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Biomedical subjects

Y Herabutya

Publications and source records attributed to Y Herabutya.

At least 37 records · Page 2Linked to original sources

Prevention and control of thalassemia in Ramathibodi Hospital, Thailand.

Eight thousand seven hundred and thirty-six pregnant women were screened for thalassemia and hemoglobinopathies by mean corpuscular volume less than 80 femtolitres (fl). Three thousand six hundred and seventy women (42%) were MCV less than 80 fl. In this group there were 2,390 women (70%) who had positive Hb typing by high performance liquid chromatography (HPLC) such as beta-thalassemia major, beta-thalassemia hemoglobin E disease, beta-thalassemia trait, heterozygous and homozygous hemoglobin E, alpha-thalassemia-1 trait and hemoglobin H disease and 77% of their partners came and had hemoglobin typing done. Seventy-five couples at risk for having severely affected thalassemia fetuses were detected from this screening program. Prenatal diagnosis was performed in 58 couples (77.3%). Eight affected fetuses were detected. All pregnancies with affected fetuses except one with beta-thalassemia/HbE were terminated. There were 3 fetal losses (6%) as the result of prenatal diagnosis procedure.

Chromatography, High Pressure Liquid↗

A randomized controlled trial of vaginal misoprostol for cervical priming before hysteroscopy.

OBJECTIVE: To evaluate the effectiveness and side effects of vaginal misoprostol for cervical dilation in nonpregnant women before hysteroscopy. METHODS: Ninety-one women scheduled to have hysteroscopy were randomized to receive either vaginal misoprostol or placebo. Cervical response, outcome of hysteroscopy, and side effects of vaginal misoprostol were assessed. RESULTS: The mean cervical dilatation estimated by Hegar dilator and the mean duration of hysteroscopy were significantly different between the treated group (7.0+/-1.0 mm [range 6-8.5] and 90.0+/-38.4 seconds [range 60-240], respectively) and the control group (3.8+/-1.2 mm [range 2-5.5] and 142.0+/-38.7 seconds [range 60-270]). In the misoprostol group, only three women (6.5%) needed cervical dilation before hysteroscopy, compared with 14 (31.1%) in the placebo group (P = .006). Cervical tears during hysteroscopy occurred in two patients (4.4%) in the control group and none in the misoprostol group. The two most common side effects of vaginal misoprostol were mild lower abdominal pain in 15 women (32.6%) and slight vaginal bleeding in 12 (26.1%). Both side effects were significantly different when compared with placebo (P<.001). CONCLUSION: Vaginal misoprostol lessens the cervical resistance in women undergoing hysteroscopy and facilitates the procedure, with only mild side effects.

Adult↗

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.

Adult↗

External cephalic version: first report from Thailand.

This prospective study was to preliminary report the safety and success rate of external cephalic version (ECV) in patients with breech presentation or transverse lie at 36 weeks of gestation or more. The aim of this procedure was to reduce the cesarean section rate from indication of breech presentation and transverse lie. This procedure was first started in the Obstetrics and Gynecology Department, Ramathibodi Hospital in June 1998. Thirty two patients were enrolled in this study. ECV was 65 per cent successful with the reversion rate of five per cent. There was no maternal or fetal complication related to this procedure. Factors associated with successful outcome in this study were the location of placenta, the position of fetal spine and the amount of amniotic fluid. A larger study is needed before the true success rate and the efficacy of this procedure can be apparent.

Adult↗

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.

Cause of Death↗

The epidemiology of cervical incompetence in Ramathibodi Hospital between 1982-1997.

Cervical incompetence is an important cause of midtrimester abortion. However, the etiology and diagnostic method have still not been established. This retrospective study was aimed to review epidemiology, management and outcome of cervical incompetence in Ramathibodi Hospital, Mahidol University, Thailand, from 1982 to 1997. Fifty seven patients were diagnosed as having cervical incompetence during this period. Fifty patients had elective cerclage. Seven patients had emergency cerclage. Success rate in this study was 94.6 per cent. Only 7 per cent of patients had complications such as chorioamnionitis and suture displacement. There was no other serious complication after treatment. Nowadays, there is still no established method to diagnose cervical incompetence in pregnancy. Treatment is usually based on past obstetric history. Cervical cerclage is an established treatment for this problem. Emergency cerclage is still controversial. The prevention is to avoid any procedure which can cause cervical trauma leading to cervical incompetence.

Abortion, Spontaneous↗

Second trimester abortion using intravaginal misoprostol.

OBJECTIVE: To find the effective dose of intravaginal misoprostol to induce second trimester abortion. METHODS: Intravaginal misoprostol in 200-microg, 400-microg and 600-microg doses were applied at 12-h intervals in 150 consecutive pregnancies. RESULTS: The 48-h successful abortion rate was 70.6%, 82% and 96%, respectively, and these rates were unaffected by parity. The mean induction to abortion interval was 45.0 +/- 41.5, 33.4 +/- 34.9 and 22.3 +/- 14.3 h, respectively. The mean dose of misoprostol required to induce abortion was 416.7 microg, 772.8 microg and 1296 microg. The rate of nausea and vomiting was 3.9%, 12% and 20%. The diarrhea occurrence rate was 0%, 6% and 22% with temperature elevation 0%, 2% and 28%, respectively. The rate of incomplete abortion was 35.3%, 28% and 22%, respectively. CONCLUSION: The 600-microg dose is more effective as an abortifacient agent for second trimester abortion in terms of 48-h success rate and the rate of incomplete abortion but with more side effects. However, the side effects were mild and did not warrant any specific treatment.

Abortifacient Agents, Nonsteroidal↗

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.

Delivery, Obstetric↗

Emergency cervical cerclage: Ramathibodi Hospital experience.

This retrospective study is to evaluate the outcome of pregnancy after emergency cervical cerclage. Records of patients, who were treated with emergency cervical cerclage in Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, from 1982 to 1997, were reviewed. Maternal age, gravida, parity, past obstetric history, gestational age at cerclage, latency period, complication and outcome were noted. Only one of 7 patients who had this operation performed, aborted. The others continued pregnancy and all the babies were born alive. There was no serious maternal complication. This operation has a favorable outcome in selected cases.

Adult↗

Vasa previa in Ramathibodi Hospital: a 10 years review.

Vasa previa is presented when fetal vessels cross the internal os as a velamentous insertion of the umbilical cord. This retrospective study is to review the diagnosis, the management, and the outcome of this condition over the 10 years period in Ramathibodi Hospital, Bangkok, Thailand. Five cases were diagnosed after the rupture of membranes with only one case diagnosed prior to the rupture of membranes. The fetal mortality was 50 per cent. Despite continued advances in diagnostic procedures, vasa previa still presents considerable risk to the fetus.

Adult↗

Maternal perception of sound-provoked fetal movement in the early intrapartum period.

OBJECTIVE: To determine the relationship between maternal perception of sound-provoked fetal movement in the early intrapartum period and perinatal outcome. METHOD: 739 singleton pregnant women of at least 32 weeks gestation who were admitted to the labor ward, underwent the maternal perception of sound-provoked fetal movement test. All were in the latent phase of labor with singleton cephalic presentation. The result of maternal perception of sound-provoked fetal movement was compared with the perinatal outcome using sensitivity, specificity, negative predictive value, positive predictive value and accuracy. RESULTS: When 739 pregnant women were compared to the perinatal outcome, maternal perception of sound-provoked fetal movement had sensitivity 100%, specificity 98.9%, positive predictive value 15.1%, negative predictive value 100%, and accuracy 90.1%. CONCLUSION: The finding suggested the usefulness of maternal perception of sound-provoked fetal movement as an effective screening test to identify fetuses at risk in the early intrapartum period because of its high sensitivity and specificity. This is a simple and inexpensive test for evaluating fetal well-being in a primary health care setting.

Acoustic Stimulation↗

Misoprostol in the management of missed abortion.

OBJECTIVE: To compare the effect of vaginal misoprostol with that of placebo when used prior to dilation and aspiration in women with a missed abortion. METHOD: Eighty-four pregnant women with a missed abortion were randomized to receive either vaginal misoprostol (200 micrograms) or placebo the day before the planned dilatation and aspiration under inhalation anesthesia. RESULT: Thirty-five women (83.33%) in the misoprostol group and 6 women (17.14%) in the placebo group aborted spontaneously prior to the scheduled dilatation and aspiration, P < 0.0001. The mean insertion to spontaneous expulsion time was 11.63 +/- 6.14 h in the misoprostol group compared to 11.95 +/- 5.43 h in placebo. In the misoprostol group two women required intramuscular pethidine for analgesia. In the placebo group there were two cases of blood loss in excess of 500 ml and one woman with a uterine perforation. CONCLUSION: Vaginal administration of misoprostol to women with a missed abortion produced spontaneous expulsion of the pregnancy and reduced the need for surgical treatment.

Abortifacient Agents, Nonsteroidal↗

A comparison of intravaginal misoprostol and intracervical prostaglandin E2 gel for ripening of unfavorable cervix and labor induction.

OBJECTIVE: To study the effectiveness of single application of intravaginal misoprostol versus intracervical prostaglandin E2 gel for ripening the unfavorable cervix and labor induction. METHOD: One hundred and ten patients with indications for induction of labor with unfavorable cervices were randomized to receive either 100 microgram tablets of misoprostol placed in the posterior vaginal fornix or prostaglandin E2 1.5 mg in gel placed into the endocervix. Those, who were not in active labor after 24 hours, had labor induced with amniotomy and oxytocin. RESULTS: Among 110 patients recruited, 60 received misoprostol and 50 received prostaglandin E2 gel. The average interval from start of induction to vaginal delivery was 19.14 +/- 10.64 hours in misoprostol group and 21.37 +/- 13.09 hours in the prostaglandin E2 group (p = 0.33). Five patients (8%) in the misoprostol group had induction of labor after 24 hours of the treatment compared with 13 patients (26%) in the PGE2 group. The difference was significant (p = 0.03). Oxytocin augmentation was 35% in the misoprostol group and 34% in the prostaglandin E2 group (p = 0.86). There were no significant differences between routes of delivery. Nineteen patients (31%) in misoprostol group and 16 patients (32%) in the PGE2 gel group had cesarean deliveries. There was one case (1.7%) of uterine hyperstimulation in the misoprostol group and none in the PGE2 gel group. There were no significant difference in Apgar scores < 7 at 1 and 5 minutes, or admission to the neonatal intensive care unit between the 2 groups. CONCLUSION: Vaginal misoprostol is an effective agent for cervical ripening and induction of labor. Complications associated with prostaglandin administration were not statistically different between the 2 groups, but hyperstimulation occurred more in misoprostol group.

Administration, Intravaginal↗

Maternal perception of sound provoked fetal movement for antepartum assessment of fetal well-being.

OBJECTIVE: To assess the reliability and application of maternal perception of sound provoked fetal movement for antepartum assessment of fetal well-being. METHODS: Six hundred singleton high risk pregnant women of at least 32 weeks gestation were studied on 684 occasions. The response was compared with a nonstress test (NST) performed before a 3 second vibroacoustic stimulation with an electronic artificial larynx. The result of maternal perception of sound provoked fetal movement was compared to the NST and the perinatal outcome using sensitivity, specificity, negative predictive value, positive predictive value, and accuracy. RESULTS: On 684 occasions, a positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 642 occasions (93.9%) and was accompanied by a reactive NST on 630 occasions; giving a specificity of 97.1% and a negative predictive value of 98.1%. Results of maternal perception of sound provoked fetal movement and NST, performed within a week of delivery, in 560 women were compared with perinatal outcome. The maternal perception of sound provoked fetal movement test had better sensitivity (64.7%) for poor perinatal outcome than the NST (58.8%). Both tests were not different in specificity (96.3% vs 96.5%), positive predictive value (35.5% vs 34.5%), negative predictive value (98.9% vs 98.7%), and accuracy (95.4% vs 95.4%). CONCLUSION: The findings suggested that maternal perception of sound provoked fetal movement may be an effective screening test to identify fetal compromise in antepartum period. This test is a simple and inexpensive test for evaluating fetal well-being in primary health care setting.

Acoustic Stimulation↗

The use of low dose 1.5 mg prostaglandin E2 gel for cervical ripening and induction of labor at term with unfavorable cervix.

A prospective study was undertaken to evaluate the efficacy and safety of a 1.5 mg prostaglandin E2 gel applied intracervically for the initiation of cervical ripening before the induction of labor. All patients were required to have an initial Bishop score of four or less. There was a total of 220 pregnant women in this study and primipara accounted for 175 or 80 per cent of the pregnant women. The 1.5 mg PGE2 gel was found to be an effective means of cervical ripening in both primipara and multipara with a success rate of 77.7 and 93.3 per cent after the first application to 96 and 100 per cent in the second application, respectively. The mean induction to delivery time was 25.17 hours in primipara and 13.57 hours in multipara. The mean amniotomy to delivery time was 7.55 and 4.65 hours in primipara and multipara, respectively. The cesarean section rate was 48 per cent and 18 per cent in primipara and multipara, respectively. The side-effects were minimal. These results compare well with other reported studies using different dosages and routes.

Administration, Topical↗

Malignant Brenner tumor: a case of aggressive clinical course and cutaneous metastases.

Malignant Brenner tumor is a very rare ovarian tumor of which the definition of this entity and its biologic behavior remain controversial to this day. In this case report a 30-year-old patient with malignant Brenner tumor was presented with an aggressive clinical course and cutaneous metastases. The disease progressed from apparently unilateral ovarian involvement to intraabdominal, lung and cutaneous metastases. She expired within two months of diagnosis of disease. The histopathology of the ovarian tumor and the metastatic skin lesion are illustrated. In the authors' opinion this case should be categorized as a transitional cell carcinoma of the ovary.

Adult↗

Mid-trimester abortion using hypertonic saline or prostaglandin E2 gel: an analysis of efficacy and complications.

A total of 149 mid-trimester termination of pregnancies using hypertonic saline infusion (125) or prostaglandin E2 gel (24) have been analyzed for efficacy and complications. The mean induction to abortion time (I-A) was 31.7 +/- 9.2 hours in hypertonic saline (HSI) group and 28.4 +/- 27.7 hours in prostaglandin (PGE2) group. Retained placenta occurred in 76 (63.3%) in HSI group and 6 (25%) in PGE2 group. Four (3.3%) in HSI group had pyrexia over 38.5 degrees C and the only one case with proven sepsis developed disseminated intravascular coagulation defect (DIC) which accounted for one case (0.8%) of blood loss of more than 500 ml. There was also one case of mildly disturbed electrolytes in HSI group occurring during the instillation. Minor side-effects of nausea and vomiting occurred in 4 (16.7%) in the PGE2 group only.

Abortion, Induced↗