Mental health of residents during Obstetrics and Gynecology training in Thailand.

OBJECTIVE: To evaluate mental health of residents during Obstetrics and Gynecology training and identify the factors that affect mental health problems. MATERIAL AND METHOD: During January-April 2004, one hundred and sixty Obstetrics and Gynecology residents (62% of 259) had completed a self-administered questionnaire composed of demographic data, workload, self-report of life stressors, and the Thai Mental Health Questionnaire (TMHQ-70). RESULTS: The prevalence of mental health problems was 29% (46/160). Somatization and social function were found in the first and second rank (18.1% and 11.9%), respectively. A resident who was younger than 25 years old, was married, cared for more than 20 patients per 8 hours in the labor room, performed more than 10 academic activities per year, or attended more than 5 examinations per year was at risk to develop social function problems. CONCLUSION: About one-third of residents training in Obstetrics and Gynecology have faced mental health problems--somatization, social function, depression and anxiety. The significant risk factors associated with social function problems were younger age, marriage and excessive workload

Prenatal diagnosis of fetal bladder outlet obstruction at Songklanagarind Hospital: report of 5 cases.

Five cases of fetal bladder outlet obstruction prenatally diagnosed in the Perinatology Unit, Department of Obstetrics and Gynaecology, Songklanagarind Hospital, Songkhla, from January 1990 to September 1999 were reported. Ultrasound findings demonstrated megacystis, various degrees of hydroureter and hydronephrosis and oligohydramnios. Sex could be determined in only four cases and all were male. Chromosome abnormality (trisomy 18) was documented in one case. Postmortem results in three cases established that posterior urethral valves were the cause of obstruction. All cases in our series had poor outcome based on gestational age at first diagnosis, sonographic findings, fetal urinalysis, and chromosome abnormality. Four cases underwent termination of pregnancy and the other resulted in a dead fetus in utero. The outcome of some cases may be improved by using the vesicoamniotic shunt placement procedure that increases the likelihood of fetal survival. Therefore, the recommendation is to establish this procedure at Songklanagarind Hospital in the future.

Prenatal diagnosis of thalassemia in Songklanagarind Hospital in southern Thailand.

A thalassemia screening program for pregnant women has been established in Songklanagarind Hospital since 1992. After genetic counseling, a total of 5078 pregnant women accepted entry into a screening program for thalassemia. Couples at risk who should receive prenatal diagnosis were 2.8%. Total cases who accepted prenatal diagnosis were 135. Total clinical cases were 40 (29.6%) with achievement by prenatal diagnosis of 33 cases (82.5%). Genetic amniocentesis is the most acceptable method for prenatal diagnosis. Five cases (12.5%) were misdiagnosed due to contamination of maternal blood cells in amniotic fluid cases. Questionable results were reported in 2 cases (5%). Abortion occurred in one case (0.7%). Improvement of surgical technic in prenatal diagnosis reduced the complications and contamination of maternal cells. This program shows the feasibility of prevention and control of thalassemia disease in southern Thailand.

The largest ovarian cyst in Songklanagarind Hospital: a case report.

Giant ovarian cysts (more than 12 kilogram) are now rarely seen because of the development in health care systems and education. We report a patient with an ovarian cyst weighing 64 kilogram, marked distended abdomen, tachypnea and dyspnea, pitting edema of both legs and inability to walk. The successful management required multidisciplinary team approach. Slow paracentesis of the cyst was done to relieve 20 litres of fluid before surgery to improve the respiratory function. Subtotal hysterectomy with bilateral salpingo-oophorectomy and partial omentectomy was done with about 4 litres of blood loss during operation. We replaced with 9 units of packed red cells and 25 units of fresh frozen plasma and plasma. Postoperative complications were pneumonia, urinary tract and surgical wound infection which were treated by appropriate antibiotics, dressing and physiotherapy until the patient was able to walk. She was discharged home on postoperative day 33. The pathological report of this cyst was mucinous cystadenoma. Only 4 courses of prophylactic chemotherapy were given because she was lost to follow-up.