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The goal of eliminating congenital syphilis in Thailand is to reduce new cases from 50 per 100,000 live births in 2015 to 5 per 100,000 live births in 2020. This remains a challenge because the incidence of syphilis in pregnant women is rising in many regions of Thailand. Therefore, the Ministry of Public Health of Thailand has revised the national guideline to control the situation by increasing the screening for Thai people with high risk of getting the disease; early detection and treatment of pregnant women with syphilis; suggesting pathological examination of placenta as well as identification of Treponema pallidum; enhancing the corporation between obstetricians and pediatricians; and emphasizing the post-treatment follow-up including contact tracing.

Objectives: To determine the success rate of ampicillin plus azithromycin to prolong the latency period in cases with preterm premature rupture of membranes (PPROM).Materials and Methods: A retrospective descriptive study was conducted. Medical records of singleton pregnancies between 24 and 33+6 weeks of gestation who complicated with PPROM and received ampicillin and oral azithromycin to prolong the latency period at King Chulalongkorn Memorial Hospital between January 2010 and December 2016 were reviewed. Prolonged latency period more than 48 hours was defined as success. Descriptive statistics were used for data analysis. Results: Eighty eight pregnancies were included in the study with mean ± standard deviation age of 30.4 ± 5.6 years and mean gestational age of 31.3 ± 2.5 weeks. The median of latency period was 96 hours (interquartile range 60-192 hours) and 76 cases (86.4%) reached more than 48 hours of latency period. Seven women (8.0%) complicated by chorioamnionitis with 1 case of maternal sepsis. Regarding neonatal outcomes, respiratory distress syndrome (RDS) complicated in 29 neonates (33.0%) and 12 cases (13.6%) needed ventilator. Forty eight cases (54.5%) found neonatal sepsis along with 3 (3.4%) neonatal deaths.Conclusion: Antibiotic regimen including ampicillin and azithromycin was effective to prolong latency period in most women presented with PPROM. However, one-third of the neonates complicated with RDS and neonatal sepsis was found in more than half of the cases. Further study is needed to identify regimens that may improve neonatal outcomes.

Objectives: Globally, syphilis in pregnancies remains a significant health concern, because the infection results in numerous maternal and fetal complications. However, in Thailand, documented evidence regarding the disease in the mothers and their newborns is scarce. Therefore, we conducted the study to explore the disease’s trends in the aforementioned populations. Materials and Methods: A 10-year retrospective descriptive study (1st January 2006 – 31st December 2015) was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Hospital records of syphilis-infected pregnant women and their infants were extensively reviewed by 2 obstetricians and a neonatologist. Descriptive statistics was leveraged to present patient’s demographic and syphilis-related data. Results: The percentage of syphilis-infected pregnant women increased from 0.05% in 2006 to 0.5% in 2015. Following the same trend, the percentage of infants with proven or possible congenital syphilis rose from 0% in 2006 to 0.06% and 0.13% in 2015, respectively. Interestingly, teenage pregnant women were particularly affected by the disease in the recent years; the incidence escalated from 10% to 30%. There were 16.4% (n = 12) of infected pregnant women who did not receive treatment antenatally, half of them were asymptomatic with positive serologic results (CMIA+, RPR-, TPPA+ results). Conclusion: This study adds new information regarding the surge of maternal and congenital syphilis cases particularly in young pregnant women. This update will help to increase the awareness of obstetricians regards to syphilis screening and treatment during pregnancy period. Moreover, it emphasizes the importance of medical personnel’s’ familiarity with the reverse syphilis screening algorithm before applying to clinical practice.

Objectives: To determine the incidence and associated factors of neonatal scalp hematoma.Materials and Methods: This prospective case-control study included all term singleton live newborns that delivered in King Chulalongkorn Memorial Hospital during July 2016 to October 2016. All neonates were prospectively evaluated and divided into two groups: cases with scalp hematoma and controls. Diagnoses of neonatal scalp hematoma either cephalhematoma or subgaleal hemorrhage were confirmed by the experienced neonatologist. Medical records of these neonates and their mothers were reviewed to collect demographic data and information regarding their processes of labor and delivery. Logistic regression analysis was used to identify the risk factors associated with presence of neonatal scalp hematoma.Results: A total of 938 term neonates were included in this study. The incidence of neonatal scalp hematoma was 3.19% (30/938). Operative obstetrics (vacuum and forceps extraction) were found to have the highest rate (15.38%) of scalp hematoma when compare with other routes of delivery. Factors associated with neonatal scalp hematoma were primiparity (adjusted OR 4.86, 95% CI 1.61-14.58) and prolonged second stage of labor (adjusted OR 4.31, 95% CI 1.08-17.25). When analysis was done in only vaginally delivered neonates, the significant factors were primiparity (adjusted OR 3.84, 95% CI 1.26-11.71) and artificial rupture of membranes (adjusted OR 2.93, 95% CI 1.24-6.97).Conclusion: Neonatal scalp hematoma was common. Primiparous women significantly increased risk of neonatal scalp hematoma regardless of route of delivery.

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 31stDecember 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.

Objectives: To determine the acceptance rate and associated factors of influenza vaccination among Thai pregnant women.Materials and Methods:A cross-sectional descriptive study was conducted at King Chulalongkorn Memorial Hospital from November 2014 to March 2015. Pregnant women were asked to complete self-administered questionnaires that collected data on acceptance of vaccination, knowledge, attitude and practice regarding to influenza vaccination during pregnancy. The associated factors were determined by logistic regression analysis.Results: A total of 412 women completed the questionnaires. Acceptance rate of influenza vaccination among the participants was 40.5% (95% CI 35.9-45.3). Most participants (320 women, 77.7%) had good knowledge about influenza and the vaccine. Factors positively associated with the acceptance were ‘advice from physicians’ (adjusted OR 2.61, 95% CI 1.55-4.39), ‘notification about vaccination in current pregnancy’ (adjusted OR 1.84, 95% CI 1.17-2.89), ‘protection of newborn’ (adjusted OR 2.83, 95% CI 1.74-4.62) and ‘cost of vaccination’ (adjusted OR 2.36, 95% CI 1.46-3.82). Negatively associated factors included ‘experience of side effects following past vaccination’ (adjusted OR 0.19, 95% CI 0.05-0.74), ‘belief that vaccination is unnecessary’ (adjusted OR 0.42, 95% CI 0.21-0.86), and ‘unsafe during the first trimester’ (adjusted OR 0.55, 95% CI 0.34-0.90).Conclusion: Acceptance rate of influenza vaccination during pregnancy among women in King Chulalongkorn Memorial Hospital was 40.5%. To increase vaccination rate, health care providers should advise or mention on influenza vaccination and provide information to support that the immunization can protect their newborns and is safe at any trimester

Objective: To evaluate the correlation of Thai Edinburgh Postnatal Depression Scale (EPDS) scores between Thai women during early and at 6-week postpartum period. Materials and methods: Two hundred and fifty one postpartum women completed Thai EPDS questionnaire during the first few days after delivery and at 6-week postpartum follow-up. Correlation of Thai EPDS scores between both periods were analyzed by Spearman’s rank. Receiver-operator characteristic curve was used to determine the cut-off value of early Thai EPDS scores to predict the high-risk women for postpartum depression. Results: Statistically significant correlation of Thai EPDS scores between early and 6-week postpartum was evident (r = 0.36, P < 0.001). Using an early Thai EPDS score > 8 as a cut-off value, the high-risk women were detected with a sensitivity of 77.0% and specificity of 56.3%. Conclusion: Thai EPDS scores during early postpartum showed significant correlation with scores at 6-week postpartum. Further investigations are needed to determine the utility of this early postpartum score.

Objective: To assess the proportion of adolescent mothers who had awareness of emergency contraception. Study design: Cross-sectional descriptive study. Materials and methods: Adolescent mothers aged 19 years or less, who visited at antenatal clinic or admitted to postpartum ward in King Chulalongkorn Memorial Hospital from October 2007 to April 2008 were enrolled in the study. Standard self-administered questionnaires were completed by all participants. Data included demographic characteristics, obstetric and contraceptive history, knowledge and opinions on emergency contraception were collected and analyzed. Results: A total of 104 adolescent mothers were recruited. The mean age was 17.5 years and average age of their first sexual intercourse was 15.9 years. Oral contraceptive pills (58.7%) and condoms (35.6%) were the common used contraceptive methods. Most of them (84.6%) knew emergency contraception as a contraceptive method, but only 28.8% ever used emergency contraception in the past. Pharmacy (27.9%) and hospital or health office (19.2%) represented the common sources of information of contraceptive methods for these participants. Eighty two women (78.8%) thought that emergency contraception is an option to prevent unplanned pregnancy and they will use these contraceptive methods in the future. Conclusion: Most of the adolescent mothers had awareness of emergency contraception and willing to use them in the future. Health care providers seem to be the important sources of information for these groups.