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Purpose: To evaluate the safety and efficacy of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) infected pregnant women to prevent mother-to-child transmission of HIV. Design of the study is observational retrospective evaluation of a prospective cohort. Setting of the study is King Chulalongkorn Memorial Hospital. Participants are HIV-infected Thai women and their offspring. HIV-positive pregnant women who received antenatal care were given antepartum and intrapartum zidovudine (ZDV) plus single dose nevirapine (NVP) or HAART [ZDV + lamivudine (3TC) + NVP] to prevent HIV transmission to the neonate. All newborns received single dose NVP plus 6-weeks of ZDV.HAART was given to their parents if indicated. We followed the infants from February 2003 to June 2006 to determine HIV-status. Calculated HIV maternal-child transmission rate is the main outcome. Among 157 mother-infant pairs, 44 mothers received ZDV plus single dose NVP and 113 mothers received HAART. There was one HIV-infected child in the first group and 3 in the second group, resulting in 2.3% (95% confidence interval, −2.1 to 6.7) transmission rate in the first group versus 2.7% (95% confidence interval, −0.3 to 5.6) in the second group (P = 1.000). All non-infected infants had a normal physical examination at 18 months. Initiation of HAART in HIV-infected pregnant women had comparable efficacy with ZDV plus single dose NVP to prevent mother-to-child transmission of HIV. In addition, the program may have strengthened the role of the family unit and stimulated public awareness reproductive health planning can help in prevention of HIV/AIDS.

BACKGROUND The incidence of hydatidiform mole (HM) differs among regions but has declined significantly over time. In Thailand, the initiation of universal health coverage in 2002 has resulted in a change of medical services countrywide. However, impacts of these policies on gestational trophoblastic disease (GTD) cases in Thailand have not been reported. This study aimed to find the incidence of hydatidiform mole (HM) in King Chulalongkorn Memorial Hospital (KCMH) from 1994-2013, comparing before and after the implementation of the universal coverage health policy. MATERIALS AND METHODS All cases of GTD in KCMH from 1994-2013 were reviewed from medical records. The incidence of HM, patient characteristics, treatment and remission rates were compared over two study decades between 1994-2003 and 2004-2013. RESULTS Hydatidiform mole cases decreased from 204 cases in the first decade to 111 cases in the seond decade. Overall incidence of HM was 1.70 per 1,000 deliveries. The incidence of HM in the first and second decades were 1.70 and 1.71 per 1,000 deliveries, respectively (p=0.65, 95%CI 1.54-1.88). Referred cases of nonmolar gestational trophoblastic neoplasia (GTN) increased from 12 (4.4%) to 23 (14.4%, p

Background Twin pregnancies are associated with a high risk of neonatal mortality and morbidity due to an increased rate of preterm birth. Betamimetics can decrease contraction frequency or delay preterm birth in singleton pregnancies by 24 to 48 hours. The efficacy of oral betamimetics in women with a twin pregnancy is unproven. Objectives To assess the effectiveness of prophylactic oral betamimetics for the prevention of preterm labour and birth for women with twin pregnancies. Search methods We searched the Cochrane Pregnancy and Childbirth Group Trials Register (21 September 2015), MEDLINE (January 1966 to 31 July 2015), EMBASE (January 1985 to 31 July 2015) and reference lists of retrieved studies. Selection criteria Randomised controlled trials in twin pregnancies comparing oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. Quasi-randomised controlled trials, cluster-randomised trials and cross-over trials were not eligible for inclusion. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two authors assessed the quality of the evidence using the GRADE approach. Main results Overall, the quality of evidence is low for the primary outcomes. All of the included trials had small numbers of participants and few events. Preterm birth, the most important primary outcome, had wide confidence intervals crossing the line of no effect. Six trials (374 twin pregnancies) were included, but only five trials (344 twin pregnancies) contributed data. All trials compared oral betamimetics with placebo. Betamimetics reduced the incidence of preterm labour (two trials, 194 twin pregnancies, risk ratio (RR) 0.37; 95% confidence interval (CI) 0.17 to 0.78; low quality evidence). However, betamimetics did not reduce prelabour rupture of membranes (one trial, 144 twin pregnancies, RR 1.42; 95% CI 0.42 to 4.82; low quality evidence), preterm birth less than 37 weeks' gestation (four trials, 276 twin pregnancies, RR 0.85; 95% CI 0.65 to 1.10; low quality evidence), or less than 34 weeks' gestation (one trial, 144 twin pregnancies, RR 0.47; 95% CI 0.15 to 1.50; low quality evidence). Mean neonatal birthweight in the betamimetic group was significantly higher than in the placebo group (three trials, 478 neonates, mean difference 111.22 g; 95% CI 22.21 to 200.24). Nevertheless, there was no evidence of an effect of betamimetics in reduction of low birthweight (two trials, 366 neonates, average RR 1.19; 95% CI 0.77 to 1.85, random-effects), or small-for-gestational age neonates (two trials, 178 neonates, average RR 0.90; 95% CI 0.41 to 1.99, random-effects). Two trials showed that betamimetics significantly reduced the incidence of respiratory distress syndrome (388 neonates, RR 0.30; 95% CI 0.12 to 0.77), but the difference was not significant when the analysis was adjusted to account for the non-independence of twins (194 twins, RR 0.35; 95% CI 0.11 to 1.16). Three trials showed no evidence of an effect of betamimetics in reducing neonatal mortality, either with the unadjusted analysis, assuming twins are completely independent of each other (452 neonates, average RR 0.90; 95% CI 0.15 to 5.37, random-effects), or in the adjusted analysis, assuming non-independence of twins (226 twins, average RR 0.74; 95% CI 0.23 to 2.38, random-effects). A maternal death was reported in one trial without a significant difference between the groups (144 women, RR 2.84; 95% CI 0.12 to 68.57). Authors' conclusions There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women with a twin pregnancy.

Objective To compare the effectiveness of ceftriaxone versus cefazolin for the prevention of febrile morbidity and postoperative infections among patients after abdominal hysterectomy. Methods In a double-blind, randomized, controlled trial in Bangkok, Thailand, 320 patients undergoing abdominal hysterectomy between July 2008 and July 2009 were randomly assigned to receive 1 g of either ceftriaxone or cefazolin intravenously in a single dose before surgery. The participants were evaluated for postoperative fever and infection for up to 4 weeks. χ2 or Fisher exact tests were used for statistical analysis. Results There was no significant difference between the ceftriaxone and cefazolin groups in incidence of febrile morbidity (9.4% versus 11.2%), wound infection (3.8% versus 1.9%), vaginal cuff infection (3.8% versus 1.9%), or urinary tract infection (1.9% versus 1.9%). Conclusion There was no difference between the use of single-dose preoperative ceftriaxone and cefazolin in preventing infectious morbidity among patients undergoing hysterectomy.

We evaluated the pharmacokinetics of stavudine (d4T) and didanosine (ddI) in neonates. Eight neonates born to human immunodeficiency virus-infected mothers were enrolled to receive 1 mg of d4T per kg of body weight twice daily and 100 mg of ddI per m 2 once daily in combination with nelfinavir for 4 weeks after birth. Pharmacokinetic evaluations were performed at 14 and 28 days of age. For d4T, on days 14 and 28, the median areas under the concentration-time curves from 0 to 12 h (AUC 0–12 s) were 1,866 and 1,603, ng · h/ml, respectively, and the median peak concentrations ( C max s) were 463 and 507 ng/ml, respectively. For ddI, on days 14 and 28, the median AUC 0–10 s were 1,573 and 1,562 h · ng/ml, respectively, and the median C max s were 627 and 687 ng/ml, respectively. Systemic levels of exposure to d4T were comparable to those seen in children, suggesting that the pediatric dose of 1 mg/kg twice daily is appropriate for neonates at 2 to 4 weeks of age. Levels of exposure to ddI were modestly higher than those seen in children. Whether this observation warrants a reduction of the ddI dose in neonates is unclear.

Thalassemia is a common hematological disease in Southeast Asia. Extramedullary hematopoiesis is common sequelae in thalassemic patients but extramedullary hematopoiesis in the spinal epidural space that leads to paraparesis in pregnancy is very rare. We managed a thalassemic patient with extramedullary hematopoiesis and spinal cord compression during pregnancy. The diagnosis was made on clinical features and magnetic resonance imaging (MRI) showing a paravertebral mass infiltrating the epidural space. She was treated successfully with repeated blood transfusions until delivery. Fetal growth restriction was found but otherwise the fetus was clinically normal. She had an uneventful recovery when she was seen 6 weeks after delivery.

Summary Actinimycin-D as a single chemotherapeutic agent is an effective drug against low-risk MTGN and VAC regimen is effective for treatment of high-risk MGTN. Monitoring of serum hCG levels during therapy and after remission is extremely important for good follow-up and evaluation to these patients.

We evaluated the Strep B optical immunoassay (OIA; ThermoBiostar, Inc.) for detecting light and heavy group B streptococcus colonization in 1,306 pregnant women. The women were examined at 20 to 32 weeks gestation and were from six countries. Compared to culture, the sensitivity and specificity of OIA were 13.3 and 98.4%, respectively, for light colonization and 41.5 and 97.7%, respectively, for heavy colonization.

To describe health consequences of sexual assault victims attending Police General Hospital, Thailand.Descriptive study with prospective data collection.Police General Hospital, Bangkok, Thailand.Sexual assault victims attending Police General Hospital between October 1, 2004 and September 30, 2005 were recruited All subjects were actual sexual assault cases and came to Police General Hospital within 14 days.Each recruited victim was interviewed, physically and forensic medically examined, and screened for sexual transmitted infections (STIs) at first visit, two-week follow-up visit, and three-month follow-up visits. Data were analyzed using descriptive statistics, including 95% confidence intervals.There were 377 victims. One of them was male and excluded from the analysis. Most victims were single, 68.8% aged 10-19 years. Non-genital injuries were reported in 32.4% (95% CI, 27.7%, 37.5%) of the victims and 91.0% of these injuries were mild. Only one patient was admitted in the hospital. Genital injuries were found in 43.4% (95% CI, 38.4%, 48.4%) of the victims. At the first visit, 2.9% (95% CI, 0.9%, 4.9%) and 1.1% (95% CI, -0.1%, 2.3%) were infected by N. gonorrhea and Trichomonas vaginalis respectively. At the 2-week follow-up visit, 3.0% (95% CI, 0.7%, 5.3%) and 1.5% (95% CI, -0.2%, 3.2%) were infected by N. gonorrhea and Trichomonas vaginalis respectively. The incidence of pregnancy resulted from sexual assault was 1.7% (95% CI, 0.1%, 3.3%).Most sexual assault victims were teenagers. All physical injuries were of mild to moderate degree. Prevalence of STIs and incidence of pregnancy after sexual assault were very low.

OBJECTIVE: To evaluate whether a 1-day nitrofurantoin regimen is as effective as a 7-day regimen in eradicating asymptomatic bacteriuria during pregnancy. METHODS: A multicenter, double-blind, randomized, placebo controlled noninferiority trial was conducted in antenatal clinics in Thailand, the Philippines, Vietnam, and Argentina. Pregnant women seeking antenatal care between March 2004 and March 2007 who met the inclusion and exclusion criteria were invited to participate in the study. Those who consented were randomly allocated to receive either a 1-day or a 7-day course of 100 mg capsules of nitrofurantoin, which was taken twice daily. The primary outcome was bacteriologic cure on day 14 of treatment. RESULTS: : A total of 1,248 of 24,430 eligible women had asymptomatic bacteriuria, making the overall prevalence of 5.1%. Of these 1,248 women, 778 women were successfully recruited, and 386 and 392 women were randomly allocated to 1-day and 7-day regimens, respectively. Escherichia coli was the most common potentially pathogenic bacteria detected, its prevalence approaching 50%. Bacteriologic cure rates at treatment day 14 were 75.7% and 86.2% for 1-day and 7-day regimens, respectively. The cure rate difference was -10.5% (95% confidence interval -16.1% to -4.9%). Mean birth weight and mean gestational age at delivery were significantly lower in the 1-day regimen group. There were fewer adverse effects in the 1-day regimen group, but the differences were not statistically significant. CONCLUSION: A 1-day regimen of nitrofurantoin is significantly less effective than a 7-day regimen. Women with asymptomatic bacteriuria in pregnancy should receive the standard 7-day regimen. CLINICAL TRIAL REGISTRATION: ISRCTN, isrctn.org, ISRCTN11966080 LEVEL OF EVIDENCE: I.

Several studies have suggested an association between maternal periodontal disease and preterm delivery, but this has not been a consistent finding. In 2006-2007, the authors examined the relation between maternal periodontal disease and preterm delivery among 467 pregnant Thai women who delivered a preterm singleton infant (37 weeks' gestation) and 467 controls who delivered a singleton infant at term (or =37 weeks' gestation). Periodontal examinations were performed within 48 hours after delivery. Participants' periodontal health status was classified into 4 categories according to the extent and severity of periodontal disease. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Preterm delivery cases and controls were similar with regard to mean probing depth, mean clinical attachment loss, and mean percentage of sites exhibiting bleeding on probing. After controlling for known confounders, the authors found that severe clinical periodontal disease was not associated with an increased risk of preterm delivery (odds ratio = 1.20, 95% confidence interval: 0.67, 2.16). In addition, there was no evidence of a linear increase in risk of preterm delivery or its subtypes associated with increasing severity of periodontal disease (P(trend)0.05). The results of this case-control study do not provide convincing evidence that periodontal disease is associated with preterm delivery or its subtypes among Thai women.

To determine the perinatal impacts of heroin and amphetamine on both mothers and infants.This is a retrospective study on the influence of amphetamine and heroin on pregnant women and their newborn infants at King Chulalongkorn Memorial Hospital in Bangkok, Thailand, between January 1997 and December 2002. The medical and demographic data of both mothers and infants were evaluated. Comparison of the consistent drug effects of these 2 drugs on the mothers and infants were also performedTwo hundred and eleven women were identified There were 178 (84.4%) and 33 (15.6%) women addicted to amphetamine and heroin respectively. Sixty one (28.9%) of them were polydrug users. There were more polydrug users among heroin addicts than amphetamine addicts, (43.7% vs 27.2%, p0.05). Poor obstetric history were noted in both groups of women including lack of prenatal care (74.9%), a high incidence of previous abortion (22.3%), positive HIV serology test (11.1%), pre-eclampsia (5.2%), infection (3.3%) and antepartum hemorrhage (1.9%). Drug intoxication was found in 11 amphetamine addicted mothers, whereas 2 heroin addicts developed withdrawal symptoms during intrapartum and postpartum periods. All infants were singleton. There was one stillbirth and 2 neonatal deaths. There was no statistical difference in terms of sex ratio, mean birth weight, gestational age, length, head circumference and Apgar score between the groups of amphetamine and heroin exposed infants. The incidence of prematurity, low birth weight, IUGR and microcephaly were not statistically different between both groups of infants. The overall incidence was 31.7%, 31.7%, 9.5% and 8.6% respectively. Congenital anomalies were found in 5 (2.8%) amphetamine exposed infants. Thirty one out of 33 heroin exposed infants (93.9%) and 4 out of 178 amphetamine exposed infants (2.2%) developed drug withdrawal symptoms with the mean onset of 21.5 +/- 16.5 hours and 10.3 +/- 7.5 hours respectively, p0.05. All heroin withdrawal infants were successfully treated with Phenobarbital with the mean duration of treatment of 23.7 +/- 11.5 days. None of the amphetamine withdrawal infants needed specific treatment. They recovered spontaneously within 6.0 +/- 5.3 days. Eighteen infants were left in an orphanage or under the custody of their relatives.Amphetamine or heroin use during pregnancy can cause many serious adverse effects on both mothers and infants. The findings in the present study are consistent with previous reports, although they seemed to be more common and severe. Increasing awareness and improving understanding of drug abuse in the medical, legal and social aspects are needed in order to reduce these impacts.

To determine the prevalence and risk factors of anemia in pregnant women.The pregnant women were screened with complete blood count, hemoglobin electrophoresis and serology tests for hepatitis B, syphilis and HIV. In cases of anemia, serum for iron and ferritin were investigated. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first and third trimester of pregnancy or less than 10.5 g/dl in the second trimester. Factors associated with anemia were analyzed by using student's t-test and chi-square. The statistically significant factors were tested with the use of multiple logistic regression.A total of 1,304 pregnant women were recruited. The prevalence of anemia was 19.2 per cent (251 cases). Classified in each trimester, the prevalence was 14.8 per cent, 20.5 per cent and 38.6 per cent in the first, second and third trimester, respectively. One hundred and sixty-one cases of anemia were available for serum iron and ferritin levels. Iron deficiency anemia, by means of serum ferritin, was detected in 32 cases (19.9%). An abnormal pattern of hemoglobin electrophoresis was detected in 367 cases (28.1%). Gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status were associated with anemia during pregnancy.The prevalence of anemia in pregnant women who first attended the prenatal visit was 19.2 per cent. Factors associated with anemia during pregnancy were gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status.

To compare the effectiveness of single hydrogen peroxide vaginal douching and a single oral dose of metronidazole for the treatment of bacterial vaginosis.A randomized trial was performed at the outpatient clinic in King Chulalongkorn Memorial Hospital. 142 patients diagnosed as having bacterial vaginosis were randomly allocated into two groups. The subjects in the first group were douched with 20 milliliters of 3 per cent hydrogen peroxide and received an oral placebo. The subjects in the second group received oral metronidazole 2 grams orally and were douched with a placebo. The cure rate in each group was assessed using Amsel's criteria 2 weeks after treatment.The cure rate in the subjects treated with hydrogen peroxide douching was lower than the cases who received oral metronidazole (62.5% versus 78.6%, p-value = 0.036). Rate of gastrointestinal side effects in metronidazole group was higher than in the hydrogen peroxide group (48.6% versus 13.9%, p-value0.001).Single hydrogen peroxide vaginal douching was less effective than a single oral dose of metronidazole in the treatment of bacterial vaginosis.

Chlamydia trachomatis infection is the most common sexually transmitted infection. It can cause pelvic inflammatory disease and subsequently result in tubal infertility. Chlamydia trachomatis infection in pregnancy can also cause neonatal conjunctivitis and pneumonia. This descriptive study showed that Chlamydia trachomatis infection of the cervix among pregnant women, more than 37 weeks of gestation, attending the prenatal clinic at King Chulalongkorn Memorial hospital was found in 10 per cent by means of multiplex polymerase chain reaction (PCR) technique and 2 per cent by using culture method. The present study demonstrated that all the 182 newborn infants had no neonatal Chlamydia trachomatis infection by using multiplex PCR and culture method. All the babies had Apgar's score of more than 7. At 2 months follow-up, 155 infants were evaluated and had no evidence of Chlamydia trachomatis infection.

OBJECTIVE: To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used. METHODS: From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included. FINDINGS: Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice. CONCLUSION: Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings.

The pharmacokinetics of nelfinavir (NFV) in neonates younger than 4 weeks of age was assessed. Three cohorts of HIV-exposed neonates were enrolled in cohorts to receive 15, 30, and 45 mg of NFV/kg twice daily in combination with stavudine and didanosine for 4 weeks after birth. Trough NFV concentrations (C(min)) were measured at 1 and 7 days of age. Intensive pharmacokinetic evaluations were performed at 14 and 28 days of age. The median NFV C(min) values in the 15 mg/kg (6 patients), 30 mg/kg (5), and 45 mg/kg (11) cohorts at 1, 7, 14, and 28 days of age were 0.19, 1.21, 0.51, and 0.33; 1.02, 3.18, 0.73, and 0.55; and 0.67, 3.21, 0.70, and 0.73 mg/L, respectively. The median area under the plasma concentration-versus-time curve values over 12 hours in the three cohorts at 14 and 28 days of age were 14.4 and 8.7, 19.4 and 15.8, and 23.4 and 18.5 (h. mg)/L, respectively. No serious adverse events were observed. In conclusion, the systemic exposure of NFV decreased after 7 days of age, possibly because of hepatic enzyme maturation, autoinduction of NFV metabolism, and/or changes in NFV absorption. The highly variable systemic exposure observed in the study indicates that therapeutic drug monitoring seems warranted to ensure adequate NFV dosing in this population.

Objective: To examine the use of antibiotic prophylaxis in cesarean section in different countries and in relation to a reference regimen. Method: Fifty consecutive cesarean sections performed in eight centers in five countries were surveyed. Data from each center were compared to a regimen recommended by the Cochrane Collaboration (one dose of ampicillin or cefazolin administered to all women shortly before the procedure or immediately after cord clamping) using logistic regression with adjustment for procedure type. Result: Prophylaxis was used widely, but only four centers administered prophylaxis to all women. Ampicillin and cefazolin were the principal antibiotics used, but broad-spectrum agents and multidrug regimens were also used commonly. Only two centers reliably administered the antibiotic at the appropriate time. The majority of women received only one dose of antibiotic in only three centers. Conclusion: The use of antibiotic prophylaxis in cesarean section was variable and often at odds with published recommendations.