10% lidocaine spray for pain control during intrauterine device insertion: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Various medications have been investigated for their efficacy in pain reduction during intrauterine device (IUD) insertion, but there is currently no standard recommendation. This study aimed to investigate the efficacy of 10% lidocaine spray in reducing pain during copper-containing intrauterine device (Cu-IUD) insertion. METHODS: This study was a randomised, double-blind, placebo-controlled trial. Reproductive-age women were randomised at a 1:1 ratio into 10% lidocaine spray or placebo spray group. A 10 cm visual analogue scale (VAS) was used to evaluate pain during several steps of the IUD insertion procedure, and after the procedure. RESULTS: One hundred and twenty-four women were included and 62 women were randomised in each group. Baseline characteristics between groups were similar. The 10% lidocaine spray group demonstrated significantly lower median VAS immediately after IUD insertion than the placebo group (2.95 (IQR=1.00-5.63) vs 5.00 (IQR=3.35-7.00), respectively; p=0.002). Similarly, women receiving 10% lidocaine spray reported significantly lower median VAS than those receiving placebo during tenaculum use and uterine sounding. The maximum median VAS occurred immediately after Cu-IUD insertion. The proportion of women who reported VAS≥4 during uterine sounding and after IUD placement was significantly lower in the 10% lidocaine group than in the placebo group (p<0.05). Median change in VAS from baseline to IUD placement was significantly different between 10% lidocaine spray group and placebo group (1.85 (IQR=0.08-4.03) vs 3.6 (IQR=2.40-5.80), respectively; p=0.004). CONCLUSION: 10% lidocaine spray was found to be an effective local anaesthetic method for reducing pain during insertion of Cu-IUD. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03870711.

Comparison of change in body weight between contraception containing 30-µg ethinylestradiol/2-mg chlormadinone acetate or 30-µg ethinylestradiol/3-mg drospirenone: a randomised controlled trial.

Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-µg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-µg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.

Comparison of Endometrial Pathology between Tissues Obtained from Manual Vacuum Aspiration and Sharp Metal Curettage in Women with Abnormal Uterine Bleeding.

OBJECTIVE: To study the correlation of endometrial pathology, which were derived from manual vacuum aspiration (MVA) and sharp metal curettage (SMC). MATERIAL AND METHOD: Women aged over 35 years old who presented with abnormal uterine bleeding were enrolled. Endometrial biopsy using MVA and sharp metal curettage under paracervical nerve block were performed, respectively. Correlation of endometrial pathology from both methods and correlation between endometrial pathology from MVA and the most severe pathology were analyzed using Kappa statistics. RESULTS: One hundred and thirty two women were enrolled Nine cases were drop out because of inability to pass the MVA's cannula through the cervical os. Mean age was 49.3 ± 8.5 years old. Mean BMI was 25.1 ± 4 kg/m². Pathological correspondence between tissue obtained from MVA and sharp metal curette was 64.2% and the Kappa agreement was 0.56 (K0 = 0.56, p-value < 0.05). Pathological correspondence between tissue obtained from MVA and the most severe pathology was 92.7% and the Kappa.agreement was 0.86 (K = 0.86, p-value < 0.05). MVA could diagnose all cases of malignancy and endometrial hyperplasia. CONCLUSION: Manual vacuum aspiration (MVA) can be used as an alternative diagnostic procedure in women with abnormal uterine bleeding.

Safety and caregiver satisfaction associated with laparoscopic hysterectomy among young patients with intellectual disability.

OBJECTIVE: To evaluate the safety of laparoscopic hysterectomy for young patients with intellectual disability and the postoperative satisfaction levels of their caregivers. METHODS: A retrospective analysis was conducted of all patients with intellectual disability who underwent laparoscopic hysterectomy at a center in Thailand between January 5, 2004, and August 31, 2010. Information was retrieved about preoperative, intraoperative, and postoperative characteristics. Caregiver satisfaction levels were assessed 3 months after surgery using a Likert-type scale. RESULTS: The mean age of the 74 included patients was 14.9±4.2 years. The cause of intellectual disability was unknown for 30 patients (41%); 22 (30%) had Down syndrome. Total laparoscopic hysterectomy was performed among 66 (89%) patients. No major operative complications were noted. Overall, 72 (97%) caregivers were extremely satisfied with the surgical outcome; the remaining 2 (3%) reported being very satisfied. CONCLUSION: Laparoscopic hysterectomy was safe and had good outcomes among patients with intellectual disability. This procedure might be a feasible option to induce therapeutic amenorrhea among young patients with intellectual disability, especially in countries with limited resources.

Prevalence and associating factors of sexual dysfunction in women who use intrauterine device (IUD) for contraception.

OBJECTIVE: To study the prevalence and associating factors of sexual dysfunction in Thai women using contraception with intrauterine device (IUD). MATERIAL AND METHOD: A cross-sectional study was conducted in IUD users at the Family Planning Unit, Siriraj Hospital. Data were recruited between October 2012 and June 2013. The participants answered the questionnaires to collect demographic, obstetric-gynecological data, and female sexual function index (FSFI) score. RESULTS: Two hundred seventy one IUD users participated in this study. The mean age was 32.1 +/- 7.1 years old, mean body mass index (BMI) was 24.1 +/- 5.3 kg/m2. The prevalence of sexual dysfunction in IUD users was 50.9%. The associating factor that affected the sexual dysfunction significantly was observed in BMI group (p-value 0.033). Subgroup analysis illustrated that the underweight group had more sexual dysfunction. The lowest FSFI score was observed in the underweight group. The score was 23.50 +/- 4.52. The significant domains were found to be desirable and arousal domains. CONCLUSION: The prevalence of female sexual dysfunction in the period after IUD using was 50.9%. The BMI was a significant associating factor Underweight women showed higher trend of sexual dysfunction than other group, especially in the desire and arousal domain.

Intraperitoneal sub-diaphragmatic instillation of bupivacaine plus morphine for reducing postoperative shoulder pain after gynecologic endoscopy.

BACKGROUND: Gynecologic endoscopic surgery is a minimally invasive surgical technique for treatment of various gynecologic diseases. When compared to conventional laparotomy, this procedure has advantages in many aspects such as reduced postoperative pain, short hospital stay, and decreased morbidity associated with laparotomy. However 15 to 30% of the patients experienced moderate or severe postoperative shoulder pain. Methods to minimize postoperative shoulder pain after gynecologic endoscopy are essential to maximize the quality of life of the patients. OBJECTIVE: To evaluate the benefit of intraperitoneal instillation of bupivacaine plus morphine for reducing postoperative shoulder pain incidence after gynecologic endoscopy. MATERIAL AND METHOD: A randomized clinical trial was conducted in 158 patients undergoing laparoscopic procedures. The patients were randomly assigned to receive either 0.5% bupivacaine hydrochloride 20 mL mixed with morphine 3 mg (study group) or normal saline (control group) instillation to subdiaphragmatic area before finishing the procedure. Shoulder pain was evaluated at immediate post-operative time, and at 12 and 24 hours from the termination of surgery. The data of requested analgesic drugs after surgery was also recorded. RESULTS: Baseline characteristics were comparable between the two groups. Diagnosis, laparoscopic procedures, and duration of operation were also comparable. There were comparable proportions of patients reporting shoulder pain at 12 and 24 hours between the study and control group (30.4% and 30.4% at 12 hours, and 11.3% and 21.5% at 24 hours, respectively). Median pain scores at 12 and 24 hours were comparable between the study and control group (3 and 2 at 12 hours, and 4 and 4 at 24 hours, respectively). Requirement of analgesics was slightly greater among control than study group, but without statistical significance (17.7% and 24.1% respectively). CONCLUSION: Intraperitoneal instillation of bupivacaine plus morphine had no efficiency for reducing postoperative shoulder pain incidence after gynecologic endoscopy.

The prevalence of hepatitis B in premarital counseling clinic at Siriraj Hospital.

OBJECTIVE: To study the prevalence and associating factors of hepatitis B infection in the Premarital Counseling Clinic at Siriraj Hospital. MATERIAL AND METHOD: The data (medical history, physical examination, and Hepatitis B profile) was collected from medical records of 740 couples who attended the Premarital Counseling Clinic in Siriraj Hospital between September 2005 and December 2009 for this retrospective study. RESULTS: The prevalence of positive HBsAg in couples who attended the Premarital Counseling Clinic, Siriraj Hospital was 4.2%, which was 3.0% in male and 1.2% in female. The mean age of male was 32.9 +/- 5.1 years old and 30.7 +/- 3.9 years old in female. History of hepatitis B vaccination was found less in male (male 6.1% vs. female 8.8%). Four point two percent of participants were positive HBsAg but negative of HBsAb. Twenty-four couples were at risk or 3.2%. Male gender and history of no hepatitis B vaccination was significantly associated with positive HBsAg. No significant difference was found between age and occupation. CONCLUSION: The prevalence of positive HBsAg in the Premarital Counseling Clinic, Siriraj Hospital was 4.2%. Male gender and history of no hepatitis B vaccination had significant association with positive HBsAg.

Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis.

OBJECTIVE: To compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis. METHODS: A retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes-including operative time, blood loss, length of hospital stay, and need for blood transfusion-were analyzed and compared between the 2 treatment groups. RESULTS: Operative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P<0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P<0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P<0.001]; and 18.3% versus 49.0% [P<0.001], respectively). CONCLUSION: Compared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.

High prevalence of cervical squamous cell abnormalities among HIV-infected women with immunological AIDS-defining illnesses.

AIM: To assess the results of Pap smear at postpartum scheduled visit, especially the prevalence of squamous cell abnormalities including association with CD4(+) T-lymphocyte count (CD4(+) count) levels at delivery among HIV-infected women between the years 1996 and 2004. METHODS: As part of the research and implementation programs of short course antiretroviral regimens for the prevention of mother to child perinatal HIV transmission in HIV-infected pregnant women delivered at Siriraj hospital, CD4(+) count at delivery and Pap smear at postpartum were evaluated. RESULTS: Among 636 women, 13.3% had squamous cell abnormalities. Seventy-seven cases (90.6%) of squamous cell abnormalities were low grade squamous intraepithelial lesions. The prevalence of squamous epithelial cell abnormalities detected by Pap smear, was higher in women whose CD4(+) count at delivery was < 200 cells/microL than in women whose CD4(+) count at delivery was > or = 200 cells/microL, with a significant difference (21.2%vs 12.2%). CONCLUSIONS: All HIV-infected pregnant women should be evaluated for clinical and immunological status during the antepartum period. Pelvic examination and Pap smear should be considered as a part of this evaluation. They should receive comprehensive health-care services that continue after pregnancy, including postpartum gynecologic examination and Pap smear. Women with normal cervical cytological findings but low CD4(+) count should be offered an antenatal Pap smear and long-term follow-up including a 6-monthly Pap smear.

Associated risk factors of human papillomavirus cervical infection among human immunodificiency virus-seropositive women at Siriraj Hospital.

This cross sectional type sub-study was established to assess the potential risk factor associated with human papillomavirus (HPV) cervical infection in Human immunodeficiency virus (HIV)-seropositive women. The series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics & Gynecology, Siriraj Hospital. Demographic, obstetrical and behavioral risk factors were interviewed. Laboratory results were recorded. Clinical gynecologic examination was performed including Pap smear. The patients were assigned into two groups, HPV and non-HPV group. The comparison of the potential risk factors between the groups was calculated statistically. It was found that the prevalence of HPV infection was reported in 17 patients (9.6%). HIV-seropositive women, who were infected with HPV, had a significantly more probability to have a single partner in their lifetime than those who were not infected. It could be that HPV cervical infection and HIV-seropositive women share common potential risk factors, as well as, the recognition of sexual intercourse as the important route of HPV transmission.

Two regimens of misoprostol for treatment of incomplete abortion.

OBJECTIVES: Misoprostol shows promise for treatment of incomplete abortion. We evaluated 2 simple misoprostol regimens to estimate whether they were effective in treating incomplete abortion. METHODS: A total of 169 women was randomly assigned to either a single or double dose of 600 microg misoprostol. The women, who would have received a surgical evacuation of the uterus for incomplete abortion, were patients at 2 hospitals in Bangkok, Thailand. The 2 groups of women were compared for success of treatment (no need for surgical evacuation), side effects, and acceptability. RESULTS: Sixty-six percent of women in the single-dose group and 70% of women in the double-dose group had complete abortions with misoprostol. More than 90% of women in the single- and double-dose groups reported that the side effects were tolerable; frequency of side effects was similar between the 2 groups. Women found the treatment acceptable. Approximately 90% of women in both groups would recommend the treatment to a friend. Acceptability and efficacy were different at the 2 participating clinics. CONCLUSION: Misoprostol is an effective treatment for incomplete abortion. Simple regimens may be as effective as more complicated ones and a single dose of 600 microg should be further evaluated in larger trials.

Prevalence of bacterial vaginosis in Thai women attending the family planning clinic, Siriraj Hospital.

OBJECTIVES: To investigate the prevalence of bacterial vaginosis (BV) among Thai women attending a family planning clinic and to evaluate the association of BV with potential risk factors. MATERIAL AND METHOD: A cross sectional prevalence study was conducted among 800 women attending the family planning clinic, Siriraj Hospital, between August and December 2003. BV was diagnosed according to Amsel's criteria. Prevalence and risk factor models were compiled and statistically analyzed RESULTS: Among the low risk population acquiring sexually transmitted diseases, the prevalence of BV was 14.6% (117 of 800). Asymptomatic disease was recognized in up to 47.9% (56 of 117). BV was significantly more prevalent among those who used douching inside the vagina [OR = 3.98 (1.85-8.33), p < 0.01] and high a prevalence among IUD users [OR = 1.84 (1.22-2.79), p < 0.01]. Although not statistically significant, BV tended to be more prevalent among women with a lower age at first intercourse, higher numbers of lifetime partners, higher frequency of sexual intercourse and current smokers. CONCLUSION: BV is a relatively high prevalent condition. The two potential risk factors, douching inside the vagina and IUD use, can be demonstrated, adding to be more concerned about the inappropriate practice of douching and more consideration in IUD users. The other potential risk factors, the impact to adverse reproductive outcomes and the prevention of BV need further studies, particularly in various Thai populations.

Accuracy of Nugent's score and each Amsel's criteria in the diagnosis of bacterial vaginosis.

OBJECTIVE: To determine the diagnostic accuracy of Nugent's score and each Amsel's criterion in the diagnosis of bacteria vaginosis (BV), considering Amsel's criteria as the gold standard. DESIGN: Cross-sectional, descriptive study (diagnostic test) Setting: Family planning clinic, Siriraj Hospital, Mahidol University. SUBJECTS: A total of 217 women who attended the Family Planning Clinic at Siriraj Hospital between August and December 2003. METHOD: Pelvic examination was performed on each participant. Samples of vaginal discharge was tested for BV infection using both Amsel's criteria and Nugent's score. Interpretation was made blinded without knowledge of each test result. Using Amsel's criteria as a gold standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Nugent's score and each of Amsel's criteria were estimated. RESULTS: Considering Amsel's criteria as the gold standard, Nugent's score showed a sensitivity of 65.6% (95%CI 46.8%, 80.8%), specificity of 97.3% (95%CI 93.5%, 99.0%), positive predictive value (PPV) of 80.8% (95%CI 60.0%, 92.7%), negative predictive value (NPV) of 94.2% (95%CI 89.7%, 96.9%) and accuracy of 92.6% (95%CI 88.1%, 95.6%). Both vaginal pH and whiff test demonstrated 100% sensitivity. However, vaginal pH showed lower specificity than the whiff test (58.9% and 97.3% respectively). CONCLUSION: Nugent's score might not be suitable to use as a screening test for diagnosis of BV due to its low sensitivity. The whiff test is the best clinical criteria of Amsel's criterion in the diagnosis of BV due to its high sensitivity and specitivity.

Prevalence of bacterial vaginosis among intrauterine device users in Thai women attending Family Planning Clinic, Siriraj Hospital.

OBJECTIVES: To determine the prevalence of BV among IUD users attending at Family Planning Clinic, Siriraj Hospital In addition, associated risk factors for BV were also explored. MATERIALS AND METHOD: This study was carried out from August through November 2003 at the Family Planning Clinic, Department of Obstetrics and Gynecology, Siriraj Hospital. A total of 300 IUD users were enrolled Bacterial vaginosis is defined by fulfillment of at least three of four findings according to Amsel's criteria. Prevalence and risk factors were determined. RESULTS: The overall prevalence of bacterial vaginosis according to the Amsel's criteria was 20.3% (95% CI 15.7-24.9%). The most common complaints were abnormal vaginal discharge (41.0%) and pelvic pain (41.0%), whereas 32% had no symptoms. The only significant factor associated with BV was duration of IUD use. Women with BV were more likely to have used IUD for a longer period than women without BV especially more than 15 years. (19.7% and 9.2% respectively, P = 0.017). CONCLUSIONS: Our findings showed rate of BV was prevalent among Thai women with IUD insertion. The only risk factor was long time duration of IUD insertion that health care providers should aware of the infection among these women. The influence of IUD use on the occurrence of vaginal flora changes and BV remained a controversial issue. Further study should be conducted to examine the issue in more detail, both among IUD users and other groups of women as well.

Collection and processing of umbilical cord blood for cryopreservation.

Umbilical cord blood (UCB) is being increasingly used as an alternative source of hematopoietic stem cells for allogeneic bone marrow transplantation. UCB transplantation has been successfully used to treat a variety of genetic, hematological, and oncological disorders in children and adults. The objectives of this study was to establish a closed-system technique for UCB collection and buffy coat separation by Optipress I device. Thirty-four UCB were collected by triple-bag system from pregnant mothers whose fetuses were not affected by thalassemic diseases after prenatal diagnosis. The mean volumn of UCB collection were 120 +/- 5 ml (range 65-180 ml). Total WBC, CD34+ cells, the progenitor cell erythroid burst-forming unit (BFU-E) and granulocyte-macrophage colony-forming unit (CFU-GM) in the UCB units were (9.36 +/- 0.84) x 10(8), (3.61 +/- 0.52) x 10(6), (9.12 +/- 1.60) x 10(5), and (5.32 +/- 1.23) x 10(5), respectively. Good correlation between the nucleated cell and net cord blood volume could be demonstrated (p < 0.0001). The correlation between CD34+ cells and the following parameters: nucleated cell, BFU-E or CFU-GM were also demonstrated (p = 0.001, 0.0105 or 0.0001, respectively). Buffy coat was subsequently separated from 18 UCB units by Optipress I device. 70 +/- 3 ml of buffy coat were collected and cryoprocessing was done by automatic controlled-rate freezer. Good recovery of total WBC, CD34+ cells, progenitor cells BFU-E and CFU-GM after buffy coat separation were observed 89 per cent, 95 per cent, 109 per cent, and 102 per cent respectively. There was no aerobic bacterial or fungal contamination in the separated blood products. By using this technique, the UCB units were easily collected, rapidly separated within one hour, and high recovery of the hematopoietic progenitor cells could be obtained.

Relationship between human papilloma virus infection and abnormal Pap smear in HIV-seropositive women at Siriraj Hospital.

The purpose of this prospective study was to determine the prevalence of human papillomavirus and abnormal Pap smear in HIV-seropositive women, particularly in HIV-seropositive women who undertook antiretroviral drug. The consecutive series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics and Gynecology, Siriraj Hospital. All general information and laboratory results of the patients were recorded. Pap smears are obtained from the endocervix, cervical transformation zone and vagina by using a cotton tip stick and Ayre spatula, as described in the VCE technique. The patients were assigned into two groups, the AZT and non-AZT group. The comparison between the groups was calculated statistically. It was found that 88 of 178 HIV-seropositive women (49.4%) undertook Zidovudine. The prevalence of abnormal Pap smear in HIV-seropositive women, who had an abnormal Pap smear, was 59.6 per cent. However, the prevalence of human papillomavirus infection detected by Pap smear was reported in 17 patients (9.6%). There was no difference between the AZT and non-AZT group statistically. There was a significantly higher probability of finding an abnormal Pap smear for cervical dysplasia in HIV-seropositive women who were infected with human papillomavirus compared to. It is concluded that there is a higher risk of developing cervical dysplasia in HIV-seropositive women who carry the human papillomavirus.

Short-course therapy with zidovudine plus lamivudine for prevention of mother-to-child transmission of human immunodeficiency virus type 1 in Thailand.

To evaluate the efficacy and safety of short-course therapy with zidovudine plus lamivudine for reduction of perinatal transmission of human immunodeficiency virus type 1 (HIV-1), a single-arm, open-label, prospective, nonrandomized study was conducted. One hundred six treatment-naive pregnant women received zidovudine (300 mg) plus lamivudine (150 mg) twice daily from week 34 of gestation until the onset of labor. During labor, zidovudine and lamivudine were given every 3 h. Neonates received zidovudine syrup for 4 weeks and were bottle fed. The median maternal virus load and CD4+ cell count at weeks 32-34 of gestation were 4.33 log10 copies/mL and 274 cells/mm3, respectively. At delivery, the mothers' mean decrease in virus load was 1.55 log10 copies/mL and the mean increase in CD4+ cell count was 93 cells/mm3, compared with enrollment levels. Three neonates were HIV-1 infected, for a transmission rate of 2.83% (95% confidence interval, 1%-8%). There were no serious adverse events in the mothers. Adverse events noted in neonates were anemia (in 6 neonates), elevated transaminase levels (in 1), and thrombocytopenia (in 3). Short-course therapy with zidovudine plus lamivudine appeared to be safe and effective for prevention of perinatal transmission of HIV-1.

Rapid human immunodeficiency virus diagnostic test during the intrapartum period in pregnant women who did not receive antenatal care.

The main barrier to implementation of antiretroviral drugs in HIV-infected pregnant women is the lack of antenatal care (ANC). From April 1999 to December 2001, the prevalence of pregnant women not receiving ANC and coming for delivery in Siriraj Hospital was 7.3 per cent (2,152/29,484) and the prevalence of HIV infection among this group was 5.7 per cent, substantially higher than that of 27,332 pregnant women receiving ANC in Siriraj Hospital (2.2%). Besides developing interventions to increase use of ANC, the test for diagnosis of HIV infection during the intrapartum period should be rapid, inexpensive, highly sensitive and specific, easy to perform and results should be easy to interpret. The Determine Rapid Test for detection of HIV fulfills these criteria with 100 per cent sensitivity, 99.85 per cent specificity, 97.54 per cent positive predictive value, 100 per cent negative predictive value and 0.14 per cent false positive. To improve prevention of mother-to-child HIV transmission (PMTCT), the authors believe that this uncomplicated rapid HIV testing should be used during the intrapartum period to Thai-pregnant women who did not receive antenatal care and antiretroviral drugs might be offered as soon as possible for those testing HIV-positive and for their baby as chemoprophylaxis.

Misoprostal use for therapeutic abortion in Siriraj Hospital: the year 2000.

OBJECTIVE: To evaluate the efficacy and the adverse effects of misoprostal usage for therapeutic abortion in Siriraj Hospital. STUDY DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHOD: A consecutive series of 101 therapeutic abortions was performed in the Department of Obstetrics & Gynecology, Siriraj Hospital in the year 2000. The patients were interviewed for general information and registered, as well as in-patient data. Any adverse events were recorded and collected from the inpatient record file. All data were analyzed statistically. RESULTS: 42 therapeutic abortions were conducted in association with misoprostal usage. Misoprostal was used for cervical ripening in 8 patients with a good outcome. 31 therapeutic abortions were induced by misoprostal alone regimen. A higher success rate (74.1%) was correlated with higher gestational age. 27 out of 31 cases were second trimester abortion. The induction to abortion interval was 18.0+/-10.5 hours (range 5-48). No factor, including age, weight, total dose of misoprostal use, nulliparity and viability of the fetus, could be demonstrated to affect the misoprostal activity defined by induction to abortion interval. There was no serious adverse event, except for severe abdominal cramping (26.2%) and fever (14.3%). CONCLUSION: Misoprostal alone can be used with caution for abortion induction especially in second trimester abortion.

Risk factors for birth before arrival at Siriraj Hospital.

OBJECTIVE: To assess the potential risk factors for birth before arrival at Siriraj Hospital. STUDY DESIGN: Prospective case-control study. SETTING: Department of Obstetrics & Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. SUBJECTS: The subjects were 320 patients who had delivered at Siriraj Hospital and were divided into two groups. One hundred and sixty patients, who gave birth before admission to the labor room of Siriraj Hospital, were assigned as the study group. The control group consisted of 160 patients who had normal deliveries in the labor room of Siriraj Hospital at the same period of time. INTERVENTION: Information was obtained by interviewing the patients. Both the interviewer and the subjects were blinded to each other. The data were analyzed by using logistic regression model and EpiInfo program. MAIN OUTCOME MEASURE: Information of antenatal care, socio-economic data, past obstetric history and present data of delivery. RESULTS: The six significant risk factors were identified; education level of the patients (odds ratio 6.11), past history of previous delivery (odds ratio 6.18), past history of preterm delivery (odds ratio 4.03), no antenatal care (odds ratio 8.55), unawareness of true labor symptoms (odds ratio 1.89) and present preterm delivery (odds ratio 2.99). CONCLUSION: The risk factors identified from this study were low education level, past history of previous delivery, past history of preterm delivery, no antenatal care, unawareness of symptoms of true labor and present preterm delivery. The risk factors from this study should have further study to get more information that can apply to control birth before arrival.