Cesarean section rate based on the robson 10-group classification at Rajavithi Hospital from 2015-2018 (2021)
Title : Cesarean section rate based on the robson 10-group classification at Rajavithi Hospital from 2015-2018
Researcher : Khornwong, S., Kovavisarach, E.,
Abstract : Objectives: To analyze cesarean section (CS) rates based on the Robson 10-group classification system (TGCS) and to examine the trends of cesarean section rates at Rajavithi Hospital (RH) between 2015 and 2018.
Materials and Methods: This cross-sectional study included all deliveries in RH between 1st January, 2015 and 31st December, 2018. The TGCS was used to categorize cesarean deliveries and all data collected.
Results: A total of 19,840 deliveries were analyzed. The annual CS rates were 35.5% (1710/4813), 36.6% (1809/4949), 35.2% (1836/5223) and 34.8% (1689/4855) in 2015, 2016, 2017 and 2018, respectively. The trend of the CS rates in each group and that of relative and absolute contributions were similar within the study period (p = 0.290). Group 1, 3 and 10 accounted for almost 70% of the study population and multiparous women with previous CS in (30.8%, 32.6%, 31.9% and 31.9%; p = 0.718), followed by group 2 (17.5%, 18%, 18.9% and 17.9%; p = 0.506) and group 1 (16.1%, 16.8%, 14.4% and 15.2%; p = 0.211), respectively.
Conclusion: The overall CS rate during the four-year period 2015-2018 varied between 34.8% and 36.6%, and the highest relative and absolute contribution to the overall CS rate at.
Keywords: Cesarean section rate The Robson 10-group classification Rajavithi Hospital
Link to Academic article: DOI: https://doi.org/10.14456/tjog.2021.23
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Bibliography : Khornwong, S., & Kovavisarach, E., (2021). Cesarean section rate based on the robson 10-group classification at Rajavithi Hospital from 2015-2018.
Correlation between transperineal and transvaginal sonography in cervical length measurement among normal thai pregnant women at 16 to 24 weeks of gestation (2018)
Title : Correlation between transperineal and transvaginal sonography in cervical length measurement among normal thai pregnant women at 16 to 24 weeks of gestation
Researcher : Kovavisarach, E., Kedthong, R.
Abstract : Background: Currently, cervical length is generally measured by transvaginal sonography (TVS) to predict preterm labor. Transperineal sonography (TPS) has been proposed as an alternative modality to TVS.
Objective: To compare cervical length measurements and pain scores of TPS and TVS in normal Thai pregnant women
Material and Method: A total of 40 normal Thai pregnant singleton women were enrolled at the antenatal clinic, Rajavithi Hospital between 1st December 2014 and 28th February 2015 at 16 to 24 weeks of gestation. Patients were excluded if they had history of and proved rupture of membranes, body mass index (BMI) >30 kg/m2, antepartum hemorrhage, or mass at perineum. The TPS and TVS techniques for cervical length measurement were performed in all cases by a single researcher (RK). Visual analog scale (VAS) score was used to assess the pain score (total = 10).
Results: Mean cervical lengths measured by TVS were slightly greater than those found using TPS (37.80 mm and 35.73 mm, respectively). The Pearson’s correlation coefficient between the two methods was 0.746, p<0.01. Mean pain scores determined by VAS score in TPS and TVS were 0.15 and 0.03, respectively (p = 0.02). The number of people whose VAS score was zero was similar with both methods (87.2% and 71.8%, respectively) (p = 0.095).
Conclusion: TPS could be used as an alternative method of TVS to assess CL in normal Thai pregnant women at 16 to 24 weeks of gestation because of its good correlation coefficient and lower pain levels.
Keywords: Cervical length, Transperineal sonography, Transvaginal sonography
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/9089
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Bibliography : Kovavisarach, E., & Kedthong, R. (2018). Correlation between transperineal and transvaginal sonography in cervical length measurement among normal thai pregnant women at 16 to 24 weeks of gestation.
Diagnostic performance of reagent strip testing for antenatal screening of asymptomatic bacteriuria using single- and double-urine culture criteria (2017)
Title : Diagnostic performance of reagent strip testing for antenatal screening of asymptomatic bacteriuria using single- and double-urine culture criteria
Researcher : Kovavisarach, E., Romyen, S., Kanjanahareutai, S.
Abstract : Objective: To determine the prevalence of asymptomatic bacteriuria (ABU) in pregnant women and diagnostic performance of reagent strip test for screening of ABU using single and double urine culture criteria.
Material and Method: Pregnant women attending their first antenatal care at Rajavithi Hospital Bangkok, between August 22 and November 4, 2011 were enrolled to collect clean-catch midstream urine for reagent strip test and culture on blood and MacConkey agar plates. The second urine culture was collected only from participants who had the first positive urine culture.
Results: Sixty-one of the 754 cases (8.1%) got the positive first urine culture. Twenty of the sixty-one cases were still positive urine culture in the second culture. Therefore, prevalence of ABU was 8.1% and 2.7% using single and double urine culture as gold standard. Escherichia was the most common pathogen in both single and double urine culture (27.9% and 40%, respectively). The urine dipstick nitrite, leukocyte, and both test by using double urine culture had a sensitivity of 35.0%, 50.0%, and 20.0%, specificity of 86.5%, 52.2%, and 93.2%, positive predictive value (PPV) of 6.6%, 2.8%, and 7.4%, and negative predictive value of 98.0%, 97.5%, and 97.7%, respectively. All diagnostic performances of double-urine culture were comparable with single-urine culture except marked worse PPV.
Conclusion: Prevalence of ABU in pregnant women was decreased from 8.1 to 2.7% using single and double culture as gold standard. Reagent strip testing is not sensitive for screening of ABU; either single or double urine culture were used as gold standard.
Keywords: Asymptomatic bacteriuria, Pregnancy, Reagent strip, Single urine culture, Double urine culture
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/7049
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Bibliography : Kovavisarach, E., Romyen, S., & Kanjanahareutai, S. (2017). Diagnostic performance of reagent strip testing for antenatal screening of asymptomatic bacteriuria using single- and double-urine culture criteria.
Maternal and neonatal outcomes of parturients with or without amniotomy for augmentation of labor (2017)
Title : Maternal and neonatal outcomes of parturients with or without amniotomy for augmentation of labor
Researcher : Thirawat, S., Kovavisarach, E.
Abstract : Objective: To determine the maternal and neonatal outcomes of the low-risk term pregnancies with or without amniotomy for augmentation of labor.
Material and Method: A retrospective cohort study of term pregnant women in cephalic presentation with labor pain who delivered in Rajavithi Hospital between January 1 and December 31, 2014 was conducted. Those parturients whose membranes were ruptured by amniotomy were study cases and those whose amniotomy were not performed and delivered immediate after the study cases were assigned as the control cases.
Results: Five hundred ninety eight women with uncomplicated pregnancy were enrolled and divided equally into two groups, one of 299 cases with amniotomy and another 299 cases without amniotomy. The present study showed that pregnant women in amniotomy group had a significantly higher rate of cesarean delivery (p<0.001) and birth asphyxia (p = 0.002). The duration of labor, maternal complications, and neonatal complications were not significantly different between the two groups.
Conclusion: Rate of cesarean delivery and birth asphyxia were significantly higher in the amniotomy group compared with the non-amniotomy group.
Keywords: Amniotomy, Duration of labor, Cesarean delivery, Neonatal outcome, Uncomplicated pregnancy
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/8451
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Bibliography : Thirawat, S., & Kovavisarach, E. (2017). Maternal and neonatal outcomes of parturients with or without amniotomy for augmentation of labor.
Nomogram of cervical length at mid-trimester in normal thai pregnant women (2018)
Title : Nomogram of cervical length at mid-trimester in normal thai pregnant women
Researcher : Kovavisarach, E., Sukontaman, W.
Abstract : Background:As cervical length decreases in the second trimester, the risk of spontaneous preterm birth increases, especially when effacement occurs early in the second trimester, and it is often detected on ultrasound examination before it can be identified by physical examination. To date, only two Thai nomograms of transvaginal cervical length have been reported.
Objective: To establish a new Thai nomogram as a reference for evaluation of transvaginal cervical length in a tertiary Thai hospital in Bangkok (Rajavithi Hospital: RH) during gestational age (GA) 16 to 24 weeks.
Material and Method: This research was approved by the ethics committee of RH (No. 055/2558). A total of 286 normal Thai pregnant women who attended the antenatal clinic (ANC) at RH between May 1, 2015 and November 30, 2015 were included. All were cases of singleton gestation with no medical or obstetric complications and no fetal congenital anomalies; and all had GA confirmed by Crown Rump Length (CRL) before GA of 14 weeks. Cervical length measurement was performed by a single operator using transvaginal ultrasonography (7.5 mHz Voluson E8) during GA of 16 to 24 weeks. The subjects attended follow-up sessions in the antenatal care clinic until delivery.
Results:One hundred and ninety-six cervical measurements were analysed (90 patients were excluded: 7 because of preterm labor, and 83 because they were lost to follow-up). The mean maternal age was 29.49+6.5 years, and the most common pregnancy status was nullipara (48.3%). The mean CL of nulliparous, multiparous and overall women were 37.87, 39.46 and 38.70 mm respectively. The CL values were constant during the examined GA.
Conclusion:The mean cervical length of normal Thai pregnant women between GA of 16 to 24 weeks examined transvaginally
was 38.70 mm.
Keywords: Cervical length (CL), Transvaginal ultrasonography
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/9091
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Bibliography : Kovavisarach, E., & Sukontaman, W. (2018). Nomogram of cervical length at mid-trimester in normal thai pregnant women.
Obstetric and Neonatal Outcomes of Excessive Weight Gain in Different Pre-Pregnancy Body Mass Index using BMI Criteria for Asians by World Health Organization Western Pacific Region (WPRO) (2020)
Title : Obstetric and Neonatal Outcomes of Excessive Weight Gain in Different Pre-Pregnancy Body Mass Index using BMI Criteria for Asians by World Health Organization Western Pacific Region (WPRO)
Researcher : Somprasit, C., Tanprasertkul, C., Nanthakomon, T., Kovavisarach, E., Rattanasiri, T.,… Saksiriwutth, P.
Abstract : Objective: To evaluate the relationship between gestational weight gain and pre-pregnancy body mass index (BMI) on the risk of adverse obstetric and neonatal outcomes using cut off BMI criteria by Regional Office for the Western Pacific Region of WHO (WPRO).
Materials and Methods: The present study was a retrospective cohort. Subjects of live birth singletons who had full term delivered at four tertiary care centers, teaching university hospitals between January and December 2012 were enrolled. All pregnant women with pre-pregnancy BMI 18.5 kg/m2 or over were recruited and categorized into two groups, normal BMI and high BMI. The level of BMI at 18.5 to 22.9 kg/m2 was defined as normal BMI, and level at or over 23 kg/m2 was defined as high BMI, respectively. Gestational weight gain (GWG) was grouped into two categories as recommended weight gain (RWG) and excessive weight gain (EWG) which defined as 11.5 to 16 kg and above 16 kg in normal pre-pregnancy BMI and 5 to 9 kg and above 9 kg in high prepregnancy BMI, respectively. The association between RWG and EWG in different pre-pregnancy BMI groups and poor adverse pregnancy outcomes were evaluated.
Results: Two thousand seven hundred and thirty-three pregnant women were recruited. Normal and high pre-pregnancy BMI women were 1,840 (67.33%) and 893 (32.67%), respectively. Of these, 2,036 cases had complete data for evaluation. In normal prepregnancy BMI, 737 (59.58%) were categorized as RWG (11.5 to 16 kg) and 500 (40.42%) as EWG (>16 kg), while in high prepregnancy BMI, 273 (34.17%) were categorized as RWG (5 to 9 kg) and 526 (65.83%) as EWG (>9 kg). The mean weight gain in the normal pre-pregnancy BMI group was 13.80+1.35 kg vs. 20.39+3.84 kg in the RWG and EWG group, respectively. While the mean weight gain in high pre-pregnancy BMI group was 7.32+1.38 kg vs. 15.24+4.46 kg in the RWG and EWG group, respectively. In multivariate logistic analysis, normal pre-pregnancy BMI group with EWG had increased risk of instrumental delivery or cesarean section (Odd ratio; with OR 1.06, 95% CI 1.03 to 1.08, p<0.001) and high pre-pregnancy BMI group with EWG, there was significant\ increased risk of preeclampsia with birth weight above 90th centile (OR 1.09, 95% CI 1.04 to 1.15 and OR 1.09, 95% CI 1.06 to 1.12 with p = 0.001 and <0.001, respectively).
Conclusion: For pregnant women with high pre-pregnancy BMI by WPRO criteria increased the risk of pregnancy complications and adverse pregnancy outcomes especially in excessive weight gain women. The high pre-pregnancy BMI should be a concern for pre-conception counseling. Optimal GWG ranges should develop based on pre-pregnancy BMI cut off for Asian women.
Keywords: Neonatal birth weight, Gestational weight gain, Pre-pregnancy BMI, WPRO
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/11079
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Bibliography : Somprasit, C., Tanprasertkul, C., Nanthakomon, T., Vinayanuvattikhun, N., Kovavisarach, E., Panichakul, P.,… Saksiriwutth, P. (2020). Obstetric and Neonatal Outcomes of Excessive Weight Gain in Different Pre-Pregnancy Body Mass Index using BMI Criteria for Asians by World Health Organization Western Pacific Region (WPRO).
Presence of sperm in pre-ejaculatory fluid of healthy males (2016)
Title : Presence of sperm in pre-ejaculatory fluid of healthy males
Researcher : Kovavisarach, E., Lorthanawanich, S., Muangsamran, P.
Abstract : Background: Coitus interruptus, a common contraceptive method, has a high failure rate. Two reasons have been proposed for this: delayed withdrawal after ejaculation and presence of sperm in the pre-ejaculatory fluid.
Objective: To determine whether sperm was present in the pre-ejaculatory fluid of healthy males.
Material and Method: A total of 42 healthy Thai men were enrolled in the study between August 1, 2009 and November 30, 2009 at the Department of Obstetrics and Gynecology, Rajavithi Hospital. They were asked to collect pre-ejaculatory fluid smears in two glass slides and then deposit a semen sample in a plastic bottle after masturbation. Microscopic examination of wet and air-dried preparations and routine semen analyses were done consecutively in the human genetics laboratory.
Results: Actively mobile sperm were found in 16.7% (7/42 cases) of the pre-ejaculatory penile secretions of subjects whose sperm counts were 2 in 2 cases, 3 in 3 cases and 4 per high power field in the other 2 cases of positive sperm. Semen analyses were normal in 41/42 volunteers (97.6%); there was one case of oligospermia (14×106/ml).
Conclusion: Actively mobile sperm were discovered in the pre-ejaculatory fluid of 16.7% of healthy men.
Keywords: Coitus interruptus, Sperm, Pre-ejaculatory fluid, Thai male
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/7010
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Bibliography : Kovavisarach, E., Lorthanawanich, S., & Muangsamran, P. (2016).Presence of sperm in pre-ejaculatory fluid of healthy males.
Prevalence of amniotic fluid sludge in low-risk pregnant women of preterm delivery (2019)
Title : Prevalence of amniotic fluid sludge in low-risk pregnant women of preterm delivery
Researcher : Kovavisarach, E., Jongfuangprinya, K.
Abstract : Background: Amniotic fluid sludge (AFS) has been demonstrated in cases of intrauterine infection, one of the causes of preterm labor. Therefore, AFS is used as a predictor of preterm labor.
Objective: To determine prevalence of AFS in low-risk pregnant women and diagnostic performance of AFS for screening of preterm delivery in low-risk cases of preterm delivery.
Materials and Methods: Prospective descriptive study was conducted in low-risk pregnant women of preterm delivery who attended the antenatal care clinic in Rajavithi Hospital at gestational age (GA) 16 to 24 weeks between May 1, 2016 and October 31, 2017. All subjects were examined by transvaginal ultrasound to demonstrate AFS and then followed until delivery.
Results: Prevalence of AFS in all cases was 72/330 cases (21.8%). Premature delivery occurred in AFS positive and AFS negative were 3/72 (4.2%) and 22/258 (8.5%), respectively. Baseline characteristics were similar except mean BMI, and type of contraception. Mean GA at delivery was the only significant different obstetrical outcome. Diagnostic performances of AFS for screening low risk pregnant women for spontaneous preterm delivery less than 37 weeks of gestation had sensitivity of 12.0%, specificity of 77.4%, accuracy of 77.4%, positive predictive value of 4.2% and negative predictive value of 91.5%.
Conclusion: Prevalence of AFS in low-risk pregnant women of preterm delivery was 21.8%. AFS is not sensitive for screening of preterm delivery in low-risk cases.
Keywords: Amniotic fluid sludge, Preterm labor, Pregnancy
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/10453
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Bibliography : Kovavisarach, E., & Jongfuangprinya, K. (2019). Prevalence of amniotic fluid sludge in low-risk pregnant women of preterm delivery.
Self-preferred route of delivery of Thai obstetricians and gynecologists (2016)
Title : Self-preferred route of delivery of Thai obstetricians and gynecologists
Researcher : Kovavisarach, E., Ruttanapan, K.
Abstract : Background: The attitude of Obstetricians and Gynecologists (OB-GYNs) towards performing cesarean delivery on maternal request (CDMR) together with their preferred route of delivery for themselves or their wives is considered as important responsible factors of increasing cesarean delivery.
Objective: To assess the attitudes of Thai Obstetricians and Gynecologists with regard to their self-preferred route of delivery, willingness to perform cesarean delivery on maternal request, and associated factors.
Material and Method: From July1, 2013 to September 30, 2013, a cross-sectional study was carried out of 1,950 members of The Royal Thai College of Obstetricians and Gynaecologists who were randomized before being sent mailed questionnaires. The questionnaires requested details of the OB-GYNs’ demographic data and asked about their self-preferred route of delivery for themselves or their wives (in the case of male doctors) and their willingness to perform cesarean delivery on maternal request (CDMR). The questionnaires were returned via mail.
Results: Three hundred and seventy OB-GYNs (18.9%) completed and returned the questionnaires via mail. In a scenario of uncomplicated singleton cephalic presentation pregnancy at term, vaginal delivery was chosen as the most preferred route of delivery (68.9%). The significant associated factors for preferred cesarean delivery were male, age <40 years, experience in practice as OB-GYN <10 years and prior cesarean delivery. Many (53.2%) were willing to perform cesarean delivery on maternal request.
Conclusion: Most Thai Obstetricians and Gynecologists (68.9%) preferred vaginal delivery for themselves or their wives, but many (53.2%) were willing to perform cesarean delivery on maternal request.
Keywords: Cesarean delivery, Vaginal delivery, Preferred route of delivery, Thai Obstetricians and Gynecologists
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/7017
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Bibliography : Kovavisarach, E., & Ruttanapan, K. (2016). Self-preferred route of delivery of Thai obstetricians and gynecologists.
The effectiveness of the modified mueller–hillis maneuver in predicting successful vaginal delivery in late active phase of first stage of labor (2019)
Title : The effectiveness of the modified mueller–hillis maneuver in predicting successful vaginal delivery in late active phase of first stage of labor
Researcher : Kovavisarach, E., Jongfuangprinya, K.
Abstract : Background: Cephalopelvic disproportion is one of the most common indications for cesarean section. Abnormal labor patterns have been used to identify this condition for many years, but early diagnosis is sometimes quite difficult.
Objective: To determine the accuracy of the modified Mueller-Hillis maneuver in predicting successful vaginal delivery in the late active phase of the first stage of labor.
Materials and Methods: From July 1st 2009 to August 31st 2010, a diagnostic test was performed of pregnant women admitted to the Labor Room in Rajavithi Hospital who met the following inclusion criteria: singleton pregnancy; labor pain, vertex presentation, and gestational age between 37 and 42 weeks. The exclusion criteria were medical or obstetric complications, or induction of labor with uterotonic agent. The modified Mueller-Hillis maneuver was performed by a single operator applying fundal pressure and assessing the descent of the fetal head in the late active phase of the first stage of labor (cervical dilatation >8 cm). Descent of the fetal head of 1 cm or more was interpreted as a positive result, and successful vaginal delivery was defined as spontaneous vaginal delivery without instrumentation.
Results: Two hundred and twenty-six women were enrolled, 214 of whom had positive results, with 212 successful vaginal deliveries, one case of delivery by forceps extraction, and another of cesarean delivery. Of the 12 cases with negative results, 4 had successful vaginal delivery while the others were delivered by cesarean section. The sensitivity, specificity, accuracy, positive and negative predictive values of the positive test were 98.2%, 88.9%, 97.8%, 99.5%, and 66.7%, respectively.
Conclusion: The modified Mueller-Hillis technique performed in the late active phase of the first stage of labor yielded excellent results in terms of diagnostic parameters such as sensitivity, specificity, accuracy and positive predictive values, but the negative predictive values were only fair.
Keywords: Modified Mueller-Hillis maneuver, Vaginal delivery, First stage of labor
Link to Academic article: http://www.jmatonline.com/index.php/jmat/article/view/10454
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Bibliography : Kovavisarach, E., & Jongfuangprinya, K. (2019). The effectiveness of the modified mueller–hillis maneuver in predicting successful vaginal delivery in late active phase of first stage of labor.