Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.

BACKGROUND: There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08. METHODS: Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events. FINDINGS: We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively). INTERPRETATION: To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication. FUNDING: US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research.

Physical health consequences of sexual assault victims.

OBJECTIVE: To describe health consequences of sexual assault victims attending Police General Hospital, Thailand. DESIGN: Descriptive study with prospective data collection. SETTING: Police General Hospital, Bangkok, Thailand. SUBJECTS: Sexual assault victims attending Police General Hospital between October 1, 2004 and September 30, 2005 were recruited All subjects were actual sexual assault cases and came to Police General Hospital within 14 days. MATERIAL AND METHOD: Each recruited victim was interviewed, physically and forensic medically examined, and screened for sexual transmitted infections (STIs) at first visit, two-week follow-up visit, and three-month follow-up visits. Data were analyzed using descriptive statistics, including 95% confidence intervals. RESULTS: There were 377 victims. One of them was male and excluded from the analysis. Most victims were single, 68.8% aged 10-19 years. Non-genital injuries were reported in 32.4% (95% CI, 27.7%, 37.5%) of the victims and 91.0% of these injuries were mild. Only one patient was admitted in the hospital. Genital injuries were found in 43.4% (95% CI, 38.4%, 48.4%) of the victims. At the first visit, 2.9% (95% CI, 0.9%, 4.9%) and 1.1% (95% CI, -0.1%, 2.3%) were infected by N. gonorrhea and Trichomonas vaginalis respectively. At the 2-week follow-up visit, 3.0% (95% CI, 0.7%, 5.3%) and 1.5% (95% CI, -0.2%, 3.2%) were infected by N. gonorrhea and Trichomonas vaginalis respectively. The incidence of pregnancy resulted from sexual assault was 1.7% (95% CI, 0.1%, 3.3%). CONCLUSION: Most sexual assault victims were teenagers. All physical injuries were of mild to moderate degree. Prevalence of STIs and incidence of pregnancy after sexual assault were very low.

A new approach for the detection of cervical cancer in Thai women.

OBJECTIVES: The objective was to screen cervical cell samples of Thai women by using the Fourier-transform infrared (FTIR) spectrophotometry technique; the results were compared to the histologic diagnosis (gold standard). METHODS: FTIR spectrophotometry is a new technology for cervical cancer screening. Instead of detecting the morphological changes as used in Pap smear test, this technique detects, at the molecular level, structural changes of functional groups through the changes of the infrared absorption spectrum. When the infrared light is passed through a cervical cell sample, a molecule absorbs infrared radiation of the appropriate frequency which excites it from one vibrational or rotational level to another. A graph of energy absorbed versus frequency is the absorption spectrum of the sample. The FTIR spectra can be interpreted as normal and abnormal results. First, significant changes in the intensity ratios and, second, significant shifts of the peak frequencies were detected. Two hundred seventy-five cervical cell specimens were received from patients undergoing hysterectomy at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University Hospital. Samples were collected, prepared, and analyzed by FTIR spectroscopy. RESULTS: Histological examinations showed 108 abnormal cases and 167 normal cases. FTIR results versus histology showed sensitivity of 96.3% and specificity of 96.4%. False-negative and false-positive rates were 3.7 and 3.6%, respectively. CONCLUSIONS: FTIR showed high sensitivity and yielded a good false-negative rate. Besides the cervical cancer detection, the FTIR spectroscopy technique can also elicit positive results from adenocarcinoma of the endometrium, sarcoma of the uterus, and ovarian malignancies.