A rare case of ruptured tubal pregnancy with a negative urine pregnancy test (UPT) and serum beta hCG was reported. The patient presented with massive intraperitoneal bleeding and hypovolumic shock. Despite the negative UPT, a rupture tubal pregnancy was ruled out and a consultation with the gynaecologist was not done. Exploratory laparotomy revealed massive hemoperitoneum with a 5-cm purplish mass at the right fallopian tube and the right salpingectomy was performed. The serum beta hCG was sent intraoperatively, and the result was 4.2 mIU/mL. The pathological report confimed a tubal pregnancy containing a 0.5-cm embryo and chorionic villi.
{"title":"Ruptured Tubal Pregnancy with a Negative Urine Pregnancy Test and Serum Beta Human Chorionic Gonadotropin","authors":"Panwara Paritakul","doi":"10.14456/TJOG.2017.19","DOIUrl":"https://doi.org/10.14456/TJOG.2017.19","url":null,"abstract":"A rare case of ruptured tubal pregnancy with a negative urine pregnancy test (UPT) and serum beta hCG was reported. The patient presented with massive intraperitoneal bleeding and hypovolumic shock. Despite the negative UPT, a rupture tubal pregnancy was ruled out and a consultation with the gynaecologist was not done. Exploratory laparotomy revealed massive hemoperitoneum with a 5-cm purplish mass at the right fallopian tube and the right salpingectomy was performed. The serum beta hCG was sent intraoperatively, and the result was 4.2 mIU/mL. The pathological report confimed a tubal pregnancy containing a 0.5-cm embryo and chorionic villi.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"130-135"},"PeriodicalIF":0.0,"publicationDate":"2017-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46441895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Adhesions developed after cesarean sections (CS) vary according to the number of repeat section. Delivery times were reported to be increase with increased number of CS. Material and Methods: This is a prospective cohort study done in Assiut Women Health Hospital from August 2012 to August 2015 to evaluate the implications of doing adhesiolysis at CS either before delivery of the fetus or after that on maternal morbidity during current CS and recurrence rate in next sections. Adhesiolysis during CS avoid the use of anti-adhesion substances which is costly and not available in our low income society. Results: Fifty patients were included in the study. The dominant type of adhesion was omental, bladder and uterine adhesions forming bands with anterior abdominal wall. The uterovesical adhesion was present in all cases. No maternal morbidity occurred during adhesiolysis. Follow up of those patients were cone for 3 years. The percentage of adhesions in the next CS after this adhesiolysis was only 2 cases (4%) and both cases were omental adhesion s. Conclusions: The use of adhesiolysis in repeat CS adhesions with ascending curve of experience is essential in our low socioeconomic countries and associated with no maternal complications. Introduction: Adhesions developed after cesarean sections (CS) vary according to the number of repeat section. Delivery times were reported to be increase with increased number of CS. Material and Methods: This is a prospective cohort study done in Assiut Women Health Hospital from August 2012 to August 2015 to evaluate the implications of doing adhesiolysis at CS either before delivery of the fetus or after that on maternal morbidity during current CS and recurrence rate in next sections. Adhesiolysis during CS avoid the use of anti-adhesion substances which is costly and not available in our low income society. Results: Fifty patients were included in the study. The dominant type of adhesion was omental, bladder and uterine adhesions forming bands with anterior abdominal wall. The uterovesical adhesion was present in all cases. No maternal morbidity occurred during adhesiolysis. Follow up of those patients were cone for 3 years. The percentage of adhesions in the next CS after this adhesiolysis was only 2 cases (4%) and both cases were omental adhesion s. Conclusions: The use of adhesiolysis in repeat CS adhesions with ascending curve of experience is essential in our low socioeconomic countries and associated with no maternal complications.
{"title":"Implications of adhesiolysis during repeat cesarean section in low socioeconomic countries; A pilot study","authors":"A. B. A. Mitwaly, A. Abbas","doi":"10.14456/tjog.2017.13","DOIUrl":"https://doi.org/10.14456/tjog.2017.13","url":null,"abstract":"Introduction: Adhesions developed after cesarean sections (CS) vary according to the number of repeat section. Delivery times were reported to be increase with increased number of CS. Material and Methods: This is a prospective cohort study done in Assiut Women Health Hospital from August 2012 to August 2015 to evaluate the implications of doing adhesiolysis at CS either before delivery of the fetus or after that on maternal morbidity during current CS and recurrence rate in next sections. Adhesiolysis during CS avoid the use of anti-adhesion substances which is costly and not available in our low income society. Results: Fifty patients were included in the study. The dominant type of adhesion was omental, bladder and uterine adhesions forming bands with anterior abdominal wall. The uterovesical adhesion was present in all cases. No maternal morbidity occurred during adhesiolysis. Follow up of those patients were cone for 3 years. The percentage of adhesions in the next CS after this adhesiolysis was only 2 cases (4%) and both cases were omental adhesion s. Conclusions: The use of adhesiolysis in repeat CS adhesions with ascending curve of experience is essential in our low socioeconomic countries and associated with no maternal complications. Introduction: Adhesions developed after cesarean sections (CS) vary according to the number of repeat section. Delivery times were reported to be increase with increased number of CS. Material and Methods: This is a prospective cohort study done in Assiut Women Health Hospital from August 2012 to August 2015 to evaluate the implications of doing adhesiolysis at CS either before delivery of the fetus or after that on maternal morbidity during current CS and recurrence rate in next sections. Adhesiolysis during CS avoid the use of anti-adhesion substances which is costly and not available in our low income society. Results: Fifty patients were included in the study. The dominant type of adhesion was omental, bladder and uterine adhesions forming bands with anterior abdominal wall. The uterovesical adhesion was present in all cases. No maternal morbidity occurred during adhesiolysis. Follow up of those patients were cone for 3 years. The percentage of adhesions in the next CS after this adhesiolysis was only 2 cases (4%) and both cases were omental adhesion s. Conclusions: The use of adhesiolysis in repeat CS adhesions with ascending curve of experience is essential in our low socioeconomic countries and associated with no maternal complications.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2017-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48934053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To evaluate the type of surgery, outcome and peri-operative complication after surgical correction of pelvic organ prolapse in our institute. Materials and Methods: This was a descriptive study that included 270 women who underwent surgery for pelvic organ prolapse in Department of Obstetrics and Gynecology between January 2001 and December 2011. Demographic data on age, body mass index, parity, route of delivery, previous gynecologic surgery, co-morbidities, and menopausal status were obtained. Clinical symptoms, diagnosis and stage of pelvic organ prolapse, and procedure related data including type of operation, adverse events, and the recurrence rate were reviewed from patient’ charts. Descriptive statistics were used for analysis. Results: Of the 270 women who underwent pelvic organ prolapse surgery, the mean age was 65.6 years old (range 43-87). Vaginal hysterectomy with anterior colporrhaphy and posterior colpoperineorrhaphy was the most common procedure (220 patients, 81.5%). The most common intra-operative complication was hemorrhage that required blood transfusion (12 patients, 4.4%). The most common post-operative complication was acute urinary retention (28 patients, 10.4%), followed by vaginal hematoma (7 patients, 2.6%). The median length of follow-up was 8 months (range 6-84), and the recurrence rate was 7.8%. Conclusion: Peri-operative complication related to surgical correction for pelvic organ prolapse was moderate without serious complications occurred.
{"title":"Outcomes of Surgery for Pelvic Organ Prolapse in Songklanagarind Hospital, 10 years Experience","authors":"Siwatchaya Khanuengkitkong, T. Choobun","doi":"10.14456/TJOG.2017.16","DOIUrl":"https://doi.org/10.14456/TJOG.2017.16","url":null,"abstract":"Objectives: To evaluate the type of surgery, outcome and peri-operative complication after surgical correction of pelvic organ prolapse in our institute. Materials and Methods: This was a descriptive study that included 270 women who underwent surgery for pelvic organ prolapse in Department of Obstetrics and Gynecology between January 2001 and December 2011. Demographic data on age, body mass index, parity, route of delivery, previous gynecologic surgery, co-morbidities, and menopausal status were obtained. Clinical symptoms, diagnosis and stage of pelvic organ prolapse, and procedure related data including type of operation, adverse events, and the recurrence rate were reviewed from patient’ charts. Descriptive statistics were used for analysis. Results: Of the 270 women who underwent pelvic organ prolapse surgery, the mean age was 65.6 years old (range 43-87). Vaginal hysterectomy with anterior colporrhaphy and posterior colpoperineorrhaphy was the most common procedure (220 patients, 81.5%). The most common intra-operative complication was hemorrhage that required blood transfusion (12 patients, 4.4%). The most common post-operative complication was acute urinary retention (28 patients, 10.4%), followed by vaginal hematoma (7 patients, 2.6%). The median length of follow-up was 8 months (range 6-84), and the recurrence rate was 7.8%. Conclusion: Peri-operative complication related to surgical correction for pelvic organ prolapse was moderate without serious complications occurred.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"103-110"},"PeriodicalIF":0.0,"publicationDate":"2017-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45372005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Werawatakul, S. Paholpak, V. Bhudhisawasdi, Boonsong Patjanasoonton, P. Leelapanmetha, Supattra Somchit, Suphat Thatphet, Nadtaya Mills, Supannee Selander, Saijai Saipunya
Objectives: To analyze the medical diagnosis that led to payments of the fist aid solatiums (FAS) regarding Section 41 of 2002 National Health Security Act (S41NHSA) in the region 7 of NHS Office (R7NHSO) and the magnitude in both number of cases and amount of money paid. To focus FAS cases and payment in the obstetric specialty which had the greatest part of FAS payment, and to fid out the quality improvement for reducing the problems in obstetric and gynecological cases. The study was done for only during 2012-2014. Materials and Methods: All of the FAS medical cases records regarding S41NHSA in the R7NHSO during 2012-2014 were collected. The medical diagnosis that led to the fial approval of FAS payment by NHSO was reviewed. The working group of the Sub-Committee to Control the Quality and Standard of the Public Health Service of the R7NHSO had created the guideline to minimize the problems in obstetric and gynecological cases. Results: The R7NHSO included 4 provinces in the Northeast which are Khon Kaen, Kalasin, Roi Et, and Maha Sarakham. The numbers of FAS payment cases during 2012-2014 were 79, 106, and 110 cases or 295 cases in 3 years. The ratio of S41NHSA complaint per total number of in-patients was low but increasing yearly during this 3 years period. The province with more number of in-patients had a more FAS cases and a more FAS payment. The fie most common FAS payment cases in descending rate were from department of obstetrics (54.38%), surgery (13.9%), medicine (10.5%) pediatric (7.4%) and orthopedics (3.73%). The obstetric department shared the greatest part of FAS payment cases and money. The top fie number of cases (percentage) FAS payment in obstetrics were neonatal death 59 (30.73%), shoulder dystocia 41 (21.35%), unintended pregnancy after tubal ligation 40 (20.83%), maternal death 20 (10.42%) and cerebral palsy 6 (3.13%). The total amount of FAS money paid during the 2012-2014 was 54.68 million Baht for the whole R7NHSO, of which was from Khon Kaen 22.99 million Baht, Kalasin 12.89 million Baht, Roi Et 12.30 million Baht, and Maha Sarakham 6.49 million Baht. The average FAS payment was 185,361.36 Baht/case. The authors suggested 5 items of quality improvement methods to reduce obstetric loss. Conclusion: The FAS cases and FAS payment in R7NHSO were rising. Most of the FAS cases and payment were from the department of obstetrics. Many diagnoses that caused FAS cases and payments were preventable. A good policy of man power arrangement of obstetricians, a continuously in-service training, and a better incentive for the service providers, the consultation and transferring system of the risky patients should be revised.
目的：分析英国国家医疗服务体系办公室（R7NHSO）第7地区2002年《国家卫生安全法》（S41NHSA）第41条规定的导致支付急救安慰金（FAS）的医疗诊断，以及病例数量和支付金额的大小。重点关注FAS集中度最高的产科专业的FAS病例和支付情况，为减少产科和妇科病例中的问题进行质量改进。该研究仅在2012-2014年期间进行。材料与方法：收集2012-2014年R7NHSO中所有与S41NHSA相关的FAS病历。对导致NHSO正式批准FAS付款的医学诊断进行了审查。R7NHSO公共卫生服务质量和标准控制小组委员会的工作组制定了该指南，以尽量减少产科和妇科病例中的问题。结果：R7NHSO包括东北部的4个省，即孔敬省、卡拉辛省、罗依省和马哈萨拉坎省。2012-2014年FAS支付案例数分别为79、106和110例，或3年内的295例。S41NHSA投诉占住院总人数的比例较低，但在这3年期间每年都在增加。住院人数较多的省份FAS病例较多，FAS支付较多。FAS支付最常见的5个案例依次为产科（54.38%）、外科（13.9%）、内科（10.5%）、儿科（7.4%）和骨科（3.73%），其中产科在FAS支付案例和费用中所占比例最大。产科FAS支付的前五例（百分比）是新生儿死亡59例（30.73%）、肩难产41例（21.35%）、输卵管结扎后意外怀孕40例（20.83%）、产妇死亡20例（10.42%）和脑瘫6例（3.13%）。2012-2014年，整个R7NHSO支付的FAS总金额为5468万泰铢，其中孔敬2299万泰铢，Kalasin 1289万泰铢、Roi Et 1230万泰铢和Maha Sarakham 649万泰铢。FAS的平均付款额为185361.36泰铢/箱。作者提出了5项质量改进方法，以减少产科损失。结论：R7NHSO的FAS病例数和FAS支付量均呈上升趋势。FAS病例和支付的费用大部分来自产科。许多导致FAS病例和付款的诊断是可以预防的。产科医生人力资源配置的良好政策，持续的在职培训，以及对服务提供者更好的激励，应修订高危病人的会诊和转运制度。
{"title":"The First Aid Solatium Payment Regarding Section 41 of 2002 National Health Security Act (NHSA) in region 7 during 2012-2014 for quality improvement of the health system and guideline to minimize the problems in obstetric and gynecological cases","authors":"Y. Werawatakul, S. Paholpak, V. Bhudhisawasdi, Boonsong Patjanasoonton, P. Leelapanmetha, Supattra Somchit, Suphat Thatphet, Nadtaya Mills, Supannee Selander, Saijai Saipunya","doi":"10.14456/TJOG.2017.18","DOIUrl":"https://doi.org/10.14456/TJOG.2017.18","url":null,"abstract":"Objectives: To analyze the medical diagnosis that led to payments of the fist aid solatiums (FAS) regarding Section 41 of 2002 National Health Security Act (S41NHSA) in the region 7 of NHS Office (R7NHSO) and the magnitude in both number of cases and amount of money paid. To focus FAS cases and payment in the obstetric specialty which had the greatest part of FAS payment, and to fid out the quality improvement for reducing the problems in obstetric and gynecological cases. The study was done for only during 2012-2014. Materials and Methods: All of the FAS medical cases records regarding S41NHSA in the R7NHSO during 2012-2014 were collected. The medical diagnosis that led to the fial approval of FAS payment by NHSO was reviewed. The working group of the Sub-Committee to Control the Quality and Standard of the Public Health Service of the R7NHSO had created the guideline to minimize the problems in obstetric and gynecological cases. Results: The R7NHSO included 4 provinces in the Northeast which are Khon Kaen, Kalasin, Roi Et, and Maha Sarakham. The numbers of FAS payment cases during 2012-2014 were 79, 106, and 110 cases or 295 cases in 3 years. The ratio of S41NHSA complaint per total number of in-patients was low but increasing yearly during this 3 years period. The province with more number of in-patients had a more FAS cases and a more FAS payment. The fie most common FAS payment cases in descending rate were from department of obstetrics (54.38%), surgery (13.9%), medicine (10.5%) pediatric (7.4%) and orthopedics (3.73%). The obstetric department shared the greatest part of FAS payment cases and money. The top fie number of cases (percentage) FAS payment in obstetrics were neonatal death 59 (30.73%), shoulder dystocia 41 (21.35%), unintended pregnancy after tubal ligation 40 (20.83%), maternal death 20 (10.42%) and cerebral palsy 6 (3.13%). The total amount of FAS money paid during the 2012-2014 was 54.68 million Baht for the whole R7NHSO, of which was from Khon Kaen 22.99 million Baht, Kalasin 12.89 million Baht, Roi Et 12.30 million Baht, and Maha Sarakham 6.49 million Baht. The average FAS payment was 185,361.36 Baht/case. The authors suggested 5 items of quality improvement methods to reduce obstetric loss. Conclusion: The FAS cases and FAS payment in R7NHSO were rising. Most of the FAS cases and payment were from the department of obstetrics. Many diagnoses that caused FAS cases and payments were preventable. A good policy of man power arrangement of obstetricians, a continuously in-service training, and a better incentive for the service providers, the consultation and transferring system of the risky patients should be revised.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"119-129"},"PeriodicalIF":0.0,"publicationDate":"2017-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43880619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rujira Manorompattarasan, Y. Kunpalin, S. Chaithongwongwatthana
Objectives: To determine neonatal survival rate and associated factors in pregnancies with preterm premature rupture of membranes (PPROM) at gestational age (GA) between 15 and 30 weeks. Materials and Methods: This retrospective descriptive study was conducted by reviewing the medical records of the pregnant women with premature rupture of membranes (PROM) at 15-30 weeks’ gestation admitted at King Chulalongkorn Memorial Hospital between 1st January 2002 and 31st December 2013. Logistic regression analysis was used to determine association between factors and neonatal survival. Results: The total number of pregnancies in this study was 99 and neonatal survival rate was 80.8% (95% confidence interval 71.4-87.8%). Women with PPROM at GA between 15 and 19+6 weeks had neonatal survival rate of 16.7% while neonatal survival rates of cases with PPROM at 20-23+6 weeks and 24-30 weeks were 50.0% and 92.2%, respectively. Factors associated with increased neonatal survival from logistic regression analysis included GA at PROM ≥ 24 weeks and tocolytic administration. Conclusion: Neonatal survival in pregnancies with midtrimester PPROM depended on GA when PROM started. Neonates in women with PPROM at ≥ 24 weeks’ gestation had more chances to survive than those with PROM at GA less than 24 weeks. Use of tocolysis was associated with increase neonatal survival.
{"title":"Neonatal Survival Rate following Premature Rupture of Membranes at Gestational Age 15-30 Weeks","authors":"Rujira Manorompattarasan, Y. Kunpalin, S. Chaithongwongwatthana","doi":"10.14456/TJOG.2017.14","DOIUrl":"https://doi.org/10.14456/TJOG.2017.14","url":null,"abstract":"Objectives: To determine neonatal survival rate and associated factors in pregnancies with preterm premature rupture of membranes (PPROM) at gestational age (GA) between 15 and 30 weeks. Materials and Methods: This retrospective descriptive study was conducted by reviewing the medical records of the pregnant women with premature rupture of membranes (PROM) at 15-30 weeks’ gestation admitted at King Chulalongkorn Memorial Hospital between 1st January 2002 and 31st December 2013. Logistic regression analysis was used to determine association between factors and neonatal survival. Results: The total number of pregnancies in this study was 99 and neonatal survival rate was 80.8% (95% confidence interval 71.4-87.8%). Women with PPROM at GA between 15 and 19+6 weeks had neonatal survival rate of 16.7% while neonatal survival rates of cases with PPROM at 20-23+6 weeks and 24-30 weeks were 50.0% and 92.2%, respectively. Factors associated with increased neonatal survival from logistic regression analysis included GA at PROM ≥ 24 weeks and tocolytic administration. Conclusion: Neonatal survival in pregnancies with midtrimester PPROM depended on GA when PROM started. Neonates in women with PPROM at ≥ 24 weeks’ gestation had more chances to survive than those with PROM at GA less than 24 weeks. Use of tocolysis was associated with increase neonatal survival.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"88-94"},"PeriodicalIF":0.0,"publicationDate":"2017-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46946206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The purpose of this study was to determine the efficacy and safety of intrauterine extra-amniotic misoprostol solution for termination of the second trimester missed abortion. Methods: A clinical pilot descriptive study that was done in Women Health Hospital, Assiut University, Egypt between March 2015 and June 2015. Fifty patients having missed abortion of gestational age between 13 to 24 weeks were included in the study. Insertion of an intrauterine Foley’s catheter followed by infusion of sterile misoprostol solution through a sterile infusion set at a constant drip rate. The primary outcome was successful expulsion of the fetus in 12 hours after starting misoprostol infusion. Results: The mean age of the study group was 27.25±4.08, the mean BMI was 26.35±3.6, the mean gestational age was 22.85±3.4 and the mean parity was 2.5±1.5. The mean induction expulsion interval was 5.27±2.66 hours. Six cases (12%) needed analgesic. Surgical evacuation of retained contents was needed in 3 cases (6%). Side effects in the form of rigors, fever and diarrhea were recorded in 4 cases (8%). No serious maternal events were recorded. Conclusion: Our results showed that intrauterine extra-amniotic misoprostol solution instillation appear to be effective and safe for termination of a second trimester missed abortions.
{"title":"Intrauterine Extra-amniotic Misoprostol Solution is Effective for Termination of Second Trimester Missed Abortion: A clinical pilot descriptive study","authors":"A. B. A. Mitwaly, A. Abbas","doi":"10.14456/TJOG.2017.3","DOIUrl":"https://doi.org/10.14456/TJOG.2017.3","url":null,"abstract":"Objectives: The purpose of this study was to determine the efficacy and safety of intrauterine extra-amniotic misoprostol solution for termination of the second trimester missed abortion. Methods: A clinical pilot descriptive study that was done in Women Health Hospital, Assiut University, Egypt between March 2015 and June 2015. Fifty patients having missed abortion of gestational age between 13 to 24 weeks were included in the study. Insertion of an intrauterine Foley’s catheter followed by infusion of sterile misoprostol solution through a sterile infusion set at a constant drip rate. The primary outcome was successful expulsion of the fetus in 12 hours after starting misoprostol infusion. Results: The mean age of the study group was 27.25±4.08, the mean BMI was 26.35±3.6, the mean gestational age was 22.85±3.4 and the mean parity was 2.5±1.5. The mean induction expulsion interval was 5.27±2.66 hours. Six cases (12%) needed analgesic. Surgical evacuation of retained contents was needed in 3 cases (6%). Side effects in the form of rigors, fever and diarrhea were recorded in 4 cases (8%). No serious maternal events were recorded. Conclusion: Our results showed that intrauterine extra-amniotic misoprostol solution instillation appear to be effective and safe for termination of a second trimester missed abortions.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45818271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Microcephaly is an uncommon but important ultrasonographic finding. The smallest-head infants trend to suffer the severest level of developmental delay. Currently, more than three SDs below the mean is accepted as the definition for microcephaly diagnosis. Wrong gestational age determination, craniosynostosis and intrauterine growth restriction (IUGR) are firstly differentiated. Then, associated abnormalities and pathognomonic clues for diagnosing the etiologic cause of microcephaly should be ultrasonographically surveyed. Teratogenic exposure, intrauterine infection (TORCH and zika) and genetic abnormalities are possible etiologies. Prognosis and management depend on gestational age, severity of head size, associated anomalies and possible cause.
{"title":"Microcephaly: Significance and how to approach during the zika era","authors":"T. Hanprasertpong","doi":"10.14456/TJOG.2017.2","DOIUrl":"https://doi.org/10.14456/TJOG.2017.2","url":null,"abstract":"Microcephaly is an uncommon but important ultrasonographic finding. The smallest-head infants trend to suffer the severest level of developmental delay. Currently, more than three SDs below the mean is accepted as the definition for microcephaly diagnosis. Wrong gestational age determination, craniosynostosis and intrauterine growth restriction (IUGR) are firstly differentiated. Then, associated abnormalities and pathognomonic clues for diagnosing the etiologic cause of microcephaly should be ultrasonographically surveyed. Teratogenic exposure, intrauterine infection (TORCH and zika) and genetic abnormalities are possible etiologies. Prognosis and management depend on gestational age, severity of head size, associated anomalies and possible cause.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"2-5"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46818458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This study aims to determine the relationship between angiotensinogen (AGT) M235T polymorphism and hypertension among post-menopausal Thai women. Materials and Methods: Case-control study was conducted. The study group was those who had hypertension or previously diagnosed and, the control were those who had no hypertension. Blood samples were taken for AGT M235T allelic characterization using allele specific oligonucleotides (ASO) PCR. Results: Of 255 post-menopausal women, 128 had hypertension, regarded as “hypertension group”, the other 127 without hypertension, regarded as “control group”. The presence of AGT M235T polymorphism was 76.5% for homozygous mutation (73.4% for hypertension group and 79.5% for control group), 21.2% for heterozygous mutation (25.0% for hypertension group and 17.3% for control group, respectively) and 2.4% for homozygous wild-type (1.6% for hypertension group and 3.2% for control group, respectively). Distribution of MM, MT and TT genotypes was not significantly different between both group (p=0.251). Conclusions: Interestingly, overall TT genotype was much higher than that of TM and MM in post-menopausal Thai women. AGT M235T polymorphism was not significantly associated with hypertension, though TT genotype tended to give a small risk. They may not serve as a good genetic marker for essential hypertension among Thai population.
{"title":"The Association of Angiotensinogen (AGT M235T) Gene Polymorphism and Essential Hypertension in Thai Post-Menopausal Women","authors":"Thitikarn Lerthiranwong, W. Piyamongkol","doi":"10.14456/TJOG.2017.9","DOIUrl":"https://doi.org/10.14456/TJOG.2017.9","url":null,"abstract":"Objectives: This study aims to determine the relationship between angiotensinogen (AGT) M235T polymorphism and hypertension among post-menopausal Thai women. Materials and Methods: Case-control study was conducted. The study group was those who had hypertension or previously diagnosed and, the control were those who had no hypertension. Blood samples were taken for AGT M235T allelic characterization using allele specific oligonucleotides (ASO) PCR. Results: Of 255 post-menopausal women, 128 had hypertension, regarded as “hypertension group”, the other 127 without hypertension, regarded as “control group”. The presence of AGT M235T polymorphism was 76.5% for homozygous mutation (73.4% for hypertension group and 79.5% for control group), 21.2% for heterozygous mutation (25.0% for hypertension group and 17.3% for control group, respectively) and 2.4% for homozygous wild-type (1.6% for hypertension group and 3.2% for control group, respectively). Distribution of MM, MT and TT genotypes was not significantly different between both group (p=0.251). Conclusions: Interestingly, overall TT genotype was much higher than that of TM and MM in post-menopausal Thai women. AGT M235T polymorphism was not significantly associated with hypertension, though TT genotype tended to give a small risk. They may not serve as a good genetic marker for essential hypertension among Thai population.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"31 2","pages":"52-61"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41282760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thanapob Bumphenkiatikul, Ananya Trongpisutsak, P. Tantbirojn, B. Uerpairojkit
Objectives: To describe and compare placental pathologies and neonatal outcomes in pregnancies with small-for-gestational-age (SGA) fetuses with their umbilical artery (UA) and middle cerebral artery (MCA) Doppler studies. Materials and Methods: A retrospective study was conducted in pregnant women delivered between gestational ages of 24 to 42 week at King Chulalongkorn Memorial Hospital. Only singletons without infection, chromosomal abnormalities or major structural abnormalities were included. Those with no Doppler study within 7 days prior to delivery were excluded. Sixty-nine subjects enrolled were classified into Group 1 (n=16): normal UA and MCA pulsatility index (PI), Group 2 (n=28): normal UA but abnormal MCA PI and Group 3 (n=25): abnormal UA PI/absent or reversed end diastolic flow (AREDF). Data were compared between each group. Results: Fetuses in Group 3 were found to be delivered at earlier gestational age with lower birth weight, higher Cesarean delivery rate, higher proportion of fetuses with Apgar score less than 7, higher NICU admission, and higher neonatal resuscitation rate than those in Group 1 and Group 2. There was no significant difference in placental weight, gross umbilical cord abnormality, and overall placental underperfusion pathology. Placental infarct in Group 3 was found to be more prevalent than those in Group 1 and Group 2. Conclusion: Placental infarct was the only abnormal placental pathology that was significantly found in SGA fetuses with abnormal UA PI/AREDF. These SGA fetuses carried a higher morbidity and mortality than those with normal UA Doppler study regardless of normality of MCA Doppler.
{"title":"Placental Pathology in Small-for-Gestational-Age Fetuses with Different Doppler Studies","authors":"Thanapob Bumphenkiatikul, Ananya Trongpisutsak, P. Tantbirojn, B. Uerpairojkit","doi":"10.14456/TJOG.2017.5","DOIUrl":"https://doi.org/10.14456/TJOG.2017.5","url":null,"abstract":"Objectives: To describe and compare placental pathologies and neonatal outcomes in pregnancies with small-for-gestational-age (SGA) fetuses with their umbilical artery (UA) and middle cerebral artery (MCA) Doppler studies. Materials and Methods: A retrospective study was conducted in pregnant women delivered between gestational ages of 24 to 42 week at King Chulalongkorn Memorial Hospital. Only singletons without infection, chromosomal abnormalities or major structural abnormalities were included. Those with no Doppler study within 7 days prior to delivery were excluded. Sixty-nine subjects enrolled were classified into Group 1 (n=16): normal UA and MCA pulsatility index (PI), Group 2 (n=28): normal UA but abnormal MCA PI and Group 3 (n=25): abnormal UA PI/absent or reversed end diastolic flow (AREDF). Data were compared between each group. Results: Fetuses in Group 3 were found to be delivered at earlier gestational age with lower birth weight, higher Cesarean delivery rate, higher proportion of fetuses with Apgar score less than 7, higher NICU admission, and higher neonatal resuscitation rate than those in Group 1 and Group 2. There was no significant difference in placental weight, gross umbilical cord abnormality, and overall placental underperfusion pathology. Placental infarct in Group 3 was found to be more prevalent than those in Group 1 and Group 2. Conclusion: Placental infarct was the only abnormal placental pathology that was significantly found in SGA fetuses with abnormal UA PI/AREDF. These SGA fetuses carried a higher morbidity and mortality than those with normal UA Doppler study regardless of normality of MCA Doppler.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"18-25"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47274365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rattiya Phianpiset, B. Phattanachindakun, D. Boriboonhirunsarn
Objectives: To determine the prevalence, associated factors and outcomes of early-onset severe preeclampsia among severe preeclamptic women in Siriraj Hospital. Materials and Methods: A total of 220 pregnant women diagnosed with severe preeclampsia were enrolled. Relevant data including obstetric data, diagnosis, treatment, route of delivery, maternal and neonatal outcomes were retrieved from medical records. Prevalence of early-onset severe preeclampsia (diagnosed before 34 weeks of gestation) was estimated. Various characteristics were compared between early and late-onset groups to determine associated risk factors. Results: Mean age of pregnant women was 28.6 years, and 59.1% were nulliparous. Mean gestational age (GA) at first antenatal visit was 14.5 weeks and mean GA at delivery was 36.2 weeks. Prevalence of early-onset severe preeclampsia was 15.9%. Only 9.1% received expectant management and 32.7% delivered vaginally. Mean birth weight was 2514.1 g. Stillbirth, small for gestational age (SGA), birth asphyxia and neonatal intensive care unit (NICU) admission was found in 1.8%, 17.7%, 2.7%, and 6.8%, respectively. Mean GA at delivery was 30.6 weeks in early-onset group and 37.2 weeks among late-onset group. Early-onset group was more likely to receive expectant management than late-onset group (34.3% vs. 4.3%; p<0.001). Worse outcomes were more common among neonates of early-onset group and they were significantly more likely to require NICU admission (37.1% vs. 1.1%, p<0.001). Women with previous preeclampsia were significantly more likely to develop early-onset severe preeclampsia. (35.7% vs. 13.2%, p=0.037). Conclusion: Prevalence of early-onset severe preeclampsia among preeclamptic women in Siriraj hospital was 15.9%. Worse neonatal outcomes were more commonly observed among early-onset cases. Previous preeclampsia was the only significant possible associated factors.
{"title":"Prevalence, Risk Factors, and Pregnancy Outcomes of Early-onset Severe Preeclampsia among Severe Preeclamptic Women in Siriraj Hospital","authors":"Rattiya Phianpiset, B. Phattanachindakun, D. Boriboonhirunsarn","doi":"10.14456/TJOG.2017.6","DOIUrl":"https://doi.org/10.14456/TJOG.2017.6","url":null,"abstract":"Objectives: To determine the prevalence, associated factors and outcomes of early-onset severe preeclampsia among severe preeclamptic women in Siriraj Hospital. Materials and Methods: A total of 220 pregnant women diagnosed with severe preeclampsia were enrolled. Relevant data including obstetric data, diagnosis, treatment, route of delivery, maternal and neonatal outcomes were retrieved from medical records. Prevalence of early-onset severe preeclampsia (diagnosed before 34 weeks of gestation) was estimated. Various characteristics were compared between early and late-onset groups to determine associated risk factors. Results: Mean age of pregnant women was 28.6 years, and 59.1% were nulliparous. Mean gestational age (GA) at first antenatal visit was 14.5 weeks and mean GA at delivery was 36.2 weeks. Prevalence of early-onset severe preeclampsia was 15.9%. Only 9.1% received expectant management and 32.7% delivered vaginally. Mean birth weight was 2514.1 g. Stillbirth, small for gestational age (SGA), birth asphyxia and neonatal intensive care unit (NICU) admission was found in 1.8%, 17.7%, 2.7%, and 6.8%, respectively. Mean GA at delivery was 30.6 weeks in early-onset group and 37.2 weeks among late-onset group. Early-onset group was more likely to receive expectant management than late-onset group (34.3% vs. 4.3%; p<0.001). Worse outcomes were more common among neonates of early-onset group and they were significantly more likely to require NICU admission (37.1% vs. 1.1%, p<0.001). Women with previous preeclampsia were significantly more likely to develop early-onset severe preeclampsia. (35.7% vs. 13.2%, p=0.037). Conclusion: Prevalence of early-onset severe preeclampsia among preeclamptic women in Siriraj hospital was 15.9%. Worse neonatal outcomes were more commonly observed among early-onset cases. Previous preeclampsia was the only significant possible associated factors.","PeriodicalId":36742,"journal":{"name":"Thai Journal of Obstetrics and Gynaecology","volume":"25 1","pages":"26-34"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49058242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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