Showing papers by "Pisake Lumbiganon published in 2007"
TL;DR: Midline compared to medio-lateral episiotomy resulted in more deep perineal tears, more likely in cases with additional risk factors, and women's satisfaction with the method.
Abstract: Episiotomy is the surgical enlargement of the vaginal orifice by an incision of the perineum during the second stage of labor or just before delivery of the baby. During the 1970s, it was common to perform an episiotomy for almost all women having their first delivery, ostensibly for prevention of severe perineum tears and easier subsequent repair. However, there are no data available to indicate if an episiotomy should be midline or medio-lateral. We compared midline versus medio-lateral episiotomy for complication such as extended perineal tears, pain scores, wound infection rates and other complications. We conducted a prospective cohort including 1,302 women, who gave birth vaginally between April 2005 and February 2006 at Srinagarind Hospital – a tertiary care center in Northeast Thailand. All women included had low risk pregnancies and delivered at term. The outcome measures included deep perineal tears (including perineal tears with anal sphincter and/or rectum tears), other complications, and women's satisfaction at 48 hours and 6-weeks postpartum. In women with midline episiotomy, deep perineal tears occurred in 14.8%, which is statistically significantly higher compared to 7% in women who underwent a medio-lateral episiotomy (p-value 3,500 g and forceps extraction. Midline compared to medio-lateral episiotomy resulted in more deep perineal tears. It is more likely deep perineal tears would occur in cases with additional risk factors.
42 citations
TL;DR: The SEA-ORCHID project was intended to improve care during pregnancy and the perinatal period of mothers and their babies in South East Asia by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research.
Abstract: Background
Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?
33 citations
TL;DR: Despite compelling evidence, magnesium sulfate use is below desired levels and clinical practices should be audited and implementation of this effective intervention should be taken up as a priority where universal implementation is not in place.
Abstract: Objective In the past ten years effective treatments for pre-eclampsia and eclampsia have been evaluated and identified following large trials and systematic reviews. We investigated the extent of those effective interventions’ implementation. Methods Descriptive analysis of data collected as part of a cluster randomized trial. The trial was assigned the International Standardised Randomized Controlled Trial Number ISRCTN 14055385. Hospitals with more than 1000 deliveries per year not directly associated with an academic institution in Mexico City municipal area in Mexico (n = 22) and the north-east region of Thailand (n = 18) were included. All women delivering at the participating hospitals at two time periods in 2000 and 2002 contributed data on practice rates. The use of magnesium sulfate for pre-eclampsia and eclampsia were the outcomes. Findings Eight out of 22 hospitals in Mexico (range 0.8% to 8.5%) and all 18 hospitals in Thailand (range 18.6% to 63.6%) used magnesium sulfate for women with pre-eclampsia. In Mexico, 11 of 22 hospitals used magnesium sulfate for eclampsia (range 9.1% to 60.0%). In Thailand, all 17 hospitals having eclampsia cases used magnesium sulfate (range 25% to 100%). Conclusion Despite compelling evidence, magnesium sulfate use is below desired levels. Clinical practices should be audited and implementation of this effective intervention should be taken up as a priority where universal implementation is not in place.
29 citations
TL;DR: This study failed to demonstrate lasting or substantial changes in reproductive medical practices within a 10- to 12-month time frame, because access to current knowledge of such practices apparently does not assure that they will become part of standard obstetrical care.
Abstract: The hypothesis underlying this study was that hospital obstetrical practices can be improved by interactive workshops that promote the use of evidence-based measures based on the World Health Organization's Reproductive Health Library (RHL). The RHL is an annually updated electronic publication featuring Cochrane reviews in the area of reproductive health along with expert commentary, practical guidance documents, and various aids such as educational videos. Participating in the trial were 22 hospitals in Mexico City and 18 in northeast Thailand, whose maternity units conducted more than a thousand deliveries each year, and which had no direct affiliation with a university or other academic or research facility. Three workshops were held during a 6-month period: the first provided information about the project and principles of evidence-based decision-making; the second focused on RHL content; and the third concerned how best to implement desired changes. A stratified cluster randomized design took country, type of hospital, and number of births per year into account. The chief outcome measures were changes in 10 clinical practices as recommended in the RHL, implemented within 4 to 6 months after the third workshop. The intervention failed to influence targeted practices in any consistent or substantive way. Three of the 10 practices (iron/folate supplementation, postnatal uterotonic use, breast feeding on demand) already were part of the practice regimen, and it proved impractical to measure external cephalic version. Selective rather than routine episiotomy was performed more often in the intervention hospitals than in control hospitals. In Mexico, antibiotics tended to be used more at the time of cesarean delivery. No significant differences were documented in companionship during labor, the use of magnesium sulfate to treat eclampsia, corticosteroid treatment of women delivering before 34 weeks' gestation, or the use of vacuum extraction. Awareness of the RHL increased substantially following the intervention at both study sites, as did its use. Despite the efficacy of active educational measures in expanding access to the RHL and promoting its use, this study failed to demonstrate lasting or substantial changes in reproductive medical practices. Within a 10- to 12-month time frame, at least, access to current knowledge of such practices apparently does not assure that they will become part of standard obstetrical care.
6 citations
Journal Article•
TL;DR: The manuscript requirement policy can maintain the research publication rate, and the number of publications in which residents were not the first authors increased after initiation of the publication promotion policy.
Abstract: The objective was to evaluate the impact of the manuscript requirement policy on research publications from the Royal Thai College of Obstetricians and Gynecologists (RTCOG) residency training program. Names and research titles of RTCOG residents from 1994 to 2003 were used to search for publications in the Medline system and Thai Index Medicus. There were 759 residents with 188 (24.8%) articles published. The publications per year varied from 4.8% to 17.0%. Residents were the first authors of 75 articles (39.9%). One hundred and thirteen articles (60.11%) were published in local medical journals. The majority of articles published in international journals (65.3%) were published in the Journal of the Medical Association of Thailand. After initiation of the publication promotion policy in 1999 the number of publications in which residents were not the first authors increased from 39.8% to 60.2%. The manuscript requirement policy can maintain the research publication rate. (authors)
4 citations
Journal Article•
TL;DR: Implementing magnesium sulfate for the prevention and treatment of eclampsia in low- and middle-income countries could potentially benefit hundreds of thousands of women.
Abstract: Introduction Pre-eclampsia is a multiple organ disorder of unknown etiology usually associated with raised blood pressure and proteinurja eclampsia, the occurrence of one or more convulsions (fits), is a rare but serious complication in patients with pre-eclampsia Pre-eclampsia/eclampsia remains one of the leading problems that threaten safe motherhood, particularly in developing countries It was estimated that hypertension complicates approximately 5% of all pregnancies and 11% of all first pregnancies (1) Based on these estimations and case fatality rates, up to 40 000 women could die from preeclampsia and eclampsia each year (1) In a systematic review involving six trials (11 444 women) magnesium sulfate significantly reduced the risk of eclampsia (relative risk, RR 041; 95% confidence interval, CI: 029-058) and the risk of maternal death (RR 054; 95% CI: 026-110) among patients with pre-eclampsia although the latter was not statistically significant (2,3) Magnesium sulfate was more effective than phenytoin for reducing the risk of eclampsia among patients with pre-eclampsia (two trials, 2241 women; RR 005; 95% CI: 000-084) (2) Magnesium sulfate appears to be substantially more effective than phenytoin (six trials, 897 women) (4) or diazepam (seven trials, 1441 women) (5) for the treatment of eclampsia Magnesium sulfate is therefore the anticonvulsant of choice for both prevention and treatment of eclampsia (1) Implementing magnesium sulfate for the prevention and treatment of eclampsia in low- and middle-income countries could potentially benefit hundreds of thousands of women (6) This study aims to evaluate the use of magnesium sulfate for women with pre-eclampsia and eclampsia in Mexico and Thailand, where a duster randomized trial to evaluate an educational strategy to change obstetric practices was conducted The study methodology was published in detail elsewhere (7) The main results related to the effects of the intervention was published separately (8) Methods The study was conducted in two countries: the Mexico City municipal area, Mexico, and the north-east region of Thailand Maternity units of hospitals with > 1000 deliveries/year that were not associated directly with a university or other academic/research department were eligible to participate In Mexico, all state and social security hospitals in the Mexico City municipal area were approached Twenty-two out of 34 hospitals approached were eligible and agreed to participate in the trial In Thailand, 18 hospitals out of 19 in the north-east region agreed to participate There were therefore 40 hospitals in this study The objective of the main trial was to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations contained in the WHO Reproductive Health Library (RHL) (9) [FIGURE 1 OMITTED] A multifaceted intervention addressing potential barriers to evidencebased practice was conducted over a period of six months following baseline data collection on clinical practices Three interactive workshops focusing on principles of evidence-based medicine, the RHL and how to implement change formed the core intervention The use of magnesium sulfate and other effective practices were not specifically addressed during the workshops The data on the occurrences of preeclampsia and eclampsia and the use of anticonvulsants were collected as part of measuring the rate of evidence-based practices in the main trial The data were collected at baseline (September 2000) and 10 to 12 months after implementation of the intervention (September 2002) We collected data from 1000 women or for six months, whichever was reached first in each unit Field workers not involved in the implementation of the trial collected the data The data collection forms were completed in the posmatal wards mostly from hospital records …
1 citations
TL;DR: In this paper, the use of magnesium sulfate for women with pre-eclampsia was evaluated in two countries: Mexico and Thailand, where a duster randomized trial to evaluate an educational strategy to change obstetric practices was conducted.
Abstract: Introduction Pre-eclampsia is a multiple organ disorder of unknown etiology usually associated with raised blood pressure and proteinurja. eclampsia, the occurrence of one or more convulsions (fits), is a rare but serious complication in patients with pre-eclampsia. Pre-eclampsia/eclampsia remains one of the leading problems that threaten safe motherhood, particularly in developing countries. It was estimated that hypertension complicates approximately 5% of all pregnancies and 11% of all first pregnancies. (1) Based on these estimations and case fatality rates, up to 40 000 women could die from preeclampsia and eclampsia each year. (1) In a systematic review involving six trials (11 444 women) magnesium sulfate significantly reduced the risk of eclampsia (relative risk, RR 0.41; 95% confidence interval, CI: 0.29-0.58) and the risk of maternal death (RR 0.54; 95% CI: 0.26-1.10) among patients with pre-eclampsia although the latter was not statistically significant. (2,3) Magnesium sulfate was more effective than phenytoin for reducing the risk of eclampsia among patients with pre-eclampsia (two trials, 2241 women; RR 0.05; 95% CI: 0.00-0.84). (2) Magnesium sulfate appears to be substantially more effective than phenytoin (six trials, 897 women) (4) or diazepam (seven trials, 1441 women) (5) for the treatment of eclampsia. Magnesium sulfate is therefore the anticonvulsant of choice for both prevention and treatment of eclampsia. (1) Implementing magnesium sulfate for the prevention and treatment of eclampsia in low- and middle-income countries could potentially benefit hundreds of thousands of women. (6) This study aims to evaluate the use of magnesium sulfate for women with pre-eclampsia and eclampsia in Mexico and Thailand, where a duster randomized trial to evaluate an educational strategy to change obstetric practices was conducted. The study methodology was published in detail elsewhere. (7) The main results related to the effects of the intervention was published separately. (8) Methods The study was conducted in two countries: the Mexico City municipal area, Mexico, and the north-east region of Thailand. Maternity units of hospitals with > 1000 deliveries/year that were not associated directly with a university or other academic/research department were eligible to participate. In Mexico, all state and social security hospitals in the Mexico City municipal area were approached. Twenty-two out of 34 hospitals approached were eligible and agreed to participate in the trial. In Thailand, 18 hospitals out of 19 in the north-east region agreed to participate. There were therefore 40 hospitals in this study. The objective of the main trial was to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations contained in the WHO Reproductive Health Library (RHL). (9) [FIGURE 1 OMITTED] A multifaceted intervention addressing potential barriers to evidencebased practice was conducted over a period of six months following baseline data collection on clinical practices. Three interactive workshops focusing on principles of evidence-based medicine, the RHL and how to implement change formed the core intervention. The use of magnesium sulfate and other effective practices were not specifically addressed during the workshops. The data on the occurrences of preeclampsia and eclampsia and the use of anticonvulsants were collected as part of measuring the rate of evidence-based practices in the main trial. The data were collected at baseline (September 2000) and 10 to 12 months after implementation of the intervention (September 2002). We collected data from 1000 women or for six months, whichever was reached first in each unit. Field workers not involved in the implementation of the trial collected the data. The data collection forms were completed in the posmatal wards mostly from hospital records. …
1 citations