Quality of life and risk factors that affect the quality of life of Thai female physicians.

OBJECTIVE: To study the quality of life (QOL) and risk factors that affect QOL of Thai female physicians. MATERIAL AND METHOD: The Thai version of the briefform of WHO quality of life assessment instrument (WHOQOL-BREF-THAI) and risk assessment questionnaires were mailed to 1700 randomly selected female physicians. RESULTS: The authors obtained a response rate of 41.9%. Most physicians were married (57.3%), they worked 57.3 hours/week, and had a mean income of 64,622 baht/month. The prevalence of obesity was 12.6%. Most (99.3%) did not drink alcohol, 69.6% avoided high cholesterol and afat diet, 65.8% consumed a balanced diet, and 55.9% included vegetables and fruit in half of their meals. The majority (62.2%) exercised for less than 30 min/day. They used a safety belt (92.1%) or crash helmet (87.5%) when driving a motor vehicle. Regarding their current health, 8.9% had hearing problems, 6.1% had diabetes, 3.3% had glaucoma, and 1.8% had hypertension. CONCLUSION: Most female physicians had fair to good QOL scores. They were health and safety conscious. These aspects can be used in a campaign to promote a healthier life-style for Thai women.

Pregnancy outcomes in placental abruption.

OBJECTIVES: To determine the outcomes of pregnancies with placental abruption and to investigate the relationship between clinical maternal characteristics and poor perinatal outcomes. MATERIAL AND METHOD: A retrospective descriptive study was conducted to evaluate 103 cases of placental abruption delivered at King Chulalongkorn Memorial Hospital from 1995 to 2004. RESULTS: There were 111,375 singleton deliveries with 103 cases (0.92 in 1,000) complicated by placental abruption during the study period. Placental abruption attributed to maternal complications including hemorrhagic shock (19.4%), Couvelaire uterus (16.5%) and DIC (5.8%). The perinatal outcomes included low birth weight (65.0%), preterm (56.3%), severe birth asphyxia (16.5%) and perinatal death (16.5%). Placental abruption with pregnancy induced hypertension (PIH), DIC and blood transfusion had a significantly higher incidence of perinatal mortality than the remainder (odds ratio [OR] 4.16, 95% confidence interval [CI] 1.41-12.24; OR 12.92, 95%CI 2.15-77.80 and OR 3.93, 95%CI 1.27-12.19, respectively). Placental abruption with Couvelaire uterus had a significantly higher incidence of severe birth asphyxia than the remainder (OR 3.72, 95%CI 1.14-2.09). CONCLUSION: Placental abruption had a profound impact on both maternal and perinatal complications including DIC, Couvelaire uterus, severe birth asphyxia and perinatal death. The relationship between PIH, DIC, blood transfusion and Couvelaire uterus with poor perinatal outcomes were found Therefore, placental abruption with these clinical characteristics should be closely monitored and prompt delivery should be carried out at tertiary care centers with adequate maternal-neonatal intensive care facilities.

Outcome of idiopathic thrombocytopenic purpura in pregnancy in King Chulalongkorn Memorial Hospital.

OBJECTIVE: To study the maternal and fetal outcome of idiopathic thrombocytopenic purpura (ITP) in pregnancy. MATERIAL AND METHOD: The medical records of women who were diagnosed to be idiopathic thrombocytopenic purpura during and before pregnancy from January 1995 to December 2004 were reviewed. RESULTS: There were 33pregnancies from 29 ITP women as four women had two pregnancies each and one was twins. Nine cases (27.3%) were active ITP, five cases (15.2%) were relapsing ITP and eight cases (24.2%) were inactive ITP. Eleven cases (33.3%) had severe thrombocytopenia during delivery and five neonates (23.8%) had severe thrombocytopenia. There was no statistical correlation between maternal and neonatal platelet concentration (r = -0.0601). None of the mothers and fetuses had serious hemorrhagic complication such as intracranial hemorrhage. CONCLUSION: There were low hemorrhagic risks in both mothers and infants because of the constant monitoring of multidisciplinary groups of experienced physicians, including obstetricians, hematologists, anesthesiologists and neonatologist.

Pregnancy outcomes of multiple repeated cesarean sections in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To determine the incidence of maternal and neonatal morbidity and mortality in women with history of at least one previous cesarean section and to compare the pregnancy outcome of the women with the history of one previous cesarean section to the women with the history of two or more previous cesarean section. MATERIAL AND METHOD: We performed a retrospective study of 458 patients undergoing repeated cesarean section from 1998 to 2005. Various factors that may be associated with repeated cesarean sections and pregnancy outcomes were assessed and analyzed. RESULTS: Maternal morbidity rate was 18.6%, including operative complications (17.5%) and post operative complications (1.7%). The operative complications included intraperitoneal adhesion 45 cases (9.8%), excessive blood loss (> 1000 ml) 29 cases (6.3%), placenta previa 5 cases (1.1%), placenta adherens 6 cases (1.3%) and requirement of blood transfusion 10 cases (2.2%). Postoperative complications included postpartum hemorrhage 4 cases (0.9%). No maternal mortality was found in this study. Neonatal morbidity rate was 20.5%, including neonatal jaundice 33 case (7.20), large for gestational age 37 cases (8.1%), and preterm babies 20 cases (4.4%). There were no statistically significant differences of maternal morbidity and neonatal morbidity between the pregnant women with the history of one previous cesarean section and the women with the history of two or more previous cesarean section. CONCLUSIONS: Maternal and neonatal morbidity in repeated cesarean section were low.