Maternal mortality in Ramathibodi Hospital: a 28-year comparative study.

A comparative review of maternal mortality rates at Ramathibodi Hospital from 1969 through 1996 including 176, 161 live births is presented. The data are divided into two time periods, both of 14 years, for comparison. A significant decrease in direct obstetric deaths secondary to infection and toxemia (P < 0.05). The rate of deaths due to indirect causes in unchanged. Deaths due to malignancies have increased. This study of maternal mortality demonstrates the need for increased contraceptive services, voluntary sterilization, patient education and preconceptional identification of high-risk patients for further reduction of the maternal mortality rate.

Plasma zinc level and intrauterine growth retardation: a study in pregnant women in Ramathibodi Hospital.

The study was designed to establish the relationship between plasma zinc level and intrauterine growth retardation in 405 normal pregnant women with an age range from 20 to 35 years, who attended and delivered at Ramathibodi Hospital The data were gathered from October 1994 to April 1995. The zinc levels were obtained from blood plasma collection and the assessment of fetal status was made after birth. Using criteria of babies with a birthweight of less than the 10th centile at delivery. Plasma zinc level in mother was collected during antenatal care and labour. Plasma zinc level was determined by Atomic Absorption Spectrophotometry. The plasma zinc levels in mothers during antenatal care, labour and infant birthweight were 66.73 micrograms/dl, 69.91 micrograms/dl and 3152.25 g respectively. Maternal plasma zinc levels during antenatal care, labour and infant birthweight in the intrauterine growth retardation infant group were significantly lower than that in normal growth infants (P < 0.05). In conclusion, our study shows that measurement of maternal plasma zinc concentration in the third trimester would highly suggest mothers at risk of delivering intrauterine growth retardation babies. Mothers selected in this way might benefit from dietary advice and zinc supplementation during the remaining pregnancy.

Shoulder dystocia: fifteen years' experience in Ramathibodi Hospital.

Although shoulder dystocia does not occur frequently the adverse effect to the patient and especially to infants can be catastrophic. The purpose of this study was to evaluate the incidence, the factors which may be related to or predispose to this condition and the consequence to the patients and their infants. All cases of shoulder dystocia which occurred during the fifteen year period from January 1982 to December 1996 were scrutinized. There were 17 cases of shoulder dystocia from a total of 109,923 deliveries giving the incidence of 1.6 per 10,000 deliveries. Of these 17 patients, 11 (65%) were delivered by vacuum extraction. Two patients had postpartum hemorrhage requiring blood transfusion. Infants' birthweights ranged between 3350 to 5160 grams. Erb's palsy occurred in 6 infants and all made full recovery subsequently.

Cesarean and postpartum hysterectomy.

OBJECTIVE: To review the cases of cesarean and postpartum hysterectomy. METHOD: A retrospective study of all cases of cesarean and postpartum hysterectomy during 1985-1994. Maternal characteristics, method of delivery, indications for hysterectomy and complications were reviewed. RESULTS: The rate of cesarean and postpartum hysterectomy was 1:1667 deliveries. Half of these cases were delivered by cesarean section. The main indications for hysterectomy were massive bleeding due to uterine atony, abnormal placental adhesions or uterine rupture. Maternal morbidity was high and there was one maternal death. CONCLUSION: Cesarean and postpartum hysterectomy is a necessary life-saving operation. Although maternal mortality is rare, morbidity remains high. Prevention of complications that give rise to hysterectomy and optimally timed surgery should decrease maternal morbidity and mortality.

Diabetic ketoacidosis in pregnancy.

Diabetic ketoacidosis, though uncommon, is a very serious complication in obstetrics. We reported 5 cases, which in retrospect could all have been prevented from occurring. Either a strong family of diabetes mellitus or presence of glycosuria were present in 4 cases. In 3 cases, the use of sympathomimetic and corticosteroid was the predisposing factor. Clinicians should have an index of suspicion in patients at risk and it might be prudent to screen for diabetes where the use of sympathomimetic and corticosteroid.

Amniotic fluid embolism: a case report.

A case of a 27-year-old, gravida 1, para 0 whose labor was induced with prostaglandin and followed by syntocinon was reported. During labor, she developed amniotic fluid embolism and died.

Rupture of the pregnant uterus: Ramathibodi's experience 1981-1990.

A total of seven women had uterine rupture at Ramathibodi Hospital, Bangkok, between 1981-1990. The incidence was 1 per 9,908 deliveries or 1.009 per 10,000 deliveries. All were related to oxytocic drug administration and two of them had induction with prostaglandins. The intraoperative and postoperative problems were intraoperative hypotension (57%), febrile morbidity (28%) and wound dehiscence (12.5%). Fetal mortality was 43 percent and there was no maternal death.