Risk factors of primary postpartum hemorrhage in Siriraj Hospital.

Objective: To explore the risk factors of primary postpartum hemorrhage (PPH) in pregnant women who delivered at Siriraj Hospital. Methods: The medical records of pregnant patients who delivered vaginally at Siriraj Hospital during January 1st to December 31st, 2005 were enrolled into 2 groups. The study group was singleton pregnancy with primary PPH and the control group was sandwich singleton pregnancies who delivered without PPH. The ratio between the study and the control group was 1:2. Baseline characteristics and obstetrics data of each group were collected. Descriptive statistics, independent sample t-test, odds ratio, 95% confidence interval and multiple linear regression analysis were used in this study. Results: A total number of 222 medical records were reviewed. The number of the patients in the study group and control group were 74 and 148, respectively. By multiple linear regression analysis, the data revealed that prolonged third stage of labor and pregnancy induced hypertension were the significant risk factors related to primary PPH (P <0.05, 95%CI 0.2-0.65 and 0.01-0.47, respectively). The three most common causes of primary PPH in the study group were uterine atony (77.03%), birth passage injury (24.32%) and retained pieces of placenta (20.27%), respectively. Conclusion: The significant risk factors of primary PPH in this study were prolonged third stage of labor and pregnancy induced hypertension. Uterine atony, birth passage injury and retained pieces of placenta were the next most common causes of primary PPH.

Prevalence of mental health problem during first-half pregnancy at Siriraj Hospital.

OBJECTIVE: To study the prevalence of mental health problem during first-half pregnancy. STUDY DESIGN: Cross-sectional descriptive study. MATERIAL AND METHOD: The 255 singleton pregnant women < 20 weeks of gestation were enrolled. They were asked to complete a self-administered questionnaire which included Thai GHQ-30 (mental health problem screening tool) and frequent psychosocial stressor forms. The prevalence and factors associated with mental health problem were evaluated. MAIN OUTCOME MEASUREMENT: The prevalence of mental health problem. RESULTS: The prevalence of mental health problem was 17.3%. Factors independently associated with mental health problem included worrying about health, stress of taking care of other family members and financial problem with adjusted OR 3.5 (95% CI 1.16, 10.74), 3.8 (95% CI 1.80, 7.89) and 3.2 (95% CI 1.34, 7.53) respectively. CONCLUSION: The prevalence of mental health problem was 17.3%. Screening of mental health problem should be included in antenatal care service especially in the risk group.

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.

Risk factors of caesarean section due to cephalopelvic disproportion.

OBJECTIVE: To identify risk factors of cesarean section due to cephalopelvic disproportion SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. STUDY DESIGN: Case-control study. MATERIAL AND METHOD: One hundred and three singleton, viable, term pregnant women in cephalic presentation delivered by cesarean section due to cephalopelvic disproportion (CPD) and 105 controls gave normal birth just before or after the study case. Demographic, anthropometric data, labor characteristics, and neonatal outcomes were obtained from medical records. The expected risk indicators of the case and control groups were compared by using independent unpaired T-test and exact probability test as appropriate. Multiple logistic regression analysis was used to determine the significant risk factors (p < 0.05). RESULTS: Significant independent risk factors of cesarean section due to CPD were: estimated fetal weight (EFW) > 3,000 g (OR = 3.96, 95% CI = 2.06, 7.63), pre-pregnancy BMI > or = 25 kg/m2 (OR = 5.06, 95% CI = 1.67, 15.34), nulliparity (OR = 2.98, 95% CI = 1.31, 6.78) and the inadequacy of clinical pelvimetry (OR = 8.49, 95% CI = 1.01, 71.78), (p < 0.05). CONCLUSION: Risk factors for cesarean section due to CPD were EFW > 3,000 g, pre-pregnancy BMI > or = 25 kg/m2, nulliparity and the inadequacy of clinical pelvimetry. They are useful in the categorization of individual women into high and low CPD-risk groups.

Efficacy of fetal echocardiography and an evaluation of indications.

Fetal echocardiography has been accepted as a prenatal noninvasive diagnostic tool of cardiovascular diseases in fetuses for more than three decades. There are limited data in Thailand. A retrospective study of prenatal, natal and postnatal data of pregnant women who had fetal echocardiography at Siriraj Hospital, Bangkok, Thailand, from January 1999 to July 2005 was conducted. In total, there were 117 pregnant women who had fetal echocardiography under standard indications. Median age of pregnant women was 30.2 (17.3-44.2) years old. Median gestational age at the first fetal echocardiography was 29 (17-40) weeks. Median number of time the women had fetal echocardiography was 1 (1-10). Indications for fetal echocardiography were; obstetricians suspected of fetal cardiovascular diseases, multiple anomalies, family history of congenital heart diseases, chromosome anomalies, hydrops fetalis, and other indications (53.8%, 12%, 11.1%, 8.5%, 8.5% and 6.0% respectively). There were 49 (41.8%) cases who had abnormal cardiovascular problems, i.e., structural heart diseases 26 cases, rhythm disturbance 15 cases, and cardiac masses 8 cases. Upon comparison with postnatal echocardiography and/or autopsy findings, fetal echocardiography had a sensitivity of 96.9%, specificity of 90.6%, and accuracy of 92.8%. There was various degrees of risk to have cardiovascular problems for each of the indication taking fetal echocardiography and postnatal data into consideration. Fetal echocardiography had an impact on the management in 57.3% of cases. Conclusion: Fetal echocardiography is a reliable prenatal diagnostic tool for cardiovascular problems with high accuracy and has an impact on the management at prenatal, natal and postnatal period. Different indications for fetal echocardiography have an effect on the relative risk of fetal cardiovascular diseases.

Prenatal diagnosis of cardiovascular diseases.

Fetal echocardiography is a safe means to obtain reliable anatomical and hemodynamic data of the fetal heart. The procedure is essential for prenatal diagnosis of cardiovascular abnormalities. In addition, fetal echocardiography is useful to follow-up the progression, monitoring during treatment and making a plan of treatment especially in life-threatening cardiac conditions. The objective of this study was to find the distribution of indications for fetal echocardiography, fetal cardiac anomalies detected, outcome of the fetuses and to assess the accuracy of the procedure. A retrospective study was done at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Pregnant women whose fetuses had prenatal echocardiographic data and gave birth from January 1999 to December 2001 were included. The total number of pregnant women was 54 cases. The indications for fetal echocardiography were suspicion of fetal cardiovascular disease by the obstetrician 42.6 per cent, family history of congenital heart diseases 14.8 per cent, multiple organ system anomalies 14.8 per cent, chromosomal anomalies 11.1 per cent, hydrops fetalis 9.3 per cent, maternal systemic diseases 5.6 per cent and previous pregnancy with a dead fetus in utero 1.9 per cent. The gestational age at the time of the first fetal echocardiography ranged from 17 to 39 weeks (median 28 weeks). The number of fetal echocardiography done in each case ranged from 1 to 10 (median 1.4). Prenatal diagnosis of the abnormal cardiovascular system in fetuses was found in 19 cases (35.2%). There were abnormal cardiac anatomies in 42 per cent, cardiac tumors or abnormal masses in 37 per cent and rhythm disturbances in 21 per cent. When compared with postnatal echocardiography and/or autopsy finding, fetal echocardiography had a sensitivity of 100 per cent, specificity of 96.3 per cent and accuracy of 97.8 per cent. Conclusion: Fetal echocardiography has good accuracy in the diagnosis of cardiovascular diseases. Obstetrician's suspicion is important in the prenatal diagnosis of heart disease that would have affected the short and long-term outcome of the fetus.

Twin pregnancy with single fetal death.

The antepartum death of one twin during late second trimester is a rare obstetric complication. Reported herewith a case of twin primigravuda whose death of one twin occurred at 26 weeks gestation. Delivery was postponed for 9 weeks as lung maturity was anticipated, since previous experience of preterm and neonatal death rates were high in the surviving twins.