Reagent strip testing for antenatal screening and first meaningful of asymptomatic bacteriuria in pregnant women.

OBJECTIVE: To evaluate the diagnostic performance of reagent strip test as a screening test for asymptomatic bacteriuria (ABU) in pregnant women. MATERIAL AND METHOD: Three hundred and sixty asymptomatic pregnant women who attended their first antenatal appointment at Rajavithi Hospital from August 1st to October 31st, 2005 were enrolled Those with symptoms of urinary tract infection within one month, those who had been prescribed antibiotics during the previous 7 days, and those with medical or obstetric complications, vaginal bleeding and a history of urinary tract diseases were excluded Urine specimens were collected by clean-catched midstream urine technique for urine dipstick and culture. RESULTS: The prevalence of ABU was 10.0% The urine dipstick nitrite leukocyte esterase and combined test had a sensitivity of 16.7%, 75.0% and 16.7%, specificity of 99.1%, 67.9% and 99.4%, positive predictive value of 66.7%, 20.6% and 75.0%, negative predictive value of 91.5, 96.1% and 91.5%, accuracy of 90.8%, 68.6% and 91.1%, respectively. CONCLUSION: Reagent strip testing indicated a fair sensitivity for routine antenatal screening for asymptomatic bacteriuria in pregnant women

The accuracy of late antenatal screening cultures in predicting intrapartum group B streptococcal colonization.

OBJECTIVE: To determine the accuracy of late antenatal (35-37 weeks) screening cultures in predicting intrapartum group B streptococcal (GBS) colonization in Rajavithi Hospital (RH). MATERIAL AND METHOD: From the September 1st, 2006 to November 30th, 2006 at RH, 360 pregnant women who fulfilled the specified criteria were selected from antenatal clinic. Swabs were cultured from the lower vagina and anorectum for GBS using Todd-Hewitt broth with 15 mcg/ml nalidixic acid and 8 mcg/ml gentamicin. When they were admitted in the labor room (LR) for labor; the cultures were repeated in the same way. RESULTS: 302 out of 360 cases had been cultured in LR. The prevalence of GBS in pregnant women at 35-37 weeks and delivery were 13.05% and 13.58% respectively. Fifty-three out of 302 cases were colonized with GBS from at least ANC and/or LR. So the overall prevalence of GBS colonization in pregnant women in this study was 17.55% (53/302). The sensitivity, specificity, positive and negative predictive values of late antenatal GBS culture were 70.73%, 95.40%, 70.73% and 95.40% respectively. There was no significant difference between PPV and NPV in any interval between antenatal and intrapartum cultures. CONCLUSION: Late antenatal screening cultures were not sensitive in predicting intrapartum GBS colonization status.

Outcome of pregnancy among parturients complicated with heart disease in Rajavithi Hospital.

OBJECTIVE: To compare the maternal and perinatal outcomes at Rajavithi Hospital from January 1st, 2000 to December 31st, 2004, (5 years), (3rd period) with those occurring in the previous two periods:1st and 2nd (1965-1970, (6 years) and 1985-1990, (6 years) respectively. MATERIAL AND METHOD: Retrospective analysis of various medical records of 196 cases diagnosed pregnancy with heart disease. RESULTS: The prevalence of parturients complicated with heart disease was 0.41%, an increase of 2 and 5 times compared with the first and second period, respectively. Congenital heart disease was the most common type of disorder in the second and third period (64.28% and, 49.49%, respectively) while rheumatic heart disease was the most common disorder in the first period (54.86%). Most of the cases in the 2nd and 3rd periods were delivered by operative vaginal delivery (46.43% and 44.90%, respectively), while spontaneous vaginal delivery was the most common mode of delivery in the first period (78.99%). All of the postpartum and perinatal complications except postpartum hemorrhage were significantly higher in the worse class of NYHA (class III/IV) than those in the better class of NYHA (class I/II). The maternal death rate in the third period increased 1.81 times and 13.66 times compared with those in the first and second periods, respectively. CONCLUSION: Congenital heart disease was the most common heart disease in pregnancy from 1985 to 1990 and 2000 to 2004. Patients in the NYHA class III/IV had worse maternal and fetal outcomes than those in the NYHA class I/II except for postpartum hemorrhage. Maternal mortality rate was highest from 2000 to 2004 (12.57 per 100,000 live births).

Comparison of combined vaginal-anorectal, vaginal and anorectal cultures in detecting of group B streptococci in pregnant women in labor.

OBJECTIVE: To compare whether the Group B streptococcal culture detection rate from vaginal-anorectal cultures, vaginal, or anorectal are equivalent. MATERIAL AND METHOD: Cross-sectional descriptive study was performed on 320 pregnant women with a gestational age between 28-42 weeks presenting with labor pain, between October, 1 and 30, 2004 in Rajavithi Hospital. Anorectal and vaginal swab cultures were collected and cultured in Todd Hewitt broth with 15 microg/ ml nalidixic acid and 8 microg/ml gentamicin. RESULTS: Forty-three (13.44%) and 33 cases (10.31%) were not significantly different in GBS detection rate in vaginal and anorectal culture, respectively (p = 0.154, McNemar). Combined vaginal-anorectal culture significantly improved the colonization GBS detection rate to 18.12% compared with either individual vaginal or anorectal culture 1 (p < 0.001, McNemar). CONCLUSION: GBS detection rate from combined vaginal-anorectal was significantly higher than either individual vaginal or anorectal cultures.

Risk factors related to group B streptococcal colonization in pregnant women in labor.

OBJECTIVE: To determine the risk factors related to group B streptococcal (GBS) colonization in pregnant women on admission in labor MATERIAL AND METHOD: From the 1st-30th October 2004, at the Rajavithi Hospital, 320 pregnant women, who fulfilled the specified criteria, were selected for a cross-sectional descriptive study. Swabs were cultured from the lower vagina and anorectum for GBS using Todd-Hewitt broth with nalidixic acid 15 microg/ml and gentamicin 8 microg/ml only. RESULTS: Colonization was present in 58 cases (18.12%). The risk factor for GBS colonization was an older mean maternal age and a lower mean gestational age. No mothers or neonates during the study period developed a clinical infection from GBS. CONCLUSION: The risk factors for GBS colonization in pregnant women were older maternal age and lower gestational age.

Obstetric hysterectomy: a 14-year experience of Rajavithi Hospital 1989-2002.

OBJECTIVES: To review and compare the incidence rate of obstetric hysterectomised patients between two seven-year periods. Theperiods were from October 1, 1988 to September 30, 1995 andfrom October P', 1995 to September 30th, 2002. The data included demographic characteristics, indications, possible risk factors, complications, and operative managements. MATERIAL AND METHOD: Retrospective analysis of the data that was collected from medical and labor records of the obstetric hysterectomised patientsfrom October 1, 1995 to September 30, 2002, the second seven-year period, compared with those in Pratumthong and Wattanaruangkowit's study from October 1, 1988 to September 30, 1995, the first seven-year period. RESULTS: Between 1998 and 2002, there were 201, 696 total deliveries with 111 obstetric hysterectomies. A significant increase in the average incidence rate of hysterectomy from 0.42 to 0.76/1000 deliveries and maternal age, placenta previa and blood transfusion in the second period compared with the first period (p < 0.05). Postoperative complications and the other risk factors of obstetric hysterectomy were not significant difference. CONCLUSION: The present study of obstetric hysterectomy demonstrates a significant increase in the incidence of hysterectomised rate, maternal age, blood transfusion, and placenta previa in the second period compared with the first period.

Enema versus no-enema in pregnant women on admission in labor: a randomized controlled trial.

OBJECTIVE: To compare the maternal and neonatal outcomes between enema and no-enema in pregnant women on admission in labor. MATERIAL AND METHOD: One thousand and one hundred term pregnant women with labor pain were selected randomly on admission to be assigned into two groups at Rajavithi Hospital from 1 February 2002 to 15 June 2002. Five -hundred and thirty-nine cases received enema and five-hundred and sixty one cases received noenema. Seventy three women (39 and 34 cases from the enema and no-enema groups, respectively) were excluded because of cesarean section due to obstetric indications. Five hundred cases received enema and five-hundred and twenty -seven cases received no-enema. All cases were delivered vaginally. RESULTS: There was no statistical significant difference between the two groups with regards to maternal age, gestational age, gravidity, parity, mode of delivery, type of episiotomy and degree of perineal tear. Fecal contamination rate during the second stage of labor was significantly higher in the women who received no-enema (34.9%) in comparision with those receiving enema (22.8% (p < 0.001). No neonatal infection occurred in both groups. Duration of labor was significantly longer in the women who received no-enema (459.8 min) compared with those who received enema (409.4 min) (p < 0.001). CONCLUSION: No-enema methods on admission in labor had significantly more increase infecal contamination in the second stage of labor and longer duration of labor than the enema method But there was no difference in perineal wound infection and neonatal infection between both groups.

Randomised controlled trial of perineal shaving versus hair cutting in parturients on admission in labor.

OBJECTIVES: To compare the maternal and neonatal outcomes between perineal shaving and hair cutting in parturients on admission in labor MATERIAL AND METHOD: Five hundred pregnant women with labor pain and no medical or obstetric complications were selected at random on admission to be assigned into two groups at Rajavithi Hospital from 1st November 2001 to 28th February 2002. Forty two women were excluded because of cesarean section. Two hundred and twenty-seven cases received perineal hair cutting and 231 cases received perineal shaving. RESULTS: The gestational age at delivery was statistically significant difference between those receiving perineal hair cutting (39.4 week) comparing with those receiving perineal shaving (39.1 week) (p < 0.05). There was no statistically significant difference in 2 groups for puerperal morbidity, perineal wound infection and dehiscence. There were no neonatal infection and puerperal infection in both groups, where as both accoucheurs and perineorrhaphy operators were more satisfied the perineal shaving group than the cutting group (p < 0.001). CONCLUSION: Perineal shaving or hair cutting on admission in labor had no statistical significant difference effect on the perineal wound infection and dehiscence, neonatal infection, puerperal morbidity and infection.