Effect of umbilical vein oxytocin injection on the third stage of labor: a randomized controlled study.

To evaluate the effect of umbilical vein oxytocin injection on the duration of third stage of labor, and estimated blood loss within 24 hours postpartum, in 50 vaginal parturients at Rajavithi Hospital from March 1, 1994 and June 30, 1995. The parturients were randomized to administered either an umbilical vein injection of 20 units of oxytocin diluted to 20 ml with normal saline (oxytocin group) or only normal saline 20 ml (control group) immediately after cord clamping. There were 25 paturients in each group. The duration of the third stage of labor in the oxytocin group was significantly shorter than that in the control group. In only 1 case of the control group was manual placental removal performed. The estimated blood loss within 24 hours postpartum in both groups was not statistically different. Twenty units of umbilical vein oxytocin injection was effective to shorten the duration of the third stage of labor but were not effective to reduce the estimated blood loss within 24 hours postpartum. The need for a further large scale study in the future was suggested.

Pearson's fetal movement count (FMC) and antepartum fetal heart rate testing (AFHRT) for antepartum fetal well-being.

To evaluate the accuracy of Pearson's fetal movement count (FMC) and antepartum fetal heart rate testing (AFHRT) in 380 high risk pregnancies at Rajavithi Hospital in 1994, the result of the 4 test FMC, AFHRT, FMC + AFHRT (serial test), and FMC + AFHRT (parallel test) were compared in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false positive rate (FPR), false negative rate (FNR) and accuracy. All tests had equal specificity and FPR. FMC + AFHRT (serial test) had the highest value of sensitivity (66.67%) but lowest value of FNR, NPV and accuracy (33.33%, 40%, 72.73% respectively). PPV was 100 per cent in AFHRT and FMC + AFHRT (serial test). FMC might be used as a first line antepartum fetal well being screening test.