Somsak Suthutvoravut

The Effect of Estradiol Vaginal Tablet and Conjugated Estrogen Cream on Urogenital Symptoms in Postmenopausal Women: A Comparative Study

Objectives: To compare the effects of estradiol vaginal tablet with conjugated estrogen cream on urogenital symptoms, vaginal health index, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women.

Nifedipine versus terbutaline in management of preterm labor

The most commonly used agents for the treatment of preterm labor have been betamimetic drugs or magnesium sulfate. However due to the side effects and limited success of these drugs clinicians have looked for new alternative agents such as nifedipine. This prospective randomized study was conducted between June 1999 and July 2000 among patients in a Bongkok hospital admitted with preterm labor and gestational age between 28 and 34 completed weeks gestation. Its aim was to compare tocolytic efficacy of nifedipine with the betamimetic drug terbutaline and to assess maternal side effects of high dose nifedipine in pregnant Thai women. Through a computerized random number table these patients received either oral nifedipine or intravenous terbutaline. Overall the results showed that nifedipine a dihydropyridine calcium channel blocker is an effective smooth muscle relaxant with low toxicity and teratogenicity. It is noted that nifedipine was a comparable tocolytic agent when compared with terbutaline and it had a similar tocolytic efficacy. Furthermore nifedipine had significantly less maternal side effects than terbutaline. Thus this study demonstrates that nifedipine has a role in the treatment of preterm labor.

Risk factors for emergency peripartum cesarean hysterectomy

Emergency peripartum hysterectomy was performed for management of intractable obstetric hemorrhage that was unresponsive to other treatment. The procedure is often associated with a relatively high morbidity and mortality especially when performed under emergency life-threatening situation. Most current case series reported the incidence of 1—3 per 1000 deliveries. This study was performed as case control study to evaluate data regarding the risk factors of emergency peripartum hysterectomy. The study design was a case-control study of pregnant women who delivered at Ramathibodi Hospital Mahidol University Bangkok Thailand during January 1997 to December 2002. Inclusion criteria was a pregnant woman who underwent emergency peripartum hysterectomy within 24 h after delivery which delivered a single infant or twins and gestational age = 28 weeks. (excerpt)

The outcome of the first VBAC program in Thailand.

While trends of cesarean deliveries have stabilized in many developed countries partly due to the successful introduction and use of vaginal birth after cesarean section (VBAC) the level of such deliveries continues to rise rapidly in Thailand from 15% in 1990 to 22% in 1996. Almost all obstetricians in Thailand believe that once a section always a section. During 1994-96 all 650 nonprivate patients with previous cesarean section were counseled chosen and given the option to participate in the authors VBAC program. 66 of the eligible women underwent trials of labor of whom 64 were admitted in established labor with cervical dilatation of 3-5 cm. The mean admission to delivery time was 6.5 +or- 1.5 hours with the mean duration of the second stage being 29 +or- 12.5 minutes. Oxytocin was used in 24% of cases. 50 women (76%) achieved vaginal delivery of which 20 required instrumentation. There were no maternal or fetal complications. The rather high instrumental delivery rate of 40% of which half was due to poor maternal effort reflected a fear of uterine rupture. The subject was often discussed openly and negatively in front of patients. Additional studies and trials are needed to determine whether VBAC can be safely implemented.

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.

Fetal acoustic stimulation for early intrapartum assessment of fetal well-being

Fetal heart rate monitoring is widely used to assess fetal well-being during labor. A 20-min recording of the fetal heart rate immediately after Ž . the admission of patients in labor admission test may be of value as a screening procedure for fetal w x distress 1 . In a busy labor ward without a sufficiency of monitors and personnel, the obstetrician may be greatly aided by an evaluation performed early in the course of labor that can differentiate the fetus likely to tolerate the stress of labor from one that cannot. The usefulness of fetal acoustic stimulation in the early intrapartum period was considered to be the clinical application of a w x screening technique 2]4 . The aim of this study is to evaluate the usefulness of fetal acoustic stimulation test in the early intrapartum period as a screening test to predict perinatal outcome. This prospective study was performed in the labor room of Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Inclusion criteria

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.

A 5-year experience with Norplant implants in Thai women

In conclusion the Norplant implants are highly effective safe and well accepted by Thai women. Older women were more compliant users than younger ones. However careful and complete counseling regarding the effectiveness duration of approved use and adverse effects of Norplant implants is essential for high continuation rates. (excerpt)

The effect of intravaginal estradiol tablet and conjugated estrogen cream in postmenopausal women: A comparative study

Objectives: The aim of the study ,w,as to investigate the clinical evaluation and compatibility of 00s (plaster) “Climara” (“Schering”, Germany) for women in surgical menopause. Study Methods: Sixty six women after amputation uteri without ovaries aged from forty four to fifty one, surgical menopausal aged 4,3*0,7 were included in this randomized study. We used the following methods: mammaryfentgen?gFaphy, ovaries’ US-scanning, registration of FSG, Prl, E2, NA-125, NA-15.3 levels in blood plasma using IFA methods (“Roche”, ” Bio-Rad”); lipidogramma, gemistasiocoagulogramma, vaginal smear. Blood pressure control and weight were recorded. To perform clinical evaluation and compatibility of bbS ” Climara”, Evaluation Index = Therapy Effect /Side Effect was studied. Results: Before the “Climara? management all sixty seven patients had “hot flashes”, hipergydrosis, headache, rapid heart rate, insomnia, Index Kupermana (IK) more than twenty points. Coincidentally with the “hot flashes” thirty three women (50% of all patients) had vaginal itching, vulvodinya, dispareaunya. Symptoms of the vasomotorical dysfunction disappeared after one month of the treatment. Then during the second month, vaginal symptoms disappeared as well. Side effects (mastalgia, nausea) were accompanied with a reversible character and disappeared at the end of the one-month treatment, with a value about 6,6%. The weight increase wasn’t registered. Evaluation Index reached 94%. The medication was prescribed in a dosage of 0,05 mg per day during six months with the ten days cycle addition of levonorgestrel including gestagen during three months. The treatment control accompanied a year of the examination. Conclusions: With reference to the “Climara? research the evaluation of replacement hormonotherapy treatment for women in surgical menopause symptoms of the vasomotorical dysfunct&and vaginal atrophy side effects were minimal and infrequent. OOS.“Climara” is the most compatible medication.