Winit Phuapradit

Topical Application of Honey in Treatment of Abdominal Wound Disruption

EDITORIAL COMMENT: We accepted this paper for publication because it should interest all readers, some of whom may decide they have the occasional patient suitable for this method of honey wound care. The healed wound shown in figure (d) would be cosmetically unacceptable to most women but perhaps resuture would have had a similar result. In the editors experience, sew sanguineous discharge from a wound postoperatively invariably means dehiscence best treated by resuture once any precipitating ileus has resolved; when the skin sutures are removed the wound falls apart in these women and usually loops of bowel are adherent to the edges of the wound (figures A and B). In the case illustrated in this paper the peritoneum appears to be intact as if the problem was an infected haematoma which is an unusual cause of wound disruption in the editors experience; yet the authors encountered 15 cases in 19 months, and quoted no case of the complete wound dehiscence referred to above!

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.

Antioxidant nutrients and lipid peroxide levels in Thai preeclamptic pregnant women.

Objective: To compare the antioxidant nutrients and lipid peroxide levels in preeclampsia and normal pregnant women.

Use of Norplant® implants in asymptomatic HIV-1 infected women

The study of Norplant implants use in HIV-1 infected women was conducted at the Family Planning Clinic, Department of Obstetrics and Gynaecology. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, from January 1993 to June 1996. The purpose of the study was to evaluate efficacy, clinical effects, side effects, and menstrual patterns of the Norplant system in HIV-1 infected acceptors. Forty one cases of asymptomatic HIV-1 positive women voluntarily participated in using Norplant implants after delivery or abortion. The mean age was 25.4 years. The most common menstrual pattern was irregular bleeding (63.4%). Mean blood pressure, body weight, and hemoglobin level were not different at insertion and at 12 months (p > 0.05). No pregnancy occurred during a 12-month period. It was concluded that the Norplant system was safe, efficacious, and well tolerated in HIV-1 positive women and is an appropriate contraception in these women.

Maternal viral load and vertical transmission of HIV-1 in mid-trimester gestation.

BACKGROUND It is now accepted that the majority of HIV-1 vertical transmissions occur in late gestation and at the time of delivery. However, there is wide variation in the prevalence rate of mid-trimester vertical transmission. We assessed the maternal HIV-1 RNA viral load and in utero transmission during mid-trimester gestation. METHODS Patients were enrolled when they decided to have their pregnancies terminated between 17 and 24 weeks of gestation. Prostaglandin-induced abortion with PGE1 analogue vaginal administration was carried out in all patients. Maternal plasma HIV-1 RNA viral load and plasma HIV-1 RNA (qualitative) from abortus heart blood were assessed. RESULTS Amongst 41 HIV-1 seropositive pregnant women not receiving antiretroviral therapy plasma HIV-1 RNA was detected in the abortus heart blood from two women (4.9%; 95% confidence interval (CI), 0.6-16.5). Transmission occurred in one out of nine (11.1%; 95% CI, 0.3-48.2) with maternal viral load > or =100000 copies/ml versus one out of 32 (3.1%; 95% CI, 0.1-16.2) of those with <100000 copies/ml (P = 0.39). CONCLUSIONS The frequency of HIV-1 vertical transmission during mid-trimester was approximately 5% as detected by plasma HIV-1 RNA (qualitative) method in the fetuses aborted from the prostaglandin termination of pregnancy. During mid-trimester gestation there was no correlation between high maternal viral load and vertical transmission.

Association of Contraceptives and HTV‐1 Infection in Thai Female Commercial Sex Workers

EDITORIAL COMMENT: We accepted this paper for publication because it shows that condom usage is significantly associated with a lower incidence of HIV‐1 infection in commercial sex workers. This important message can more readily be obtained from a community with a high prevalence of HTV‐1 infection. This paper also provides a sad glimpse into the lives of these sex workers whose condom usage is at best described as modest.

Maternal and Umbilical Cord Serum Zidovudine Levels in Human Immunodeficiency Virus Infection

EDITORIAL COMMENT: Because of the low prevalence rate for HIV in Australian antenatal populations and lack of a national or state policy for offering routine HIV testing in pregnancy, we have relied on our colleagues from Thailand to provide readers with information concerning treatment of pregnant women known to be HIV positive. Readers are referred to the January 24, 1998 issue of the British Medical Journal which contains 7 papers concerning HIV infection in pregnancy and neonates. The editorial by Danielle Mercey ‘Antenatal HIV testing. Has been done badly in Britain and needs to improve’ (A) should interest readers since HIV testing has been sufficiently performed in the United Kingdom to provide the information that in 1996 only 15% of previously unrecognized HIV infections were diagnosed in pregnancy. The prevalence in tested women in London increased 6‐fold from 0.03% in 1988 to 0.191% in 1996; for the rest of the United Kingdom the comparable percentages in tested women were 0.005% and 0.016% (B). For comparison, as noted in this paper, the prevalence rate of HIV positive mothers in Thailand was 2% in 1993, or more than 10 times greater than in London in 1996 and 125 times greater than in the rest of the United Kingdom. Tourists with sex adventures in mind should be aware of these facts when planning their itinerary for overseas tours. Obstetricians in Australia should heed the statement that ‘The advantages of ascertaining a pregnant womans HIV positive status before delivery are clear’: transmission to the baby can be roughly halved by avoiding breastfeeding and reduced by a further two‐thirds by the administration of zidovudine (A).

Pheochromocytoma during Pregnancy: Case Report

Pheochromocytoma during pregnancy is rare. Only a few hundred cases have been published in the literature. We report patients with pheochromocytoma diagnosed at antepartum period. Manifestation include hypertension with various clinical presentation, possibly resembling those of pregnancy‐induced hypertension. Confirmation necessitates special biochemical examination and the use of different radiological imaging tool. Treatment combines medical procedures with surgical exploration, mandating a team approach of diverse medical expertise. In the first and second trimesters, tumor resection has a good fetal outcome; in later pregnancy, delivery by elective cesarean section followed by tumor resection is recommended. The overall prognosis is mainly affected early diagnosis and multidisciplinarian management.

Umbilical Doppler Velocimetry Prediction of Discordant Twins

Objective: To evaluate the role of umbilical Doppler velocimetry as a comprehensive test for the prediction of discordant twins.

Serum Vitamin A and E in Pregnant Women with Hemoglobinopathies

Objective: To evaluate the relationship between the status of serum vitamin A, E and hemoglobinopathies among Thai pregnant women.