Diagnosis of Cephalopelvic Disproportion or Failure to Progress of Labor in Rajavithi Hospital Compare with The Criteria of Royal Thai College of Obstetricians and Gynaecologists

Objective:To evaluate the correlation of the clinical criteria for cephalapelvic disproportion (CPD) or failure to progress of labor (FPL) in women underwent cesarean delivery with the criteria endorsed by the Royal Thai College of Obstetricians and Gynaecologists. (RTCOG)Material and Method: Two hundred and sixty one women underwent cesarean section due to CPD or FPL in Rajavithi Hospital from June 1st 2008 to May 31st, 2009 were retrospectively enrolled. The correlation between both criteria were analyzed using the criteria endorsed by RTCOG.Results:The correlation rate of the clinical criteria for diagnosis of CPD or FPL in women underwent cesarean section due to CPD or FPL with the criteria endorsed by the RTCOG was 82.00%. The correlation in private cases was significantly lower than those in ward cases. (53.2% vs 85.5%, p < 0.01). Maternal age, Bishop score, cervical dilatation when diagnosis of CPD or FPL by clinical or RTCOG criteria were statistic significant difference between groups.Conclusion:The correlation of clinical criteria and RTCOG criteria for diagnosis of CPD or FPL was higher (82.00%)The correlation rate in private cases was lower than those in ward cases. (53.2 % vs 85.5%, p < 0.01

Pregnancy Outcomes Among Parturients Complicated with Diabetes Mellitus at Rajavithi Hospital

Objective: To assess the prevalence, demographic characteristics, route of delivery, maternal and neonatal outcomes and complications of parturients complicated with diabetes mellitus (DM) at Rajavithi Hospital. Materials and Methods: Retrospective analysis of medical records of cases diagnosed pregnancy with DM from January 1, 2005 and September 30, 2007. Result: The prevalence of parturients complicated with DM was 1.84% of total deliveries. The most common maternal and neonatal complications were hypertensive disorders in pregnancy (25%) and macrosomia(33.6%), respectively. Occurrence of hypertensive disorder in pregnancy, macrosomia and neonatal hypoglycemia were significant difference between class A1, A2 and ³ B. Conclusion: The prevalence of parturients complicated with DM was 1.84% of total deliveries. The most common maternal and neonatal complications were hypertensive disorders complicating pregnancy and macrosomia

Natural Birth

Nowadays, increasing numbers of people prefer to spend their lives close to Nature. Many natural products and ways of living have become popular around the world, including in Thailand. Natural birth, or active birth or mother friendly birth practice, as it is sometimes known, is the practice of birth care which encourages a mother to use her innate birthing instinct while receiving skilled, supportive care from qualified health professionals. An interesting and important question for health professionals caring for women in labor is ‘How do we view birth?’ Is birth seen as a physiological or pathological process? Or for that matter, are the changes of pregnancy physiological or pathological? Before answering these questions, we would like to introduce the two model concepts of health care for birth(1)

Adnexal Mass with Surgical Treatment in Pregnant Women at Rajavithi Hospital: 2002-2005

Objective: To analyse the incidence, histopathological diagnosis and pregnancy characteristics and outcomes of pregnant women undergone surgical treatment for adnexal mass at Rajavithi Hospital. Materials and Methods: A retrospective descriptive analysis database of pregnant women who underwent surgical treatment of adnexal mass during pregnancy in Department of Obstetrics and gynecologyin, Rajavithi Hospital between January 1st, 2001 and December 31st, 2005. Data collection included age, gravidity, parity, gestational age (at the time of surgery and delivery), histopathological diagnosis, maternal outcomes. Results: There were 66 pregnant women with adnexal masses that required surgical management among a total 45, 143 deliveries. The incidence of pregnant women with adnexal mass requiring surgical intervention in pregnancy was 1 in 684 deliveries. Of the 57 cases had complete data for analysis, 14 patients (24.56%) underwent emergency exploratory laparotomy, 43 patients (75.44%) underwent elective exploratory laparotomy before delivery. The two most common pathological findings were mature cystic teratoma (33.33%), endometrioma (17.54%). Only 2 malignant tumors or borderline malignant tumors (3.5%) were encountered: the first one was serous cystadenocarcinoma stage Ia and the other was borderline mucinous cystadenoma. There was only 1 preterm delivery (1.75%) in the elective surgery group. There were no any significant different between elective and emergency surgery groups in histopathological diagnosis, demographic characteristics and maternal outcomes. Conclusions. The incidence of pregnant women with adnexal mass requiring surgical intervention in pregnancy was 1 in 684 deliveries. The percentage of malignant tumor or tumor of low malignant potential was 3.5%. There were no any significant difference between elective and emergency surgery groups in histopathological diagnosis, demographic characteristics and maternal outcomes

Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis

© 2019 Wiley Periodicals, Inc. Background: Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence-based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. Methods: A search of 13 databases was supported by hand-searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. Results: The 43 included studies were predominantly conducted in tertiary care centers of low-income and middle-income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. Conclusions: Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole-of-life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden

Group B streptococcal carriage, serotype distribution and antibiotic susceptibilities in pregnant women at the time of delivery in a refugee population on the Thai-Myanmar border

<p>Abstract</p> <p>Background</p> <p>Group B Streptococcus (GBS) is the leading cause of neonatal sepsis in the developed world. Little is known about its epidemiology in the developing world, where the majority of deaths from neonatal infections occur. Maternal carriage of GBS is a prerequisite for the development of early onset GBS neonatal sepsis but there is a paucity of carriage data published from the developing world, in particular South East Asia.</p> <p>Methods</p> <p>We undertook a cross sectional study over a 13 month period in a remote South East Asian setting on the Thai-Myanmar border. During labour, 549 mothers had a combined vaginal rectal swab taken for GBS culture. All swabs underwent both conventional culture as well as PCR for GBS detection. Cultured GBS isolates were serotyped by latex agglutination, those that were negative or had a weak positive reaction and those that were PCR positive but culture negative were additionally tested using multiplex PCR based on the detection of GBS capsular polysaccharide genes.</p> <p>Results</p> <p>The GBS carriage rate was 12.0% (95% CI: 9.4-15.0), with 8.6% positive by both culture and PCR and an additional 3.5% positive by PCR alone. Serotypes, Ia, Ib, II, III, IV, V, VI and VII were identified, with II the predominant serotype. All GBS isolates were susceptible to penicillin, ceftriaxone and vancomycin and 43/47 (91.5%) were susceptible to erythromycin and clindamycin.</p> <p>Conclusions</p> <p>GBS carriage is not uncommon in pregnant women living on the Thai-Myanmar border with a large range of serotypes represented.</p

Serotype Distribution and Invasive Potential of Group B Streptococcus Isolates Causing Disease in Infants and Colonizing Maternal-Newborn Dyads

Serotype-specific polysaccharide based group B streptococcus (GBS) vaccines are being developed. An understanding of the serotype epidemiology associated with maternal colonization and invasive disease in infants is necessary to determine the potential coverage of serotype-specific GBS vaccines.Colonizing GBS isolates were identified by vaginal swabbing of mothers during active labor and from skin of their newborns post-delivery. Invasive GBS isolates from infants were identified through laboratory-based surveillance. GBS serotyping was done by latex agglutination. Serologically non-typeable isolates were typed by a serotype-specific PCR method. The invasive potential of GBS serotypes associated with sepsis within seven days of birth was evaluated in association to maternal colonizing serotypes.GBS was identified in 289 (52.4%) newborns born to 551 women with GBS-vaginal colonization and from 113 (5.6%) newborns born to 2,010 mothers in whom GBS was not cultured from vaginal swabs. The serotype distribution among vaginal-colonizing isolates was as follows: III (37.3%), Ia (30.1%), and II (11.3%), V (10.2%), Ib (6.7%) and IV (3.7%). There were no significant differences in serotype distribution between vaginal and newborn colonizing isolates (P = 0.77). Serotype distribution of invasive GBS isolates were significantly different to that of colonizing isolates (P<0.0001). Serotype III was the most common invasive serotype in newborns less than 7 days (57.7%) and in infants 7 to 90 days of age (84.3%; P<0.001). Relative to serotype III, other serotypes showed reduced invasive potential: Ia (0.49; 95%CI 0.31-0.77), II (0.30; 95%CI 0.13-0.67) and V (0.38; 95%CI 0.17-0.83).In South Africa, an anti-GBS vaccine including serotypes Ia, Ib and III has the potential of preventing 74.1%, 85.4% and 98.2% of GBS associated with maternal vaginal-colonization, invasive disease in neonates less than 7 days and invasive disease in infants between 7-90 days of age, respectively

Maternal Colonization With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses.

Background: Maternal rectovaginal colonization with group B Streptococcus (GBS) is the most common pathway for GBS disease in mother, fetus, and newborn. This article, the second in a series estimating the burden of GBS, aims to determine the prevalence and serotype distribution of GBS colonizing pregnant women worldwide. Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus), organized Chinese language searches, and sought unpublished data from investigator groups. We applied broad inclusion criteria to maximize data inputs, particularly from low- and middle-income contexts, and then applied new meta-analyses to adjust for studies with less-sensitive sampling and laboratory techniques. We undertook meta-analyses to derive pooled estimates of maternal GBS colonization prevalence at national and regional levels. Results: The dataset regarding colonization included 390 articles, 85 countries, and a total of 299924 pregnant women. Our adjusted estimate for maternal GBS colonization worldwide was 18% (95% confidence interval [CI], 17%-19%), with regional variation (11%-35%), and lower prevalence in Southern Asia (12.5% [95% CI, 10%-15%]) and Eastern Asia (11% [95% CI, 10%-12%]). Bacterial serotypes I-V account for 98% of identified colonizing GBS isolates worldwide. Serotype III, associated with invasive disease, accounts for 25% (95% CI, 23%-28%), but is less frequent in some South American and Asian countries. Serotypes VI-IX are more common in Asia. Conclusions: GBS colonizes pregnant women worldwide, but prevalence and serotype distribution vary, even after adjusting for laboratory methods. Lower GBS maternal colonization prevalence, with less serotype III, may help to explain lower GBS disease incidence in regions such as Asia. High prevalence worldwide, and more serotype data, are relevant to prevention efforts

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention