1. No category

--
t
c
al
9
f_-.
g6ldn6naun
?'16
6il16
6nU1
$t{1t
[61lfl
ffi
il'lailsi
tln
flusnla
rn6[1
tl
The Journal of PrapokklaoHospital Clinical Medical EducationCenter
JPMCvort2No.1 Jan.- Mar.t99S
<1i
uA
d
ltil 12il1tililI il.n. - il.n. 2538
lssN0857-0914
3 nrtcisro6un$rdsuandesuiluri
tl
1l?lltlilsas1nre
e nlanlsilasuranGritfioluTaurslulo
adrgil*rnn
VSCefoxitin
:
C Salbactam/Ampicillin
arrJfrfiru*dorJouriulunr
aoirdqnnan
jb
yt1nltulilau
e
n$AnmrGgusfisil$toso$flrodsnmrf
urmriilrimohnnf 6dfiudrnnard
5
PartialHydatidiform
Mole
{SCtafq#
For severeinfections,
Furthor information available on reouesl
HNB|
Thoi Ltd_ pho.mwaiet
&Dt.
302 Silon Rd. Bonskil 105mTeL2g-2qr
Hoechstts
StopsAnginaPectorisin 1-2minutes.
lso MackSpray
(isosorbidedinitratein an oral spray)
rapid andreliableaction
goodstability
* * **** * t # ##* * ** * +* t * * * * * * * r**** *
withB.l.D.dosage
Prevents
AnginaPectoris
lso MackRetard20 mg.
lso MackRetard40 mg.
(isosorbidedinitratein a sustainedreleasecapsule)
- convenient
B.l.D.dosage
- no peakplasmaconcentration
* * * * * #* # r#* # *+* #** *+ tt#* tt+*# #* *
Furtherinformation
available
on request
F.E.Zuellig(Bangkok)
Co.,Ltd.
10500
SilomRoad Bangrak Bangkok
Tel.2330110-29
En. 5312
Fax: 2331651
, 2383342
xrld^ududnmdntrl uilil sft'taflfn frfrn
Tmlrs'nf'railrsilnrnffr(r ?t il n)
/-$
u:rrurGnrrfiilinryr$reuililEiil:cfin
a
InuilF{'l$n
ilttil16n'|l
urerunmdRrugra 4il?qn
ta{ilt?6u16n'tt
nrauyinrifi'urrn
nilvuttot1finl5
runvrdnr!onnra nrdnrfiu
urauilYl6il:cn1y{
qTtD?qil5
uraunntiil:sn':6
6:fiolnnrn
unndnfuo::ar
dnn?59?fFt
uleruytylBy{:flno
x}[r{?zu1.[1qn
uraunnda-n:d'a
afn6"[aer
urerttnfldirsn
uruf,€n'rdniu{
uraunyr66rr6
l6
uvrvrdn{ritfi
?'r$uqn
uraunndnuo
c
-S
I
aufiir,:d
-g
eo
/
tflt*FtuEJ?zu14
il:ca1umfig
uraunndrflarzrrp iiasdilns
urauuyrdd:cJi'aR:Inurnr:
urauuvreirjid
r,d1r11ilY{qn|1:1$l
ursuiln6ids
giniiunnn
unvrdnr!,rfi:nr
urnnfiiur:n
t
unvreirnr!,rnT
:fi
qrr{uri
r*rauvrvrdiria
U::0'ln1:
unvrdra{rqt:
{l,rxflfl
c
-,J-
uraunmeiil:snrn i:nn
rry{7tt
}1tu{unilaFl
runvrdn{,rr:r1t
Inarnr:
vriununvrdnr!,:qfiumo,:rirrunr
uraunmeiaf,n
6n16onu
rn#unrrnr!rqafl?1ytfifini'nrunn
I
rnf,an:nfodrru'r
Ruofnri
-g
rnf,zn:nr!rREnrnTE?A?dn
ur,:ArrtineJr
g.r.lfinrnrr{u5
ur'rruf,ufig
orSvr'rd
a-
o
3
I
Eur,rfi
flffonTr
il1AUililAUeJdYlfi
firp&givrar4n
{rhafli'onT:
1.$1f
fll?At?:tru
f,nrriuvnod
urrflrtfluil:r:nu't
qr::rulufi
1.[1ffl1']0:611
nuTrufra
urrfi:z:
rRnnaror:
fiarlnr:l
u1eJt6{ndil
qruf,:ua
drrTn{ru
al'r
eiarnrt l:rnsrurnil:siln rnfir d'unq6
o.rfior 0.6'uvrqizzooo
Ivr:.(ogs) sz4s7a-84
na zsa In:nr: 311s11
nlffunaan
flnc + afu
v
lo'tilarl
I:,:narurnn:cilnrnf,r
nunqi
The Journal of Prapokklao Hospital
Clinical Medical Education Center (ffnnC)
Editor Consultant
Prakit
Kasemsarn
Editor
Somchai
Poonawagul
Associate Editor
Ghatchawan Sompeewong
Editorial Board
Saluey
Phongpanich
Prapap
Yuthavisuthi
Prasong
Teerakidpisan
Chanya
Sathitwiriyawong
Pornsak
Nimvattanakul
Chatchai
Sawasdichai
Vithayut
Namsiripongpun
Jitti
Kositchaiwat
Rajanee
Vivatkul
Thanong
Prasanphanich
Cheocharn
Viliyaluppa
Prapassom
Kosakhan
Predee
Ngaotepprutaram
Wichai
Chucheapchuankame
Peerada
Nawakulsirinart
Daranee
Suwapun
Winai
bunchongkarn
Urai
Poonawakul
Prapas
Weerapol
Phuamchit
Chinwong
Yupin
Tongkumplala
Sudsavad
Likitwattanakul
Voranuch
Chalit
Manager
"Kosakhan
Chitcheuchun
Samnao
Sindhurat
Sirimada
Suksawasdi
Nittaya
Khantilaphan
Pleonpit
Jarupong
Chaiyasit
Bhinyovithayakul
Leelanuntawong
Sompartana Suwanachut
Orasa
Kasanotai
Nirachorn
Art
Segsom
Boonsirichai
Office address
TechnicalDepartmentof PrapokklaoHospital
Assistnnt Managers Orawan
Amphur Muang Chantaburi22000
Publication
Quartery
Owner
PrapokklaoHospital
Aungkasuwat
?'ri 6l"t
to(uudnrtd nr'r u?r?rgfl'taflfn frfrn
tt.rn sril'rautv il nrnfi't
The Journal of Prapokklao Hospital Clinical Medical Education Center
df4
In
v
A
A
12 flult?r l il.n. - il.n. 2538
arstiry
Vol. 12 No. I Jan. - Mar. 1995
uta'l
Gontents
Page
uttrurEn-rrunas
t
uilu€rtrr'rEnrr
MESSAGE FROM THE
EOITOR
EDITORIAL
rAX
guruttri
nr:fl{ rfl:ilnr:rn gr andr
(u
Breast Feeding Promotion,
uflurnro{1n:?
Whose Role?
6^
da?a ytJvw'tur w.u.
Saluey Phongpanich M,D.
A
GV
V
uutr Sm%suu
n-r:sn
ul,o{yrr
:nrJBrir
rfioluI:wsrura
ORIGINAL ARTICTE
The Perinatal Mortality at
qa
otn il:ytllfl
Aranyaprathet Hospital
?nJnwonfrq1?yqaw.u.
Sompop
Salbactam/Ampicillin VS Cefoxitin :
11
urrJfi
firuvrfioflorf,ulunr:r.irdonaosr
ly
lthiarwachkul M.D.
Salbactam/Ampicillin versus Cefoxitin
as Prophylactic Antibiotic for Cesarean
ly
lllit?fl{11toil
Section
ilwntw qnriqnfr w.u.
Prapap Yuthavisuthi M.D.
nr:f;nurnjisurilsrilflor u{nr:#uor:rf
20
I
lurur:qrr
iiulrirur
r.lrnn
::iffi'uhnn::ri
non-registered
andRegistered
Obstetrics
Mothers
Au!uu€
lJ1ttluutyuuun w.u.
Chirachai Nimchaiyanan M.D.
q.tuu'rtrr{rJeu
Partial Hydatidiform
Comparative Pregnancy Outcome in
28
Mole :
CASE REPORT
Partial Hydatidiform Mole:A CaseReport
:rusru{r1au1 :ru
tuf,ndwryyz,trtw.u.
Somsak Hanchoowong
M.D.
?t6rtn?nudrnr filnrru t*ilsdr asr{nfrfi n
lmns..ril'lailrvrlnrnfir
The Journal of Prapolklao
Hospital Clinical Medical Education Center
ilC u srTtCr r.n. - iLn.zsga
arsd
VoL 12 No. 1 Jan. - Mer. 1995
urir
Gontents
Fage
uun?'relfir"au"
33
REVIEW ARTICLE
Management of Menopausal V[omen
wrut ailni?attfr n.u.
-A'-
Chanya Sathitwiriyawong
RR|rlrurHrr'|
ilftd'rfrirfiolnma fi.u.
cl-fillc ourz
rJfinrrw
rirnr$tnlrri
MlacELIAilV
rhnrli?nlnrf
dtuts utd n.v.
Umnaj Balee M.D,
u1rr'|3
INTERESTIITIGDRU6S
Hormone Replacement Therapy
e
-X
M.D.
Prasong Teerakidpisan M.D.
Hormone Replacement Therapy
?ftan1 tvtndn n.u.
Sirimada Suksawasdi B.Sc. in Pha
doarrnrr
ABSTRAGT OF JOURNAL
OUARTEBLY STATISTICAL
REFOET
r1{DtcATtoN
0ex0ph
EYE For the treaiment of Acute or Chronic non
pu,ulent coniunctivitis, btepharoconiunclivilis
and keratoconiunltivitis:
Eye-Ear
non specitic superticial ke.atitis
Oeep keratitis
Acne rosacea keratitis
Drops
coMPosllroN:
lridocyclitis
ilitd acute i(itis
OeramsthasoneO.1%
Phosphate
(As oexamelhaSone
non purulent blepharitis; scleritis; episcleritis:
sc leroconiu ncl ivitis :
ophthalmic!s-
Sodium PhosphateI
Neomycin Sultate O.5 %
(Equivalent to
Neomycin Base O.35 % )
0ph
Chfor
I
riltill
Chloramphenicol
n
W
Chloroph
for
5 mg.
irtt
dacryocystitis
oi.
;
ffi h
th*r-0ri
.. akun
O.25 % & O.5O%
Antazoline HCI
is an anlihislamineusetul tor
ocsla. allergies.
Tetrahydrozolile HCI
is a sympathomimetic.agentwhich
posses vasoconstricled aclion,
uselul lor ophthalmic decongoslion
in coniunctivitis.
Eye Orops is used
coniunctival
intections
and blepharitis,
ct&ei
keratitis,
which caused
by susceptible
organism,
corneal qlcers, Irachoma
traumatism
ot the eyes.
naoln- oouj
?-
Poly-Elph
?J'1,t4?looton
Gl a u co -Op h
Eye Drops
Ounuarrt]tailn!f0
lriiirioFrviooijar
ilr:ne irufilr
TimororM6rearetuinruuru
e maFo o.zs s: o.so rUniriqd aoo ri.o'o,
fug[!
liuranm riaaamuiui6uaralq
entr lltaiaiu)
to-t!
liruaamboliasrnnn!sr!
o 25 [.Jriliud
aiua: r ron ira: z a:'u rhlamlror'lilliuri
iosnrr }inl6oiljaranrrrg:t
o.so dairitad
luuornnJta:
r nur is: 2 ii! siomuir
1lgnnrlianaumlu**ritnF
ciirfi arl:anrau
Iault raoa m r-m: a{ullli
E
TF
lElr
-
Anlazoline HCI
O.O5%
Tetrahydrczoline HCI O.O4%
Benzalkonium Chtoride O.OiS %
Hydroxypropylmethylcellulose
Indication:
H
-
coMPostTroN
Each ml contains:
m
-
!!jqH-0ptt
Eye Drops
lilililflliltl
Timolol
E]!]B For lhe ireatment of External otitis, Catarrhal
olitis. Furuncular otitis.
Ear
I
r
Eye Orop6
m
ffi
O@.
p6s
.ctiyit$
mic@geih
rt.fr,
g slttat
b.d
m
uhh
bcti.G
ot .nlib*iic.;
Potysyrin
wtich
a*bdd
ia .
&l{tl[
sdttr,
Gm*rilln,
f,tiw
, e
Struh
an!.
[m!a
4&d
ar.Sl{ham
ilet$a.
hrlicdbn
Fot.Oph
Dr@.
EF
ir{actin,
sd
bbphartti.,
c.ued
by
i.
ed
L?dilia,
luacrptibb
b
coniumtrv.l
d-rFrjitit
Waniah,
sEaE,
O6na:
2-3
to llt!
dop.
timaa
hto
th.
coquctmt
.e(a)
bi
I dry
RhinoHist
Er
head E held with the 9a. !p to
several minules. Regeat applicaiion
lwo to thrce trmes a day-
Eya
aq@a
hsFin
cddd
Drops
Each 1OOGm. contains:
2OOm9.
Nitioturazone
Nifuroxime
375 mg.
2 Gm.
Lidocaine HCI
q.s. lOO Gm.
PEG
INOICATION
For the trealment ot Bacterial
Olilis extorna. Otitis media,
Pains in ihe Meatus.
AND DOSAG€
AOMINISTRATION
Cteanse and dry the meatus.Instil
tour d.oos in the meatus while
Foly-Oph
idft
tablets
Carbinoxaoina
talcato
rs a potant tntihistamanc
with a low incidaac€
rs a 3yopathomihctic
amina, ha3 ,i
acuon
3imilar to Ephed/rnc. srch .3 tha nasopharrngaal
ya3ocoi6tlcto.
and bronciodrtator
rclaoni.bst
relalrvelt
waater
,n rts pr!s304 ca.dtrc.
fiydraatic and cis
3timutlnl
actionr.
Congestion
RhinOffhea
A l l e t q-i c
Hay
rhinitis
tever
Each trbrer conrarn3:
P3.sdo.phedrise Htdrochtorid. - ,- _ 60 m9
c . , b r n o r a m r n c M a r c . r . . _ _ _ . _ - . _ _. _ _ - o - e
Oos.o. Ch,rdren ] tabrct3-lt,-cs roey.
adu[s.
r r a b r c r 3 - a r r m e sa d . y .
Esnta-0ph
n
$
coiFo$rTfor{:
G+ntrmbin $uli.te oqrtuetent to
o.3 s
Gcntd|ricin
lndication: For thE treatmsnt ol
intactione,causod by suscsptlbl€
microofganism,ot the €xlotnaleyo
and edng a, whirh caus€dconlunativitis, blapharitris,dacryosy8litis,
keralitls, trachoma.
Dosage:l€tl{l 1'2drops into 6ye($)
6yery{ hour8, ln E€vereintectlons,
dosagemay be ircreaagdto 2 d.opo
evsry nour.
Ointment
Eaci Gm, conlains:
Chloramphonicol1Omg. (1olo)
INOICATIOH:Chlo|oph Eye Ointfllonl i$ u3d foJ coftjufiSliv€ tnl6€.
tlons and blepharitis, K€ratitls
which ceuded by eusceptible
organisnr,comgal stcefs, tfachome,
traumatismqf lhb eyes.
DOSAGE:Apply to tho eys(s)34
timos a day, ard beforo b€d,
Eye Drop
Eya-Ear Drop
cotrPosrTtor{:
COMPO$ITION:
4.O%
S{lfamethitol
INDICATION$:Eye Acule and
Chronic int€cllon ol the sye8.
EarInl€ction ot the 6ar,otitB rn€dlaDOSAGE:Eyalnstill 1-2drops ir}lo
tie coniunctlvalsac (s) 4S timoE
a oay.
Ear lnsfil, 2.1 drops inlo lrlo ths
auditory canal /tO timcs a day.
P1rdni6donr Acetato
1%
INDfCATIOH: For treatment of
acuts or chronic non-inlecledcon.
iunciivili$.
DO$AGE:Shaketh6 boltls w6ll ehd
ihslilt 1.2 drops topicalty lnto the
coniuncliv4leac{s)4€ time6a day.
Eye-Esr DroF
coM:
fw@Fh4ndlqdih
elrrffiBffirffiMdi
€ffi$thb.qlidrt
b Gdetin
s6q
' &d
eMbbl
r€!6
' td
ryN
r.|ffilmdldlh
I
I
-
kbdftbnbM
ffillt@in.{r&q.d
ElEFotuhhdo,
6i6M['
ffir
'@n
10 ht.
os%l
.qS
!3%
kr$G
kitli
Uot$tisl
*bilir,
.pi*&tir;
mr5iiim
ah.ldfta&rtu
5AEtutuh|ffiot
@& Fnrub
'-J
dilla
rdody
In rh Gonlrncrid
99q&E BE 12 @r
.Ets)tubdr
rtua8.
E![ 24 d@. rtr S.
A@rbry 6d
fu lo * rlM . @.
I
I
\
tl
tl
bJ
i-i
I
I
t
ffiil
tn&;t
Ear
l|ropr
@ilP0$rfoH:
Chlorrmpft.r{€r{
t.Ot w1y
rttamnaalCtJ:vnoud:au-r
rt$i'rw
o*au:urllilnaa d'tfiaaluarr{ncr
rstaso
srnr:dnrau
rnfurdaroq1f,tvan
rdu dorXdnreu
Xtitru.n ditil'lut4
rfhdu
'lduaanXa&ao
nnnrarli'lf
r-r rul
{lnu s n{.1
GEiloutt'
( Piroxfcan
I
10
mg.
DUSTII{G POIYDER
gsch Cm. contalns:
Gcntamicin S{ffrtc eguivafcnt to
For Acute gout Rhsumetoid arthdtig
ankylGlng srpndylliis
,tru|g nue$orkaletEl
dwdeB
!rn{ujtriu
f**furl*nur{w
@q***"erE
r: dte rJafi
1il r lu:r#lrltcnililas
rrnfi
&rJrnuJle
z rfr icjorfuSn
arnrdn€ui&rdxftdti{n1{
rrnril
iuhar**
fu!.!$il.$!
*rr fr
{uJ::lrmif{rn
r dr lsfurhorofutlr
r efi lrriortu6n r.o lu
r ria
rlouh
Cenlamiein
l.cl$8cinSliogrrinol
lmi|lo acetic acid
Dl-Thruonlnc
L-cyslino
1 m9.
$OO unlt8.
t5 mg.
1O mg.
1 mg.
2 mg.
6tErqal
1fit:slntn$rri*rnta18o d*ufie*r$ uansnhsef,s dm:nrft*ner {mnrmdhetm*ilrrulim
$ouirdrir}r
Vol. 12 No. 1 lan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
il??il'lfin1tu0a.i
a
a
d
^^
? ' r : f f 1 : q u u n 1 : f l n u 1 $ } t y t r J f l 1 f l g tnTn u n
lrvuorXo,-)
tT.rllululnvtTiunrnnl ouytqT tflNl{ tijuouuYt 1
a,i),a,dav
ljo.tuYt 12 U.tna?1il??qJ[1n1Tfi:U 1 :0UA'lq1{00
o.rnri'r'loy
rfioil:sIurfituil.t,r
rfl;ilfli.t,rqilr::ilun;
'[u-flruo
oius::rro.r uyrvrrilud
nTsoHfi{d'r
u
rn
n ?1u r{,Jil il 1ulJo.tr{1 I o{ ul il il 1o n n -.tyrs.l
dn r : 6'o
tvdAdaat
[Y111
nUgUUnlTfrn]e'r
rrl4yrufl"tfloTnniln
tT,Jyru'ru1nilrgnnr rlsuyrildfsfivrf o.rrrna n#.ru:ntu{ufi
r{:silnrn#r,o"uvrqi ourfluTn:onr::?ilntiilfisl 22fiillnxr2538ddlulrrd vn.:gudnlrdn:*.re
ld'iu
<-tttf
rfis:6riJuoril{fl{a1n
drusrnr:rir{ruonu.uluyrnst
ililr?nurfi'u fi'u I:.:yrsrurnl,r:silnrnh6'uvrqi eirr+rour 6i aror:rivTrnrirnrnirrnil-r:[?Tfl1flo{
n13il't?nfl1r'rrilqr6orfluIo:.ln1roi'uruu naJn't:6nur ?nuri-suytytufl.'tflo{ilT:il,Jrl0rnfr.l
Tn:.rnr : u: n ruos16i'zu
t6'nqrxrriluo{6il'ron
fi6u-flrfiou1ryrr.ioontrjfutf
turi'rrio16o.r.rirnrofiiqluri'
us9*
.,
X
frterrild'vT.lRu
rz iu ohutu217nuufr'xilona1nfr dnrf.rrL:16'nqeurriuuriu,:rfrorarfi
1fiu:rululiruourn
yrhifi
#.:t fi onr :r u1ur.{n'[uI u?n-or olI nr,rnr r g
qurSnr:6nurvrfiarHuurritux{ni..r.tqioliln1n
al
^
ri
Ino lftT.:n1:9{n0ttytTtu[]tNl,0in::nT?.tfl'tr1TrBEl
na,0ur:il1;n1:6.rld'Toot1erotriruvror?..1il6T{n6i,t.)
e
tlc/f
'
T
4
t o u T'l u il 0 n ufl u ?.1$.1
14'1
6firur{nrturlrn'rrnfudTouo{tudrur 0.rilfiflrn:
?YlfJ'1fl u tt fl : [5 t T.1y{
u''tu't fl
ri'enr:il:?,r fl1r'1:mq?r
su'r-.lr
guritufi'.1
rflllqurinr:6nu'r eYr
ro;frrJ:;Turrisio
rfrouulryrrififiIanr s
(o
q
y X
cZ a'A
X
yr
glilil
ql
trv{?]u R']14TUURS|
[t1,{ u ll+il n 4- 5- 6 t1.{[U0.t
t6'eiruhjmnfi
riau#.rrlonrlu$nsou.rfl
I
cr
i
T
r6t
7 tr14{ t6ru0!1jU',]u[uu 17 [t14.:[ltou'tost tilAilon
dl,l fu rdar,l'rso.runn?1rulu.r
r :er :ariud
- 14 16l
y
w
a
A
a
t a,A
d
u0unflutulltaon[il0 10 n11ilytt[fl1 0"la''lTUltltytu ufluor-iufifi
qlju
rsr*n'iroriu6uornosr?un.j.rrilu
^
oo
a
9t
|
I n t n ilt uqn n fl t T I T il u u? n q [[ ni n 00 .J[n:,Jn'l T9 q6-uirrrn::u firrtEY ry{i.rsuyln?rlyi.rraruo
ranruyirul6'drfluoils::n$'1fiiln'1r0ilfl1il''l:nfli1.r
rilurTa,ltooq6-uSrrrn::rurfis.lodrrrdur
r?uorn
I
q s o
<X
f
d
,
t
InT{ n119 tH Inq rUuIil5::3.J0l.{yt:{qilljT! tUTl{1'U uylurrrul;nt: rtol,nr:elorri?lnrtr#aogndrur,mlrri
.
,!
u,non14
flhn-qil1nfr
s'r?il:silnrnf1", t?inrril urnu'lvtgonta:'CIod'ruuyro.:rruduirr
ri o.r
'Sulbactam/ampicitlin
yl
rn''rrrr{fu d ovrr uI os 6 o'l r r urfl urj rfi uu oon
VS Gefoxitin: atJfritut
i,|<
fi vr:rqnirireioondnrrflu{'fivir.rruo
rirtHfinrfio r f o r1aoriul nn r : lt r or'oa d a n il 1ir?rrirv?or,,
t[y,tvlulvt u:314?"t.]Ftflly
[[t^tnufl1ffn{ Qy[1n{nril
drAaaa
.f wa1
XX
a
A'
ylyllut
tu I n q InT{n'l:u1Jilil't:?ilqa0qn{11:g't:9
o 9 a
r
,Xa
d
a
X
Cv
01ufl 'rfl.:no0gil n0 o'lo'lts$19uil?r?rfi96{ylfi d1t'lqfl
-
' n1I 6 nr*1rrJ6au rfi au I as o
0n1r oso
o r:r{1 nm : e.r
,,
.n.rrsrl E?J
frlllr drno::rf n-udrnarrtf
a0
odor{eir ur un1rI r.:t4u'tu1ntrrsil nInfr1,i'uvrUq5
nr:nrJinlr rfi olnTrouarulaoiruil:c n06, :1 uilu
tuqnn0o.tLn:.tn''lT9onuu Lu?'t::7t[nT,Jn1T {dru ria.:'Rartiat
Hydatidiform
Mote,[rflyuyrn.:1tl
vlvo
[oo1liluu'louo1un:u
1 :ouo{nfl1't y11nfluun1T 6u1 6irri.rrril:iun:u rir urufiour6ru rai.: riluorjr r fi,r
lCl
qva
4
Avls^l
a
^
X
frnur E 6e'td'5
rTtl ri'Sn''l
16'0il"tonnr rfi u:6rrafru 'hviru(ei ruq;1d'iurJfiI rrriorn.:r:a1:o:iudri1.l
't
uoviruoror:ri urfr
mo-r.r il *rr nfi riau n'rn iu r1ryu.rn?1il 6i1t'.l1Jo.t.r,.t
orflunr:r6orsr
ouc ruo
:fl 1TE
$
s
I
q tv
r
)
'
o
4
U e4 el4 e
f
yl'11tto
yir
lfi ru14fl 1.3yt
n'r nn.ri {6'q I ofi'oil ful {u n:1 oi#rl ol {r r os
t14[? to unluuo !140 oulQnnl
o
'
e
.5q
04
d',rndrrfilu
iufrdnqmng1a,rnnfl6.ruan
rnfioorn rdl srhrfiunr :tri'r s5oor il rr nrtrl''l 61uri.r j doiu
6r
'
)-
91
^
y
-
tA
4
r
q
js
d
tle
n't :yl u ilfl o [[ y{Ytu Yt0u [ 14u I a 3uff 9lu lr|ytu 0 : [o [t fl 9tJ
n6'ryqf
oror:riulryrfiufrr rirr.rirbhJronnr
qruuei
mrrlr, fluxqa il.u.
-)
aJ
d
iln E fluun 1 ,J.n. - N.n. 2538
?Eenrfluinl#fnaunnodtaniaifin lxwarunnwilntndt
il?tu136ur3nrr
rAXLrr
n,,md{ffi?un1tt6${$n6?suil$riil?til'tmtaflnt?
ea
il.1t.*
6la?9 iltrtil'tutl
,Xal
n.rwlilflnnJfirao'jr rhuurrirflut.n'',tdfi rusirfifin'r'uou{u4nriu figtnl^rnru$Rtqtn'tv{
dr
d
^A;dt6dAa
i
r
i
f
t
tul{qnnnnilqiln1v{
riluteinsnlo [tn303
ualal"]nnqo!ou[{v{']: dnmffuHTnr
Ln5u']n'rTuo:rj1jfi
qnrFnilln
luariuriouuriv;nnutuouroo
tu'lr ur a r6ouumror6?onr:n
.
rq
e
X
Aa
u
\
crura.rur urfl ufl our6nI oni ocurihul uririaun.l
uyr$ tu:; u;rafrr"]d
6.r1fotar:rr?uorirr duner
uruH.rdr
Hfinornur{rornsirriltctnsriYtur
r?rufi
urnanu
ahnriru uwornnrtl*rsrurlouldf;oeir*1
o q e
fA
te?u
rlrgnrdr1o:nr:ossunurnlunr:d.:
o.lrlt?n1tfl u{qqn To?uil'lulJlloil
Yt''r.l1u0
Htuulu
u
X
X
X
r
v
j-t
livc
t4
c
n1:rRU{$ni?ul{rJutjtT{otfi tonYllnolnililqnrn1ilo
q
J
v
v))
)
i
X
---.ft-!-y-.
n{0tilil[tJfiu
fiqoluoulnn {Y[nux1l0{tutTo'11{
-s
'r
''r{
q nn1nrfl n1r ufi yrrt uflcfi r''rrt[q?4 nrt 6'uiu
:Yrswayqtr?il cr-.r
ugi:; 6'u{u?rar : e: dsI r6I rfi unx1il d1eirg
i
la.rrtord Io uriruuorfluuluururdorflurnts.rdrir
lilljf[3vllf, u{$no?uuil$ilnqf,{ tlj1nil Q'rnHfln"lr?au lfir1nnrn::r6'udrri n{il1 fiorJfrffiorirrroilnio
4eX,'
riuqudtdtt,6urJ*Iusri
[ur:uiun{l u r,rurl6nfitronrrrou{ue;fifi#u o?16'runrnnaqlilsnonoilfl
qy
^
I
X
|
|
I
l51r [uf,n1u
f,.raau si0n''r?6i.ilflTiln''r?rnu'i$n6?uuuutl
r;vwqq6'utnt:rYrrfr r ki tnr :t run; rdaf,.rn"r
soi
rr"1 uinrrfi fissrimnl n?roqqlotfrr{rnrirfr
ro.rwouilunr4"1nq m'rl#rfi'orlqurer
Iosaroi'n1frfianr ufi
il'rnil1uo.wrur Io stonrr atir.:fi.rrTrgnrtor t6n{uiu mil1rnlfiuilqn:lufi vlr.rrntd'
.lr,
ri
Jo
X
.
e
!
flqurnrrrvte $attfirl rt{u.tIfi no ? suu ttlt tuTrYt1.t'11{n?T0qq1otn uil
firnrttlr':{r'l6orurrffir6n
|
A X
ue
4
r6nd f,1rn?nn1uqo.t"r1{tlrolflu.l8qsll[Oil1nn'l13 tO01.[
rlrgnra,tqT nrueirt"l,fiuul nntulurerr;frt
d' v c @
1u::6'unnrl$s:fi6'usi1{t1iu
[uT:nunn1{[t8;r;fiuR'
qnr#u.rdruuuunuonornr6'no;ldfuornr: lilunu flT4Tuqnn,.|nT
ur: aui
tHuiluuil[a u.0qqnta?uill,r.r\t$1nx
Yr''r
q
)X
v
I
v
aJ
v
rl
vlse
r
ae
d
av
el
nTUfi?U$flromqoun?u{toTu4ilflilnu[:Ro1il
qaoorqwfiflfi1fi
96urrvrri qil1Tur{yrri vrululfl
r::rurr6 tYof,
rnt. tti.uruurilurru; z-siunfr{nooo nT11rnrgrqn::6'urfluidlnfrfinfi'uruj nr:Srafird
uri6'rusiri u6'.{n::,{ ung
uwriti'nX.r1o
sril1:o rir uiloor4fi{ruri'uT
rntJ{qdld' rJ:sIusri6'* 1#nmruf,
6$ra{ra.rnr:udurqnd"ruur
urj6o1ufrufi
duri16' u0uflourltluqzotn{l$n.ntsu{$no1uuil$lJ tilo tl4ttlJ
fA6
l.fv
[ o u f l 0 o r t f lr t l r q n q o u i l n l u $ 8 . ] R fol 0 8 ; r n o
--clrrA-9t
$il ttf, !$fl
fi'] Ufl il?{U51rUT3}1X.hl
!r{03 HnililYl { Bil
a
e
.
X
{
v
Aqn
I
!
rriunmurircirynoor#s.rd rdauJdi,ufiaun6tar urJ
Ba! rU16 ouurirrJ6uuruI r#ul qnd':uuut,o{ sruto{
X
r,
I
X
v
t
utttJtttl
[au.:$no']
unlqnl{ernoe ii.rilil'l61frqnqourulun*ocio
1 rr"l usnclntinrlnu rHuu?rrrl1'lmTn11
- 3o i
1l
uuriudndwnfi.rdu
ri'rhXrdnf,{ tilq1iltilYr otdn1.Jtnn [ou Iov{1ts1.[1Y10.1o
o?1$Hn?{ullnQiu.t$ut
*n
{anug6-ui ntneex [tfft Enutanftilnnh dwnqi
ll
r
r
A
I
r
$
f
ve
e
a
Vol. 12 No. 7 lan. - Mar. 1995
t Prapokklao Hosp Clin Med Educat Center
a.
3
'
-
;
r.1
nerafi dr n"'ty
fi qodnnurafi .rfi 6o 6'.:uriro.l
q
q e
.
X '
ty
d d, I
d,
i
I
sr:sufn fi.:nr Trunfrd'rgr
urifruluqrutuffriJufrrcir
riJunoyri'lu"[ri'r1ilfrilrIfluo; d'o.t
a.rr6o.sdfiomr #rto
^A
X
v
nx1il6f1
[50Ioural^n:od1.J
uuru
uil rfiu:J::Trrr[rRsqild-'r
0,Jun
n''ln:fl l.Jnrrlrv{vtf o?rfio;rfiurgqor:6'r
c
t,
A\uvA
X
r
v
o
olf'
lJ0.r1{Nuil
rfi
nil
n
r
d
o
ura
ri6
rfroIo'5un?.lruir?alfiufrr
n
:
r
fl
fir
fi
fi
;
6'o
u
ri'u:J
o
lrir
ffnr:rrJfiuu
nI
fr
a
Vtucl,l
Aq*
63a{6uronLrs3ti'uil'rr#u.rqnfir uuru
Io n til u4 nnilto TUUT:yl..|uurJ
ruJ [y{0 t14u:Tqn.l vTsun
uil orjr I rios
gar@
r.t
fl 0lJ1? ff1r'''r:lufl lt
lllll
AaY
0't 6[1fl u oTfl 'rT'rTfi{fl lJ fl n il
q q
eq
vX
ovt.tnlu[[fly [0[u0u'tooautnnu
q1Jnlvlvr
..a--.Aqv
a
)ai
dr
4 roau Iv{0[14u:Tqn{qiln']1^lytqiiflo1l0.1u0:
tuou.]n9
4
enntguintrFfnarunnuf,'tcnfnilfrn
Inntnutnnfttlntnil
fld p ariuii t ,1.n.- fi.n. zss/
/
A
Ga,
v
uilufinufliltl
n"t?n'tsila{il'ttniledrrfrn
tul:r il s'ril'raairurft v[il rl
AAV
alilnil oilfial?trna
il.il.*
I
Abstract
The Perinatal Mortality at Aranyaprathet Hospltal in 't993
Sompop lthianrachkul M.D
Depadmentof Obstetrics& Gynecology,AranyaprathetHospital,
SrakaewProvince.
J Pnpkklao H@ Clin Med Educat Cents 1996:12i4-1o.
A retrospective study to find out the p€rinstal mortality r€te at Araryaprathd hospital from October
1, 1992 to September 30, 1993. There w€re 30 porinetal deatfts and 1,845 total blrtfis. Tho perft|atal
morelity rato wes re.ee/r,ooo total birtrs. Tho caus€s of perinatal deatfi werc macerated stillHrth (4o
percent), asphlxia (zs.ss percent), pramaturity (ao percent), congenital malformation (to percent) and
specific condiUons (o.ez perccnt).
The perinatal mortality rate wa8 slgnificant reduc*ion wlren fetal bir$ weight was 2,5oo grams or
mone.
*ih ug6-ui nmrtu fNnutulaaigtht ma {tniams uf,a
VoL. 12 No, 1 Jan. - Mar. 1995
I Prapokklao Hosp Clin Med Educat Center
Z
j
-'.-- -.r v A
a :;yr1'1.3?lryt
1 q8']nil yt.fl.253sfi,J?Ufi30 nUU1Uil
y{.fl.2536
T?ilTrUs[?fl,]r fl un:mr:nt[:nnnoo#.J[[oi
o-sr
r "rsr1uI a.ryrr : n:J5nhrfio ufl ud'rfia{rd'tg
A
qe
Ao
a
is
orrn::ifi rurnn
oofiL:.ly{u1u
1noiruilTrryrs'[urirr
unrir
-
cA
5
q
I
0 l{fi u.JYlu't lJ't I T t[ fl o { n .:u Tt fl ytI' n 1 1'{tun 1 tq u n
-
Au,
i
1,oooniruiiuhJ
fi rfrudior4n:r uo:rtoi'funr:ri'u
mr.:d'rug6n:x' Insm''rrn
urnnflaot 6.rs:r{audr
[?TT:[:] uil{:h u [u rT.:ro.:rur :o r I aen..tr n6'.J
n6i.t?
j
rs 6iuq rln'rwour rius oIil Tir1$1.{ufl; n 1T}ifl u1
a
6l
9rr
."
r fr o H1 fl 1 rfi En I Tst1 ur o.Jyt.'lin I n ; T.tu fl y I d u o 1 o.t
il:i rvts' Iqunu'irtuil:: rnndr{quuru#rd'o:roru
nlTO1U
llo.ryl''r
:n:Ji nhrfi ooyoritu:y
oiusl:r rir urj:; rn efi
s
rir fi'tvTer
uTo: sr:.: liueir il u, no. ndo'' n4on''rr0r1u
jJ0.0yt1
:nuTn1[uo[uu:3[nfln n1n.:y{
tu
0t1l''lflxl.tn4
oou
I
a
A
'
io
-
-
I
fl101nnn?lil
I
i
ualn fl'rn4ordflo.rri'ulff rriu nlTst'ru
ot rflun''rtCI'r
1. nlTetluil;nhrfio' (perinatat
death)uil1u6{
l-
n'r:a.rurro,ryt
r:nfi fior qdruoi za #:.tol{dutrJra6o
a''rnn1T1''r9toan6[aillfwnnao
n''t:fl'tuQ''tnnlTAo
[60
Y i
- N".
+Y^---r,..
rijud'ueitafu rJ:: ryrdlvrsriu nu'ir6'CI
1?n uu-luunuTnnnaqnt$qt
:r orr ur o.ryt
1,000nTilsulrj un:nr:oru
il5nhrfiofior''rr,
ronoi'r{ri'uluuoiR;:1u,01u
duadri'u
llo.tl1']rnu:nrfionrutu
z 5u
9l
dtvrI4
vet&
t]oosHnr uadrrfi r srntrro{l''tro'l
rJfi RvrGnlr
I
q9
a
e
a
n1T t14u:n1'tyn.1€t1ufls|nT1il
Bfl!nil']: rl5nt:N
a9
z. do:rqru"o{yt,'rTnil;rirrfio'(perinatal
mortat
ity rate) 14
N,lufi{yl1rn orr srJin:rrfiosioohu?u
fln1fi
rfl'tuofin$o:#rntto.rqtsurfu onoqounl:rfiu
n1:tnnoq1,000T'tu
3. nl rahriln flr n4on1rst-.t
u ffi .6'u
rilu{o1rrrun
''r
fl ril qo1ur0.0Ioug: r I n; r6uoo-'tnu$[r,:Jr r iq^
9.
:'tu:1N?10ila"
it
d
ovtra
t
f
tlto{o1n tT\:l4u'tu''tno:quTgtylfl u{ tililn1:?ou
- fl'ttilq n 1:n r uilinh rf old'rnru"riro.r
Wigglesworths
rfluuurnrltunlT,fi'qndil
- ff1rfiq1oJn1?nolutunr:r{ahuunoril
rfru':nuoo:rotulJoJytl:nil?nh
rfiounsff1
ruqnlTo'tu
A
e
jU.
o
A
qrd
X
u
e
0.l910.tn1Tfln:9.l
untul r.{dyt[ou''l [Tr1]ult 0iln ru a.:ou
X
a
&
av
a
, vr ,
-
I
i
$n:tuultuoluliln1T1ouot{aatu nlomo;urhjg
lu
-oaayerd
nr'trldlatsrrilqfitalu
- ff.urlEn1:n$Tnrfioo,'run'rutil
CIfl8O0UUnn1nTil[nU?10{ tun1TylQ3flO0nT1st1u
z iu drurxn
I 0.0
n,r:nilinh rfiqlul:ril urul floiilil:: rmflqiohj
6r',',Iilil1grio1ufl1nno
n ' l T y rf l 1 . [ 1 T 5 U U U : n ' l TI U O1 U 0 U 1 r Jr J u r JU n ; r q n
AA
v
q
v
d
a
e
a
au
?91
oq utg ctitnflo{ n l:?o u
Aa^i
1. r14ofr
nsro or'rsrlurJo,Jyt't:nrJ?nh
rfrofr
I
v
r
4a,
[T,lvtu1u1n0TillJtt Iylfl [uu.tuuT:il"tru 2536
4. R.t?r1-tetoon6rou.(fresh stillbirth,
asphyxia) ilil1u6,Jn1To1ufr
[fioo.rnn1Tnr;ilu
.'r?rrJ.roo0nG
nt: rfi oualnnlToflooIn;fl
rou Tor.l
mr:norutu:ru;naaonionru'lu
z iuufrrnnoo
Aa
s . n 1 T o t ' t U O 1 n f l ' ' l I H E l [ f l y { . ' l ; (5s p e c i f i c
2. ril aflnu1u1flx,.|ru#ruri'ufT;il'i1Jn1To'tu
rao
lJAtn't.'nuTn1 tilo [ta:u114un?11?n
$Tnfl fl 00
a^d
''t
y{
3. I a 1 t n T1: 14141 ff r fi q n''l Ta'l u lt 0.Jm1 Tn
a
l,lecr
oU
i
rao
'
e,
rlil
il5nh rfro oy'[d'riJuuur n1.tfra! u1'[rjuri-[tqia til
a
v
t
A4
ad
il te Trfl I 9t?o u't.til o v ?fifl 1:? ot,
tfl unr :fi nr*rfiouran-.:
rfr.:ilrr rruu'r lr.lurfll
conditions) Hr,,1u 6.tntrst-t u1Jo,lnlTnolntJt:q..1
rfluT:nronrs'[urrwetrn::fura:nr:naoqrriu
^
X
nrrdqrfio
sr,
n?1&rd'ulflfiCI$.1
ru.'lt4?.l{ riludu
6. ntTnfloqrioun".lnuou(prematurity)
aA
uil1ufriR1?rfimr:nnnoeriou
szfrJqrffiua,.tniur:n
.
d,
a
Y
I onnl:frtJr:,irr6ounirqofiruro,Jm:o
r
6
flfr n ariufrt il.n. - fr.n. zasa
?Eerlryfnltf,nnunnsfrlrrnin1fin Imnnu:rlnftilnnit
Ad
2 ilu1"ro'lnnr:nnoovirilro
ernnr:rrfi
fiaRrt?ott
r,84s?1u 6nr:nnoo:Jn6 nr:rir6'nnrrnrirfro,r
nlf,litYt
,{
vAv)
n'Ifr n'l?RIaoo ?uot
flt eoBJ1
rirHl*nrrRaasuaco'n:'ln1?n'l
s
r
u! ao n''t:flfl00€t?trtfl :o.too
Fqrflufoun;7s.7s,9.86,
mrrnrJiritfin douCind r qn1nil uarnlTd?unnaovirrYu
I
-ay)
Tt.fi. 2535
n01$1t
30
n$s10$
7.92,1.46ttn: 0.98n'ui6i,qiu
Tt.ft. 2536
o1r10d3 udnod1rilqnlro'roloonrrnrlirirrfio
(rlt )
o-ru?uTrlrR
Total births
1,845
Live births
1,8'16
Still births
29
n1x Wggle8wortt classiftcation
druruilr:n (:r?r)
Souac
12
40.00
3
10.00
fln80noun''rltllo
6
20.00
R1'rtlJ'lOOontre$
7
23.33
f,1tiln[$]\'1i
2
6.67
6ntflnnltnTl
t
Al
AlUIUAUUU
I
A
Macerated/Fresh stillbirths
A
TC
ilnlTUnn..|run
12.17
lo
(rz'r.+z)
(ratio)
Early neonatal deaths
1
Perinatal deaths
30
Perinatalmortalityrate
l,.lr-)
a1nn1?1nn1
,l
16.26/1,ooa births
1 qnmil
flu?1tut:14?1.1?1t7r
1t.fi.2535 0it?1{7t30 nilU,lUU ilt.fl.2536 lJnltnfinoo
)
i1n01?1{71 3
it,u
r
a-)
e
a
fi l:.:nururnoiqrj:: rvrafi.:fi
un r,B4sr1u lilu?rlrn
aadl
lnoilTv{ 1,816T1U YllTnfl1URBoO2911U ttf,:T{U?1
utnlt$n
i
i
ff1liln1A.tn??n'lU?JA.lil1tn
t
,
-)
luil1tn1fiu1flflBnT!?r?'l.t?t{Yr
1 qfllRlJ
!
a-)
?{.fl.2535 o.t?UYl30 nUUIUUv{.fr.2536nlBunn'.]l'
ygjlnlrnrurflouriurfluerrnq
6'n:rYtr:norurflouriu
t:t.+z uuu Wiggtesworth
n'onr:nnrusntvitrTu
flu'iryrlTnnrurj?rirrfiq30 i''ru 6orfludn:rnrs 0uouttTn r:l-01'{ulf,f8Ua!
40 lro.tfr1tilqn''rr0''ru
1Jo.oyr''rrnd?rirrfio
rvirrTu16.26sioyrr:nnnaotio"uu fr'rrlrol''rnn1Tn1?rn1T?r'lfl
oon6[ou?rulfl u
t
a
,ee
6'ud'uam6olslo; 23.33rhuf,.ulrCIo1nnrnaoo
t
1,000:1lJ
rio$nhilun n?T$finrtttciri'rrfio uffvR1rnorofi1!
nfi,t.rd e f,ntnrcnltoeoe
I
ytuiouo! 20, ro $fl3 6.67s1il6i16u
aRUotvftltoaon
olu?ilnrto (rlu)
losaz
Normal delivery
1,471
79.73
Cesareansection
142
9.86
Vacuumextraction
'147
7.97
Forcepsextraction
27
1.46
Breech assisting
18
0.98
1.845
Antibioticwith UniqueActionMechanism
New Broad-Spectrum
Bactericidalwith a unique
action mechanism
l{il1
gil
Fosfomycin inhibits the initial stage of bacterial cell wall synthesis
and it acts bactericidally. In contrasto9-lactarnantibiotics inhibit the
final stage.(point of bridging of the cell wall).
BacterialCell Wall $ynthesis
I -lactam antibioticg
Fepttdogt)€an n€tv{ort {ce[ wslt)
l(rhsn, F.M., st el.: tha mehtnirm of action of falomycin (pfiGphonomvcinl. Annals Ne$, Yor* Acad$ny of Science 235:364336, 1974,
Funher
intorhalion
ts a4idle
on req!6sl
THAIMEIJI
CO.,IID.
PHANilACIUTICAT
Bargkok 10330 P.O.Box 2248
FOSMI
clN
( Focfomycitr sodiw
)
FORI.V.USE
DtrIPTION
ffitreMmFindfi
ffi
lMb
re:
(.). (tR, 6),(1, 2. @i@!)
tlqtne
t
fl
*/
\
,/
\*...
ifih
of 2 g diidd
ir J00 ml J% dlce
duda
!
tlwplMMnof
ls?.kqhv6Mdd
ft
dft
d cdrpldio
of ft
gffily
htuh.
nir
@
ffi.
diq.
l.!d of 25mad
d 12M
tu
dsh.
ft
hdflif.
*u t.E |ffi.
hm
tu dnry
mqflE
rs ffi os.wvisin
&ffd
r2|'N.
Th.C@iadffi
ei6 ryB
h 8i*
m
hftu.
D6r'm6
hjc.
tid d I t Fdd
i t|s
i}M
d 7.0 mS'
S{s
d ddftfd3h&hld6.
tuffibe
ffipd
nid wd .lM
h p'ridts wis Mqids
dE irhtru
hirtu
s@dnlN
hmwc
dpifugd
$m. Ir ffiB,
ddbh
tya, loq.
o h h&q,
k.
ws
@,
el@drnK,|@lffi..b,
\o/
qglqoP
erk
fffiuh:
Mokdk
vcirh: lge
C$&ddrh:Jry
kur$tw
kiji
S&
Kr&
Ld., Jr
ffiSitr
i3. w stffi.
turdwd
in l%? h !
MdtuMy.'tuAtu
$bhwiddtu
|
sf$
dl sqleNe
it i! F|l.M bytuhd
ryMis.
hsfmrcin k &
inbMd
etk in hirh M
* tu rdv! mwl
I wdiq
ryM. qtu
gtu.
ttrseq,
I fffi rffi
M cldl tu wym
N-eryliMsiGl.{hpFql
rmfrc,
&rcby
Mt&t
ir ffiryh
bi:|M&pls
d
e Md
ell *dl lFtust
nwd ( fi, tu !{!. h
dtul
&bs
sdhb
hbt ft tu st of elt
INDICATIONS
ftr lV w t id.rd
F6ddr
fd e fouosins WEtu
&
b fsfmycin'loslptiu.
siN
of Ps.!&dou
EtugiMs., hew
d n$d&8
@., S*.otr eeffi.,
6rb!
ids
6 S@rylx$cu
aweu\ d EAbnchb
di : @id
hni$,
ffidifii,
iild
Mhie.
cE! @h,
tu|wdlc
dis
of rb lq.
p$bd,
pibinr.pchgkift,
itrtude
ink,
rydt$ &rik,
td,tMftdffilitridi
ImGf,
& ADMIMSMNON
Id.r€t&
6p infusid: ft
wdrl 6lt tu 1. of tumidn
is 2 b 4 8(Fcry)
fd dults d
tme 2m 4 (pi4y)
At rn chiltut
ffi
of &
e 8i!o !y inhre@s
fip
in|ifu
it 2 6!id
ks.
h
is disled
in t@ 6
&
5m d of iMvaN
fldd d info*d oaq e Fd
of I b
hmtru
chiltu
m*MACOLOGTCI
ffi&.M6ycin
CUSSnCATTON
IH RMACOI,oGTCALACTIONS
Aturbl
A.thdt:
F6hryh @ MUly
s rFidE
sd r,
qdv.
I k 6Fcirlty hirilt drc Sid
Ftufs.
PM
iqt'@
P@u W's.ffi
m.c.tc.B,
td mld4{
dis
dm d [email protected] aw.B N
k ddrfu
dfsf6t&
h dk
frm e
u$bdc!. X b | tuM
lidlriry b etrdrd
wnbt k d
b fm .Suiuhrbtd'
rveeED,
h&Md*dtrut
qei
h &b*eir
&sFbhd
&hddledl.
tuhxh
is tu inb Md
dlr in high@q
6&dv.MFt
ry@ {turMfdi
4l h$fi4,
ith.lMMS6
ft.@N"
ffi,
ftetry tud.
@!8lwiF3odFryt
ntu8 ir.Pi|)wi6Mffi&ptedft
M
dl *d ry'fus b aryd s Aii fNr oga It
'fu,
&Iffi
adudL.durtufdwdd
HIIMACOXINEtrcS
Atio.prh rd Atffi
h ddt F.id6, i@.|s
inl$
d I f Nd
iD 20
podtrd r ti$ F* bld
d d tg6 d||@ de!
ffi
d ?4ryh
tr r nif,qB.fre ititu,
*ficb
b E ft&m by 6 M tuiniffi.
r'
8ffi1y tuM
||dldldukdviqr@tu
hvffifit
iridmst
tu @d dly dqs
fd db
d
e tu i{msfd
hwcMdpiilNiqhr
'M.
& tu $lvni
m d d v#
8t!6 in 2 b 4 dvM
td inidh
6 5% 8ll|e
Sh
fd iri(S
k ud b
dslE
I e 2 g. dFdch.
h inh@
iaidi.o
n$t
bFf(MffiJfrhrbnffi.
ft rb.
try &qs
my E diusd
.dbg
b ft S
d e FM
d tu $ldry
of dE itrf&.
CAUTTONS MI
USACE
M
f6 lY E sh{ld b &itrild
iMv.mr
Me.
In dilb.
Mdftbb
ttu
b bFf(M
by inc!€mrdp
dty b} tu
fn tu &h!iilu3i6 *kw
I is hn
td glddirb d qtdgr
mJ str
fdbwins
& imv@
&iniffi
dd!
tu8. !kfN.
sff.
cidft
ddhda*iftctdbhffidtu
ili*tu3ic
d tr ehis
bb@rqed
6.tuffi!
&ds,
M ft n€ d whd ft ha d&
! inid
tuUbstu
rFlitL.
mmloNs
ftt hg tud
ntddi#.
b dntrd
vib re b p{i6ts *it
Uca. h Dwr:
tu dq
ddn &u ftr tuiMo
dd4
&@
drwy
b a ydb
.ffirM.
l]ffi,nbtuilhbrdft&dbrftUin
[email protected].
bhEdFhB
wbGFro
lq{mtkq
smg
tug, I is ffi*
tr
b Fidcdly
liq
d
Fdffi
li6ry tffi
edl stubtiel
ha,s
BE.
FdDbh
14.5 fiEq ot dm
mds
F 8 (ts@y);
jt 1o
ffigly,.e
tuhb
dn
tu
fttrhsiry
rldeMdm
Fiswtodb
i&tuble
fdl@, tituy
ny@d,e.
tdw,
ADVEreE
TEACNOXS / SIDE Em
fd ffiT.
kimlly
ft 'CB
Uu;
kf
d.hiib
MM.
ir rm cM, d @idly
&dq
dtudyechp.
Rqtret
or!h:
A csSn d
S4m
in tu
a.k!d
tu
,ds
d
M
F6b46r
BUN vdu
fl,
evdq
Cmafll
rtrd FiplErd
nerwc
tu&dy
!ydm$
hdds
d . f€liry d nubhs
Ddbos ffiy cxFd.N
iu &
d & liF folofrg
& N of b dNa. rc@wi
of l!ry tu,
ce ol adrnid!@im
e|M
bly edody
|kd4ld
ffi6:
& eidd!,
rSdayGE
pdb
mY Mq,
d
@db
SF! of
&v.lry
idrdGtmphtlu
ttr
sd.&.dd
G !Md!,
GstdM
!|rig,
vmidtrg.ffiid
p.
dffi
dffiil!
my m.56.
q a l*line
*ln: h $sis.
Ftia6 say &v.lD dptis
d i6inglddlm
-d
rtQr hl*nb
&v€lq
o re @h.
argidp
my ec.ffily
sui
O!k$
tu€ ft @t@of
toll M*,
d dr,K.
rcnita d ckr dwnfd
d Esi6.lly
Fficnd my
.xFtu
. fdint
of rsrE
on rk cb.
TOXIclTY
Sn
of tufofrydh
Sue
(FoM.Ni)
t2$
2,175
2,625
5,lm
8m
P
M
s
rc
(iletg
r2E
2t6
7,e
6,1$
1K
1.650
2,m
2,m
5,lm
4.m
t50
20m
2,46
1,tb
159
tuM.td
chh
ffi:
Sl|ru
brbiry
@
Bdd
Mft
ruhm
mdic
@ i! ffi mg&g/&y itr
il6 d$ryt8/&y
in mffi.
tub
bildry ss inn6
ed &F idbd
tu |Nhm
bb 250 rur
Mrer& &
lg/&y fd M
nM..
(]lhi
IDnM!|&,mdeddedtudin
rdo{sd
Es e in rdqrniciry
as. M frrigd.iry
of
faf@Fin
dun
b b
fM
in.rFilM6
e tu
ituh
d I8C d lrE dHi6.
STOhGtr
ODITIONS
rcm^ndFAcKnc
tniedsi I g(F&rcyyvd X tov
28odrry) idx tov
FddinfM6h.vdl*b
il|iltHJl
ilrltm'lr&Co.ttD.
Ea8rd
,0J!0
P.O.tux m
Vol. 12 No. 7 Jan. - Mar. 1995
o1r101l 4
y
Lu
I Prapokklao Hosp Clin Med Educat Center
, A
o''tnCIryl{fi4 flu,ilyt.lrnErrurJinhrfiotfi
fo :r fl r ur o{ rl,ifl fi €.rsro[14rrr-tu r?1.]n-u 1: 1.31
ilrfl'rll{o aouoiailli 1 qnlar fl.ft.
16Y
a-Av
2535 n{?$?1 30 flUg1tjl{ Tr.f{.2536 y{u'i1lijun1:nnooni,:urn
ohuru e i1u fiorilu
iaunl ao ro.:ohil'tuyn:norsrj?nhrfiq
ilr:orfifi
s ownil ? tu In s?nun'If,o'rrJrroillllln
fA
9r
u
A
o
{0ryafr'rbl
av
A
(3osav)
druruniiodsrfl
Total birth
olqrsn'jl.t 2o-3sfl iluohu?u2411u dorilufoun:
80 rniil']rcr'tfifiorqfioun.j.^l
20fl Hioilrnn.jr ss fl
iluohu?u6 rru Forfluioun:zo
1,845
Perinatalmortality
?n
1.63
Female: Male
13:',!7
(ratio)
( r : r . s) r
Primipara
12
40
Meternalage 20-35 years
24
80
6
20
Less than 20 years or
more than 35 years
o'rlloii s do:rorraua{il1militir tfi e tiliuu rfi suntnirmrin u:netaso
I
11114$nil1?n
utnonoo
(nir)
dtrennr:n
nnoo
(:rs)
o-ottotggoo
il1tnn1er
rjinhrfie
(:rc,)
nr:nrjirirrfio
(/ t,ooouirttrs)
OR
1,000-1,499
10
6
600.00
194.88
1 , 5 0 01
- ,999
21
5
238.10
40.60
2,000-2,499
112
6
53.57
7.35
1702
13
7.64
1.00
>2,500
95% Cl
39.42 - .t017.56
1 0 . 0- 1 3 9 . 1 1
***
2 . 2 4- 2 ' 1 . ' t 9
1445
OR = odds ratio
**
gso/o61= g5o/oConfidenceinterval
***
|
|
uonqirrorirrfirlueiT
drunr{flfiA p <o.oo1
a
)aY
a1n0''lT'1.1fl 5 ytl:nnilu']14iln$Tnnn00
v,
1,000-1'499' 1'500-1,900,2,000-2,499Ufl3 Sl.:tt$1
-
Xu,a-
2,500niilfi dlrj fid'o:r o1urjSnhrfieryirriu 600,238.r,
do: r qr uil i nhrfioosrlfiil duorir r firigdrriruyn.iflfiG'
d'rnr:nu:nnnoos#T
Hrinfioln.ir r,*o niru
.-4_._rade-AaZ-y
I rl 0 [ u Tuu Lytuu n u il''l Tn[[:n fl n0- ofr
frur Hu n 6tr u qi
-
Jra,
53.s7 t[At 7.64 dan,]TnflOo1.OOO
:1rJ Sr',]ilflhd'U 2,500 n:ililu[l1
8
?Trrnlpint#fnaturwtsatmia1frn lfinutu.rlnftrfintn{t
fld n atiud t u.n. - fr.n.zssa
unlorrol
vrl{nltulrnfddrulnnr:QnnrJ'rrelunrnl:n
ilrtndnrlnrulu z
s1nn1,lf,nr*rn#'rdxu'jr
,firoo.nT:lrrsrurnofqrJ::rnn tiildfi
n.r:f,nr**durriufrnrrnrs:ro.rnirn:Jinhrfin
ufls iunfi'rnnonfil:{wurureoiqrJ::rnafi'l'rururiou
rdsrfiuuriunrrno.s'n'ofio 1:2e(or:r{d r)
n'rrilEn1rn1,
6.r6e.irfisqr6'r"*...";,,*,.;.;;
uurnr.rb{rfi"o.rr.oo^rir{*,.1n1rnrnqpi.*nuorflurnr;'jrl:tvrururnoiqrJtrvrarflul?{vlu1lrla
irurnrfinldfirnCsrdrrrnrulonr:nu:nnsonun;
'..'o.ruf,:yr1m1fi6iiodu
*tiu'dunttn
nr:dnurnirdrflunr:6innrrfi*,r::n'
Tou rlnnrn:firirurqrril'rrrotunlr$un
rfiu:YarynriorrHd'.:
-"--r-'--'-"-'- d,rrioxnur.rari.r.rarlntrjelrtr:ai
- - --r-'''--.'-1r"- dnnooosmr:Y:":tmosonitrurTttjt*lu]o
frirunrrdariT
ur{u6o6'un:ru1u:irru:nufii
osr{,rcio
ttfiuil{o
u ,r
laur:nlrnn'ir udu
hjl:'llrururnfrfidonrT
I:.rnururnoiqrJrrnn
rflu1:.r?rururnTllu
rfu.ro 1zords.ro{aorTurT
uuourilr*r doorfi lr.lttururnt'tr;ilnrnfir{uvrqi rTiol:':t'tururn
r{rrr::urofiuqruaf
ftniorj:r6uqi
{rhur'rT,q''riunr:inur,.u#iu.ro.dr,.
ernnr:6nr*r
ohnn,,riun:nnood'ru
crnnr#im*roiodtd',fiufiugu , thniufrnuru:nr:nnrulunrrfi
lil1nu 1:1'42
rlr'lg
" ?{unlln,]ulllouqunonl:n1ufln
m:orfiurRnoorln:d.rudiufi1 qalnil il.a. zsss6r
---.r- ---.-.--.-.
-..-. -
, u
yrlTn
?1t7130 flttu1uil t{.fl. 2536 flu?10nt1fl'lg?B.til1Tn
do*u
n?{nur1ilnurool:.:tr.ururnlnrnln:n[
- -,
-
,
:
)
,
q
r]irirrf,ors.rIr.:fiururnsiqilrrvra rvirfiu ro.zo 6'nnr{rurvirri'u2i1 Glarrnqttruluqilrernnm:
danr:nnoo
1,000
?.*Jd.rri,rn.rg.raqj
rdorrJisurfiuutrossn6toulu::u:rioxiunr.:liuo1l.wr6un:rfi
riul:.rrrururnnr;ilnrn#r r"unrli 6'.rrflu Rnoo{t;1{11n1:$un1:u!trufTtilr{iln?']llmoq.
tR:oJLloYlc;nt?lioul'l1
ll']n
I:orururnqurirru'ir fin:rnrs?,o.rrrrnd?rirrfio
-u0nl1nilun?
rrirfr'uro.sdon.r:nnoe
1,ooo
rru lufl il.fl. 2s34' n'lrufinrjndlslvrr:n1*r:usrieut{un::riun:::l:
t{un::r{nnoo(t'tsl' csr) fisnrrrutfr6'qdo
un:I:rwuru.lflr:ua{ d,rso-n'nruruo-rn
rj?nerrfiorvirrTu
rz.secionr:nnso r,ooo:ru 1ufl Tr':nururnsiryrJr:rvrafi'r1ilfi
fl1luEn'lrft1ulo'tnr:nil?rirrfioln,lfrrnnrqi
rr.fr.2536'*girsouJ?uurfiuuriuT:ifiururnr:sui
10't.wigglesTnn,ernHnnr:iinr*r(nr:r'rd s)
nu.iraqi*nl..*r1e.6dr ;;;
1ufl n.a. 2s27-2sso,
nu'jrnr:nrsrflouriurflnmtnqnrrnru6'ui'uu:nds
sianr:nnaor,ooo?,ru d.rlu,jrd'n:rn,rro1u?,0.r
vrr:nr]irirrfieluT:.:nsrurnoiqrr:rrnari.rdrn,jr rtulaunl40nll;tl']ooon6tcunu:amurfio fsun:
ttruiunr:naaerriaurhuuonrruf,nrruci
fin:rnruza.lyrr:nrJ?rilfin;t,*ugoqooqidqlm
1t't:
1,ooo n'][uountfi1ruqloilM{uraunl20' 10u836'67
!.r?r1r.r
1uilr,r.c.2521'o
rr{ilzts donrrRnon
lufl *.a. zsza" cl.ltln'lnil rrulor:JiuurfiuurTul:{t{ururn:T'iu6
:rrJ 6fruiudlr{}r{u1u'rnr1,riu6
e:unncirlrisu:ilrurn6avtu
o.zcionr:Rnoo fl n'a' 2s21-2526"
fludn:rnruiloonr:n:J?rirrirnrrirriu
founl s.r d.:
Sreurflud'ud'uqnfrrudo
I -t^n...r*rir=r",,rr,, 6o'jralraq
t"a".
1,000r'ru ronrnqnlnrJ:;rnn'lnu
rr
ltttl:oujnt
.. ,
drcrtfl*rx:r;flti'u'rturlor tdn nrrf,npr ordx ulctuuqQUil']c,ln{il?u?llJ1Rn0071[1't]lu1u't80
uH*noudrn::ri rl::ufle druluqjinr:crnn::lidqn6'oltulrlau
3'rurv'r..rrfi'*5fi0 n'rr1''r.r
*^unot uo:nrrqunlutu:tiuR::f6's'n'jr tdu
i.'rl.norrrid,iuonuuurq"fir; ;;u;;;;;
q ^&.---t
ctunlr$$nil1to1!ilnflr3o,to:Tnunrn80nqor
,iu
ohuruqnarn: n'rrruf,nmrufl1ill:nnnoocuqrlnmi
d,:rflul:,rriuu
trjiuurfiuurTulr{nululnrlurfud
.
[tY{Ylu
Vol. 12 No. 1 lan. - Mar. 1995
9
I Prapokklao Hosp Clin Med Educat Center
aA
rufi'ltlfi6.:nr:finr::JiurJq.rnr:gunil1:o1
rnsnlrn
ttTnnfloo ilt{a0ooafllqluljo.]yt1Tnil?rirrfiot" 6.r lufior:onnaouflsfi'0.:nnao
rdu n1Td1partogram
v
YN
@
a
f
il{# nlrtriildoul#iinr:nnoodrfiuuru rilu6'u
n T\:n u n 1 Tfl n u1 n T{ u 1t0.1!T.Jilt u 1 u 1 a 0 t qil : g t Ylfl
q
Y
A
,
'
e
uva
(sl1T'l.tYt 5) o.1l{iln1il't:o'rto;un'tTqunlilT;u:
2. n?rfin'l:i6'urfirurGru
uiou1fl1
rfistHtofloi'u
n
01nn1:flnu'tvtr.t''tl.[tj''r lr'tu?'r1{''rfi
unl0.lYl']:n
a t e
Y
c
I
o,t r
e
i
aY
i
fl \:nTTR0 U',1.0
nqt nfl 0.1 [[ n gn "t[HYt1:nil n n 0 0ilu']14iln
Y
- Xu '
|
^i
v
v
,t
A
frrfru':rio,:nuntxrfi [du rir.:lrnrfinr:nnnool
aa
i"
orruei 2.s00nfilfril[:J d'o:rqrurolyrl:nilin1tuo ifnr:nnoo qna'rnrfiyrhnlrnnoo
r[lu6'urfiorilu
lllv
e
o
Av
r
[[u']Yt
f .itun1Tnon11:d
s.,rJiu:j1.:qnnrn:#tuwnri
1,{u.ul.tn
un:
r{r r.rrirfifigurnrl'o.l
naool#firJ:: Rvr
Gnl^r fir riJul:Id'
0gnofl.3lo0u't.tiluufl''tnqytl{flnel
q
e
v
e
Iu "114
il 1Ufi n n tunlTnO 0 6tT't9t''t
U1Jo.:fl1:n
a
f
X
te
u:n1 Luolj0.J[T.:y{
u1u1n0Tqu:r [?1fl 1tu0Hnunl?;
^
A
vtee
n']:1j']ooon6roufi.:r,ru[d'ioun323.33(or:fifi g)
euh
f,
I
iv
a
e a
ia.l
6r{
[uufl't [ilo11]J0.Jnuto"
n1iln1To ttnmo tuTg14?'1,:
IU
A^AA
n l Tnn 0 0 l[ n i n't TI n 0n ?!'n''tTnn 0 0yltfi tJ''t; fl tJ
-t
o
A
x
d
l,lvo
9ryyA
'
Z
t
odr.:n: r6so-qn r6ou rfi orir un-ufio1rnn H.rfl1ril q
nTroTuryi'1fryi'itd'$nril1nrflufl"trfiqfrfl..tilrrn
rlo.:rTu'[6'
n?rfio']Tnn$n:il.1rru?yt.t.::-lolrTuirrufiu
nu[9ru'] [on1iluoL14flnil1t{''lnflT:nnt.:[tTn
flnnu
llI
tf e
^
d
o
a
c
A
IOflUflOlIv,lYlU ttd;iln1Tn1ilUOR''l']gnTTRtflU.:RU
1l
I
6 t sYo.{
r r:Jal t 6t rrr^ryrriyrnn{,r fi rulh nn: : ri s'rn iu
A
e
&
Vuo
qer
I
^
Y
6
6. n?:ltu't u'tilfi .tfl1 [ilqn1:st1 u1o.:yt1:n
fln1u0u'ttJuuu loiln1tuTgfl1u.:'tu[14fl{fitu.to.:nTTn
j';Yit
qdlv
.
eA
6
-
A
dq,
v
,
-
X
i
6r
uv
-
tu"lf'tytultJ''tn1J1.{[1t00yLottu?7t1{lun1Tnoo0T,.l
I
)
l
^yt'1.:1
^ ^ - - . . - . ^ a 4 - - --
t il 0n "t14uo 0'tuoT:R?1uuuoill[ ngno n :0.:R1?! ftTTR
tfl u{n u
r
trfld'uriuau atoot [fiil6qfl ?1uff1il1Tnliln..t:q:?o
11il'1
fl 1n n TTnn :,t [LTn il1Yt[:.:yt u''tlJ1n0TryUT! [71fl
A
4. n?rd{rff?illfrfi
nr:rJrno::fififi:J*Rvrinryr
5. n?:iin''trdtrfluoT1u\r-lilyt1rno.ruil?ri.r[fio
fl']HTU[:.:v{U'rUlnoTquTt
lyrfluu ilqo ttvwlu
4
d l
il''tnlu
^
a
a
d
n?Til ggt[ll tytu:J:901140,:nn0o0
n0o
ris
a1uI o{n1:n:J?rirrfion.l
s {n''t1tiln tfi il''tt{'l nn:TnY} [:.11r{
u1uln
aiqrJ::rvre4nof.raun:!yT.rfl
hi'
aao rreirYrrJn6fi
<)
,
v
a
t r4 t
q
I
Y
v
9.1"r
n n :TRyrffn 1u0u1il u6t0 [:J fl ?u tu140{n n00uu
mr.:T:.1yrur:-r1na;ilil:sInq'[6'tir partooram il{#
q^uu,i
liln 1 : O [[ fl n ? 1 il n Uil U1 I 0.:n lTfi fl 0 O
{
&
T
|
l4
rVl va
e
[U1{[T.:1r,1
U'ltl 1 nAilTil
t.
a
dVl
U.:
rll e
uJLOiln1:uu.3ue.run
flouy{ylulil [o$ttnuo{na0o
A
I
A
yt
v
A
Y'
9
[1'{U{0U1.:rAU10A.00U0rutJ?u[lruiln0uo?u
iliUl{
!1l
cAdeaety
ttlr,tYtu
ff'tlJ"t0ilno:910.:[? uuil1q [tnil0.Jfifl0o tSunu
oqerl
ra
r
q
A
o-o11o"tur o,0yt1
Tnil inh rfi oluI:.:r^ru ru r n
Ugl[110.:Q'ln
df
t:.J1,{U1U''ln 0 Til:l :3 tYlfl
fl:il
t
Yr"lt14lrJiln?1il00ruo.J[[fliuT;flylfR1y.tlun']T$un::u3
onoq6.tfioun.:
oirp:-l:;rne srs.Judiufi1 En.rnil il.fl. 2s3sfi,:{ufi so
n-uuruu y{.fl.2536 T.tilr?fl1 r fl ryirri'u ro.zo
sionrrnnoo 1,ooor''lu nu-itfl,t tilEn1to.tuuo.tyt,.trn
jr)a
frr^ruiloufiqo6onrrsr.turfl
ouu;u rn;R1?ylJ..tel
y{uiouny40runy23.33
aan6rauy{uilrn6'u6'usor6o
T
n il Rhsi'u $nsdolt et.tu"tJa.tyt.r
rn:J;nhrfieqynen.0
orir.:firiudr6'ryyr"'r.cflfi
A rfiarhurinvrrrn[rrnnnoosls.J
[Lei
-
Xv,
2,500nfru6uhi
uao.rlr{rfiu.j.rn1:nr:dulfrir:or
9'
1roIdt{oltuy
'----r-^---f
Y
---
soqu
rj'rr{lnoTTR n,lTg![tnijfi.{go.0o::n
m,.l[fm1:nrLTnoaoo
j.
--.{-:tt-r
4-u?----y-&...-,--
Ar
-
;
X
a
1 . 0 1 n n 1 T f l n u 1 v { u 1 - r R 1 ? y v r 1 T n 1 1 0 &ru']fiuno.:rlst
2,500n:ilTutrj unsfr'firfltpu.ofru
6a
oon6rail riluerrHqnrro'ru1J
o.:yr1:nrJ?nlr
rfiofinr
I
A
e
^
A
Xt
i
v
a
uau6r{ilntnoflilgnn00 s{n't?!uu'l0yua.:nufiT0
6r
i4
d
I
q
n''rTq
un lilT: u:nn0ofrilqiln1y{o3ii[t?ulunlTnoa'oT..l
Er''t
ulJo.ryl1Tnrjinh rfion.r'[6'
10
zr.nrp6n',#fnwunnuaternin6finl:vnafl.rrlnftilntnit
WigglesworthJS. Monitoring perinotol deoth. A
pothophysiologicol opprooch. Loncat r980;2:
fisrfin:ruJrsn'rfl
648-6.
lavua
lalsunrJqar uluuwns2Taa nlttllnrflu
eo
World Heolth Orgonizotion.lnternotionol
Revision.Vol 1.
Clossificotionof diseose.tcT5
HeolthOrgonizotlon,
1977.
Genevo:World
elqrni eludo, r.lrvqnonulrvfiq, ilrvnu qvroiqvrf
ttn;n(uv. uu,]vr1{nlronanrrnrsvr,rnrl?nhrfin
1.ulr{nsrurnm::lnrnd, {uvrq?il u.A. 252a-2s3a.
ctn, r4utinrrf,nmunnriarnnfnfifinlr{nsrurn
flrcrlnrndr2535;9:r90-8.
6rn.rd 4cmrun?fi
qn. n1?n1sno{vr1tn:i?drrfialu
1r.:rsrurnlcaor. mrotlrrvtarurntn:fi zsso;o:
'
t
fld n alfud t il.n. - ii.n. zssa
unt tlr.twu'tu t aaiqil r m a fiaryqt abi
{a\uz
o!
u1lflua11gi1uv
ronmrdr{6{
t.
CunninghomFG,MocDonoldPC,GontNF,Leveno
KJ, Gilstrop LC. Willioms Obstetric. teth ed.
ConnecticutAppleton& Longe,1993:'r-9.
z. World Heolth Orgonizotion. Wodd Heolth
Stofistlcol Annuol. Genevo, tPs3.
13-28.
s. nhuul nrqr4unr, rJrsn-nf lorJr;rn?3n{nof.
nlrn'lslro.rfl1rn:l?nhrin.'[u
:nf,rrnnfruTirLd.
riruu': nrqr4un'I,filJiln il { rflils,'niln'nd#otrr q^,
ai'ru lrnurln,
nr.nufiar.rrin{n6,
qri'a 6uvra:Jr:rn?3,
ur:rurinrr. nl{rvrnrJulunr: n'rrinf,udruiihfirfia,
2530 i 59-73,
a. World Heolth Orgonizotion.Report on soclol ond
biologlcol effect on perinoiol mortolity. Vol 1.
Budopest : World Heotlh Orgonizotion Stotisticol
PublishingHouse,tczo.
'|
t.
Poungsok S. Perinotol mortolity of singleton
pregnoncy in SoroburlHospltol1e83-1e87.
A thesis
submltted in portiol tulfilmentof the requirements
of the Moster of Science (Humon reproduction
ond populolion plonning), Foculty of Groduote
Studies,Mohldol Universw,1e8e.
Vichibondho P, PornsinghoT, PochipleuxP, et ol.
Problems of hilltrlbe people ond integroted
devefopment J Med Assoc Thoi tcat; 6ai159-73.
O-ProsertsowotP, HerobutyoY, ChoturochindoK.
The perinotol mortolfty ot Romothibodi Hospitol
1979-1985
: onotysisond lrends.J. Med AssocThoi
'1987;
70:329-30.
Vol. 12 No. 7 Jan. - Mar. 1995
I Prapokklao
11
Hosp Clin Med Educat Center
A
Gv
et
ultufigtufllJlJ
Sulbactam/Ampicillin
: slilnfiruv rfrar1a.rfru
VS Cefoxitin
[il n1t fl'tnnna0n?t?{?til?il a{
6l.vVt,
rlzvntr anrianG il.il.*
q9
Abstract
Sulbactam/Ampiciltin versus Cefoxitin as Prophylactic Antibiotic for Cesarean Section
Prapap Yuthavisuthi M.D.*
*Department of Obstetric and Gynecology, Prapokklao Hospital, Chantaburi, Thailand.
J Prapokklao Hosp Clin Med Educat Center 1995;12:11-19.
A prospective study compairing the prophylactic antibiotic for cesarean section was done
between sulbactam/ampicillin and cefoxitin. One hundred and frve pregnant women who undergoing
cesarean section were include in this study. All of them had high risks for postoperative
infection such as labour pain and membraneruptured more than 4 hours , vaginal examination3
times or more. They were randomly assigned to three cohorts. The control groups received a
single 2 gm. dose of ampicillin.The other two groups receivedeithert.s gm. of sulbactam/ampicillin
or 2 gm. of Gefoxitin intravenous after the umbilical cord was clamped. The incidence of
postcesarean endometritis was.31.4 percent in control group, but it was 11.43 percent in
sulbactam/ampicillingroup and 8.52 percent in cefoxitin group , which were statistic significance
( P < o.os ). In comparisionof sulbactam/ampicilinand Cefoxitin,there were no statisticsignificance
in incidence of postoperative infection. Within the limits of this study, it seem to conclude that
sulbactam/ampicillin' is as effective as cefoxitin in prophylaxisof postcesareaninfection.
*nd xotuf,6 -ui ndnn x [sonstut anssilnn h {unqi
t2'r,r?nrpin:,#lnallr,nnonlmia6fin btnenunn:r;ilnn#t
unrir
qrvdtvrlryo.l
ilfr n ntiufrt a.n.- fi.n.zasa
a - au
rrlurnrErirfi'nurdlfidsrfifiu
rflJilu${n{T:ounna{n'
(toxicity)riau uncldfinr:ldurilfr tytdo"
''rnoRB0nyll.nru'
tuu0lu 1{ u n1:3"t
rflr*nrJfiirrsdurnqnCldin{r{srr.t
ampbiltin
(cesarean
section)rfilduadr.rmn rY.rlurJr;rns
un::rnrhjuvw6{rflwrr
n:ounqrrdold'unrsrfio
ryrsornsfi6toil:{flururnyr:;rjn
rnffr
unssir{:J:r
lunrtdr6'nnnonrlcr:
drirurlfrrfluurrJfidtsrlorfi'u
lufl n,a.
{uvrrli uu'jr iinr:nirfionnaomr{urtrfror
drruyrJunr u unrrfludusufulu
vrrrurirfi'orriuo
zszslsunc a.z [nrdn:reir6'onnsnnr.:rafirri'a.rl6'
:1o1iu
lfiudr*r4so9 rflufuin: rs.o 1ufl w.n. 2s3s
1u::s:un-{u.dldf nr:rirrorsrlunqr
1unr:rir6'nrfi
llrndu rdo1frr6n
riio.rornfiriorird
t,du
rurvrnno.r1drf,uutJfi6rt
Cephalosporins
rfinruriiiiinrsnrJoaofiulhdu
vru'ir
nogqnflil.rnrir#o.r
rlo.rriu1nnr:dr6'en
ruri'ir
nr: drfionnoonr rufirfia{$d?uno6'n:r
urdfiuutflduri
ldldHndn'i'ru.d1du
4rau14-16
unfi'.rusifi il udr yrhtr{frn tl ;
n1urloiryr1r n1eYri'r
cefoxitinrxrr:iif,r*fioufiqnGhrrdouunfiriu
morbidity)
rfiududru (
un:ndsululr:or (Maternal
uwnlrot'lrl Il rnqnlo.tur
uactericioat)lfin:ounql
6o
nr:rird'n fir,rurio
udqn
Inurom; nrr6ordsufr.r
t
{uo{fiuulo.:Ilrnr;n
-
ccii z c[-melthoxygroup
^
Xt
nr:6n
r6ob^rxmqnd'n
rrunut#rj::lrrulsun;ss- nhlfrnunruciar#ouunfiriudfi
p -lactamase
tiutdt
e a
r
r
ftY
ro-rsrvirsarnrrnnondni
3B'-' d.rdnrflu
enzyme t{0Bnqntr tnHno ua;u'tilqYlt9l
^ lr r,l
t )
tu:;u; ro it u.d1dfin.tiins.rrYun{TuunfitTutfrnfihjfilornrs
(anaerobicbacteria)
n6'rdr6'o
un*dfinr:rirutJ$- louronrntrn Bacteroides
rdonrifnnnrrGor{o
iilrulr:dwilo.rrTu
riun'ir nrrhiutJfifitrs nr:6nrdolunr : eir 6'nnao
6t*ru'r1fr{rhsriouiirfi'n
nqn:nrrnfirrio.t ueiur
antibiotic)
Ioudnnrl lunrilds:rn1$Tririir r6onldrsr
rdsflolri'u(prophylactic
rr; {rJruur.r:Tu
lulnsdrdnRnon
ufiicrndniiusru rvirfiu
nnoorfioncir
mdsrdnusrnu'irsrrr:noo6'nrrnr16ordon.116'rJopTufinr:d'unusrtsutbactamdrrflu
oritiiriurirrYrg*'
penicillanic
oonqvrf,fiurYo
derivative
acidsulphone
nr:tfrurrJfi
6rw rdorJo.rn-ulunr:ilrde - tactamase
ur
enryr" 16 rru'jrrdorirlrnruqjfi'l
B
e}fi rdu rJ$ftwdr p -tactamrrh ampicillin
nfirfio.rfuril1fr1u:ru#ih{urduoqocionrrf,
ufrrc:rirbl
aAtu
r
r
iil: urnaonff
uturu fiq.rrirnfrunno
{ururiouRaae o0nqilfoToufiqiltaaul
unfirful6'n{rou.nd*u.ro
finrmrrenrrriorRaonun.uoioiinm;Iofioorr *rrdod*rfiqld'nnrurficurndurriu Haemophilus
rfinsonldr{rl:J influenzae Neisseria gononhea Enterobacter
un;iint:t:frrnio.riionrrcrouillrn
,
,
(intemal
monitoring)'-"
luTrr:'runnn
|l83 Bact€rctdesspecies":'un:ri$Ciinr*rnrnu'ir
,drdtirlttrrfi
onr:6nrfodnurisulfiurie,coti, nrr1frSulbactam
nurrninur
nrudri'uamplcillin
pneumoniae
dlrflurdouunfiriu dnd.r nr:6oc#am.ruirrrl6'nnori"ofi
Klebsietta
ar-ar
us:nn6tfiuutvir
o1fl'rfr(aerobicbacteria) un:rdsuunfiritildC.t nio6n'jrGefoxitins
ipiu6lruhdo:drur sulbactam
ld'uri anaerobicn'ludrTuampicitlinmnhnr:finnrnnno.rldrfluur
o1n1n(ahaerobic oacteria)
streptococci , Bacteroides fragilisf ottfu
fAdlyvirv,vv-
rJfiirw rf,orlorriulunr:drd'nononqnrnrluilrfot
r rfl orrTurirufi rnr r i r f,'n rujilurfiruri'uur cefoxitindlftdH nd
u'lJfi6rr* drnir'lrfl#lr+n
r{ofier
Rnonmrrnrirfra*tu
wd'aofiqnfn:auoql
iinml
urrJurfrouunrrflustuqlunr:fior#oriou
Vol. 12 No. 7 lan. - Mar. 1995
I Prapokklao
Hosp Clin Med Educat Center
13
n1u6{!60
r6'nu#r 6.rrfluidritfErrru:Jndtu
T:.:r^r
ururnyr:::Jn
rn#r'fi'uyrui
inoil:va{rf
I
th
, i
{erqrJ:re.rritornr:6nr*rn*rdrfiodnr*r
Sutbactam/Ampicilin
frileun{1fi2 ar16;uu.r
rJ:sfimGnT
nlo.:u'rSulbactam/Ampicittin
r:Jiuurfisu (Sulbactam5oo mg. +
Ampicillinr gm.)rrirnr.l
rTuCefoxitin
rfiotfrflusr:Jfi6t+:rdoflo.:riulu{rJrufi noo r6 oooh ut
t ru: vrhnI : sir qionooctq or: vTufi
'
y
it
fi rir6'oonooqorvr'r.:fi
fi1fr'ol
ua:fitlofiurfrurgreionr: H6'rornufiunr
ua:do
rdnufi'r
not50
9tt
r
i
2 gm.
{rJeuniid 3 os'td;uurCefoxitin
rrirn
rrH
o
no rfioqfir rdufi'u vriufi
rafi'.1
ornHfiumru
O
A4
A
AV
?fio"1[uunlt?ou
a:6ardnufir
u
I
,
i
a
6
a.
A,
nr:urJiuurfiuurlnla,lu1#.J
"
o najruqorn
nn9 ilq?ou''r{yru']il']dnur
rflufirjrufi ilrqo
il
rdoHrt'lnr:rirl'orru
nnooqotn''r.JHrirrYo.:
ru I:ll,r uru'tay{Tg:J
ntn#-r nnuru:ornrrro.Jn1rAq
e
dY'
'-A
o-A
lnt.:loqnonrau nr:6ordo
ouytuT st.:ust'tuYt1 y{n:9R'totj ilt.fl. 2536 o.J?uvl30 nrrfihiufi'.rnr:dro-o
fiuHarird'o ntr6ord'olur:uuyrlrrAuflssrrs
tutg'tuu 1,i.fr. 2537 nqilo?0u''t.Jytu'ttj1flnul il
*,u,Ja
Iosfifiurrura.in116ordo6',r
d
nilflilusto.laot:Ju €10
r. nr:fitrirad'lnjrd'o
(feorilemorbidity)
r. o'rrflu6'o.lrir6'onnoouq:
Toufitrild'nhnuol'[oTo
t
le
tl
I
e
j.
,
A
A
I
rir.:Hrir (unscheduledcesareansection)
aq
v
i
'
^
e
X
I
e
A
2 . i l U 0 0 u l f l u . t o 0 n 1 T 9 0 t r o n n J f l ' t onl o0
adtYl^
iln.t: tquflT:n [tfl;n{u'ln't1
$anu,lutnun']']
t
.1 t
a
a
,
&
r n nr :fo qilfi Qfril 1,0
il1 n ryi1riu u 5orur nn.i.r
38 o.rfl'lrsnudusorir.rfiorJz fl#.: lunnrvirrfi'u
e d'rTil.:Ios unr{ulurir.r zq frlrJlrafi'.:nird'61
,
4 t? lil{ 14T0iln',]:St:',t0yt'].ttr0\tftfl 00 gr.J$sl
yXut,
3 nT.:fll{lu
v,ll
z. In:.:ruognd'nreu
(endometritis)
fiornr:hi
drnmrJnrfinFurHfiu
noriufiruogn
Torufinr:lxr:
rurdo*unfiriufioril
s.'lilfi'lfiornnT
ss r#ooroyruraionlrir
:{qqrun4fivrrr:Jrnlilgrn'lr
AA,UC
s. nr:6qr4'ofiurnrn$ir6'q
(Woundinfection)
o.:fl1[6DA[tljfl 14:0 100.4 0.0fl1?11[Tiltayl
frornr:'l:i uilnFirqr-efrnr:a''nrau
u?rJ r[o.r
nrrlu za#rlurriounr:ni,d'o
+ .l u f : J : y r - 6 'rrrv" A
a rmp i ci tl i nHi o ( c e t t ut i t i s ) f u h r Hd o . r H i 0 1 4 u o { o o n i l . . l ou1r n.nt
._v
Ioufinrrn^rr;
rdoo;l
run6o'trir
rurdouunfiriufiorr.r
cephalosporin
^x
4. ntr6orfio::ulnrlrGuflsamt (urinary
tract infection) 1d'ornnr:rr{r:rd'aturJsarr:
nau9.l'l616l
n'ir rou61/run.
Ioufiuio'lrifr
oln..nr]fl
fl..r?;
o.lilfirj:sifinioornr:roilrnlCIraiol:n6'u rrurdorurn
fiqilnfi fibiHiolilfihifierrru
rioudr6'o
A
nr:? rn:rrd'ru
nnr:6nr*r tfnr:ohurru
nr:6nt*rtflu$uu prospectivestudy s.t
rfiuuvrr.lsfifirordoryod'ruif
Chi-square
test
tudrsrr oroirncim fi{:Jruurirrir unr:6nurrfodu r:Jtur
-.-;
A
f
p
locrfi::6'ufiurfr6'ryfi
<o.os leutf computer
105 r1u uilloonriJu s n{ru 6":a?6Computer-
s.hifirJ:si6'l6'iuurrJfr6':r*rurrioulurirt
ziu
program Epi Info version s.o1a. public Domain
(control) S o f t w a r e f o r E p i d e m i o l o g y a n d D i s e a s e
rfluneirunruqt
generated randomized cehedule n{lnt
eh
'
i
35 T')U
{rJeanq'r{ir
oi[6'funr:dour Ampicillin
2 gm. rritntynoo
yrh
rdoooh tul rxs nr:r^ir6'onnooru
or: rt'ufifi ufiu
\ve
a
-
I
SurveillanceCDC Epidemiologyprogram offfice
u.s.A.
14
flidu ntiufi t u.n. - fr.n.zsaa
nrffir(uinlrifnuumnuf,ttnin1fin Tfinnunnftilnrndt
<IrtaturAr.
A
fl [u?tul1tiR?1ilunnn1tnu (n']t1.lYl 2) R1ulu
NAn1tflflU'.l
.,Jitveti|.vUr|J
lrBU.tX[}tn'l:H'ln0
etr
f,
o
a
I
a
Hulu1tyr1n1Tflnu1Yt.tl4ilqil 105 T"lU
^
X
O.ttn Ufl R.tt? [U01?1.tyl 3
eteg
A
r
I
n'llnnlA0$n.tHlnCUU tr1n0']t1.l7l 4 03lr4U?']
n{lu:n rflun{lnruqu (controt)3b r.ru {rhudtdiuutJfi6ers#orJa.rfi'u1un{l
sutbactam/
2 gm. rfr1yr1{un0or6oos{'l
atld;um Amipiciltin
finr:fiordorbun'ir
uwnrildtdiu Cefoxitin
amptciltin
z gm.
d.:rflunr:1fr1tjfi6'lu:t$iorls.:rTu
tunrreirn-onnoortunq'runruql(controt)
dldiru. Ampiciltin
Jp'url
"lu,
n
11n
:fil#fr'uo{Ioufi'drJrhilxr
nr:hor#sdnulffiiou
odtfiriudrdq (p=o.ooo++)
, ,l
u ys
nqril 2 tflTuU,.| sulbactam/ampicillin un;firiufid'q6onrr:Lt:luo0n5'ntsu(e =o.ozree)
a&
( P=o.osses)
dr u
1.5 gm. ilYht14tl6r
35 TlrJ
uasnlr 6or dofuHndr n"o
, i
r-t6tiJu1
s^!tl:Yufr.r
noso
nqrfi 3
Cefoxitin 2 gm. 01u1u
nl rnerro:3uuyn.rrouflflf,1?3uf,3R1'l
35?1rJrdUrTU
rir'rrbri'r6'q(p >0.os)
hjnu'i rSnrfl r nnd'r.trTilo
finunuto.r{rJruluucin;n{llnrrr.rd 1)
fir uunuJluurfisunr:6ordsts.rurfild'iu
ru'h fiarrl
r q nr:drn rrr{ luueiwnriuuJiuu
rfiuufiunrilnruqu
hi yru'ir Snrr ruunneirr fi'u1ud'ruo
(nrtr.rd s)
T;u3t?n1frq{ unneitri'uo
0Tqnrrri 1!ur[?fl''r1ro{n1:Rnoo
dr.rfiriudrri'q
rdurdu'lrTu
t
t
' t . ' - - -- du^u
ilR3n'ltnn[to'
drn:'runnchurunirgo.tnllnr?tyr1.tdo{RnooBns
tvrtitue$n8n[flu
!nu[s?rrn1?3
niromrur:irriuso.r
r6oondrnrrd16'odrunmsnr: rir6'oSrir P <o.os
vrv
riourir6'nun:if,q{iilfr
$yrrndorr:to.rnr:fr.:n:rf
uriavo{u
nJisutfisudnuawcor
srur.rdI il6ro{Rr:
{dtradriu'rGflnu.r
Control group
Sulloactam/Ampicillln
Cefoxitin
Ampiclllin z gm
'
(x = ss)
Xs SD
(tt = es)
X*.SD
(n = ss)
Xr SD
Age (yead
Parity
25.3 L 4.8
24.4 ! 4.1
25.6 ! 5.2
0.8 3 0.6
0.9 1 0.5
1 . 1I 0 . 7
Gestationalage (week)
Length of ROM (nours)
Length of labour (nourc)
3 9 . 1J 1 . 9
39.7 t 1.8
38.5 3 2.1
9.1 t. 7.2
10.4I 6.6
1 3 . 8t 5 . 8
12.5t 5.6
5.7 j 2.5
6.2I 1.8
1 1 . 9I 1 . 2
12.2 + 1.4
1 3 . 1J 5 . 4
5.9 I 2.1
Vaginalexamination
postoperativeHemoglobin(gm / 1 o o L l h 2 . 1 + 1 . 1
Ht|',lgtilE
- ririrjt#rml,rrodux + sD
- ROM = rupture of membranes
8.61 6.8
ffi
Citrobacter
,i-r
'l-
IlFnq
Haemophilut
ok
whatsequential
Ciprobay
therapy
didtous.
Ciprobay
trum
covers a broad
Nei$eria
of gram-positly.g",
and gram-negative;
pathogens, includ-1,i
ittg
multiresiqi.
' ;
tant strains.
'Ciprobay
reli::l
ably eradicates
large number'
organrsms rnvolved in hospitq$
acquired infectio
and shows bacte-
ilp
Pseudomonqs
.rl&.
:E
-
-
U
Enterobacter
tiresistant strains as well
as B-lactamase-producing
organisms such as staphylococci, Klebsiella and
Pseudomonas.
Escherichia
#
and cuts the cost to about
ii,fr.iendlV
i i U - i ^ * i . ' ?. ' . - ' .
le;:C[nethird of that involved
ln qther established
peutic regi-
Shigella
fi.ens.Further, the
I,fime
and care
[:::"^:t"ill
1:":
:"-torand nursing
staff as well as
hi;i the time and
ll'.efforts involved in
material disposal
are markedly reduced.
1l(,'.
I
t
*
Staphylococcus
g ram- p os i t i u e org a ni s nt
/]::-,
Sequential
Ciprobay
therapy: treatrnent started parenterally and continued
the oral route.
/]:-,
Z-\
\JvVv
/^\
/^\
\rv\J\/
/]:\
by
After parenteral and oral administration, Ciprobay reaches high concentrations at the site of infection.
Sequential therapy is patient-
Modern medicine harnesses the intelligence of
Ciprobay.
ff
StaphUlococcus
,.-.
Treatment with Ciprobay
makes full use of the intelligence ofan up-to-date preparation: Ciprobay attacks
the infective organism at
the base of bacterial metabolism and
prevents the function of bacterial
gyrase.
Since there is no plasmid-mediated
resistance against Ciprobay, the risk
of resistance development is low.
/4,
i4e.
Jili
-
il
Salmonella
.-ry.r.
-qE
Legionello
3@
"F"qE
't
ii-l
:.|-;
-
/
l-!
Streptococcus
G!
Haemophilue
ffi
Neicseria
(asHCI. H,0):tablets
Cipr0bat:
Ciprofloxacin
Concomitant
intakewithNSAIDS
250,500,750mg;(aslactate):
inlusi0n concentrati0n.
canprovokeconvulsions.
Transienr
fluids(50ml,100ml)100mg/200mg.Prcks:
was observed
whenadmtnrstered
Country
specilic.
Indicatiors:
Inlections riseof serumcreatinine
stmultaneouslv
wtth
(dueto sensitive
$idccll8cls:
Gl,CNS,hypersensitrvily,
organisms)
0f therespiratory
tract,middleear,sinuses,
muscut0skeletal.
eyes,kid- cyclosp0rin.
cardrovascutar
genital
(including
g0n0trhoea),
paramelers.
(gastrointes-andotherreaclions;
neysandurinarytract,
effectson bloodandlaboralory
prescribing
0rgans
abdomen
Seefull
Veryrarely:pseud0membranous
psychotrc
tinaltract,biliarytract,peritonitis),
skinandsolttissues,
b0nesandj0ints;further, information.
colilis:c0nvulsions,
ano
reactions,
septicaemia,
inlectionsin patientswith reducedhostdefence,
anaphylactic
including
andfor selective
shock;Stevens-Johnsorr
Oul otherCNSreactrons:
interstitial
nephritis,
majorliverdisorders,
decontamination.00st!0:
Depending
including
on indication,
125-750mg (oral)b.i.d.0r syndrome,
hepatic
necrosis;
impaired
100'200mg (i.v.)b,i.d.Acuteg0n0rrhoea
Kidney
lunction,
including
a iingledose0l 250mg (oral)0r 100mg photosensitivity;
transienl
l(idney
lailure,
trans.
(i.v). Reduce
doseif creatinine
clearance
below20ml/min.
Seelullprescribing
inloF ient hearingloss, ability t0 dnve 0r operate A
7/a.\
mati0n.
C0nlr,indicali0[s:
Hypersensitivity
to ciprofloxacin
0r otherquinolones.
Chilpregnancy
patients,
dren,juveniles,
and
andlactation.
Precruli0ns:
Elderly
epileptics
patients
withCNSdamage.
lhl0ncli0ns:0ral:
mineral-containing
reduce
antacids
Boad,Banglok.
serum 130/lNorlhSalhorn
absorption
of ciprolloxacin.
0ral/i.v.:CiproflOxacin
canincrease
theophylline
:
ffi
qb)
[.3,,],li#1f,',jiill'liiih',.'iiJ;ln'''''"''ttaygf
Diplococuc
Vol. 12 No. 7 Jan. - Mar. 1995
15
t Prapokklao Hosp Clin Med Educat Center
etln{fi 2 uflo{nrlrliisutfisunl?suilindouriounooo
av
d
d
gtfi
q
t
I
lil4u?uttnavnqil
uayanuorvlro{?flryry
(tt = ss)
Sulbactam/ampiciltin
(l,t = ss)
Gefoxitil
(trt = ss)
23
21
22
6
6
4
3
Gontrol
1
AntepartumComplication
- None
- PIH
- PROM
- Twins pregnancy
- Pretermlabour
1
2
- Placentaprevia
- Maternaldiabetes
2. Anesthesia
- Regional
- General
r4il1gtilq
2
1
2
2
I
1
32
31
3
4
32
- PIH = Pregnancyinduced hypeftension
- PROM = Prematureruptureof membrane
enrl{d B udn{dorj{dlunr:}iroio
{rhuusiavn{ru
CPD/failureto progress
Fetal distress
Breech presentation
Twins pregnancy
Control
(tt = as)
SulbactamlAmpicillin
(N = 3s)
Cefoxitin
(lrt = ss)
23
21
24
4
T
q
2
1
2
1
Previousc/s with PRoM
a
1
I
Placentaprevia
1
2
ilil1Utnq CPD = Cephalopelvic
disproportion
16
,]
un 72 nuun I u.n. - a.n. 2638
-dvdd
nrffirgufn'ntlnawnnoatminifrn lfinnutanfiilntnit
J
a
{r
r
I
9r1r1{n4 ilder{}ton'ltmlTatullnocoqu
Gontrol
(N = os)'
None
Febrilemorbidity
Endometritis
Wound infection
UTI
ilx1srr,rq
14
4
11
6
r
P value
Sulbactam
ampicillin
(lt = ss)
Cefoxftin
27
3
4
1
28
2
3
1
15.4f
0.73
7.64
6.77
o.00044
0.69448
0.02188
0.03395
1
2.06
0.35722
2
(N = ss)
-+ a e t r i , X ) a
fi{rhu 2 t1u liln{ilfifiii endometritis
iruriu Woundinfection
SignificanceP < o.o5
UTI = Urinary tract infection
rfiuurfisufrun{u
nrn{d b ilGrn{n'n6ordolunciudl#ur
sulbactam/Ampicntin
Controlua;nciufil#srcetoxithtrlllsutfiuufiun{u Control
None
Endometritis
Wound infection
Febrilemorbidity
UTI
Control
Sulbactam/Ampicillin
(tt = es)
(l.l = ss)
14
11
6
4
27
Gsfoxltln
(r = as)
(P value)
1
3
2
0.00151
0.0r682
0.04636
NS
28
3
I
2
0.00359
0.04145
0.04636
NS
4
NS
1
NS
P value
NS = non significance
uJilgurffsu
nlrNd 0 udn{flaRrr6srr{olu{rlaudtdiu$1sulbactam/anptcitlin
fru{rtuifidiusr cefoxitin
Gefoxltrn
Sutbactam/ampicillin
P value
(N = 3s)
None
Febrilemorbidity
Endometritis
Wound infection
27
3
4
1
UTI
NS = non significance
(iooru)
77.14
8.57
11 . 4 3
2.86
(tt = ss)
tDens
28
2
3
I
80.@
5.71
8.57
2.86
NS
NS
NS
NS
1
2.86
NS
J
Vol. 12 No. I Jan. - Mar. 1995
nf:1{ll
i
I Prapokklao Hosp Clin Med Educat Center
{
t7
or ?i
? ltdfl{n1:11'llUlT0 l1{4U?U postcesareanendometritis
Control
(tt = tt)
Sulbactam/Ampicillin
(lt = +)
5
2
J
I
No growth
E.coli
Klebsiellapneumoniae
B streptococcus
Enterococci
2
1
Cefoxitin
(tt = s)
I
I
1
a
usrd'rr:Jiuurr4uu::Hr rr nq rurd'[oifu
ur
?o't:al
Sulbactam/ Ampicillinun;n{rufildut Cefoxitin
Sulbactam rfluarp{ufro.: peniciilanic acid
a.lno1r'r.Jd6 aiy{u'i1?t{ 2 nq'il finr:fiord'o
sutphonefiqvr6'rlurirrou'lsri
do
B-lactamase
hiuflndrlrTu(e = o.rzoas)
Iounu'jr finT:6orda
nfr.:10urdouuofi ri u uayrflusr ruEI o.:nr r dou-r
tolr#ouunfiriu Sutbactam
og,iufi'uroulsf
F
Sulbactam,zAmpicillinun:iosat
8.s7tun6jufitd'iur:r
tactamase
rirt#roulmi B-tactamasetrjrrtr:n
Cefoxitinorilnhfru ritaiunr:6ordofiuzunnir6'er
tAeY''
rurrirarssrilfr
6rri:16'urrJfr
6rwfuoonqilf'tder'du
y{u?1ilTouflt
2.86 yr.l 2 nqsJ
il'tn rryu'jrnr:t#Sutbactam
durn-uAmpicilin
ruflo.t'j'ru1ilfrd':w
Sutbactam/Ampicillin
ocdrlfi'uroonqtrf*it#ouunfi
riu'[finiros?1.ril1ndil
161dsr
nlunr :r1orriunr :6ordoHfi'.r
nr r air 6'oonooqor:
jqvd
I
,Jrrt '
#.luuofirisrfiod.larnrs
(aerobicbacteria)
ttni
6n'jrurfi1frfiuoqifi":1rJ
6o nmpicittin
z sm. uflt
(anearobic
uunfiriutfiet'lrid.rornre
bacteria),'-*
16'nrndrrirrfi
urur{unr:td
Cefoxitin
z gm.
A
o'.rrrarur:fi
X
e\
iat
oldrrurl#riJuutJfi
6.:urrfiorlorfiulunrr
r il 0 B r.r0 R1 t r yt't y I u 0 ?J0,0fdu ? u n il lilt T{il q $ n
nir6'onnaoqerryr''r.i14ri''rfr'o.r
d.:linfinr::Jurfrouorn
onrsuud'rnr:r.ir6'or
sir* so.rt{luo"lr1.Jfr7 o:[fiil'i1
f
q
e
4
,
Atnv;
[ilr.lilo$nanrflu:oufl;11.43 tunqunto:uu1
v-
X
,
q
' t-
n lrry{rs [fr06i':utilqirfi 0lilfi" u (frlo growth) rfl :13'j1
r500nnn't')
ornnr:dnurtu:rgrrud nudr n.r:tf
(Aerobic
td'vrhnrrryrrndrn#fi.rr'',n.o
bacteria)
E
, Z
/
)v,X
^l ju 'J
Sutbactam
5oomg.iTrurTu
a
Ampiciilin
r gm.16'r{ad
ryr''ru1{ tT 011$J 1J1{1{UO{ tU ilt U 0n [il 1t .:0','I
n1fl
rfiuur#rrTunr:tdcetoxitinz gm. lunr:rlooriu
(Anaerobic
bacteria)dlyrlld'rj ou lunrttb^r:truoqn
nr:6qrdoqrnnlrlh6'0fl
naoqer:nrrufirfior
uo:fir
dnuauH#.:rir 6'onnooq or:mr,lu rirvia.r" ai':ur6ofi
w X X Y
uv
ldrundn'jrnr:tdAmpicilin
2 sm.idtfii'uoqjiurlogiu
!v{1![rfl?[5o1uuu Iotrfi ytln E.coli , Klebsiella
orir.ofiriudrd'ry
wfiu SutbactamrAmpicinin
6irnru1;flrr
pneumoniae, p-streptococcousfl?iltdo
fiotrirrurl#rfluutJfi6rul rfi orJo.r
rTu(prophytactic
Enterococcus tfu
nutun{rufild'iusr Gefoxitin
antibiotic)tunr : s.i
r 6'qnfloorlst?yr1.rt rirri'o.l
rdo{srnilrCefoxitin'lil'ldrunsio
r#odadufi":*-'
9J
18
nrffirguflnnFlnwunnastrtaioifrn
hwnunnwilnndt
postoperolive morbidity. Am J Obstet Gynecol
drd
t
e
Ueo
a
't987i157i794-8.
q
eh
).
I
Swortz WH, Grolle K. The use of prophyloctic
onfibiotic in cesoreon section: o reviews of
595-60e.
literotureJ. Reprod Med 198'l;26:
Cortwrlght PS,Pifiowoy DE,Jones HW et ol. The
use of prophyloctic ontibiotic in Obstetric ond
gynecology: o review. Obstet Gynecol Surv
u
rr{HU?ulril1n1TR','rne
nTl Un,]UrOYr''rn',]Tflnl'',]
Rooqqoflr'ritnfi'rfior
ehururosnu Touurirosnrflu
s n{ru"1ns35r1u n{rudr rflun{rnruqu(Controt)
z gm. rfluutJfidrwr$iorJo.rriu
w16'iu ampicitlin
lunr:ei'rfiornaoor{err
o'nz n{r osldiusulbactamz
'1984;39:537.
uis Gefoxitin2 gm.
ampicitlin1.5gm. (UruaSVN@)
tru'Jr nq'rrfi
rfluutlfr6'lrurfioflorfiuntra'rd'u
Snrt6ordoriaun'irn{ru
16iu sutoactam/ampicittin
d r a d ) y e . v l
n?uqilog1.tiluumnq [ourot{1tfl']roolso tvr:.DJo$n
'
ds
o
e
-
t
Jt
uuryirrTu
ffnrnuunletr:nrlorn-unr:6or#onlddrfi
Cefoxitin
fisrfin:ruilrvnlfl
u
294-7.
Gibbs l?S. Clinicol rbk foctors for puerperol
infection. Obstet Gynecol 1e80;ss:l78.
Repke JT,Spence MR, Cothoun S. Riskfectors in
ihe development of cesoreon sectlon Infecfion.
SurgGynecol Obstet 1984;158:1'12.
'l'1.
Hogglund l- ChristensenKV, ChristensenP, et ol.
Rlskfocfon in ceeoreon section infection .Obstet
Gynecol t983;62:145.
"t2. Duff P. Pqthophpiology ond monogemeni of
postcesoreon endometritis. Obstei Gynecol
tJ.
)qu
Howrylyshyn PA, Bernstein P, Popsin FR. Risk
foctors ossociqted wlth infectlon following
cesorectnsecflon.AmJ Obstet Gynecol l98l;139:
9.
iluruunvrrirl::fi
n tnuusru6'
flolrouq
rn#r {uvrqi
dahurunr:I:onururnn::rJn
ur^rvrriuf
rsn'ru nrfimfir ri'rrafirn{ru.rrug6a
iti n atluii1 u.n.- fr.a. zosa
qy
u:[lrnTTil ?lrnn''rTfruufrqil
un:alQ1nrnrffuo
,x
:1U.t1UU
drri'efirriuarlu
usrraror;qilu?fvrldrso{.r
u''l uNASYN@
rdarirrurlf,lunrrfinurnf.rf,
1(
Reference
1983:62.145
Johnson SK, Ohur M, Golosk RP. Prophyloctic
ontibioticin obstetrlcond gynecology.In: Zospon
FP, ChrMion CD, ecls. Controversy In obstetric
ond gynecology ttt. Philodelpho: WB Squnderc,
'r983:450.
Phelon JP, PruynSC. Prophylocticontibiotic in
cesoreon sectlon : q double blind study of
cefozolin. Am J Obstet Gynecol 1979i133?,474.
Wong R, Gee Cl, Ledger WJ. Prophyloctic use of
Cefozolin in monltored obstetric potlents
undergoing cescr€on sectlon. Obstet Gynecol
1979;133i474.
1.
Sweet RI. Ledger WJ. Puerperol infecflous
morbidity : o two yeors reviews. Am J Obstet
Gynecol'1973;'l'17:1093.
Cunninghom FG, Houth JG, Strong JD, et ol.
Infectious morbldlfl followlng cesqrean section.
Obstet Gynecol]97ais".ds6.
Goll SA. Ihe efficocy of prophylocfic ontlblotlc
in cesoreon section. Am J Obstet Gynecol
1978; l 34:506.
Gordon HR,PhelpsD, Blonchord K Prophyloctic
cesqreonsecfiononflbiotic : moternol ond neonqtol
morbidity before ond qfter cord clomping.Obstet
Gynecol 1979;53t'15'1.
Duff P. Prophyloctic for casoreqn delivery : o
simple cost-effective strotegy for provention ol
19.
Kreutner AK, Del Bebe VE, Delomor D, et ol.
Perioperofive cepholosporins in lhe hlgh rlsk
pofient Am. J Obstet Gycecol 'le7e;134e2s.
EnglishAR,RelsemoJA, GirordAE,et ol. CP-4589e,
o p -lociomose inhiblter ihot extends the
ontibocterlot specltum of F - loctoms : inficl
bocieriologicol chorocterizotion. Antimlcrob
4-9.
Agents Chemolher 1e78i14.41
Wexler HM, Honis B, Cqrter WT ond Finegold SM.
In vitro efficocy of Sulboctom combined wlth
Ampicillin ogclnst onoerobic bocterio.
i876-8.
Anilimicrob Agents Chemother 198si27
Deboroh M, compoll-Richords F, Brogden N.
Sulboctom,/ompicillin. A review .of its
phormocokinetic
onlibocteriol octivity,
Vol. 12 No. 7 Jan. - Mar.
properties ond
L995
I Prapokklao Hosp Ctin Med Educat Center
theropeutic use. Drugs 1987;33:
577-609.
Leone F, Morondotti MG, Mozzello P, et ol. A
multicentre study of evoluote the effect of
Sulboctom,/ompicillin combinotion on onoerbic
micro-orgonisms. J Int Med res i99o;t8:
19t -200.
Hemsell DL. Sulbqctqm/omDicillin for treotment
of polymicrobiol pelvic infections. Drugs llSo;tt:
22-5.
Crombleholme W, Lqnders D, Ohn-Smith M, et ol.
Sulboctom/omocillin versus metronidozole,/
gentomycin in lreotoment
of severe pelvic
infections. Drugs lrao;st(supplz):rr-rs.
Gonning J. A comporison of porenterol
sulboctom/ompicillin
vorsus clindqmycin/
19
gentomycin in treotment of pelvic inflommotory
diseose. Drugsl9g6;31:lt-17.
Abbossi Af, Soid A, Gober A. Intromusculor
Sulboctqm,/ompicillincombinotion theropy in
gynecologicol ond obstetricbqcterriol infections,
J Int Med Res1e9t;te:44A-eA.
25. Howrylyshyn
PA,BernsteinP,PopsinER.Shorlterm
ontibiotic prophyloxis in the risk potients
followingcesoreonsection. Am J obstet Gvnecol
'1983;45:285-9.
Gonik B. Singleversus three dose cefotqxime
prophyloxisfor cesreon section. Obsiet Gynecol
27.
1985;65:189-92.
Gibbs RS,Si Cloir PJ, Costiilo MS, Costonedo yS.
Bocteriologic 'effects prophyloxis in high risk
- 82.
cesqreon section. Obstet gynecol 1981:57:277
2A
Tmenr(uinlrFfncrunnatr7minifin
lfinnunnftilntn{t
,'
un D gilun I il.f,. - u.n. 2638
-<uad
A
€rt
v
il?rilfinuouu
414dVG
n,'tinnt/l[ilt Blt t?t8il Rail a{ n'ltm{n??R
-[uur
rnrdldur nfr nnrrdfrunfrnnrr d
6rta dnlrariuri il.u.,*
Abstract
Comparative Pregnancy Outcomes in Non-registered and
Registered Obstetric Mothers.
Ghirachall{lmduiyanan M.D.
Departmentof obstretic and Gynecology,PrapokklaoHospital,Chantaburi,Thailand.
J PrapokklaoH@p Clin Med Educat Canter1gf,4i12i2o-27.
A sfr.dy of 1oOwomen urthout antcnetal care who doliver€d at Prapokklao Hospilal from May 1,
1992, to April 30, 1993 was performod to study ttrc complication at lnuapartum and potoartum periods.
A control group consirsdng of soo womsn wiilr 4 ANC or more was uaad for comparsion. The risk of
inhapsrtum PROM and prcterm delivery in t|e study group rcra g.ez and 5.93 tmos highel than tf|e control
group. For ttp n€onates, tlrere were incHance ot low bts$ weight 2.oo timoa hlgher in the study group,
shorter gestational agea (re.ro-4.67 wks. VS. 39.9s-1.2r wts.) and longpr pedods of hospitalization (e.za7.82 dayE VS 4.16-5.26 dryn). The incklenca of perindal mortary and abandoncd neonates tonded to b€
higher in the atudy group, but no 3tatstlcal signilicanl Thc main prcbleme fior not attendlng the antenatal
cllnic were time constralnts (sa percent) and econornlc rsasons (ts percent).
*n
$anug6- ai nsnrta tstwatut anl;;iln tnin {unqi
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
unil-t
a1n flfi 6n1Tnfloon'Ir,Jy{u'tut ny{TtrJnrn #1
2t
rujisu
rfiuufi'uillro'rfi
rhno::d#r
uoi, n*rdu'hj
tu6'rurfisrri'u
1. R"t?ir[ytrndoulufi
usnnoo
2. R"t't:[[7t:ndoulu:cffinalonoo
,fi'uvr
qi il u'i1il'r: o1fi naoer
n.,,nqr uil i rir rfiolufl
rN.s.
zsss
lilldilrnn:rrig.r6.rio
trn;ss.38rrnriounc
phno::fhin:u a oYl Tourhuillnil1
za.+o
rj.lnnrrri
Y!.
ai.ru:n rfioo1unrrriill nn.j,r 20 #rjorri''lilufr'r'
o\ryr
r :n fr rfi orurrfuos6durYrfiuruun
q?nr ilr?r
r:
'
tAa
'
pJrnn::d
fr6r rruriunr:q
unr;il?f .innooto
u.l{fr
:J::finfinl r' nu'irolruruo#.:loInrrilrnn::rifi
i.rn
Iquo:.tdodo:roru:J?nh
rfio6ofirrur:otnrJrnn::ri
s. Hnfi'ilfss{n1:n
a. m rnqfrvrhlfrs0i#.rn::fhtd'iunr:
err?o$ ttat:il.ir.rcls.in::f
iaquar?dnr:
16'vrhn
r:6n:*rtusoridmn
naoqer:fi
rXorn
aoo
v
eJ1
nof\rosyruyr
1Tno1uilinh rfiq1i0
T:iilururnrq::rjnrnfrr .6'urrqilu:su.irciufi 1
uar'
turj :: rnqfirir 6'.:ri'erur
6'fl:r or uil3rir rfiofir o.J ilqun1nilzsss6.:iufi 30 [ilte..tuu
zss+riJu:;us
groqj un;er rilqnr:or uilinhrfiodrulmnj
rilusrrnqr r?n'r1 fl fifiorqn::f za frJorfdutrJuiofirlrurin
!,!1
ol
fi'srrur :n rlo.rri'utd" nr :fr rur :o rtrur r rl.rno.l:ri $rnnnoo 1,oooniruduh hirosld'iunr:rirsTo
rirt#nr:ifinfiunmrfi
oiln6rarnr:6rnr:ridrfr
un; rironaqnr{n rirri'0.:m
riou Ioulilohfr'oo,rq' ohuru
Y
< uri'tl rlqHrl d^trirt'unr : n[6.r
virtri'nr : nr rril i nhrfio n''t:6t.tnrrlifi 5onr:n ooqilrri ou
^ - - . f- - .
-
,
X
q.truil1To1n q ilu
q
|
|
,
ytux''t
fl1 rfi q fflil tilq ff-'tN.'trn
n{rdnur lduri sni#{n::fifihjrnrrpJrno::ri
ufi'lr16'firrurnhno::fioeir.:srhrsruo
rriunrrgnnao ra6o't6'iunr :or?o$un:sfl.ir,rd.rn::fn #.:d Iquuflyui
nounhuuo unsrfiunhuuon,rruEiulnfiqs.rtunia r6'rnrirfifl1r1To{q?J
u#uqiof.rrdur oun:syT.r
r!r411tq{n::n ru1fil'ril 6fl6s rflud'u ftfirufi'lr
r6uo::rimonoofi
rfro,roaool:,rnururnr^r:siln
rn#r
I:nHtanrryo"rnrirrl6'yr-uyir.rfi
o;rirsnqohil?iln1: o-unq;
otru?a{nr:nl6'
n{rnruqulfiud ncrS#.ro::fifinldiunr:o:ro
t
ea
aZ
_--.!g-_ _
-q
d.
vt
urEi[usnryrfloquurNfr
nerTolo
::inhutrd[ilrias guafi#o.rdrnn::lisoil:"n
rsruran:;ilnrnfir6'uyrui
c
jl
t&daa.a-.l",t
,ll
;
-
e
e
I
dt
u rtlev
mil1nd00yl
[?.]l'tu"tu1nil?silnrnd1
ounurTtorJtilldiu
Y
ZXy,
,
6t.:tt6l 4 RTtlJU[:l
o a
-X
_-_-d.e
nlror?agun:yn'irrdrn::rirnu
d.:rirt#rfioflrprar
uri n1:rnu?4ilfl
s1t$ilfl 1:Oitli
''. dfrorum rfiu:iorynaoriotro::ri#,r
urnyr
rlun: r6'tlrirfi {g uo nr :fi n.rrl fdugl uun:
z n{r
A
v
^
^_---._e1'61' 1
r
c, j
"
nr rrtrrTrlofililqrarfi o;d'a.r
rru6ry
rflufrrrirrTry*i6'u Iourfiuriaqno.tnsni#{n::lifi':onooofi
fiqr*nruri6
aY'q
^-XX
2i
rn i"
"
a.rsr.t
lomlnl:roluluui,lofin$lfi1n1t! rryt:n6oufi
oro o:,lnurSorillfinhuuoyTl
z nq'rulounq'rudn:*r
e <
&
a-&.
s
i
o
Inorilll n: tid ny{r'10Jn1Tq.tn:Tn tfi 0 tlJiluu?yt.t{
rfiurioryorln:1uoun:u
i oor-rurtrun{uuJirl ufiilu
qd'is'aa
lunr:o uosorinq'rufiIo
urolrls $asdnurdsar
rraqfi ufiurioryauuu
unrestricted
randomization
ouflTU
virtfrserifi.ro::fitrilfiiun.'rrsrr?oE
rnr;rn.jr.r6ror:d300r'l u nr:g unfrnnoo#.r
z n{il6'iunr:g unoYl
uoi
d'uog
riJuuutrr.:nrriounndol
un; ufi^tr:Jfu:Jr.:
rfio r :niu r6un::dnnoe ua:nr:erh
rfiun..rifl
floelsnru
no0'lu'tilflqtrel,tflTTnn lil torun"l:$ tt8Tg14i-t.to{nr1n
inoil:yarrf
rdodnr*rr^rnnr:#re,::r5turlT
:orfi'lridrno::fi
,^-o.lu,
u,
uur il frf0 vTelr.l un:'[ d'iu nr : ufi'l rn m : uyr:n dou
sr1ilo?''rrJrnrJ1;ffiJ
n.rrgrrnnr:nu:nrfier16'iunr:1#
Apgar scores'uun:ri:srfiuortlo::firdonnaqleu
ifrol Battard"rrT:nfifirhrafinerhn.ir
e,sooniil
ilfi tz afud t ,r.n.- ii.n.zssa
tncnqafintrffnstunnanm{*ifin lunrrutanfttJntnffi
22
gollioryn1#n'r:irn:r;fi
nrrrfrurnrnr.rrfrfi
nqu.rr.r
u:nrfier:16fi:nrdnuldguadfr
rato$ilqn'r
adfiflqnr;rTufinfi'rnnoo lourir t-test loufrrila'rri-qfrP<o.osuni
+ (Hrirugunnr:numrfi
odds Ration'rurru gsgo
urrorwqndru n,tTn'lnft:rilR:r$rdu.t1#
z rfrTru.rd"ilri$n:rrruvr:nditr
confidenceintervaltf Wootfs method
nnon
1:lguorioi46n{rlltnft
lrfr
Aa
v I
cnina-lnnao
z. fr6n{rJ'rsnn"{nf,En
qnnulfriunlr? unmnuilvrri{iu fintoucrlila?1il
ufi€l
mrJ1rf,l, unrehuriruoonmnltoltarurnlq
e-o f,rjorrdu$rusin:d
o:rcufr.:nnsqnruls
aa
3. Yrnnqillf r?! e nrmdrhnfinu:ntfier
riaun'ir 2,soonir niofiflqrrumtfier c*diu
r,.u
nrrqunufitrnl'xuyrtndori un;irfidruoanotn
lxr rururnTauq&''rtIvryrri{iu fiotoun1iln11il
rnm:elr {lduwntrtJrfiido1nmnu$fufirfiuu
nfldsririufnl{ud'rnrn
-#onu.ron
dlqur:ur,vtfldnlJriufnliuti'lnrfl
fijrulir
{.rJru1u
;- ; 1: "-t ,
lYlYr']Tnx1ilu1ui'lnnnilun'l
flan1?6inu'l
r. ntcun:nf,o$lurcucaeoa
qsr
J
,
-----i
I
1 tlfin.ttltt1t1{?1n''11!q{u1nr"l
l1nn1fl{m
lhi
u;nnaoao.rnq
unnrisunlrrdun:llie?iluw
ilrnnr:li iinrurdultflu e.ozlrlrto.rn{lehnn::fi
rflus'sBrilr to'rnr!!
ilcrnnr:ri drunre:f,nt#trt.r
riiolorn
rt'!u Drevr
o'rc
o rriruihifirftrrf'rd'rg
r'rrsrr o.t
rfia{lnr:ngrtilu
riia{rnr:ng.rtilu
rurrldrrr
"'
,,t--.x.t-.- - -'
iiohurunrt:un:ndoustfiul 3 r.lu drunm;
. rs^. .
n"ll:?n
x a
un:nfau6u16uri n1?iR11ll0utRl{l9$'l
)- -...1-..-.-r v r0 t q , r n ^ - ^ - . 5 ^ ^ ^ - . - ^ ^ . ! .
. o s1
? c' g
Y
r l |l ,
J lll1
\ l ln
l l l$
u nn
l l f! l 0 n Y
i ll s. ' fI l| al afl llr1l l {' dn. rns tqr . U
uttY|U
| ^
,q
| a
<
__- -l^
afTrhfgrfrfvrffhllD!,
n
llUg
ef
I
a
qevy
y
),
t,re
1.e._y *--..t-. tnr;ntr n'lTflnoetnunluue ton0$t$n']Hoilnn
v
ll{nfluu1ilunlrn:o1nt lqll1sono illoTunnun1ull{
-
o*rn.tfoorrliudnLi uonsirlriu Intfi nrr::n
nond:riourirrunhinrrnroujiuu rfisw r.rafi6't#
goiu ufiicrndu{tlrj
nr:r{d r riruruuaviasavqo{nl?vtFt:n{oulu:ctlcnaosl
miubicrnn::r{
(n,=loo)
nre;un:ndon
nrilrhnmrd
(n"=soo)
OR lasns gs GI
d.+*
dr*lr
10
19
2
1
1
17
5'
6
Hypertensbn
PROM
Ohor&imriionitls
Plac6ht6 pevia .
Abruptio placenta
Preterm delivery
PostiermAbnormelpreseitation
Twins,, .
+
**
te
o -
)
-
loanc
:l
I
&
v
(ro.oo)
(rs.oo)
(z.oo)
{r.oo)
(r.oo)
(rz.oo)
(s.oo)
(e.oo)
(r.oo)
95
ililuB3QqilT:Ounl1! IAOI|U:OUS3
non,applicable for statistical testing
OR = Odds Ratio
qirnnn iasaa
21
18
1
2
0
10
12
17
5
(z.oo)
(o.oo)
(o;ss)
(o.oz)
(o.oo)
(e.ss)
(+.oo)
(s.oz)
(r.oz)
1.47
3.67
6.10
't,50
0.62-3.44
t
1.75-7.74
0.43-| 71.83
0.14-16.37
na
5.93
1.26
t.06
*
2.46-14.56
0.38-3.99
0.36-2.67
0.59
0.06-5.32
Vol. 12 No. I Jan. - Mar. 1995
I
4i
J Prapokklao Hosp Clin Med Educat Center
o
q
tt
23
v
Y
gt-ltl{li 2 0lu?1{ilavio8rdvfl o.lR'l?vllll:fl - tc[ot{
tu:utlvfia.qflo09l
niirrdrno::d
t
n{rulridrno::ri
(n'=roo)
I
R1?eUm?nga$
(n"=eoo)
og
siruru Yauac
o1$?il
Retainedplacenta
4
(+.oo)
Hemorrhage
a
(s.oo)
Puerperalinfection
8
(a.oo)
25
Urinarytract infection
5
(s.oo)
8
ragac
(r.oz)
(z.ss)
(a.ss)
(z.at)
(z.ss)
j
0ul
I
5
*i
o
rf
u1u'1fl
0'r1{'ruxl{Yt8
HrT.tvr
oR iaetncss Gl
0.54-10.80
1.29
0.26-5.69
0.95
0.38-2.23
1.12
o.23-4.79
1.29
0.26-5.69
t=7.35
3 . 11 - 1 . 5 9
4.53-1.70
2.47
P-value<o.oot
(X-zso)
-
p-value< o.o5
OR = Odds Ratio
rioa (r-ew)tun{ulilehnn::firurnrilu
z.oo rvi.r
:rrirsdurfionoooro.snsjru
nmgun:ndou roJn6iilel1nnrrri o1r{fl
olnolT'r\rnz uao.r[fi'rfru'ir
.t
v
X
A
rU rav
''r
(38.
uu fl n tuvl''1.: tildrnn::firioun'jrn{ldrnnrrri
t1{T:UtHnnna0oYlvruill n I u [r9rIlJ&J
1o-+.oz
frJord'
€
aaa
Jaf
a0
s
rllrr
rfirufi'u3e.e8t.21 #:Jorri)orir$rTudrdryyr1.:flAa
flnqfio n']lg:nfl 1rq{il t0n1fl rnq lun8Ntil tllnn?TR
oorrfl
ufluz.+sryimro.:nairurl.lnnrrri
eirunm:ur:n#ou 6'0:ril1:nqrunfl
:d'or:''rsr'tuil?nh
[fiorrutun{ru
c
Atae^X
nnr:frurnn'ir ndrurJrnnr?ri uoi'[ilfi
0t{ [1u n']ron[6i06na.:nfloqln1Tqot5o14fl{nfloo lil r^lT
fiurird'nr
d'oonoo
z. R1?srrYrtn#aub+:cacfi
q-
i
e
r
tq
^Xaqurate
n"lTO A [3ATA{n'1.1 t0lUU fl fl
I
'l? g
-
o
as
tlJ SJfi']'1[JttOn61{nil
i
rf
t:.ril|u']u'la
0u1.tiluufl1nqil'l{Rno o'ru?uxuYr0H
t
vl
t
d
I
|
|
c
|
ae
I
1A,tnqiltil r.l1norrRu'riln?"rnqilfl1nnT:R 0u"t.:ililu
fi 1iflfi6 fl1[uEn']:o1u?lonil1Tnuflcl,r'liluorr:r.1fi+
- . r - . - - ^ - - . -- .. -. -
q
r r
r r
d
rtrCl4r
4. a{1
wrqfidrlfraoins{orrrilrildiunr:qua
tul
t&?121000at:n
1.5e;U)
1duso.rrHqr.rn:l oJr,J''r
ro r frhj rur ahnn:rri
vd
3. HenilDUooYlltn
I
qrc
a
0']n01T''1.1113 t[flO{t14t14U?'t UlfiUnYl']Tn
i
r U
r r
d,
|
d
|
urnnfl oo rflfl ulJoJnflI il [il t{''tno::nu0un1''r t l''lnfl:TR
de
-
fixilnqil9.t1nnT:n lily{u
rirfiqnr.rnfifi(+.ss+r.zo
iuuJisrrfiuufi'ue.r-
I
-,;
flx1rfi1:nQnnooyt.tytu 2 l'tut$nqiltilrl''lnflT:R
o
o u1.:lJl{u611fliln1.Jflosl
f
a
V
-
L9luvtufi 1Tn $Tn tnqu-lnun
;
r vt ra
r, I
r{ w
rualT"rJyr s q,JR?utfiru
tr4[nqr.tn?1til[IIxn1
1-.-^^---4
fi.:rumnSounsss rrny'lilfir3utoun:
15
24
ntntgufntrflnaxtrnanrnfn1fin Innnu.rrlnrcrlnn#
f,,
*tiuii t u.n. - ii.n. zsaa
nuN+ s flafi*dto{nlrR
n{rlddrnnrrf
nfldrnetrd
(n,=tot)
(nr=gos)
nTtgfimf,dtr
OR
eTm$
(iauEu)
dnru
loserssct
{logw)
V !
r. ri'rufinnrm*:nrfiorofi
u fi-eso
z- iru{n
<z,soo
nir (uw)
2,726.8-560.4
18
!-
- uluun r4iloo'nfll
{.rz.ez)
(s.eo)
+
3,058.2-351.2 t=5.60
a
10
(s.so)
(s.zz)
<0.00,l
2.06
r.03-4,06
1.21
0.31-4.31
(nmrcomla)
t)
)
,
(X-zso)
2. orrprrridionnonrohu
'
I
as
I
38.10-4.67
39.98-1.21
t=4.00
<0.001
r
3. nl1nulilunilolnlm1qn'r:n
(smdlfo gestational
age)
I
(z.sz)
s
(z.ss)
2,82
0.96-8.23
7
(o.ss)
(2.sil
(+5.sr)
14
(+.sg)
1.54
4,51-4,n
1.52
0.29-6.97
4, Apgarscore
- nA1t u ' r Y t < 4
Aa
-'715l{',tY't
<7
e
5. nl:ntilf$q{
46
J
-r
o (r.ss)
rs3 (so.ro)
t=0.8,|
0.4184
-
6" n11ilt7ltnnDil:iulilil1t$e
'1,.:
- Trauma
'l
^li
- n1?!0ntt8nrj
12
- Resp$ratoy
distess
syn{rome
' -,flypqbitrrublnernia
(o.se)
(rr.as)
1o.so)
1
,
0.60
0.03-5.32
18
(r.oa)
(s.so)
2,14
0.93-4.89
7
(ru0)
3.17
0.96-10.30
1,12
0.60-2.09
9.83/1000 1.006
0.11-9.57
5
(rs,ar)
19
(rLos)
:rrr
z. mrrnrruilm-lfic
; ' 9til'birfi
r,
- Pednatalmortality
e. :vu:unrfia$:rnururn'
'l.
0
9.90/looo
. 59.{0/1000
3
16.39/10003.78
5
6,28=7.82
4.16-5.25
t=2.54
1.OO14.OA
0.01
I5
'(x--peD)
t
- 0$i ltltlt.nuuln
>3.?rl
{
9. nltnQnn0eyl.t
46
z
p-vatue
<0.0s**
fi,ffurhti'qdr,f,'lorrrtiiadu
sl
(ls.sl)
(r.ss)
0R= &ds Batio
1't6
0
(ss.os)
(o.oo)
1.36
NA
0.84-2.20
Vol. 12 No. 7 lan. - Mar. L995
J Prapokklao Hosp Clin Med Educat Center
I
d
9r1:1{1t 4
25
iirururtavmrilnflr:nt gto{nltn
neirr'l,ridrno:rf
t
611tlt0l
ndldrno:rr{
Dead fetus in utero
1
?
ldiopathic respiratorydistress syndrome
J
,|
Congenitalanomaly
1
Meconiumaspirationsyndrome
'l
Severebirth asphyxia
1
nrr't{d 6 rtfloirtfiqe.railfrnrlo'rafl€d{n::ridtritdnllnn::rf
riu.rsrrrurirfiuflqlrrn6oqrlar:n
lfio9ta
c
rd
' t . t 4tilil[?fl1
da
z.
ll
I
3q
,
€
6. qN[qa;e]rno::lirrsiurnaooriou
'lilrfiuortr,frrilu
z.
B. dr.:nrsufilu:.rrJn6flril.r?nRInoilloJ'16'
e. rilunr:or'.on::ffitri6'ornr:
tyt
e
38
38.0
15
15.0
12
12.O
8
8.0
7
7.0
6
6.0
4
4.0
4
4.0
2
2.0
1
1.0
9
a
ilrnutil[ytu.tila
Vl
tagne
a
iln1:3.11Uil','tn
3. rdunrlsirurnsnruuinr:o{lnn
4. r7rufioqjrlou r6uvrr rl:jt.r ::ra-irli,oHio
'[ilfiournrurdrnn::fi
s.
-
drutr (ou)
I
d
10. [$Jg']1S10{r{lnnTTn
11. finuuon'irki6'o.rrhnn:rf
't2. d{taq:nnoofifru
1
1.0
1
1.0
13. n#':r6'rrarirfikifiriEr::J:cmfl
1
1.0
%
?1,cnlflain ?#fnau nn€rntan{n6fin Innaunnwthntndt
?o13$t
flfi n atiufit il.n. - fl.n.zssa
fn :rn r :n n 1uRn ao u fltti'n:r n r:n q r u
arirlrrd,a*det-.
il5fi1rsntunqillriil1nn:tn ilqileln1lnrs{tuu 1.006
1.n'r'reuilrflfionln:sa;nnoc
Bnr 3.78lvlrtorn{ldrnn::r{nrrudr6'uucililfiriu
l'Lilrlrnn::ri vru ehriq vrrr efi6'aaonfor tiu u nr s:t, n. utdf og
nr:onooriounhnuonq
:Xd
qri6nr:r,[qrfurflu s.e3 rrir ra.tn{ruilrnn::li dnsrlff-''' *
Kleinti'u Moore$fllfinr;s'
noon$orriu:1u.i1r{1t0.t
4. a.,rqdri.tfiaoidoe:rfldldfu
fl'":li: "."..*ilil*T"
ln:n* rxT:'*x;::1
eni*r
a::,i
"0^,,u"",r
q.rrhuernriounr:t6un:ullun{r'[lidrno::riglrflu
fitJtd,il;;;orri ,ltgn.r,r*a:rgfierlrrfluflqn.r
s'ozuYitloln{udrnn::li orh':firiutir6'rg
flrgurvrr.r
tir6'rgd.rdrHneioqtnt^rourrTuluriotrTu
nmcunrnrfranln:sscn#onnon
e.
f,rnr n:ouni,l un;nr:f,nprrftfin,r.rurdu.rdar
n{rukiilrnn::lifilonrnrfionm::n6'Ntflu uwnr:finr:ufit1fiqru.ryrio1
j riurlndru or:fi
urtdunncirl
z.+srrhsom{lrJrno::liuihiiirlrthfiq
srir.rfirigdr;rUd?,lt ;rrorddorogl:.rr,rnruro ".rr^r,r"t",rf,un;rJ:;Iurriro.rnrre'no::ri
surunr:uin,r:rlrnn::fi1#n{r{r1r.:un:fiil:;f,n;usSurfirJdil #rdororf,ur?{T'rttJ'rrnrtunqru
rs*.utunq u
f
"rr..1,{?uR?..*rf,rornlou
kjilrnn::ri filonrsrfionrr;6ordorafr'rnnsoq{"."
ur#unoulrrn.rot.norrrid
;;r.;;;rulfiriau
t^l
ornn,;rirr6*riounr:riun::ri
".rr,.r;::H
6.o'o:nr:drsrn6o
1il,]t"ffi-Jtnr..,u,.u.uinr:
nrrfrrr:n 6.rd'o.roqj:ogarnr:urun'j'rnrildrno:ui
{fi:rul6,riourrlrsnnohuru{rl1rre6no::fi
s. flaiilduo{n1:fl
a
d?u
.lrlflrrr.ratl9.
tunq util c 1nnlTR v{u11Nu1llun u rn fl n0o
-
v
)
,
,r -r--r-'
- - . SA^
tfiuuHnnr:8on::litunni
ornnr:6inurr:Jiiuu
rofiuryirfi'u2,726niu rioun'lrn{rurlrnn::n6.1
drd'rgvrr.rsfi
6 riiofinur lildrnn::li 1ul:{nsrulnn*iln rnfir {unqi nu'ir
rvirfius,osenil odr.r$riu
d
.
.
-)
r
-!,--,^-tehnn::fi ohuruifr nnoori0urt1ililo$83q{ul unnn0iltou
6rnr:rfiovrr:nu:ntfio#rnrinrioulun{t'[ri
2.06rvitro.rnqlnlrnn:tlin::fi rr nn'ir .l'rurunr r nnnaorhrarinrisuSlr nn'J'r
nufiqri6n'r:nlrflu
q6nn o'rqn::f rSaonoofirisun'i'r :; u: trardeYoror;
riudrfiqvrr.rsfifin:rriunntu:.u.r.udfi
odr.rfi
t[l*"
rh.rftiuthfi'q
f,nsrd o"tt"" T:{r{ururojlo.trnto'tuatmr:nutun'ho
unlRil:"(vr.a.zsza)
r:iuLeveno
Texusnu'jt nr:ehnn::ririr'lfq:i6nr:aizo\tn1tn vrrrrfi6 fiuurTrilmlnrttfioYtr:nnrurlirirrfiounr
x
x
Y-vtaeAra-1
n1Tnqnilooii.3il''tntu lilqHnnnnlo.tsn:i*lrilr
u1ililn$a uf,on{o u 1ilNuufl1Rq tN 0 tljT UUtYlUUflU
Avaad
_
(isunra rn:ieunct+) nrtdnrr r^lrnn::li6s rlqrarra:ugfic nrnnr:6nsrfirflu
nriu'lrirhno::fi
o
nr:ooao uu'lYr1{ !un1:q u ouf,t14''rvrrtufiltnr:lilmr.lrnn::li
nnrtdn{ ruhiehnn::rifi
dareafur rn[6'rT
fios
uodufr
riounhnuomnn'jrorqn:uirdaonoo
fisrfinttililturflfi
n'iradtfifiudrdtg
nazrauqotl sun ntiil ft fra t naa s'rufr'
z n{r unfrourTufia\ffiantitiwtnutanrstJntn#1{unui fitA
s urfi l6Hnhiuonsir.rfi'u1u#r
mnrrorrui r. ounn&J* unt iutlt fia
nr:finsmsr Levenori'u MooredlfiHnriruo.: luw'tillfrt "tus6- t
ui zratsai w i uwnia a#ud
irirfr"r,a'uu
fiur,lnr:f,nrrdtu"jrlTtornairu aiinunheti" rilfin'nstiusuulunnfrnv-rd
[6u?ri$",'' uoifi
Apgar
scores ,o'rruin,i til'tnhirhtsq\flatniaaflnililaand,r
hirlTnn::rir;fiqri6nrmo.:nr:tfiontn
1
'
finoa uflzonqil1fl1I a dlfranuitufro{unntfru
rn n: :fi '
el"r
n'ir rur :onn{ rur,J
aA)a
n1:fingltnu?nu Apgar scoresYl 1 ll"]Ylufl!
ilaya
Vo|. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp CIin Med Educat Center
27
lY^
tona.|:o'l{o.t
t.
qlt,
aHgrn5nruaio,ilrrqvrnaldrviq, :Jxnrn
"arfi
1tu tl Iu
ua y n ruv. rru? vt't{ n n o n t'l n't?rvr't?n ! t n
te{nflrurnilrvrlnrndr {uvru-3fl w.A. 2s2a-2534.
rrrnrrqutinrrdnrtr unvsnrnsrfn6fin tr{nfl r!rn
nr;iln tn6'r 2fi5;si1so-s.
FosterDC,GuzickmDS,PulliomRP.Theimpqct of
perinotolcore on fetol ond neonotoldeoth rotes
for uninsuredpotients: o'nqturol experiment'in
WestVirginio. Obstet Gynecol 1ee2;7eiao-s.
Neye RL,Hqrkness
WL, UttsJ. Abruptioplocento
perinotol
ond
deoth : o prospectivestudy. Am J
Obstet Gynecol 1977
;i2ai7ao-6.
n'ruu.r er4rnuorr, rJa;ri'nr{ lo:Javra6gndrtfr.
n:rur,l.r
n'rrFr'rfl
flo.rvrlrnGnhrfror.lu:nGnranrferrur6u6.
arutrnrxrilus,iuE''nd#orrrq^,4u.,,
IEt:y]
n-?rtininrr-,
qr,i'r 6unrrJr;rGgodtr
]Ty!^,
il??ru16n1t. nq{ rililriulun r:6'runilil11r?J
11
n n:.Jtn fl ,
2530:59-73.
12.
13.
MooreTR,OrigelW, KeyTC,ResnikR.Theperinotol
ond economic impoct of prenotol core in o
low socioeconomic populotion. Am J Obstet
Gynecol 1986;r54:29-33.
Ryon GM, Sweeny PJ,SololoAS. Prenotolcore
ond pregnoncyoutcome. Am J ObstetGynecol
'1980;
1 3 7 : 8 2 6 -1
8.
14.
't
5.
'16.
no.ioulliarlrounin nrroutis nrsnrxar6lrru4$.
uruulruoutig uriun; rdn 2tn5-253s.
Schlesselmon
JJ. Cose-control studies,design,
conduct, onolysis. New YorkOxford University
Pres, tpaz:rso.
Kliegmon RM, BehrmonRE. The fetus ond the
neonotol infont.In : BehrmonRE, Voughon VC,
Nelson WE, eds. Nelson Textbook of Pediotrics.
'r3thed. Philodelphio
: W.B.Sounderscompony,
1987:358-421.
BollordJL,Novok KK,DriverM. A simplifiedscore
for ossessmentof fetol mqturotion of newly born
infonts.J Pediotr1e79;95;769-7a.
d
oa
A
^
"!A
yilrinitvr
tmilfit {1uq1tnc.dnnil?Jqnnil1{n1twlylri.
3. nr{ rny{:Ju.run
rr 1r.:fih{-qr{,tn{nrnil.rilrl-ilardfl,
c{ilyrr{
ril{drmru.nmr:j5fl
urfis116r
rr,lnnrrnnonriou
.rfidrnnredun;lridrnnreritulr.:yrs1L'rn
nirauo,ao.:ri-fi
'18.
nru:
ffirt i n.p1.25r5.
ivnTfirrufngnrranfiirufinr
25'r7.
nqnrnmf
n?{ryril:llrlunt,
"nr{rnr311payrd'1
2 5 31 : 18 7 - 2 3 9 .
rfiqni nrqn.iufrfi,ln
6. rr{. rlrguroutls$d$nv
Schlesselmon
JJ. Gose-control studies,design,
r6n"[uur,ld.:
rdorutraulunlr
rvmil141unr.
Inrsnn'1614
2518141226-7.
rnurirlnnruuf.nraahrnnrlrpuraolu-fi
run-rnnoofi
trilffdrnnmd'luuruunofinrril
lr.lilflr:rrnmti6.
o-rrrfrr'rudnrqnrnnf
iirufr-orldrnrnrnirur,:-fl
flrns.
nE{rflnr.Ju1unt,2523.
no.10u'lNgntoun?1 n?ilou1ilfl n?!ylrl.id1f 1truq1.
3
t0.
vJ
?'rfl.1'ruruo.lFlurro{n'r?rJ'rn
2526.
nttn. nE{[ytllu1r1unt,
Klein L. Nonregisteredobstetric potients. Am J
Obstet Gynecol r gzr; 10:795-802.
BruceSL,PetriRH,Choo S,WilliqmAM, lmoijuniSO.
Unregistered
obstetricpotients:foctor in perinotol
lossein regionolizedperinotolnetwork.NY stote
J Med
1979;79i137a-7.
1 1 . Leveno KJ, Cunninghom FG, Roork ML, Nelson
SD, Willioms ML. Prenotol core ond the low birth
weight infont. Obstet Gynecol ress;66:5e9-60s.
conduct, onolysis.New York: Oxford Universitv
Press,1992i17a-6.
MorrisonJ, Nojmon JM, WilliomsGM, Keeping
JD, Anderson MJ. Socioeconomicstotus ond
pregnqncy outcome. An Austrolionstudy. Br J
Obstet Gynecol 1e8ei2s1-307.
Cunninghom FG, MocDonold PC, Gont NF,
Leveno KJ, GilstropLC. WilliomsObstetricsrcth
ed. Connecticut : Appleton & Longe, rrls:
220-9.
no{ourrirlnrornic nrxourris navrtr.:dr61xu6fl.
-
v
.i
s
<
a
u.1
?1?1.:'1u6ililu1r?o,1 Ln?{n1?pln1'rnrflnrrynuirrn;
nr r our :ia uil ua: r6n n"ru in 4l t vr-eiufi r z- r s fi'uflr fl u
2526.4tifr'a, 2s26.
Behrmqn RE. Preventinglow birth weight A
pediotric perspective.J Pediotr ]trg5:107:BA2-5a.
28
zrrniguin',ttlna.rr,nnsf,laniaifinlfinnu.rrrnftrlntnit
fld n ntiuii t u.n. - fr.n. zsse
namufrilaa
.u
Partial Hydatidiform Mole :
rramu{fl?s l r,a
eufrndnrqgrwfil.u.*
Abstract
Partial hydaffitiorm molg : a cas€ report
SomeakHanchoowang
M.D.
Departmentof Obstetric and Gyrcology, PrapokklaoHospitalChantaburi.
J Pnpokklao Hosp Clin Mec, EctucatOenter tggo;t?za-gz
A 3z-year old Thei prognant was admltted to Prapoltklao hosdtal bccauac of tlre intrauter{ne fetal
doaft ol28 we€ks gestaUonwtththe honeycomb like dacenta. Thcprcgnancywastenninated bymisoproctd
2oo US vaginal stnpodtory. The pleccnta was hydatidiform mob pardally. Th. dcad latus appeared normal.
*n$ulrry6-uinrinnalxnutunnr:iln mh {unqi
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
29
fiyrr:n1un::rir nu ri'rtord'uilnfi
rfluvirriu'[rir^ru
omrufiorJn6lo
rulo?o,lBpDssruu.ryirriuorqn::fi
I
ai
[u:vur s ilfrilrurur (lnr.e. 2s3l-2ss1)
15 silordreu uhn:'rrJndusr:nfrruro'[Hru
ncjru.rru
rnfi'1
96-uirrrn::il10{Tr.t?lu'tulnyt?yiln
u'weirufifr'nr*eu:nd'ru:rrd.r
(6',rnrr^rfi
1 uds ;
ounqSfiry':-leun::fi"ldrJcrqn
82 :1u alnahulu 6.l6or
r or on:r flur r fa.lonrsr
fi Hem angioma
v
unrir
eqi
e
d
Avn
dvl
r,
nlTfinoon "rnilo 26,742 T'ru ruqrf{lilrnufr
partialhydatidiformmole [nU
n,1TT']U{'luljoo{'rJru
9'\
ia
a
dl
HU?u:'ruuo.:n0tUupartial hydatidiform mole
To{:n
ndoorooyrflu partial hydatidiformmole
nto
r rl o{or ndqr i
-ru l5urd'a
J a n ? o,lr n u ny
ry'rl
:'ruu:nfi:1ulrulfflurr:or:gur5nr:6n:*1
$ylylu- yrr:ntunr::fikifi
nmru
fieiln6ornnr:$:roonqrYrm.l6'
srssrSer6fin
T:.:l^lururnlr:y:Jn
rnfrr
6.:':r.:uHunlT:hutuuu
expectant{r.!rtrur
rdaY
drnn:rddn 2 n:-{ r{':Jrr:ff,n'jrnr:ntun::ri6'u
:rs{lup1ilau
er*.ru:nrfi
aiufi s f'urrqil yr.fl.2s37
t
,
-4
o''rr{32fl ordr^riu:rrn1:na
{'rJuraf.rlvru$
-r"
e
4
a
a
?10H0'rtR0$J0.1
B.114XOnUflU:
4Nn,t[u.trOil0Hyl
6'oHiqnil::niLi
99
otn'tr6hrT6u
nr:ffin'irinosufio
uc.rrur
z {u
{'rhururdrror
- A-ra ,3
trfl31ul{u.0
!uoutau
IVAAd
lf :y?elllt{gflnlcfel5
rfluer::f u:nrJ:sohr6ouoiYrqofr'rurfioiufi
16 nrng1nil y{.q. zsst flleo;ru;unnoodo{ufi
23 u.ruluu yr,fl. 2538 mahnn:uin#.:u:nrfio
o1u.nr:ri a #ilord' fiarnr:uvfl#a,rrfi'nrios
zunnr:or:rordao
dTruInariur 1.0 nfruzrofifiqr:
drurlvr:oierio
uay 2s.2najlrdoeIo VDRL= Non
reactiveHB-Agt6'runnu
s Y.'
il"rnhnnrrri€lfrfi
z rfioorqn::f r r frJorfrrsv
flx'tilfl.Jla.JUaoruoqnuvirri'u
r eiru s rfiflonrrgn
ra''rrarim
'
e YA
A
<
r
8J'tr{1flnr:no:.Jl1 3 [ei0o1t{oTTR1s fru6l'I4[fltt
ueienrrrgrrio{usorJo$n o{fi :ro.ua;6o {'rJr ri'[6'ir
n"tf,o:?oo::rid'rErroi o.ld'nflfrmrci' rfi o.:orn
1u'relro.:uoonlorr5r
fi orjn 6 rJdn r rqr?ail{u?"1
qt
n"l?\vl 2
30
flfr u atiufrt il.n.- fi.n. zsse
?Edlifluinitf,nwunnustan{nifrn lffiwiltunwftilntndt
fl 1tgtt?o:"r{R1uiltR?lf
2oo Us) r ufio
6Jtfur Cytotec(Misoprostol
ucrufr'rqet:
uiru
t6un::firurn
uHfiumrrrio..rnnoo{rJtr
I
Vitalsisnsoqitutnrxdrlnd
rz drlrut mr:ntnnn{oufin
oonrurud'rornrnfrusr
s flr$ 4 oso niru fi'nuilsnruuonl&iiluo?1ilfinr:usinhuficr
n?''rsJq{raJuooruoqnrvrrd'u
dq-aax
rufi a: ; 6'uny6o ril.rtrild'fiurfru.snr : rduso.:ri'ela :nil1il1otl4IU
05i141{.:110{[l{o:n
14iln 950 nril
a
d
a
I
a
I
Aamr:ntun::d
u?il$n:so fl1u0nn:{il1{{uanuils[fiilailtNofl'18
fl'r:er:xonr.r#o.rrf
frrifinrt
e
y
d
I
,A
(9l{:Un1flYl
4l
eq
n1:0T'tnoflqT''rs1'tqilu?
1 il ? [ala.tn1tn
"[un::iuqorduufrr
(d{nt'rfi s)
qdv,
lU/L
UrinehCG titer oqj::ra'j''t{1,500-3,000
=
zssa) 41,186
B hCG(rud zo Nnr1nil t'^t.n.
mlU/ml
BUN= s.s finfiniilzroGfro:oirofifiu=
o.ssfinfiniil,rroGfio:
z{u {rl'ru'lfiiuor.1qrort#n6'uriru
nd'rrurl'.rqor:
vaa
1 toou
llflvu$tc1T?ofin{Lln.nuoTan
I
umiorm[
qiifinr:aalpartial hydatidiformmote fiu'jr
'[u
1to{n1T
to,ooo-1oo,0oo
riaamn d:rrurru t
Yc,6tltvva
tn#r {uvrq?
u1u1nv{TnJn
sroo:rr5' qffin"n[ulr.]y{
il::mru r tu zo,za2ta{n''rrnnaonr:ifiofia
AAuYgt
Rr:?uoflu1ilnu
' f , fy
e
I
Y
eX
d
a
u
t-V
o
t?Rffirqo ilt1{uJ50ufl t 10 tv]1ulf
lgr$nql0{naun1Tfl.tn
vtt
Xvw*
{::Jrs:rufr'ldiunr:iuodu'jr tilu partialhydatidiform
fl1:nflrslun:::{ Texgorqn::dzo fi'rJorri
rtn: microscopic
moblouorfrlnlTorlo macroscopic
[ilo,t01nIu0{0n10{:n
pathology
firfis'trro*&'rtilrililufrarorfru cytogenetic
karyotype
1u partiatmoteriu'lriohrflu
analysis''o''
v
l,
AA
nliinul
6'aouflutriptoidy rsruabJu.oofo.'',ro:rflu
wtfru'jr
o:rontulur {u'irrjrnilqonrhrrijq r rfiufirilsr: diploidyfi'[6 nrtq:rn karyotype'luntfifi
- 1 ayrflu partial mote fifirJ*lusriluuinr:tfreir
n"t'llru1.l:oufl : 25 0.11[1nT']u.lauTy9rulj0{fl?ilu']
vr
!g
Vol. 12 No. 1 Jan. - Mat. 1995
I Prapokklao
rirrilu triptoidy yr''r:nlilnrrti
:Jin:*ruriqjaru:a
it
nrrrufiorJn6 roie r6ulordrtun::fun:
n-nnsfi
Y
o C
I
AA^
|
l/l e
til sr rrr : nfi 6i orar;:oo'td' er".:
uunr : o: vir[#nr :
froortrifi'uqr^o'
nr:o:?or4lrsduro.r B hcc
u
Hosp Clin Med Educat Center
31
q
a
ei
i
o,
lurfroosorfiilrufi
rilu partialmotefi:J::Isnirios
rrr:r:r rEiro.oo:qr ortrra
i aou.,lur
nnrqirJn
6t or
&
d
I
a€U%"
n'lT 0in:Tnunon [o'-
j
9t-ll1{11I
Complete ttoU Partial hydatidiform moles
n?'liltlslnsirl:v}fdr{
fronJisurfisu
Embryoun;
amnion
2 . Cytogenetic
analysis
Histologyof
the placenta
1.
3.1 Mesenchyme
Complete mole
Partial mole
TTJTJ
fi
46,xx
rirubaqjrilu Triptoidy
Delayedmaturation
Scarcityof Hoffbauer
Less delayed maturation
No karyorrhexis
cells
RandomKaryorrhexis
duringcistern
edema to
formation
Pronounced
All villi affected
early in molar
cistern
evolution
3.2 Hydatidiform
change :
unaffectedvilli
Maze-likecisterns
(after ts weeks GA)
formation
3.3 Vascularity
of villi
3.4 Trophoblast
capillariesformed in
situ, empty of blood,
disappearwith cistern
formation
of
GrosshyPerPlasia
haphazarddistribution unrelatedto
events
mesenchymal
+. Malignancy
potential
Less pronouncedand
slower in evolution
Varyingnumberof
persistentlyimmature
Yes
Persistentand functioning
lmmaturityand focal mild
to moderatehyperplasia
mostly syncytial
"Trophoblasticinclusions"
in villousstroma
No
32
ntffirryfnnilnaunnuntminfrfin Tvnnunnftrhnn#
Sriad'.rrno"irqri6nr:ro.r partiat mote
|
-
J
xwrf,s
nnnffitnilruR1fl
e.
a''ra9rqnn?1yt11u{1utxn
tn tt'liln1To121n1{
nu'riivruri,a.rdurdoadr.rn:16tt0
itr gross us!
.J
microscopy tflouun:tH'J't.t complete ua: partial
fld n ntiud t ,1.n.- fi.n. zrea
ltoltouwfiqwunntiu$naa u wi{wtfis
frinfrin{uttugfi- uit zxnrttr uflrui aunntftJfi fio
lnvilfr1u6'
{a\uz
mote filufr'jrelkinu grossembryonto tetus filfinwnat'rud
fi nrru'oirnrrrri r d'.rrinrrrehn-rgluo'ru
u nt t[N watu t ant il nt n#t
^)
n116nn1ilt;0.! malignancy potontiat nfrlrtn
o.lv
E
tX
nlTvr''rliln']1n{olrnffuqnR{
ronffirfir{6{
'1,
Wotson EJ, Hernondez E, Miyozowo K. Portiol
Frydotidlform moles I o revlew. Obsiet Gynecol
Surv l9o7;!2:5ro-r.
Be*owlfz R$ Goldstein DP, BernstelnMR. Noturol
history of portiol molor pregnoncy. Obstet
Gynecol 1985;66:677-8r.
SzulmonAE,SurtiU. Thesyndromeof hydotldlform
mole l. Cytogenetic ond morphologic
conelotions.Am J ObstetGynecol 1978;13l:665-71.
SzulmqnAE,SurflU. Ihe syndrome of hydotidiform
mole ll. Morphologic evolutlon of the complete
ond portiol mol6. Am J Obstet Gynecol 1e7a:1s2:
20-7.
7,
Czernobilsky4 Borosh,\ Loncet M. Porliolmoles
: o clinicopqthologic study of 25 coses. Obstet
Gynecol 1982i59i25-i.
Cunninghom FG, MocDonold PC, Gont NF,
LevenoKJ,Gilstroplll LC.WlliomsObsiefics. rp ed.
Connecticut : Appleton & Longe, '1993: 749-so.
Oyer CE, Cqnick JA Mqternql serum hCG levels
in triploidy : Voilobllity ond need to consider
mofor tisue. Prenct Diogn p92i12.7-9.
RomeroR, GhidiniA $rforl M, Collen M, FisherN,
Hobbins JC. Fksttrimesterdiqgnosls of oportlol
mde wilh the combined use of ultrosound ond
chorionic villus sompling. Am J Perinotol 19g9;6:
314-5.
Vol. 12 No. 1 lan. - Mar. 1995
J Prapokklao
Hosp Clin Med Educat Center
33
ililn?'tilf uiu.r
et_4t6leJt04
nlrCIua?nrl dneluaemilnil5ueirrstau
$
oits'r adniisrsd il.u.*
anrrsuruorJ:;ohrdou
Hrursdrsnrr;fi
trin':J::cfrr6ou6e6ioriuuru
12 rdoudubj 6o
tsfld'a1nlateratvaginatwail rfiariorufigmaturity
inoexfi'[6'
.t.idu
aA
Iouroduso?'[nuosHiloil:;ohr6ourfioorq
siufuso3fi
51 fl
s,r.'rroiuu;n'r:u
arilinurrJryra
r
A-Iaua,
rrwfiarqrIuro6rlrlo.JsoTlnurrirfr'u
zr.ziJ(rnr.s.zssa)tui r.r
nruorJ:; ohr6au nr :'[d'iunr :"fi'n
nr rur.Tqn
r
-
Y
du
e
qta^
o.luusorSlyrud'0.:lffiiflil::mrBr tu s oqjlu{l
o
ja
a
J
,
d
Hruo:J| :; ifr r6ou 6.r
riJ
urir,tfrfi nr : rrJ, fij suurJn.:fii
nr.:irlnrs 6erlnuas#rn*r
-
q:u,
qrnlilyt-1'lil arnrtrfi urriunr:ililorJ:cdrr6ou
'
.1r4,
o:ro?r,lnruyTilil str?o[6'tuil o:ronrutu ufl:
rf erru:
r5uJrnruogn
o:?aL6oour:;6'r:rhq
rn triliu
rNonJlfl?ufirueil:;dru6ou
soiorofiarnr: tur6ooBUNcreatinine
rdnsrrfilaonrxqndufr'{o
U
6J
41,:
[q$n 01n1TT0U?UXlufl1ilSt',]uoutilUflU
orlor;o;uaafIruulu:rufi'd'orn
r:6ufur rraruo
A
A
I
d
,;
[ i l . ] 0 a 0 n [ f l i l a u . J ' l u 0 1 T i l t u [ : J a u t . [ 8 i l n . : . t ' l u rJ:;oh
r6ouo5.rnr:fernrruuill$uuro.ln.rrgn
ax1sJahrfroi"t fintl r:Jduuuil aIs o.roiu I : dur{u{ rfiorirurirur
unr'',r,,du.:rrrnr:rfi
onr gnri'nluournrsr
unsriuuytl,J
rdurJnsm:
rirhl'fiornr:doronaoufi'.1
un;rfluuurmrrtunr:'[ri'aafTuuvrcr
rryru
lolror^n;{fi
d'nrsu finTrruuiurj'rorrwirrurrrys
rfionr:nriou finmrurf,urlunr:rfion:sgnr^rp
ld'uri nufi?inr
@qraY
Alrrau
?0.:afu?slud.:rfrn:ru
nrs:Jsarryilounnu m r ror5r:'lil rnufiqer: r.rolrirHrinql'rrio
I oonrir6'r
yru
rTaar
r :ki org eirur.,r
atu:: u: urro; oor:rrf,ue n1ufiou6ruq:r6'oguqraimn iuil::yrruorHrr
lunr:rfiol:ori'rlor ngnnoordoqrfiildu ua;rfiol:n fifiuonrdururias
a X
^- -^ - 4
nryEnr{?utuo{o1nn1:sru[fl
uIuanT:
rT?
nr:hi'aoiIruuno
gn0u,]nr?q
rrnufiqilrJ::Iusriorjrrmn
Y,, )c
yt,J9{nillfi
Iouror^nslurru:
5 flu:n nr:ril6rLuu:Jn.:firfiodu
UAq[Qu[T14
UTT[yt101n1Tyt1.1
vasomotor
At
-f
-
y
U
y
I
yl
v
r
-
! l
df
--,,X"i
t
j
rfi fl 1ldr1*0{q']n1'toa0'tItJur0fl t0Trail fi {0rfl onJ
'
i
e
i nstabiIity a I n I Tyt.'t.:
tg u u n r.t r6ufl gar r ; u n s
tv
orir.:m nrfiorrir rifsH
ruoil :gah[60il
s
da.rneaeu.n.'',ndfi*n::wrmtouti.ruoeroo:r
q
a
a
r
sq
nr:ifiofiuan''txiniloil:sd1r6ou ilon01nn1T rfrn.o
Iunr:rfroL:nu'rlo
un;Haoer
rdoq unsrlorriu
lilfi:J::ohr6oufiooiori'uuru
1z r6ou dtruriun{u I:nnxgnnlu finr:finut^ru.irnr:t#aofl
Nuyro
uyru
o'rn1flonn1:uil0il:ydrrdouu#r oroifiodu sr rur :n nod'o:r or ill ou:r lnld'our.rrur n uori^:fi
tri'uriuoul 6'[osnr:o :r ordooil 1rs6'uaoililu qsnum nr :tri'd: unmil :; Lr-q
:: {.r un: r :'[#dr Bsitu:: rr:
"
xdu rsn illnndl 40 tu,/L,Ltt rurnn.ir2s tu/L r?ruoYul
o,lirJHtJoil:yoh
r6ou ril q:: u; rr nr uru
'[un:dd
ttns estradiol:J:cmnr 1o-2opgzml
1o-1sfl ruqi1fi'[d'nu6.to.'rq
7s fl Tosfi#orl'rrulftu
tilsrur:ao:roHr::oi'r-raofku oroldnr:n:ro
r5.rrd'rul ru:r5.16'.:lo
qn riluT:no'u
{rh uffrilurus
9t
*n$u,nug6-uinrnnalxwatutawxilnnh iunui
i
et
d
v
?7r?nrryinv#fnwunnuntmfn6frn
Tvwaunwrcrhntnitild p afufrt u.n.- fi.n.cdsa
34
::uyfrfiornr:
I
disorders
.lv
r
u
I
A
d
e
6
"qua
rT?]loilno $n;
$lrnnil0ma:Yl'1
[14[n00$l,itcr']
active thromboembolic ttsra1o
un!
df
d
o'rnr : n6ul #
nt :nj ur ii r un?v!r{1t d'il #vrhtrYS
sr 16uuld nr rtf srvrr.:fitari.rur o:hi rir ud'urirlfr
N 2 uuu
luttuuljo{n1T[l4g0TttJuYtotlYtu
$
q9
q9
I
Uy
rr
tllru .) rqtln nlTrl4$uilllJutou 5J r[R!n']t[1,luuu
ldnogSflnior;riu HDL-cholesteroluaEUl
'i
O0[ilO\t
01oilu0nlu1nul,r'1141{{u1t?tuYr
!T [o
i
r
a
1e
6
1. nlTlo.rluurilu:ouc1triU
q9
a
f
e
I
t
y
1.1 [fir4fl[S]?t0UnOOOnU21 ?11 Un',l
1.2 lfrranlo:rouflunnr21 via 28i\
a
7-14 Iu
uolhi't:J:ror6urflur?R1
qv
r
i
,
ic",l|
.
ft rfiaaofTruur
:rrum6
a€Tlsrulil
:rouAudlffi
rn?13fi4fiuulfiTuo
ruo;aoihufii
$tun{laaflruu
dl
l{UO
7 iU
t
arzt
raaa
fr
I
2. n:lttfi$uun0lil4.t tgu
acetate?un;
fl{ln:1cfi tfu medroxyprogesterone
iuw
s iln. norgstreliuo; o.s iln. medrogestone
s iln. nu'ir6'sfl#rflunnrsdrrdnu e iudordau
c!ffiil''troflouiunr:tfio endometrialhyperplasia
t
t|v
i
A
o
I
vqva
ros rnrrr$ld frrl#rfluuuuriarualll
6oiari'u4niu ${ rull$l8r''ln
2.1 tfrrorln:rcusrjr.rrduT
q .^
aA1#lusnifi
6'o&nB
noonu#?
noru'rnTil:to$6iln{rriu 1fr medroxyprogesterone
2.2 tfrrosln:reuir$'uLJ:rca6unialrTuacetatefun: 2.s ln.findsniuqnr:uirruriu
rofllorrou
lrJqniuleu'[rlnrlo
nr6tucio
lipidmetabolism
nr:tfrLJ:rou6ue;iifl
2.3 tdu'rfitfiqvr
f':r ruvrtrasf
hur osdruHnludrunr:nn
10:muLJrrosfiuun! rauln?roil Iouno:sdu HDL-cholesterot
rdrul rfthiurif,er
6oeiofi'u4n{u
rduTibotone
qrifinr: rfinl; r5.1
nr:fior:rurlfras{lluvrouytuniohi rnsi!
sfiora{raslolrcudfisr,lfirfl
uao{Ilunnunu
w{noqjtun{uaafllur::lrr6 lfruri conjugatedtri'tfinun:tuToloduoqjfi'u{iuuinr:ueinsrru
nrrrio{iu
n$'.rcrntfrao{hrunouvruufrt
equine estrogend.rfnld1utrdurfuil:;rrru
0.62srn. $ni estradiotu?nr:rrnrx3tfl$:tu:g trdoo:mJ'un,Ufi'dd
lolrtrl:tc;1fi1u1,uloiun!
biopsylu:rt.li{fi
i'uss z ln. rirtfir;d'u estradior
1u6*l n??ctfi'ruuntt?i.t endometrial
vaterate
ryirriu40-60pg/ml str:nrJo.orTul:nnr:qnrqurfioooonfiorlnfiornln:weqnHiordsnr:n:rl
$fluuTT[?11o1ntrvasomotor instability'[qi gnriu
endometriumurnn'jr
uttrasoundilluR?1r,$u'l?Jo.t
darrfrrutu.reu''r
uio 8 rJr. noroxryth endometrialbiopsy 4nf,
1u:'rufi.fiorn1T1i{u:.:ore
'[u:rufislognuo;'tdiuraaTn:tourfiu.radrt16l'l
lu:rudfioTnr:fir{16u,iernurareda{noril1eu'rfl,r
qe
rdu orctfur
uonilndfrnu'ifuinr:rr.n''r.6'u
q
I
d
r
I
!
|
ef
onn14.1
tousrtir
tulilntilYl1.1T0{Raoqlvrornu,.|Saixfif,
y
tf
-
-
aq
A
u01t
uJumnuiluunlu{iluoe
ilonQlnn''r1
n4a0T
fifinrur*r6'arJunrrqunaniluiualnil:lit6ourdu
vrr.rfirnriolupJruoiunr
z.s nr:iu:J:smruattrtdfiqrurir loutsvn:uou,d"l
nr:t# 17betaestradiol
a
-lqv
o v.l
Jr
)a
.| a
rEftJril.tntten nlr;uil:lynu
nfru 6rfi estradiol1.5 un. srngusiil6qfienfiifr.rUrd
ft imrtr rir6'rg1iln'lr
{un: 1,sooun. nlToonnhf,{nrs#tnur:sn
estradiol{un; soldn:nil
-
)a
-"(
n1tIeu
rtun'ltaannln{n'lumun'l:uuntu$1}4Bn
nrrtfrsorIo:roulutrrJiurJ::nrudr?a66a
uu{{ urrri.rrirul#nr:vr:rd'r6du
tfia:oTn unlnr#urfia.rdrufi'ur{rbi
HDL-choteterol
uoncrnrirlfifi nn'1
tUnUlU
tO.t n1Tn1?n[?[11
f : ; e"uq.:du r : sr1ar riul u1#t e,rr'urnr : fr erri.r !?U lHTl.ln'lUnT;OUn?!
rdarornT
rfi ursiru6'u6ovrhlfi nlrl6iun?'uJroltotdelngnunlu rndTdwdru
unoqr6oor rirurun
I
a,a.,
SnlTnJfl-uutliln.]18{ coagulation factors
oalv
al er
a
da
q
i
v
a
6ou6du
t1'rrilqrBn'lilts?st3o{flnfluiauiloil:coirr
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao
35
Hosp Clin Med Educat Center
aA
aA
naunil?flil'l
rJrva.rd
d:frolnorail.il.*
zsfl e e r - o - o ' rtast3 year
{'.rJru'rf.:lvruqiorq
ng
1
j'
.
rJrc{6nr:rhnorrr{ : fiilrtlrurd-tnnr:r{
y,t.fl.2537 tYt"ur + n*.: Tou:.n
ilrnqr::r5n#i
urn rfiooi un::r{
a2
uTiQ't[610ilnT.iffoYl1rJ?uYl
25 ilnu,luu
9t
a(
nTunluilOnfl0o1l{Y} 1 rlllg',tul.lyt.fl. 2538 o1qn:Tn
j
d
zi d
f
- @r
39 flUO114 lt't[;.l1 rU']u',tfluJ0?uyt 29 tJU1fi8.J
19*' f,':Jor{ r{nrdooVDRLnonreactive,
HBsAg
positiver.lnn"lrstr?on::drilu6'.ro1T1{fi
1
yl.fl. 2538 oi'rurio.:r6un::lirfluralnqrioulr
.i I
t'
\l
ra
o
o'uo
[:.0?'{u"ru"rfl
3 T'][rJJ [rjriilnInao fiTou'r[oilvr1'J
lq<Xa
To.Jnn00 ?11Tnlilfi::Rolto
nrm{d 1 t{anr:ert?on:rrf
I
nau.lsi'ulafisr olqnrrff
rirnrin
?u1l
rsqiilgoqiloofl rdss#r'lonr:n
90/70
't9"
1 FB<O
+ve
Rn6
11 0 / 7 0
24"
1/4>0
+ve
9 Xt.Ft.38
qn4
90/70
28"
1 /4 > 0
+ve
8 n.v,1.38
51.8
100/70
32"
2/4>0
+ve
7 yt.u.37
50.2
12 t',.n.37
n'r:o:xod,lonrsu:niu : qruunfi 37ou
frno: 84 of.rzurfi oallt4'tu[e zo nr.]/u1fi
aZatqZ
-f
a
r
a
r
Vl ra
vl
nl'lxJol{tafl q 110 / 70 tJnfl r3J6tTlJT011
Lus$l $tt14fl0,1
Y
vlrd
-
[xju01n,l:lj')riil']1run 52.5Rn.
orr?0fifil?10.0-n
eir:;d'ltooruodn'td' 4/ 4>
IJ
s:6a ern'rfetatparts'[6''[il6'qrouFHS +ve, Uterine
contraction,Interval 3 il1fi Dulationso iurfi(S-)
or?odo'Jnnoo ilrnruonnrflo 1 orJ. Ft?'uJu'r.l
rir nroqniounr 50 ql#rn:'rri,ililuorn
un;I:J.r6.r
il1n n6i'r6i'rl4riT
ld' tri4'erau
Z
s
eh
X
o
1. $flaon1rd{n::ftorfi:Jru:rufi fir}yrar
Vle
0!t:u'r.l
2. unyrrifio
[ninrcrrYdrr.J:rud
t6',torttt
t{
1l
yiyirfi rdnnrtnlunt:finurdut fi.rfi6io
ultrasound
d
16l
r6no
:n rnr;frrirlrx fundus
qj'luzir:Jn6
6'ruraririo
j
Amnioticfluid index'[6'z+ rru. ltngqT?ailuR't]',tfi
^
A
* nqa,t'tug6-ui
t2rntilt lxwu nt awsvilnt nh iunt\i
1
L
A
R'lyt?t 1 fl6tn1To:,te ultrasound
qgt
aa
u
g
_
r)L
x
or
tnnl5?1{oas
t:fi1,o{rylJ?u:'l
uil
il
e
vr
X
d@
1 . O n A O n ' , ' l : s t . J n : T R l J 0 . J r I i l ? ui li :l l q u - t
0v t::J1,:
z. orlri'nr:ifiod'uT:err
oreirjru:r ud
3. arl#nT:quainr*r{:-hu:ud
36
44u44
iln E nuun 1 il.f,. - lJ.fi. 2538
71id17gu{nltdnwuwnafllm{n6fin
htwuutawwilnnit
ue.lif fa
toou
Y
,
3
a
itr
[9] tilO tYlln{U']OTlYl
[U{61.1
I
Prevention of postpartum hemorrhage
r. rJorardyrutufi:J'ru:rud
rfiqdud{ucitu[ilo{a'tnn1?! polyhyclramnios Yl''l[ilNn1:ucllJU1u
period)o:rfiu16'
,rurrirr*o.rl'ufi.(antlpartum
odrrrurnro.:lroqn 6.:o;virlfrrfio uterineatony
qrnilxi6nr:rhnn::fi 6tnu'irrlrurinro.:frrJ':l
'[fflu:s
usH6'.:oaoo
fi tflusr tnoro{n"rrontd0oilfi'{
oqvd
A
a
AXy.\el
tfrilfiutiousJrn (poor weight gain) un;turotol
A
a
a
a'
v
d
cY
A
I
il o n$ In r: iltJ1J1+1
0 [ n n [ il 0 [ muun il 0'] u n TTn0 .0usl
e'
d
"rbXsofi's'iliro;ufioR1xrt6n A
" vr'
o1r{nT:n28 fluo'rl4
A
A
t
eq
d/-..--\
dr
e
eA
A
vl
I
nR00Tgu:
[t?n 0.tn2?iln1TUa.tnu[ou
qe
a
a
a
"l
- n1Trfifl'lrl{l
tflennaotdog un;[0]?uu
ylyt
v
Y
v
t ^
d
[t6l[:il [lUfl:TR
[fl 00 [?fl 1.lfi U',]O1USr.J
d
rr1rfluuv{vt
ufr
ro?qr6ulorfrlufl::ri (tuen) r nsfr'1
- ntifieurl,{'tn Ergonovine (Methergin)
28
raSo
32
d'rjorf
CI:xon::rilugnr;#.rn::f
rfiod:u;n1:nnfloqrfr'?
r{rnfrrru Hfounoordaoel'r
unryi''rn-r:fiu6'ueiol:J - nr:tri' Oxytocint4uot{lfinoorfiooal"rdo
finr:fi os6'uilufftynr6'.:nai1'r
q
tf rflonlxr IUGR
fr.lrlooufrvrr
d
e
f,.qq^
I
v
tf
v
e
0u'1.11.{0u
1 T?$J{ finJYt'l:nnRoouflx
f l 1 u f t U n l l i l t u l u : ; u : r d u n : : r i n as o r
Ytdq
(intraparlum
period)tlu l lu'j'truoqnfr
luro [uqjrurn
Inhibit lactation ufiinr:onoofiwtfionr:
^
uo
A
q y
a
u
y,&,-
Sl
f.,tn0il1uilyt
[9''tl{il01lJil1 0.:n?: [fi nITUUU{n119.1fl
oudr::6'u xyphoid durYuera'rsirutoryrr:nl6n[rj
rhuilIoslnr:io rdrurt (breastnindins)raiod':ruri'u
I
,
A
)a%
e\ve
.r
d-orou fr urTT't
o'nun1?sfi frui n:r rur nn'i r rJn6 nl:t#ul Bromocriptine
(poVhydramnios)
n6ir
uonornd
o'',nn.rrrronrulufi
Counsellingand Psychotherapy {,r-hufi
ja
ya
Y
^
ro
or
o
rtrurirld'[ili'oro1{?i{#fi'o.r6o'irvrr:nluor:r{o'roo;nn0qqoTvriln?1N
[[on1tilo nuoilo0.taffn
9.lounoo.l
r4raa
e
a
a
a
v
e
a q
€v
vq
oqjlurirfrorJn6(abnor.malpresentation)H?o
[0nJn"'l1v
tfl5.rrf{ut0 uv{Yl8H$unrnula{n0.:tJn11il[111
fiomil fiqdn6d.ruqirirrfio (tetatanomaty)
a
with polyhydramnios
2. Fetalanencephaly
3. n'rr8$n;nur{'rJru
Terminationof pregnancy tfio{qrn
yr1:n'[ilnrrd:ro.:(rJrurfluanencephalyfl
q
vl
I
d
e.
)
d
a.^
J
rl/l v
a'
t i l f l 1 u 1 T n i l o : t J 5 1 S r T 0 9 r 8 U[ O
q ,l l l o f i f l 0 o 0 a n i l 1
o .f w
E
a
a
cX
1v
n''lryt't [14n'] :st .tn T: Rff uq q n.ta{ o ?TI n 0n tu fl a ao
|
|
9U
ro
d
A
o
a
q
9.
oo{
I o.J{rl r l'[ut rwriu uo: rJ:t d'urJ:v
nr.ri sr'[o
a
4
e.
"
f
.i w"
r
-q'
R','t1:A0[A
H i l 1 Ut O U n l T u n A U [ [ f l t [ H n 1 f l { t 0
9l
ou{rl rrl uoruiurraqnr:n[fi rfi odu'i6' :lqrar oio\r.l
a
Ayt
c6a
dl
ea -
4-
\_
Yrr.rlllilA:n',tilflstttY{Ylu
nna [1,1il [0n1flN1nil0u[v{u.][T
t
,it
_
rrsi
fi or oo; rfiqnr : dr n; : rifi vrr : nfierr r rufiorrJn6o''.r
Xa
n'rruoIuuu0n
Anencephaly tflu
q9
vt1.l50Jnn0an0u n1lilflltT00{0tv|0't:tu1tfinn00
neural tube defect
^itdr..aa
gfrorafil n''rrri''ruyrootfluur-ru
multifactorialoo il
(cesareansection)
AIo r nr :sir6oaoaom1.it4ri1ti'o,t
genefinru qrunn''rudx:Truyi'rrJo'6'uvr
r l ft.:ur ofi'ol 6'rt
(augmentation)
nr:rrul#nr:rfuot:fddu
(emironmontal
factors)orri6nr:vtinutuorruinr
oiru66nr:td's1 oxytocin r:7tfl1,:ranoqt6oqoh
il:;ruru r sio 1,ooonlTnfloo ua;fr'rfiqor:
ff'nr::: {.:n''11
siloQn I nn rfiotornruoqn frnrr de j s X r a t j
11r€lutl_lun11;uil'tn0u 1 fiu o:il [0n1flYluo:
"A
polyhydramnios
A
X"|vtya
' !f I
d
u
d'luntlrirutri'
ss.i''r.rilrnornR1'x
fluO0lll0vtnot:jl{R11vu.r1[q0nT0un; 1-5 6r.1
asaXe^a?l
(amnionlTtriunrrR6iTuolu1rn''r:t013q{u']fi:1
onild
ru1Tnn
ori6nr:lornlr [fioR11!t%rd'oroar
q
^;
Xuud
r: r6un::lin noe e q e
tomy) finr::: ivj r o"raavyre'rt#n
q
Vt Me
(prolonged labor) ufio.:orn
U''l?1{1Uoon'[il'[fT
yrrrntun::firilu anencephaty6',rriurirurirrflu
-l
baseof skull 6roroo:rirlfr'nr:ritt ursil''rniloCIn
n 1 lil 14il { vl t €lu il u sr: t ll l+R't 1 t u [o t u u T: Yr']u
od'r.rfiori rfiounou
toticaciJiunv a i,lafiniru
YsaaY€
0Jn?TRn.t 3 [g01t$?n?JA\tn1?OJntTR
Vol. 72 No. 7 Jan. - Mar. 1995
37
J Prapokklao Hosp CIin Med Educat Center
rlfrruns
r?a.r "li,.ril,.l.rfiigftilri"
41ill{l
d
il1A ?t.u.
risu ?iru:otr{'16{0ri1o'lrd
nn.rJ:cfigr lnsilFf1ud, ritra, or:6, uflilst,
riarfisrur'ryrflnriuavfifirfis:6 dror:il
riaudururu6'0.:3l
6
osouonryirua,to'r:ri il1uuy{y}
fA46euA
u:3n0
I
tnl*ilfl']ugt
ufl:nrw[ty,tytu
a
t
r
[01fi1{'tvl
qed
aA
[TJl4U1U1niltrUnInfl1ouyrq: ?mTil1tfi [nutfln::]lrJ
nr :qirrfiu6i ol'[urdo.td'uff'rraiu ul^rytri froI
|
A
"ivt,
rmfrou{
qruvirtrJ
6rritnorJ:EYrufi
rnsurn#os
u#Tuoiq:Jfi#u
nion::tra.:uoia:r1on
nfilfims
stm
a
j
-o^r-^._
_'...._.
ra
o u,
-i_vt , ,
u u?yl1\tnn ?Tufl u 0t.l1ug fi! _ n- .uyt
u'l[iluo.rnilronn1lunr:ilronarrfiu:6snrr{a .rust
?'tilil-t oryt-1'[
o'
€
6
r
4
|
^
d
4'
4 d
uflurfiu:6uriornr:dursuNyrri.f'sRnfi"
das uoiq
m:rqn uriinr*T
urafi
ouo:uln0.tn.irRldule
6onr:
rJfi
rfluo{rurrnnxTil6f1d'Ero.ryi"n4s'tx'r:rifi
rifidari"rlo
uhj?ronnunlrio,r d'ulfiuri
fidaanrfu
q
y
'A
e
rl
6
I
v
d
[[14.]1{ [Un1TflT'].Jfl::n [tA3n?"1iln1?UUl tililO U-l.lLT, r. ilrrurGuror
t3J*l'lff6tlsloTlGl
lll
e
j
y
o { 0 t u Ti 0 n u I n I a 1 a.Jill u 0,1T''l ? t T.1il u''tu -l I
I
d
'6t
s
2. ofiilu1Yr'tu
r
r
o
l|^lr,_--y
€e
a^
t
a
A
uJnnylTy{u14
T0t0 "t1,0.tnilou
w::ilnrnfrr,duyrqi
rfluodr.rd
r{ilnioytri6'0.:rfiuir6n3.nluiqfiofl1o'tr lilfioqnduto,rrf;fiu
[rsrYlfflotuu{[uilon?1fl
{0 ulo n0n1:rililogt[iltms 4.s.lfl']?1Yt
tilqorfio{oilo Hnonn?.r
Aard
vlilnl tilol
tJfliln"lyt iln ilr'r:8J fi riluuuuo drrlfr'fiu
s. ET't
rN:ufTatilil'tyt'lildilq:r
rruit fr.:rsl,loi^o
l
\lee
Aa
e
d
6
, Al,|.
ltilnu$8;llffslttylnu 10{fln1uiltrl4{uIo
uonornn;riud'.ineirr
un:[oTU
ueir:rdor:Jfrffiorudru
tAo
e
^
I
'q
i
r
^
a'q
a
a
d
(
at
&
|
ta,
Asa
n1TU01t:U[1.t9^tnHnO
n0t[y,tylun?l 217 €1U o.l[[otu
6.1unvulraSoqfl
fl1nrfl1.:n,rrtufiyrrir:''rli1osri1'[d'tt
ny
2525 T?S.J
12 dU
I
a
)
virld'6n'jri6u uSofivirun:;D?rlrflgn
(rl:rqvrr
ovlya
qtn#uil1fi''ril:;uduroru:rn'a n1rdln1J
6i srlHa.i I ourj.rrrTrHrur gil r fi rirufiounvrdfiautrarj
a
t9
AraA
qn1ilflCIT qo?slsyl
yTunnutauwnia\ma nd
a1att ife niltn t nSrt4a t t t arat ra{
natn'tsdnw 5nat iu uwnantsa{
wtu,tqgm#.t
xilttnnt
**X
ilJqruffiluqq{il
Vl,-.i
yrrt:1tfra 01 oroitrJi-rfi
nruyttytytufl']flo
5 1rrnn{n:ai
rilunr:oonfrniaffruansnlwurs
erurirsro-s
fi6o
ilrynniou
y)
virurduul{'ir orudftdnrrrill4ioo-l:uru
rJqerlor)'
i u't. fr d':-unr rJf ry1u r acil T! qr ur fn :enir onfl il r6'o
t
,
"ulauwniiafrnF'att',rla,{td ," zz frnau zssa
[t twatu t awwtJnmfu {unqi
a^!aa
r. flqoTerf.r
s6oiin?rildxnq66rJ::nqfitou
3 ilTsn1T
1. nluqoin o?,1uEo5omi.rnrs
vrhR.rfi
6,orruqndol
rJ::rrq6roud'runru
38
s4
1
un n fluun 1 u.n. - il.n. 2538
41
TlrrnrpintttFlnffiunnsffimin1frn\wnarunnftilnnit
2. rdqctonrtrqeinnr.rrrorrXoR.rfi
6mrqn6'ol
il::nq6rou6'runor
3. d*qe?ernruqo?ovrr$o6ofi,rd
6mrqnCor
rh:rqf,roudrule
io. finrrlrfruqnoia.rrflua'lurfi'ni
rri'rlqluufnnt:r'ir vrh6SHnd
o
z. rJ:;nqfin1uolrurfiillourJfirifiXnfio.rortr
nrluvi.rqannrat
1oilr;nr: 6o
Jl
virdrfrHnfrr f,rilrrTunmuqi.rfi
rflu
o::ruorsodnnunldinrartfiunrrn
rflutJflruuqfle6'l
vX
r?ru ro iiafr riun'ir qf,nnr:uun (n1{
or:uo:rrr1r.t
r. nct{unr:dr nr:f,ur: nr:fiu#u rirn::16) rir.: rrmisrfirr
rfiuorfiurtiirtnnrn$xr drurnda rflu:run:r6uoru':runxlilqcicr
s ?iarTr'Jdudrrl
6o
X
cv
froa-to
ila +-t rflur6qc?n
rn0{nfl{rnr13nnu
rio r-s rflunruqo?n
z. ncrlunrlud{6.rfinalluun:nr:uorioruu$ruqlTo'
rsrriliuu; rnr:nf;vrfluninrif;u
rdorlrfirTrfrlr{nruilrdr r raisrfluurvrri
aur{qm
ra,rriuunlrTu
ud'l r:rfi ri.rrfl*r{qmaqi Sfirnsd'arutufi
l:into'ir
3 . n ;r{u n rri l :;n q 6 frn a 'l r n;r fo ri:\JuCrnltrtririrriuf,qqrrTudruo.:ufrrfi
!
..r
lu'uorinrs.rnrruuurorfienrkhiu nr rT'r0;r?1rJ1oHrilfl1uitrdnunvrci ritirurnrri
r0{ " atf{R'lt" qnitr 1
6n1erirarunrna{rfi
u:6uo:'Ndn::qn gooncl rflunhrtrcrudn"rlfin'e
go.:rin
fi6o'Je'lYturf' nn:tumuutrvrriunvrriGoorir.rrtu
01Tu!11iln1{1.rN',1 4
c?r 1 B0.tnrrd?ro.rgrarraa;6nldmnfiriouhi6n
4. n:riunr:qorfic Innnunona'r.r;
n:rfi6n6'olg niordrr1rrd'rrontsernarun:8.t
ndmucinhf,nd'ldo.rlcqnlffi
oern f,rnruoriu unstfrnmrrnr:vundor d'rsli.tnr:
oruri.: rx:r; rfir*rrinnrJrlum[1o"1
uisd'rdnnr "drud" fi0.rrra.rfrrluruluqiurndg
rfiurT:n#g
u us,ohi
r{u.rafro n'urdrd'u rirl#fi nr,rrirnln,r
s. n:riunr:4ortorf,uer
ro
J
n?1ilunnuilfl; {nIon1Yrffil']ilun;
urirn:r4.r
{rtr ulfr uio$r, iuuinr: 6Cni.,tt*l1ttt.
fiS16'nl
t{u r:r rfluuyrntilnd I r;S
rflurnis.rrTrdyr
d.rrrirs, rTod
A-a
nudfinrlrf,
fronu'itflunurri'o
6. n:riunr:rloohuuruRru enil:n Rrru0lHuso^tod't
'i
:ro rTrri'uh
rf,uvrru;r;nudnhqnrlrriurnmufl,l nioisn?rrfi rld ou'rnriro:l:lfi rsic
'
A Aa
A ca
,
rfa; 6rfirilufr$rdudnnrujiorjrr unruR{r:rdalfil$a
7. n: r{unr:4o rr,tnrlnnrvf,o
6r:rdo.r
qo*cintrmir drne$nn fiar:- n#urirtfr r:r oru6mrdr rSoldn:,rduyrn
rfa
ut!tulu Qnn1flr?1ff:
ri'orflurinrinrr f{nu?urra* u?nr:iliilurn: uns
arrsr::uvnilo s
fn i'nuiu r : n nr tfl ufi.rdr6'qfi.r
J
i
,
u'ou
ee
a. hinilr'u lilrr,i.rrdrGomflrrrorud
r:r un;f,innudu
fiJ .drn'qO.rn'ir
r:rfrorf6'n6'r
ocld; 6o1f dorf,uanr vrhlotfr IoriinfrnftJrlirr:ril r tfluuurfinuurrJfrffid.r
rJgnlo
rdoudn{r.r:nr.l
murcrnrriliiom:lX,q6in''uswituJtqvrr
rit^ ' ' d ,:iuuuiarr,i.rilo.rtu
e. runnl,.|uq\t[uuor
dnri:unnrriruriuulln:ri'oioeiruldnmlurirldru
a
a
r
o
lc
il
uifi o;vrhnru; d.ln'lrurhr:nu16 srtj0ulnn;lfi1{qnn$Y||uullillmuuTo0Hlilfl1u?t']r]l
0''tlutrlltYr''r{n1u 3
d f a -
fll
a
I q v
A
r
t
a
tu
u fi tilllT {it tl.ltnnuTStutl{ql, Ltnnu
niolluriloueruq:nid.r
unvrrirflunualr;:oiuuu
Vol, 12 No. I Jan. - Mar. 1995
4l,f
er
o
dr
J Prapokklao Hosp Clin Med Educal Center
)aa
39
froId'irrilusurfrnfi6fiqr*eiro
uns:yu!r?n'lfifi .rtflunr:rJ:;noufi
dr.rufro3rt0.tN1*tsur16
o nr:vrirarirfi
6)nfl! rfiutfio.rri'u rriu
fiu::ruH5oorxsrffi
n1:.:'lililfifi6n1rei'1.1
6tcio'lrjf,
{6u
fi.h
' r. furirprqorr un:fi'6'n
yrhtri'sr
r'[nun'r
rr
n
rHq
6ofira6'nnr:
:vrh
o;rt:
as
u
x
n
ar
hi'rf,Junnr
firafi'n
Y
/
c
)
srn,
J
v
tla:n0 tnBr6yl
lJ0\tfl{Yt{14fl1u?1
SlUrtl'[ilrfl U?" an l#fr'unnr'lrivro
rrnr trl'rnrur;
rrnr bi'qnnnr
lun r :ehrfiudio tunr ::jfrri6fiorarirfiuaseer
ufiu
rJi#ryqerr f.fi'nqunu60f,,i'nfiuii,'n
ffon::roir.:t frrr7rIoRrfinuogoYo.Jil:y]tqdilfifa
fiqlqlunvqlru
finr:6'unr:rJ::r^rqGrlfiffitufiu
olilrnnr{fl uriufi'jr ohuild,lg'tr.wo't6il n1rJ"tu frqrupr unroiaqrururfu.jr
q*,rud,dr,drtrJnr
a
v),
qsouorifil: fio;1:rilu nr:frorrirfiiuror.ir.rd
loJeruuHulm
IRc€l?1iliufi
nr:6'o,r4oori.od
qunudfi
ufi'nnr: ay6'orylha:1:o
rir.il: 6lrfllurHortfu::n
6.: :yrfiuuiriuodr.il: fi{qrur::urj:;rvrdari.rrl:fi
qgi<ru,uA-^tY1
-t
g
,.tn ff 1 [ : oyrt u u LlJ6t'til fi u't il u n fl ? UTUAloto u 1.t1{1
izuuor:ruil:;
nrdonr.:1: fiorrusYa{nr:adrsl:
'ungffi q.n4ioH
qail#ug.t
flao
godofirvirfr
ril
fi'nn.lrruo?o nr:rfiurrio,rn?rdo{fl,l
rnrrsf'or:iuld n.:ruhrfiil
lrorDr:t,u'rArfiorJfr
ri6oiolnn
unrdinoritq nd'ol rJ*Iusrit#orirrrtu9
fi6otorijuds::'[risrn
rijun1flfl
o,rTnn
z. qnon''qqeni6'nqnna d0f,,6'nruo;rrirto
rnsdisrriu
z. o-'ord'ryqerr
6o flrru Iongirouvilunnn.ir
Iqu6'rurd'u
R?..n
fl1n1ro
f,nmurjoail-ruun:fr.i'nr{a
q.l
udro?rui.ifi
sJ1ulJo.tfi
fi'nnr:fierurlfi
:i6 $flsqnrrrrN1o: 1 OoaSondouorjr,lnl:
un;i.i'nfios
f,o'lrrrururr
rr7rlo
iorqt rJx sl 6t o.:fionr :fi oun:ymh i..j
la frnnr: rJfr:ifidoqnerndu
tdn6
1 6'1rr6'irn.::o:nunionlri
n,
I
lil
o
Y
-&-. t
v,
A
,
uu 1 ilo,]1ilq{fl
il']uou'].:[T i?-t?iouyt.t0r.iorj-t
"
Jul.[ j
oyl: o:frruri'ufrfiu-rfo.r
o:1f o;rrndo.rorsl'rrafi
o1rililTlslou1ituuudorj:csr6il::Iumio:1: ra5o nSoo;
uwrirfirnouodr$:6.ro:1dr.rn6
jq.a
a
-- !l 9/
U
o )
fi?'roy louTrfl nJ9.tn0y [? yttfi Itfi lllfi Et1Ufi li.t g1u;
rr:lr r dod riun.jrfi'rJr$dr??sr
urJn.jr
g ru'lri1t4t{o?r.1fi'u'[tuioor1ujlilrnu
n,l:,r-nrod''lnfiir
r::rut orfrrJilinru6onud rnianufi
ufr'd.rfiqruauiG
a:'t: fionr:fiqudrodriltd
rdorirl:.tur6'ro:rhrfi
orun nornmrurflunufieruq:nl"
U
t| -r
*X
a A
o:l::ir.: rijurun6H6arunrdtoda.rl:
aaooail6{1Yu
rorun1ilrilunlur1jaru
n5ofiqu3.ir
frtr fir:r
,
6ofiermruurururo{oADrrrlqr
riur
a.r
uasil:ilslrfifi
fr'r
r
rrfo
rou
o;
arnl
ruofr'rn1.r
oo6'0sr.r
fl{Eo
ier-'r
rflusr::go{6isl
nr16rurnfi'rfirrlr o:fioruejourioruriorsru
fifiirur
d'ord'qqerr
fl''t:1;il1nu{1,u
daf,orrurfluaivjr
fi'neru
-9.
& ra
sra :r flu'i r Iorlg'lw R'ti i r14
fl nhfi'.:n?1il f, n?1il nficl
arsn:rqr.rduru$r{yrrirflil
l^r#.or
n*rfir {nfion-t']rJff']tJ']:nun:qilfrrN riodryirl:odr.l't: ufi'r qnnR Hiorior o.:urryr
druuvr virund,r.r
rd'ous6
^l---.--a
f e-laaq I
vu
a'n
Ur: n qoiil0u6 [r{rnrur;st Lrfl;f{n $i-[nrJfurJ
r5finul Hri ri'.rrio6.:rir os:r finl ir mrod'.:d
1I ruriuyryr
-I.rfi
yrh
ri.lrs3ru nr :sir.r1t#aoooffo.r
" t. 6'o.r::irinurqrnt^r1fr'd
Bnnqnr{fl o:trl'
ro5.Un
oni'ril:it rfioHn6
2. nr:si-t.:o:ountr
+. rior6'qqerr
r:iu
3. odrril:rur5r
finr-l:turrx 60f.6'nr^ro6
[nn f,{nil::rurru1ilnrrlfd.ru
4. dalfinr*rqiorfiora{reruo
fonil::mru1unr:u5
rrfilrr fonorrrunorHrursvrod
nr::Jfrrififioun;
s. odrnd''rflqnrqrJm:n
ythnr:oir.:1 qnooailnr:finniouHfi'uuou
ufli
6. odrfiilerffin,,
^J'"r
n1Tfl4nfl1r-luT1{[r,la1{3
fl flsr:''rol r f ur uurrvrrirnru l^rfo^rr r ufi'r
s. nrfi'ryqor
nnrd'urfi
rJ.r;flrr virurflurJ::rruryofiiunvrrisuuyr
virufi:J.r;mnr:ai
ff'nnrndofinrn
A
|
e
vq
tu
r
vel
d
oaaa'V,'t
AA
!19,-tqafe@,.1
v
(
9u
q
at
4A
;nr?nriluin1#lnwuwnantetninifin
Tvnnunnfiilntndt
f,fi n niufi t ,t.n. - fi.n. zsee
:ra nr:
tfiil$u?n'r.rrJ$ri6
vir urT{H
ar un.te3
ro rio
fto?1uflnrmeutilljfi.to; tntuun?ilnRu
Iouffurnfirisnrafi6 ufi? rTudrdryrio
1lB.tu1{nuffn't
t
&
rle
r
t| r o
,
I
nurfiu'Jrt{rd'q6'ududu
ueifi
u1Qttoyluyt2$ilfl'tu 6J tlT{ noiloontuYt']it1u 3:ll
"1 donmri,infifrunu
rirn6,aauqn
d'.rnnoni4qnudoule
rl:sluniurn
fi6'n1ntrflu1m
'Jr
afiulrriufioulur::nfrrstolnooufi
uflyrfiLfiil6Ji,tflludsnmununialfisuqnnulunrT.rfr
#rthr1#q*sia.r:-urrgnr:8o fl rn$lrufr
" u$rqncrf'lrrir:rtnr:
il1nil1u :ruw rdunfourt;tirfluuri.rf;o
udfiilstr,rri
A
I
ci
.l
r
llee
y
Aa
rds!rTu
r;uul'rlr sur6ofifr1{
1r:; u1ilfrrrrdeilrsil irqgrnfir t{ra {ri'r fiutnfrrfsnr n
'r?
il ilYr'r.i
?!fl rfrrfir rlrjrtu
d o vr:.r1#ufin:rtnrro
ilfi r1slr1$ll rfluuuryrr.r
urRu6ut"
rf,onisd'ndufr'uRurfi
ufiuo8ilroun
nurfiuonudu?n{orrtmufi.t {ri.:6'uriqlr
"1. nxlrr{1lr1tn , 6s1un,:dstn:a
yrhnr :,rr uhi'rfl uHne'rr5o'[ei6 0r n'l r r$SIonr r ilisr{rurun r:tft Hlinnuld usin.tolvr:ru
i fi'uo{
orir.rnl:finrr uficurflurirufinulrvrf udr
rvir 1 rTu
sdTdvir! virurT.rfiotu
z. nrrufla: :nfrrnro$ilsiofioisnrruurnu#o:hjvrhnrirdrfluunvrf
auitrfir,trrlnrrl d.lulrvruanrrflu{
unr ur nriu rd so; rir r ne'u rToriorlfrr.rl d 1outd oqrgrcnJtn
t:ro{
drnuofimnr.ruio$n4::rfiuudoft6'urlnn:o.l
nmrqontaiiurnrv{ flfinor,ldau
s. nnil'lilzn?u : finf,.rrnnrfiulou'lrj6o$ r:ro;il:rnq6rJfiffi nruh utororui1o6'rro.rhil6'
)qva
' Y
i
.
, A a
aA 6J tilBlntneHnqngo
2526$frt zssafiiru i uri
dorT.rd'u:rs.ruflyruanrfl
torrnoul''r[soilrilqrauuu
urifionr:rfirl:J un:iunhnr:dutfi unr:rfulot, 7 r{ru?o3s frs tvirrtu d$ms,ffir6uounnrias
fi6s uu?o
rdonmlfi'orrunn:lilrJtnqdfiofr'urlosr
duflftrfru?h{fi
Soqifil
a. nmnf;whiwnr:: ff{nrlfiffifionr:tfiruu'r: z nrrTr*nn nraltnouitrdwtrsnt:l
z fro#rt4Ts:*ilrlosqr{nialerprurfiou
firgd:lnr:fr'rrJrr
i loufiufio
drlfi.t
s. dantConfird t #.ilenr:rirfi.n.t d.t rfiou'1f4rfluf,olanru fidolti.r loutot^rrta
$aifiil?o 3
l oYiuuaul #r fl unri'rfi t oooutft l oud ofntiq o?er {firirn6finntssnrunurulnro{nuro.t
tv
aa
nr6ts6rir6'lro{nu6'runr.tu nr:il::nouisr6l.{trtn::lfioqi6.r rr :ia ucifitrifi
[sR?1ilq0ff1141TU3n1'
qy^
I
a I
I
r
e f5Ju:Tqo{.rJn'nuf,1tr0
nfinu:sn urnunnft:tJ:;trq6nu
toufl1n1: rlqraror'[:rT
ri{urnutr4nan1Ttru
6'u'[6rarnfislnufu
riruomnou:rufiurnin;Frnfiorft
dfi.rq;finunr.r{elrfldf
in.rri fi fio
trl
a Rr1rrranrwiam$hlil: intnnub{rflunu n:rfl qda{i'r.r'ir trr ot w fiorioril6u fi.rokinhnts
lan'rnfinnldrnunrnri{n'tf,u
rlfiffi rf,ufi#utdo.r'lrifi
nrlrr rdadoldtri6oratriiuutn:
nr:fi r'ur#.ru
rahuUy
I
fiu-.rfiuxnriiufi
z. netridnfiiserr
t rfl*drJinurunrnlturr6on
.;
fiiloc;oiurutfirior
s. na'raf,snrionrfn: Teffioutiounrutir.t uuvrriiufi1 fild.rnniiou
Uiliraailra
rdrlo'irs;1rrilrr1:ovl:nr: uishinr:ld
tillTn{Qillnulu 14:o[nTnTil
Srioudo'dnrt.*u.uuttiufiulrn 6orda'r
e. nx'rrilil{ngr* : iirihwflur{rrinfun.r
tfiouunmri6'ruriu
ruquufiur{uffi'u
#.raulilufissu
Sn:ounir d'u:iuno
{'f rurru {'fTru
R'r1uuoilsn:ou irrtn 6u I rriu fiulu1fl Hfoflfrri.rd'urTtgtrdu'1
10. n?1roirinn"n6i:
r{ruru nia oYo.r
Ioutonr;odr.:0.:
rfiorJ:;Iusriuvirviru
f,6'nr r.rnfi'rf,6'nr'rourf,uuxvr6 nr: rduri'r
nun;r+a*6urfiu" nr:onn1rlnarnrrduq:rirrutl fi.rriurtr'trifi
{ri.rd'lfrgtrhit:irJ:rcuaonns
Vol. 12 No. 7 Jan. - Man 1995
I Prapokklao
c
Ia
i
I
r
v
v
fl'l [v,lIT1InvlOn2T [tgln{n.lnqn0u1.3Ylflfl1']11'].t6lll
fvrJ,eve
[ou0't.111t1'{
0ilu19u6f
ilT{uI
I
4l
4. lfr'roriuornnr:tfsr
tuyrtfiodar::ru
rJ:;Iutrfii'ulq n1rfrfluv?''ro1n1:ilrorroiri16
.U
o t4
Hosp Clin Med Educat Center
5.
6.
[?J'10'100y0
nnoU BonU
tllt
lfrinur{iardilnrro.lnilro{
tuyrrrdnnrrru
1r{fnr*rnrrrufr'u
Tourq},{r:a
dr.:8rra,r
rorld nrrruriluulrvrri
n,r:rnr:ytrilrn:.:fifio1oac {'tJru"
tvte
a
A
A
a
v
v
$il
A
r
v
A
v
a
nr:allfur,{vrrifinrrrufn?''rilff1il1rn rrto
flo.t
n:0n0u[o 0n[T0,Jt:a{!fl't? n1:t.tun1:na{
a
Iy
rJ::Iurfizor{rJruunnd6'0.ili^in!
rflua11n.'l:n.rr
tilurn uriiu6'r.raqj
nrsrlilI:.rils1u''rBrofl
su'lrifi6u 6nr*r arur6on:;:rrfioryirum:.:vi'l.rts
fi vrr.:fi
'lu
n [0 il1nn?''ltnuto ail1 1:1Tn1Tfifl tyt'rn?un ttr::lT{x'tyt' fi'ir "urrnrifiriuuounfr'ngnrtr#-)
nafiriuvro.:fnqr6il6'rrarirrtfi r u rino:{.: rr{a o:6'orrflurinriuuErnoqlil
CIaootrxa.]fi
rijuuyryrririlu
nlr
tiuuoo
r fstr lo' tnr 6r ,Jlilr ffn#au,,
o1Nfl,J€rtjvt"l[14[flu [[l tylu [0t[l4iloilnu
r r dl
14'lt9l
u.l unffNuunl:il'l t.11.[14'tyt0.l
T3&t9tTi',l.10u1{
d\iv
a
-
9
oqeA
e
|
dlle
A
e
v
omru:"r:T
ur{trvlo fi6'or:yi.t ttt:r:tfluqru
a
v
flo.t€lu aT{ j
[[n't
-
Vlev
-
A,
n1nn"lu1A.:nq1*yl?1
"Truesuccessis not in learning
Z
".
t:10']014.ttos1u1{']y{nil1$Tn but in its applicationto the benefitof mankind,'
c
I
t)X-,
fiHnrsyiruoEjfi
fi rflungulrvrri rflun.til6-1
r0.fluvjr
a
a
v
a
dU v
,
Aa
rir'tu :r da.:mvrhurirdd
x"tnn''tTltoTo14:o14u'][fl
00n Io fl?ilnilmililTqn
#.fi ,r.rru'''norgun{:Jr ulfi
U
ir:'l sd.ruoiu::ilru:re
firirosl^rorfi
uou#t6'ormiufiorousJ.lflau
fi6nriolrafi.r
u.r1ne5
ct
Trt€
yrh
ffa.l
ei
r
usrhil
iuqir
[ouflTU lJ80il trlUyttgt't tT?1fl110.iflil
:r ur lyi.ru6n6'unir i nu rfiio1fr
[qa
1^r:sr1tfiq''r6
fi'i1 "ordrryuxvrridlfirfiu:6
*nyrri f i #r rTurnqnr : nirvir fiuI: nun:Tsn 8.:tuqnInnr Aa
r vl r
I
U 'i
s
frdoitilfr:':u ueioilriooenud"lou']n:r:rEJfinr: fi{errid'rru#rr:T'trif,nl*rlrlil'rn?1u;6ia
r:rfi frrsfis
driurqtC
yrri
rijuod1.:du'lil lri uvlnu"
n1rrflunAufl o1o.r:f$ilnf yirlfir:rrird'u
6'rr: r ro$rlfi nr :6nur siorirarernrnr d'ud6
ufl 3il{T30.3frYtT.:
U10 n?','t qiln n)$ar!fl1n q
o rr 1fi6i?u
rfrniunr:r[liluy{nf6oorT
ri'luH6fluyryt
rifi:J:yrnffi r6 un:il:ysrruElo.rnr:
rur6ofiotito
I',]u6ro\:Nnl1il
e
a
ziq
1. fi
rfluadr,rmn uasil::srrufi:ootirefinrrlHi.roqj
t5a tun? 1ilfl'13J1Tn1
0.Jollt0J
.lq
a
a
FtolJo?ltiuuto
Hrn r:tiluu riurrnfiount gun{rh uua;r.ird'ondiua
:
finu*qiHrnr:lfluogunn15
2. vl'tugt0.tNn?1il [? t0 ?914
? 1itt[?|tnu n ur0.t
r.rfi
oulrndoon'trJri.ru
ru6o
6oorrruriluflnuriu
il:ymsu 0{rflunnrurvirvrigru
ol.riltiJuo;u}rilrid
Ylye
I
v
A
a
n u
3. n1ilSt0.tIo:ufi?''lu t1000x1nfl u tljla{yt''lu
riauoufiorfiIonr s'[d'rfl u 6ogfi ufrrri'u.lr *yrvrriri'r
q
d I4e
fl0 t111nt010iFln{:Tu
rJ::rvrsfirs,ooofrhifirn*#irHti.fi riluaror:fiuyrvr
fi
s
rJ::nr:fi
nionguvrnri
riluarp rflurn:r;
qilffrJfifiyi',r
j
q
'
d
,3
a
n?orlqfiloroarniuiurufioHnmuia.rnlr
un:tnT0JUT;ouail,J1il1a{[[il{11U[tflg[fl:U1 0nAU1.:
6o t::*tfiururJfiri6loo*nvrrS.iru
rfiotooiruur.i.r
1 n'duerumuoi n1:a6'utduuunqrrilurftdoq'fi0
o#.r6:ftJrntdsfiacirrifrqreutorviru
fi srsqr:ror:f n.r'rir'rn'rr rrffn:svt:?{qvulrisosJius6*:d
usivrrr
fl{nrniilHrinurd'uuotfufir.iro:nrnn
u'ruuy{ilf o?u rnqe,r#?
vir u'[6'rirm
aq:Id o:J:snr: 1yrT
frta
r e
I
d
d
$srff{nila180yil0{?1 $ytylu[T1T']u il:n1']filnl^r.t 9
qo
6voat
I
e
d
14c.4
|
€v
vv
il{orlfiu.ttt#x tuournfln::yr:?.r6f1f1:ruffll oshi
a q i A , A l 'tl.[H:0n
r,8J1J',rilUryfi
r{ilrT00u'tJuu
oiltqttn
"r. hi'fiqruoror*5
qr4
ye
*
2. tfi rd0nryril9.rTUY|00?11
,il
,l a4 e
e
A
r
I
(
eh
3. lfi ttol''rtJTs t ttyrou:3 [u51{1jo.1HlJ?U
riiovirul6tjrir{rursu;HC$
firafihifrufio;d'o,r
" y ) ^ X u5H
yrhHrXrfi
r rg.tfril rflu{ri.rolurTqrr fiorirfi ru
42
a,
ilfr u siufr r il.n.- fr.n.zase
nrenrgufinaFfnwunnontcrnfndfrn
lfintnu:rlnfttlnnit
vrafir:rgr::t ro rj:tnrr'
ff-lf lTfBq:rJ?ilriunil: uv{nuffleoflxrar n:n[
drrflutrrr* niu}rfi :rsr raisfinrjna:a.r ilnrinurfla ua;1dl:rvrururar^nsilnrnfiT
rflugud
rflunfrnn::rufittlunr:rlnnra.rn*
lfiuri
nrrf,nrruwvrrinfifin
ntae:riun'itflu1:.rrSuuunvrri
'irld unrdl#HnHfi
=
1.Yl1ll
nr:trX
erurufir
,dst,t.suunuvi.lu:nfi
e
^
'
'217nufiu'irrfltnrrtfisdro
=
z.6in
n?.tililTiilrqa
12 IU T?riUorflOU$rYrU
s. u?ern
= fl"I?fiflJ
inr.lrf,ln mor:dt:rfirurf.rnnrs nr:aq6 rn:
4. 0']9't3
= R'11ilnT.l
UflUO.tn1lt[?BU1nS{
I
= nrtriauluu
s. livrr:
o.ctil;
n:rrlrf,u:
z. alnr:
nrrlhilnm
nrTruhirfiuorfiun
a.eifi{ar
fi?1iloeYt$
s. fud
ll rr
ra
lt
r r
ro.orrlrrrs
nrrrukifio(ftnfildnhrounou)
a
I
cr
14
tv
a
I
l
llv
I
slfi'uriruldrihr{rftfiuriqrT rflu{drurunr:
rodrrnururnn:rdnrnfr1., uviodn'ir 11 il
I:onururauvird lin*il1uo"lnv{T:lnrnfn?ri
a
Bnornr ruuHlilqna{ufil1uryfrrofTtlr tloffilil
liq
t
c
A
A
c
a
a
nU{ tnqil1t0.t0?l1l0 7rilT3B.tflYlT.lltillttilil m ?Ol1tqil
dulnqiunr.r
dlr::a.rdri'ru'n:rtffrJ:;trfiJtnuuri
rJrotusrdvrutfiEffinrn lfrrstnrnurirj::trtn
rrrlnu nrnfin:rasrr;ordrirud[6nr;:rmlr
'
o eY
rlcrnioorulln riu'it^rtord
do.rlri
rir15u.rrn:r: nruf,i fi':'ruiln.tuncnr $nfi'r fiT0Yrrirlilnunqrqnn!
#ac'rcirgO.r
6ar?ou:n6anrrlf crrriu n:olfiorjr.rnrpf,uur fnx*nrnnrufi::trsrirurr
n?au1.te'ln{nnn{ trrlqtilf,n'tun uil.lu fl0 tur;uouruXrrurqrfrnirrrriirtfi;qeh n::orr{
6ovrtgnsfr?rrsslffi
T:.:nururnn::dnrnfir6'uvrqtiirhurft
ilR1uld?h.nunrolf,urlueiv{rtt1lfndldfi
tvirqniufr
flnsu:r rfiuTonnanau1#rfl
#ds{ri'neri'ut6'1qrg rdolfirJ::rvratrhn.ro{'[dnru
oro,:tiurmdnlulrilti
rauJayrilnrn?1ur|loufru{o$
rnn roHnrdqllnn']Tr,14 virufnrfinunvrJlnri
eteeAti)tla
X
)
aa
t)
d
r$y€liv
qe
qd
^)
n
)
a
ld
,
,'l
r0{qnnndl6qj dulduria,reltri uTU$}mfth:fio $av$unuTnnrolTil r-rlrifinrutuuRiuflnluilBu1iluil
rnsufrrild vhu{dru,unr:1:o'tururnfl:;ilnrnfr1 dnni.r dldlrrfiultflunuru 1$fien::r,dyfru
nuirfi n
#.rvr
un:r6'rnfirfifir:rsnrrldlrtsutrielssiarlc'{ff'
nrulf,n:;rirun:wn::rireishj6'*lduri
nunnrilnrj riu'jrrfluficnt:udo.t
cloug fiontrdr f irriTulfiwlnirr rua.rinqfirmmu qarn
grorriorfi
tn:r; tflu
ruorrirlofiunfiu ri,ruri{rJru {r5u1d {4ndurn flrrrf,iqundo.r uRtn??f,riueiluanonlrJ
tlfi m cio{Srrr; qnr
ofloas$Rr.mrdorfror{ocru
uri:irllnr:
gn{r.r fionr:ud uno.l6,rnmln6'qr4no
e
a
Osa
d
rlnrdu 1fiiinr:fru60{6 "ilruR*fiuuuuarjr.rd6 l6uri orcrrduru$rnifiueyrdrrrrr;seiaogurarerrfi
ornrhu{vrhlruddu 4uilu1 6o viru#runrrr orerrfunnaintruilndua;rioqorfilfiol:uururn
rin'rirH6o
ldrdunril rurn"urJtfilt4ooufin'.,i'q0.rdrund.r n::iln tnfii {uvrqt uiol:'r riuuur^rn
,&atcea[)t
?tlt{ltunBB?e'l1uil1unt{7tu5uf,?lt r,.|Tlfls YrY|"1l[
e
vrdctAfrv o
rtmuu nnr : f,.in Bst nt ! ?lhn1: nri'qq ur^r
nnr,tfirfl*rnirornurunuiu6 unnyirvirung.rvlnru
1rT#.r
* ciuiuurirri unurrnf eruouyirueuur^rrf
virufiftlfrd0ln usa;n:rrgrriaufi'lunudorriroru oqluf,suTefrol o{tuf,.rnrsomu6toillrqfi'rorlr.r
odtfinrrlnurulurfiooyrnxRyrrJ.n6'urur1ddintunrrr6un:n:;rirnrrl6fjor dulrt
rfr'urHqnr mi
aqjnrutuuvr un;vitrrftbl?frufiarirvi
fiultailauqat
nnu#amrrunndgarrl?luun frtffiln:rnr:
rfieneltv
dorffilnr:iimnuyrnfidrrafiirl?luuyr
1l0.tnr:?rr'r.i
VoL. 12 No. 7 Jan, - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
43
lY^
tonfr-|lo'l{o.t
'1.
'lurarirdo
vi?yrilnrxfi (:lnpiu lrr: nmrflgn : :.la;qmo:Jgnln)
urirar.roturi
6'r.:1u(g) urir zzr- so.
n'rr:JHzugxnqnfi
?rl7r1;1rrruT1.
s?fl6r?illilo{eaun{1il. s. rdoulqrirn6.'mqnra'1u,riulrfi'ufi0.
firudnfrlfir.
n1rfinfi
ur{ufiqu frrrifi r.:firdfigrrua:nq{ryll\"1,
oqoroi.:runr;r'rrvnurrryn-lnvr
ur.:frnr i evuri u
2s30
(unrerrti)24ilq':en1nil
uri'r so.
zs:s
zssg.
lriuonfihrinfiuli,
o. oqntii?a;rcrqn.rorl?\ryqnal,rvr-rJirrgrunvuilvre.
ufir a-0.
(r) ilrir r-s.
arrffirrt 253r: 40:671-8.
dr.:u6'c1u
3.'e
z. dr,:uffrtu(o).
ldil vG.:n.r.lrtric.fitdntremriurfluunflri. d'r?s'rn
(o).
rJev or u q n fi 6 uil ylfl"r uu yr. 1uu ri.r n'o uri u r a'l u ru
8. dT{udalu
s. dr.rr6qnryrUlrud.:e?
l,nfl$nra6nr, uyrnflailrnilttiliilrcrylpitne, 4afiiuvrnd
iorLrrfircfl6u1t.rvraurfirfits
araul rnsilfifi !r1r6r?il'lurolilrn-lfrpfl'lrail.'lu:
n il u vr I n ; n il ?NI vrvrg'guu yr.t f o u tt n'en r tn- ruy{':
_t
unnnrryirnI16ru
nq{rw^{.ilililnt{vl 2, (t,Ntrs.lllylTuJil)rru'l 3-7.
aId'u. ouarnflunrrnrvrl.rvr.ru
udnr r r nr r. n ry :j r fl aNr6sn r vr.: ng rnffr r{t oqjri'c
rndtnn u,rrlc{{6rfloonrr.grn'ar;riru rrqurir
yrnuyinr6n?srnrni
n?{ilrs11tfilruf |ln;fiilr{rq:ylrtr.ruusn{r?1{n1t
{rrryrnffiuyr?,r?,}d
3r fiurnu
'lunrrnryartfiGnqun.rnruri
(1ilu{rnhrinfrrr{),
zsze
2ts7
u.Jt
zrzq.
4vrorinrrr
r * a 4 * d d
)
-
d
Y-l
,N I
edrda
^
,
M
?trentpfn'nFfnwunnuntrrnfnifin
Imnnunnftilntndt
,t
-dudd
un E nilun I il.n. - u.n. 2538
t
l,
g'ttl 1?
iu
Hormone Replacement Therapy
iiilrnr {raicd n.u.*
ou
rrJduuutJn{Jrur olnnoou#oun;6or#orf
q noo?iln1: r fi oI:nfrlo e''ro r 6 oovrfonrrqn
il1n1u 5Jn1[nRUr:',]XOlqUUUl??'il lilOnUr:1ilo1q
Xrl
il1n1il n1lyt1it1ullA{O?U?3{1,.t.'6J 110.:11{n1U qnioil (osteoporosis)
)
I
€r
t
r.l
Reptacement
nrtihua#?suo{Iln (Hormonal
n u oNx![fi oLrRtJ:1nn1fi
a{ ou'l.t[T1{tuflnT${a1q
su
I
J
n , o
r
J
)
-o
ftrerapy)(Hnr)
T,tt?to! rfl BLrfltJ:Ton1fltutuYtl.tlutuyr go $,Jnfio
lurloluiuinm utriqrir rnfirm{n rr uflil rt
.l
.qe
d
.
X
A
o
iuuiloil::ohr6ou (menopause)
riuror rtutd
d
a
,
Jt
r
a
flgtro:$nnilornr:vrtiun'ir "climacteric"nro
I
"postmenopausalsyndrome" dlorourjlognrilu
-Xa
3 :3U;O,tUfio
fiu
lfrfinr:ldaofluurTue
sirr n{rurrrg dorlo.o
u?fd6dqon'jr?f
duln
n::qnrlndouun:60'irtfl
lurJoliuuiTouei.:u{rfrn:rnr:nrulun{riuufr.r
yruorJryfr
rfiocrnl:ofi'rlo
r6ou(postmenopause)
(nartdisease)
rurnn'jr1:nn:t0n4nisil
rfin (tvpe) unviinnaTnrrfir{riiuania
2. Perimenopause
oudlrid (risrs) loo HRT
3. Late climarteric
t. nrttfion estrogens
ornr:finrJn6ci'u
1 rriuarnr:Yau3u?''rusl'uJ
lunrir nh6'r (flusrres)r,nCoounrrnoaunnr,tdu- rfionrfinro{u1un:tulqlfurfirnmssil
)
(night weats) uouhju{u ?nnrilro a1:iln[ nTln'll1itYl 1
t. Early climacteric
'*n{anw ndtnzn [r,tnutut an:.;tJnmh ium$
Vol. 12 No. 7 Ian. - Mar. 1995
J Prapokklao Hosp CIin Med Educat Center
45
nil#airriu Hnr
st't:t{d I Estrogen.
Doses available/unit (mg)
Estrogen
Oral
Estrone deivatives
* Conjugatedequineestrogens
Piperazineestrone
sulphate,estropipate
Estradiol and derivatives
* Estradiolvalerate
Micronisedestradiol
Estrop; and derivatoves
Estriol
Estriolhemisuccinate
Synthetic
* Ethinylestradiol
Quinestrol
injectable
* Estradiolbenzoate
Polyestradiolphosphate
* Conjugatedequine estrogen
Estrone
* Estradiolvalerate
0.3, 0.625,O.g, 1.25,2.5
0.3, 0.625, 1.25,2.5, 5
1.2
1.2
1.2
0.02, 0.05, 0.5
0.1
0.5 mglml
40 mg/z ml
25 mg/2 ml
1,2,5 mg,/ml
10,20,40mg/ml
Estradiolcypionate
Vaginal
5 mg,/ml
Estropipate
* Conjugatedequineestrogen
Dienestrol
Transdermaland percutaneous
1.5 mg/g
* tz B-estradiol
TTS
gel
* tz B-estradiol
0.625 mg/g
o . o 1 %i n e 0 g
0.025, 0.05, o.t (release ratetday)
1.5 mg/dose
a Not all of these preparationsare yet availablein all countries
* fimuturj:rrilfllnu
- turortdur (oose)firnrur:aruro.t
Estrogens
fl #rirHiunnTfrornr:ruro(dose)
estrogens
rfl ;n'r'rilur.: (potency)efrn':rfitd'riufion"':q'nhid'{$sqrtunrr1.rfi2
roturtfioqrunh
rfiouuufi
u (oralcontraceptioes)
46
nrsrtrfluinl#lnrnunnuttcrninifrnlfinannxfttJnm#
nltl{n
d
f
al,
U lilfnlt0lAoil
ild u #ud I a.n. - fi.n. zase
o
d
v
Ertrogensfilllt{ltCildrfi:U
HRT
(Adequate Estrogen Dose)
Daily dose mg (Ug)
Estrogen
Conjugatedequine estrogens
0.625
o . o l 0 - 0 . 0 1 5( r o - r s )
't-2
Ethinylestradiol
Estradiol valerate
o.ob(so)
Estradiol(Transdermal)
nr:riulflutuT ncirdqe(i4fi
Subctrtanoous implantations
nr:lf estrosens
1. n'lrn::?1u3o.ru1
riylqnrr uf,Infinhi
availabte)Io ural n r odr r ii.rlun{.ri4uilorJfisr'rrdsu
I
r
eh
(menopause)
lrnnruflufrr lduriuld conjugatedf,il'] [flilo ll{Hu',]UU',]ilT','rU
tflunrrurnfio:
estrogen(Premarin@)
lu:ruro 0.3 iln. riou
z. ruroaooldurrrYrhj$#r
ll
rivyvey,
l6rulTila1n?u(?il?u
ln?u ua?RauI lflr,1il4n 13 r60s (60 o.s,0.625,0.925un: r.zs run.)
qi^r.\a
[01u'loonlu:1ufiu1[fiuru16r(overdose) ilTo
nuiaur'lri16 (intolerance)
Percutaneousapplication of gel
n'tttiton route to{n1:l#ul (adminis-
r. 1fiurbl'ldt$1efiQnfro{ (accurate)urn
-
A
X A^
t
'r.tg$O , s , a
Uni 8'11Unnn'l{
R?1lU{71711U1
$nUU:tJ']3111^lUll
A X
tration)
oratty : rf,il route dfiuruldlrndqo
)
4vr
[5.r1UUf,!:''rRlSnYrqO
Parenterally 1. lntramuscularinjections
riuhfluueiwiu
z. nr:n:6's.tiuilrgmum (orat)progstogens
lunaufiru dJlJo.trou[60il61u
Transdermaldelivery
2. Subcutaneousimplantations
So6:
'tdnndno rTunr:iutJ:lnru(oral)
r.
"1
3. Transdermaldelivqry
4. Vaginalrings,Vaginalcreams
conjugated estrogen
9'
A',ly
4{
parenteral
tOfit0lCfgtO{
tration tllrlfgi1{ sl
oto
2. ffio?n1un1r1#u1rfiu.lfiJorrin:,
adminis-
Intrarnuscutar injections ldfisrlfruf,a
.l
m0001n
tYl''tul{
s. tfur.iruuf,! [oluloonornir{nrur'rg
(reversibb)
t6uo1fi1T
4. nqolnlTrirr tdu.l1js.r:ruuyt..|{
5. noornr:fr.rr6urrdsrornrfir blood
r. lila;ornrhraiuflf
z. lfr:rd'lurturdsohjnuhrsus 6oo;qr conoantration-time profile
6. Batn?1xhi
erhreuororur1utfi'r
rrnnruud'rdo (initiatpeak) uciilfi{qrntu:r6'u
{rl'rl rar
u i a d r l x u u fsl r r ' r u , d r r o . n o r l u u o n n l {
u1xtR0ul,''r.lo''1il1n
l9:
Vol. 12 No. L Jan. - Mar. 1995
J Prapokklao Hosp CIin Med Educat Center
g. Chronic impaired liver function
lunr:virsruror6'urra:n[sr
z. norJfin?t1::fi'j1.JU1(drug interactions)
10. Recent venous thromboembolic event
r{uuroit 9
s.t#urtururoeirfild'Holun1rinu"rrfiarorn
occlusive
dressing
?irlfiurduairu(diffusion)
fimri.l#u
tz. Undiagnosed vaginal bleeding
stratumcorneum'[6'6
z. nrttfian progestogens
e. Hndodunr:#rrn:rtf
47
ctottingfactors,
reninsubstrateflofl.l
tt.
Chronic thrombophlebitis
Progestogensuillrilu o iu (generation)
ue'in;iuo;firunoio
tipioprofileuerneir{n-uri1.:
rfiolorn
fi androgenic
activityeirlri'u
1. First generationyt?n testosterone
frar6ls:
derivatives
aynoTGrfirutot $cisst
HDL rdotornfi
oroogrfien1r:sn1uI noa.lfr
frrHri.: (skin androgenic
effectqX{r:iu noriestrel,levo"norgestrel,
initation)
tu{rJruuru:ruusifiorodrtrl'nln;nrur6o.r norethisterone,
norethisterone
acetate,ethynodiol
10. nO glucose tolerance impairment
'[6'6n'irlfiqiud:gnru
lorfirilfiraorn{'l6'
Iorruil;uaiumfiuinrufiuuflr
diacetatettfls lynestrenol
unt{u desogestrel[[ng
runuu6ll[r14u,rfiqil[xuu[ur:0u
fi androgeniceffectsthd$ilfiHndo
1 4nfl:.]mluauu norethynodrel
d
,J
u,A
YA,)
rt9.ruu''r[14il
LDLC[[n; HDLC$eiR9tTG
2. Second generation t{?n progesterone
Vaginal rings and vaginal creams
Vagenal epithelium a!$o6il estrone ufly
estradiol 16':r o riunn
n oi:ytfi'ur.noshjs*rrtrsrua
derivativesasnq TG usitdfiiledo LDL $nt HDL
cc
AA
ufrorqrn$ androgenic effect ofr rriu medroxy-
ornooiuratolutrsinsiurinrornnr:fi vaginatsecretion progesteroneacetate,didrogesterone,
progesterone
$n! vascutization
6l Hnr rl"rufludo{inur:g6'uur
[tRYmedrogestone
g. Thirdgenerationnrnor:fitro:rtrdtrail e;
1#srirrsruaufluari'r.rmn rYr::d'uurq.rrfiuhJosrfio
ornr:vio.:do (btoating)n:t?un:t?.n
al
fio;tfiorarnr:ta{ menopause
frorhrul# Estrogens(contraindications)
Triglyceride,Lde, LDL" = Low density lipoprotein
cholesterol,HDL" = High density lipoprotein
(irritability) fi androgeniceffect oirmn d.1'lilfizunsio
HDL nil.r
unrliln.ru (nervousness)
usiri'r:sd'uuror\rfiul:Jgestodine,norgestimatetrfl: tibolone (6'.:rjofO =
t. Stroke
2. Recent myocardialinfarction
cholesterol)
gnrnlfisrtJa{
3. Breast cancer
a. Endometrialadenocarcinoma
5. Other estrogen-dependent
tumours
6. Acute liver diseases
7. Pancreaticdisease
e. Gallbladderdisease
progestogens
A,UA
Iua{o1n0,]n1:1,'lntn
U.t?Ja,tprogestogens
lr;,
[ourarur:orirr0toiaLipio profite(LDt $ff; HDL)
X
-
qe
Y
"'
(dose-dependent)
d'lriuor:1#
;
c
)uo
luturoefrqofi'[6'Hn'[unr:inr*.r (towest effective
oose)6'.:$rq.fluqrrrtfi s
frunuturolfur
48
?lrffi,Winnfrnwunnanrrniadfi
n lunatu:rrlnfltlnndt
nrtl.td s {illol{grehgetot
,,
flfr n sfufi t u.n.- ii.n.zasa
Progestogens(lowest effectivc dose
of progestogens)
Daily dose mg
Progestogen
Norethindrone(Norethisterone)
Norethindronercetate (Primotut-N9
0.7-1.0
5.0
Oral Progesterone
. Didrogesterone
Medroxyprogesteroneacetate (Provera@)
dl-Norgestrel
* Norethindroneacetate (transdermal)
vq
noflRlttnulto{
HRT
r. XarltamdrCo
300
10-20
10
>0.075
0.25
2. nxltfin,rrinrnrdolc
rfthiuriuorfi{uwrirb{rlfirJhntrnrtr.rfie
disease s. guuumrlrntinruu
r. rJotfiuunginur cardiovascular
Hnr
(cvo) Iouronr;odrrfir coronaryheart disease
s.t Cyclicalty(conventionaltreatments)
(cHD)
z. rlorriu$n:inur ostooporosis
ornnr:f,nrt'tu'ir nrrtd estreogens
rflurrnr ts tdsu
rf,uradr,trdur(monotherapy)
lunsdandsnuailtcrirritou
nrfl .td r nr:f,olfiuottGn osteoporosis
Patient category
Treatment
Premenopausal
Moderate exercise
Early or artifical menopause
Oestrogen with or
without progesterone
Natural menopauseplus symptoms
responsive to oestrogens or
positive risk factors
Oestrogen plus
progesteronefor t0 years
Moderate exercise
Naturalmenopause; no symptoms ; no risk
Notreatment required
factors
Avice on lifestyle
e;nlrlfrrfi n endometrialhyperplasiail*rurarioun;
toCuotnouu 30us! breastcancer(rflsrhuriau) uddrlf cyclicatty
rdu lou3u'lrun1ufi?n,tu
menopause
aarrStvv
iloilnf, 1\rflu o1lu ruuuTullu $8l{llJll nu 0?u?t[ l^|fl progestogen 6otf, progestogen :ruhldrs
3. U't;tYr',]01n1:vasornotorsymptoms1l0il
"l
r14fJ?[g'1
luri'l.rfrrstoorourdaut:nn risk ?8.t endometrial
hyperplasiaB{
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
49
tt
gtul{il
5 tu:gutnguolu?1r?1{1r
l1 progestogens :?ttflU estrogenso1nR1:
flnurilllt 18 rool{
at
o.tno.t:'tifr5 regimens
fi rrarur:er.lfi
qo6o
la
- qlfe estrogens
orniufi r fir zs (zs5u)
u
- qldprogestogen
orn{uftra fi,rzs(rz iu)
- 1# arugtreeorniufi zo6i so(s {u)
Estrogens ProgestogensDrug free Endometrial
(dav)
(aav)
(oav)
hyperplash(r)
25
0
30
q
25
25
10
25
12
0
5
s.z Fixed estrogen-progestogen
combinationstiJunr :ruaruestrogens
ir ruri'uprogestogens
lu oosagerormrdnnfiufrnusorifinr:lfi lumr:r.:fi o
3.3 Continuous
tearnensrihrnr:lfi esuogens
irilfiu progestogeno
ryniu firuao$rmr:rrfi z
911:1{fi 6 Fixed combination products
Estrogen + Progestogen
Bstrogens
Trade Name
Day free (day)
(company)
Day
* Cylo-
Estradiol
Progynova@
valerate2
(SheringAG)
mg (rao)
* Prempak@
Conjugated
(Wyeth-Ayerst)
* Estandon
Day
Estradiolvalerate
1zno-21s
22nd-28
2 mg+Norgestrel
(ro oays)
(z oays)
Medroxypro
12nd-21"t
22nd-2
estrogen
gesteroneacetate
(to days)
(z oays)
0.625mg
s mg (rao)
|
-t
I
(rr oays)
soo mg (tau)
1-'-21-'
Composition: 't. Estradiolbenzoate
Prolongatum@
1 mg
2. Estradiolphenylpropionate
4 mg
Testosteronepropionate
20 mg
4.
Testosteronephenylpropionate
40 mg
5.
Testosteroneisocarproate
40 mg
(organon)
Amp. t ml
Dosage and administration
? ml lM every3-4 weeks or longerintervals
* Primolial
Composition : t.
2. Estradiolvalerate
Depot@
(shering AG)
Testosteroneenanthate
Amp. 1 ml
Dosage and administration
1 ml lM every3-6 weeks
90.3 mg
4.0 mg
50
?vriltrgufin'IrflnatunnaAtrain7frn
lxwuutanwilnnffi
fld u aiufr Ll.n. - fi.a.zsea
t'ttr.rd z g$rclfis'llao estrogenuar progestogendtllrurcaull'rniu nRr
Drug
Daily dose
Oestrogens
Conjugatedequine oestrogen
Oestradiol vaterate
Ethinylestradiol
0.625mg
2mg
20 mg
Progestogens"
Medroxyprogesterone
s.to mglday for 14 days each month
OR
2.5 to 5 mg/day continuously
5 mg/day for 10-12days each month
OR
350 mg/day continously
Norethisterone
a Dose of progestogen will need to be adilusted if progestogen side
effects occur
g.a Trandermaldelivery
$n1:1{d 8
3.5 PercutaneousappticationSo'lTT{d 8
3.6 Oral contraceptives(ur'rtutu)
n'1t1,0fi a Estrogen products
Trade Name/Company
Formulations
GenericName
* Premarin@
(Wyeth-Ayerst)
Conjugatedestrogen
* EstradermTTS@
tz B-estradiol
Tab 0.3, 0.625
1.25 mg
TTS 2, 4 mg
(cioa-eergy)
Dosageand administration
Apply twice weekly
(change onec every 3-4 days)
* Gastrogel@
(piette)
Estradiol
Gel. 0.0696
Dosageand administration
Apply 2.5 gm. daily to skin (preferabte
abdomen)from day 1$ to 21o
and oral progesteronefrom day to'n
to 21"'of cycle
Vol, 12 No. 7 fan. - Mar. 1995
J Prapokklao Hosp Clin Med Educat Center
51
9^
t0nfll:0'l{o{
t. ura"nuaf crtinirfln'nf,
olurr qli'rr"mlri.
n r r r fir rufr to.l aofl ru!"r!'pr. n ruyrn n-nn'lfi n f
turivrurdsrfinrn : Text ond journol corporotron,
2536.
z. e-tifl 6urJrtrnig. Postmenopousolhormone
replocementtheropy.'lu: ronnrrilrvno:.tnrr:Jr:ql
New drugs ond novel concepts. nru:mntnrnnf
ilurifl flrnrJrdfl
$uil. zssa.
Wn
o-nriuvttt1n16
av
.
fA
d
of
o
0 y
m6[0[405il1
u6uTl
Tl16il0t1mg
a1n0l
52
?nilTryinnffnatunnuntrrn{nilfin
lxwnuranrilnm&
flii u afluiit ,r.n.- fr.n. zasa
damtdrr
l1?J$'lslfrtit
0rrs1eindiisrod,oriqrgrnofnrimd,qfinmriooinri,dilt1s{$?qa
Prognostic significance of
morphologic
changes of the corpue luteum by transvaginal
ultrasound ln early prognancy monitoring
Glock JL" BlackmanJA Badger GJ, Brumsted JB.
Obsfet Gynecol t99s;8s:s7-41.
luteum
corpus
s lu o :ru (louecas)d.tn:ro'trinu
tstu as:ru (foun;sr)
un;rfiodu
orn6'nnirsm6
dm:aetnu corpus uteum (p = 0.ol) su'tn?o.t
corpus tuteum hjaur:olf,lunr:ritutunml
#Hrracrro.:nr:#on:rri srir.rlrfinrl tdon:ronu'j'r
t
- iL!'"t
nfu,rHxcu[oYr1f
"- rt:6fl$1rfionrnmru{rfiuf
corpus luteum lunr:
to{frnuilglrngrulota{
corpus luteumfi:Jiurnrnon,io''tnn''lrot?oniturn
o:tfioHntflu nonviablepregnancytt tu zo :'tu
(laua: ss) lulnr:dfiu nonviablepregnancys tu
#rn:rf:rul u:n rYu::6'uao{Iruunr
Hnffnfsst 27 T1u (ioua; rs) ro.r{dn:'rot{uiliurntrfiudu
(p <o.or) lilrruomuffifiuf::ra'jr.rrlirurn:sal
nrr#rn::li leruvrhnr:f,nur:cil'iror6ou$urnru6.r
ttio
udouRrnrou
Tr.fl.2so6tusni ss nil d.:#ro::li corpusluteumr{u*6'uaoililu progesterone
ludrmrq +-e ftJnrf finni +s nu (lauw ez) 17-hydroxyprogesteronettcl'nunrrud'lfiuf,
dinrrficrnrourdaurrtltrd $nJronn(isuecre) rfinfiaurTu:l d'uestraootl*n#tYoottfilurou r6isu
sY.r
nfi f 1u:out6oud.rldfu clomiphene citrate dlA;u cbmiphenecitrateorfirJiuromo{ corpus
'
I nil il01n1:1J8.tn',]:t,!frrnnnuun:utnufiil:;i6
r
eZad
n1: $yr\r!r1?l
:sil nrril tfruleionr:tfi onrtdtnt:ri
Ueo
s
y
(
Iuteum un::: d'uaoiluururnn'lreoidoi.rn:rli
1u:our6ouo::rutrG
Z
t
e1:J'jr trinunml#lviuf:;ndttulotoit
viT,:rius-a iu trn;rsrcrdaon:rcnrr:6'uaaflruu
corpus tuteumriu:;6'uaoSluui,olnrrd{n::ti
progesterone, 17-hydroxyprogesteroneUn; fnr*rwtor corpus luteumhjfurt'ufriurarird
nr:yrhmu udnr:nn?rulolro{corpustuteum
estradiol
Ar
nr r tfiornr r uvLr
riouor qn:tfi e fi Jnrf filri'uf rTuTo
fiRn1:f,n1*1TlU11 nnU$310.t corpus
uonilo$n toYl10nnT1.r1?en1{5o{Rn8o2 n't.1
.
A
6l
luteum fi.rrflu macrocystic, microcystic H?a non
.
Yt tv
e
av
v
d
&
c
cystic!ilmmufnut{nnilm0{n1Tf}inlTRu8;:lou10.l
aoilruu nlTv{u nonviablepregnancy(vrr:nh,i
srm:nfi6iqo{ouorqn::fifi.:
ra srJorfi)rfiqdu
o:*r1 afindiisrod n.u.
n qil,tlagfi - u7r ?vn t',.J
[:.iruututaw;;ilrun#t
{uryi
Vol. 12 No. I Jan. - Mar, 1995
J Prapokklao Hosp Clin Med Educat Center
53
Cervical intraepithelial neoplasia in women
Efficacy of oral beta-agonist maintenance
infected with
therapy in Preterm labor : a meta-analysis
human immunodeficiency
virus:prevalence, risk factors and validity of
Macones GA, Berlin M, Berlin JA.
papanicolaousmears
Obstet Gynecol 1995:85;31
3-7.
Wright TC, Jr.,Ellerbrock W Chiasson MA, et al.
-7,
Obstet Gynecol 1994;84:591
ierqrJ:: arrir o{n''lrdnt*rrfroi rn:rrri'run
qv
^
p-agenist maintenance therapy
10in1T IT
6l
ea
nru:{vrhnr:i6'u td'ythnr:6nte1
rfru?niu [ilnlTnoqunn1:1a{ preterm labor un3oln,.lT
q
X-a
-y--.4.
o:JnAro.r
tn il{ uonolRu u{q e.td
qffinr:nr:rfion11ilfi
r{R6il1nilq$nlilrvullJ',r{
IunlTnoquCIn,lTla.t
n o u r4
o & n s 1ruf iu r J,rf n i l 1 n i l q
o n (ce rvi cal recurrentpretermlabor$flgnlTtfiru latency peroid
iqq^
intraepithelialneoplasia) (Crrrr) ttasnxlildtJvTuf 1il0[5 p-agonist maintenance
therapy
1ro.rctN ri'u:lo,t'urf,u.ooirlg
on0ooildnu'tfrn
uuri.rrioX
oduornn
ailfixrqo{ Ioutfgruriory
n
n?rr,,Bn6'0n(validity) fl a{n''tTflT?ayr1.trsfl
6ans'r medlineritauori'rfi0fi6'u'irprematuretabor
r!fl:
(eRe smea')tu{'ufrd6ordo HV Tqul6'rirnr: B-agonistreceptor[[fl: therapeuticused irruniu
q vn
^ -^
a
fl n:e'rrl.rHU?
uil ryJil6toIrdo HrV alruru 398 flu [[a5
-
vn
ira '^
X
n1: review text u:nt?ru:ru:rru 6 T1u.t-11{
rusifinr:rTooon
2 r'ru.:1u rfiooornrYorynnlrin:r.r
HtV ifru':u 3s7 ou tunT:
{rJura{.:fitil6ou6o
6nr*r{'rJr uusinsnuos't6'iunr:frunrsni n1r6lr?o frnr::rrunrry membreanerupture i.rruqi'rg
AAA
--j,6
yr''r.J
rsfldefiur (enesmear)
nl:str?oTo
unfiorrsrs q.Jlunotv{u.t 4 T''lu.t.ltt
flotil-]il1?tnt.linttuu
'
U wo
(colposcope)
un;nr:ot:ro DNA solrd'o'[risfi meta-analysis'td'drurur$rJrurzirri'u
zzo r-lu
oqga
= rrr) fifiqruarutiGerrrufi
(Centrol= 10e,treatment
runnrtiirnudr qrifinr:rfio crru tun{ru riruuo 6o membraneintact,GA 20-37wts rio4n
vt:rlti'tfrogo(humanpapillomavirus ) (HpN)
v
nv rrirfi'ufounyzo (ao,rssa)yl.t4 :']u,J'luar$nu1u1 meta-analysislou9tquality
{':jrurarflrfiG"rdr
.l
r w oiu,^
&
1un{rury'nfrfi'lilfior6a
utv rvirii'uiosnr
4 (1sl3s7) evaluateun; data abstractionleuld'€iroanillrflu
f
(odds ratio= 8,7, p<0.001)n?'llih (sensitivity) odds ratios (on) uflr risk ditference Toud
1o.rnl:qlrx86Y?u
PAP smear ryirriuioga: 81 dichotomousoutcomeso;oonrurtilu randomeffect
om ilsirty{r; (specif
icity)ryirriuYauny ez :Jo6's
rfts.r model ttfl: fixed effect moael rfruiu continuous
fi rfr6'qfirn^trria{riunr:rfiq clN donr:6ordo outcomescl#rir mean weightedaverageluusin;
HPV(oddsratios.a)nr:6or4'oHIV(oddsrario
s.s) Tlu.l1u0.lailU'lf pooled OR for preventionpreterm
nr:fifi cD4 + T-lymphocytecount rioln'jr
2oo rrad' doluTnrfio: (odds ratio 2.7) un;
Aa
delivery= r.og(iouns e5 Ct= 0.6-1.9e)pootedOR
for prevent recurrent preterm delivery = 1.05
(5oua: 9s Cl = o.ss-z.os)meanintervaltodelivery
nr:fifiorqrurnn'jr 34 il (odds ratio z.o) o.tn
^-Xa
r.{fln1T'railuo.ltru:d't'i1 nr:tf PAP smear = -0.22 oays (iaun: es Ct = 2.s+r.gg) eirniu
'[un
r :o :r oil 1nx "ril froil n 6'r ot rsn frJrn uorq n o.u-6'nr:to.lnr :; u n:n do ug a.t preterm'[oi'un
lu{'r-hufi6ordouv riro:fi:J::fiyrGnlrrfiurno
RDStil'tfinora.Jrau
5or:ni
udud
ol,rfutu'l ?rir}}a'l?[uE yr.u.
taa
nfrl$nuflfl-utnTntttJ
11t
fteed
t',JWA1U1nWJyiln I n fr1 lvnUi
-
qt
flUUflTUn1T[t
o1nn 1T:? u??ri?1u.r-'rulflrilu,l
r
^
p-agonist
maintenance therapy
nr :tfin r :inur rsus acutepreterm
rafrio'rndfi
tabor
jj
preterm delivery Unt
[?{0mAtnOqUeln1f,1,8J
nrcntguintrf,nwtmnontminilfin
IfinarutawsrJnnffi fld p aiufr t tl.n.- fi.n. zase
54
ornr:rYro
r6s{To.rpretermurnaanrtun.:ldtong child monthsun3 o.n, oirz',oochild months
therapy
termmaintenance
aroo:rirl#rfio maternal tudtqqnurt (relative
risks.22,isunsssCl o.3zglucose
intoleranceld
doo.tdtttttio:t{rsdrwrn
zz.zo)1un{udAr,dr shiseltailu'jrlri$o1n1r
ru ofo(iouw sz)fiornT:rirurnorrflurh(secretory
qlirn:'r riooinri n.u. type)zr nir (iouw ez)un:riru$rdaorJulfirfiuld
(ioun;rs) yrunr:Gordsshigetla
n$a,nug6-uinvnna r
lurdn
"*.
r!fl:
[xwatutawtilrun#t {unqi orqriaun'ho rdauo.ooinzroochitdmonths
rfiuq.rdurflt*
,.t o#orroochildmonthstud':.rorq
tdo
Asymptomatic Shigella infections in a cohort re-zi rdau(e< o.ooo
r) Io uyrudorirurornr:Go
of Mexican children younger than two years shigettafi1*ifit.n.tgodtn.ut'lq 6o issnl 33
.ftAYQr4
tut?{a']q 0-6 to8ll t0rj83 40 tutx{o1q 7-12 talsu
of age
ioun: +o lurirro,q rs-re r6ou un;ioan; ze
Pdiatr Infect Dis J tseq;t3:597-602.
lurir.rorqra-z+r6ou(e< o.or)nu'jrsruliu{rol
Xura
oa1n1?
rds uwqqnrnhififiarrtfrilfiirfr{'unr:rfi
nlrifiarnrr
rndr.fo*t.otu 120-140
arjT.lfiriuahriquone
fi'odru$s{nr:6erdo shigetta
(asymptomatic
shigellainfection)tuu6nrfinfii megadatton virulence plasmid lurdo shigella
orn''rrun3tiiiornr: d.rri.rd'irvirutence
tri fintldnr*ri6'ururri
su onr;{tr l.rru6tvrh
nr t #.rn{ui4fi
onr: rfiorato
r.rrdurfifiernci
6nl*ruuucommunity-uaseo
lur6nerqrioun'ir
z fl n.otdufi'l*ihiflo{trsri
snigetta
ohuru 367 T1u tunromur$0{r0{n1.rliln6lnkirfioarnr: nr:r^ruqffin1:1ro0n1:Antdo
lq
v
I
iu'a
A
X
i
c
:;n'irrrdau$nr1nilN.6. 2s336rrdouf,r+mnumtililo']nlTsir${iltr|o8'tq&1n1ullltqnolqiloun?'l
y{.fl. 2ss46oor,rulogrdgilfiruro{rdn#rjo'rrdnv
ndu
z fl rio'jriin'ttf,i^t{ nationimmunityeior#oruT
Guenero L, Calva JJ, Monow Al- et al.
alra
&
e
v
e
A
I
ue
1 FtT,t InUlOilntnU?nun1Tn1UOOA',]:t O',]n1ltlt
n''ril01t{
arrduu unlrfiuqooirrrr{'r,n.r*d,
rffo.rrf,s
Hnnr:6nur1u2,e95childmonthsTo{n']tdRtc,]
flu'irrfiosrnrrrirsrHor73o nfr lourflunr:
^
I
..
V
Q
r
y
ootTa shigella 65 nT{ tumlTn 53 T']u a'].lq$tall
(rdaunqunrnlfi.rr6aufiuuruu)
nu ,..r, ,*ozroo
f,rrt1a Q$xqa il.u.
n$anuqatt?TnttN
Txw a tut nw:xtlnt n#t iunryi
Vol, 12 No. 1 Jan. - Mar. 1995
J Prapokklao
AA
lA
55
Hosp Clin Med Educat Center
qrA
?'lg{'ntd0a n'l5lffl lfgl{'lu?au 3
4
lnau
Quarterly Statistical Report
No. of Out-Patient
No. of In-Patient
Department
Oct.
Nov.
Dec.
Medicine/fiqnnr:
6,367/252
Surgeryzriotnnrr
Orthopaediczri'onnr:
Rehabilitative
medicine
Opthalmology
1,943/2,513 3 1 1 5 6 , / 1 , 6 3 12,969,/1,330
't,32O/92
1,377/ 85
1,375/69
Otolaryngology
Pediatrics
Pediatricpatients/ri'ornnr:
Well baby clinic/ri'onnr:
New born
Obstetrics& Gynecology
ri'ornnr:
A.N.C.u
Obstetric
Gynecology
Familyplanning
Psychiatry
Dentistry
5,925/294
605
Nov.
Dec.
628
562
517
577
526
199
229
198
1,081
1,248
1,136
823
784
776
43
55
51
653
620
547
35
26
47
211
203
19'l
464
493
450
476
482
459
156
142
139
70
70
62
1,686/ 184
878/923
464
't,745/725
633
1,359/647
1,623/ 182
1,673/19g
610/653
6't4/662
493
1,562/912
644
1,295/514
450
1,729/873
641
1,282/546
281
304
1,814
1,448
1,339
1,223
1,014
1,122
96
113
311
Otherservice
Total
5,375/275
Oct.
27,668
25'8,34
25,891
2,776
2,905
2,685
56
'r7r?nrryinwFfnatunnuf,'trnin6fin
binnunnflthnnffi
flii E otiuflt u.n.- fi.n. zssa
No. of Anesthesia
Types of Anesthesia
Minor
Major
Generalsurgery
Neurosurgery
Urologicalsurgery
Orthopaedicsurgery
Thoracic surgery
Plastic surgery
Eye
E.N.T.
Obstetrics
Gynecology
Investigate endoscopy
Oct.
Nov.
Dec.
191
844
249
28
87
,t:
185
902
233
42
73
241
5
68
50
22
108
40
20
151
804
232
30
75
212
4
50
41
30
85
32
13
39
42
22
113
35
18
No. of Anesthesia
Types of Anesthesia
General anesthesia
Begionalanesthesia
Brachialplexus nerve block
Local anesthesia
Miscellaneous
TypesofX-Ray
Plain study
Special study
Upper Gl study
K.U.B.study
Biliary study
Arteriogram
Myelogram
Bronchogram
Miscellaneous
Ultrasound
Oct
Nov.
Dec.
273
234
43
212
78
384
471
34
183
103
358
208
14
166
110
No.ofX-Ray
Oct
2,669
128
51
47
3
3
Ilec.
Nov.
2,819
120
43
t:
2,733
116
39
ul
2
1
:
:
:
15
189
7
136
7
151
No. of Special Investigation
Types of Special Investigation
E.K.G. record
Fetal monitoring
Oct.
Nov.
295
273
54
8'l
Dec.
243
87
Vol. 12 No. 7 Jan. - Mar. 1995
J Prapokklao Hosp Ctin Med Educat Center
No. of Endoscopy
Types of Endoscopy
Esophagoscopy
Bronchoscopy
Gastroscopy
Peritoneoscopy
Cystoscopy
Proctoscopy
Colposcopy
Sigmoidscopy
Blood banking seruice
Units
Donor
units
Volunteer
units
Replacement
units
Professional
units
Transfusion
units
Whole blood & Packedred cell units
Whole
units
Packed red cell
units
Lyophilizedplasma
units
Frozenplasma
units
Freshfrozen plasma
units
Plateletrich plasma
units
Plateletconcentrate
units
Cryoprecipitate
units
Albumin
units
Leukocyte
units
Hemoculture
units
Compatibilitytest
CASES
Emergencycross matching
units
Mobile units
times,honth
Pathological examination
Autopsy
Surgicalpathology
Prapokklaohospital
Other hospital
Cytopathology
Prapokklaohospital
Other hospital
Clinicalhematology
Clinicalchemistry
Clinicalmicrobiology
Clinicalmicroscopy
lmmunologyand Serology
57
Units
cases
CASES
cases
cases
cases
cases
cases
tests
tests
tests
tests
cases
Oct.
Nov.
Dec.
3
9
25
4
4
2
4
a:
14
57
1
t:
;
2
4
2
2
?
Oct.
14
Nov.
Dec.
787
353
434
1,114
705
*:
933
727
789
683
441
242
1
31
957
848
472
376
10
38
t:
,:
,o:
878
753
412
341
23
t:
I
4
1,36;
75
q
Oct.
I
398
335
63
553
445
1,69;
95
I
Nov.
,,,UOl
150
9
Dec.
a
3,295
'15,885
353
305
48
646
549
97
3,262
'15,124
6,695
22,124
6,090
6,233
21,380
6,198
108
43
,*
283
7'l
s83
423
160
3,29O
16,337
5,803
18,889
6 , 19 3
58
znffiiflufn'nfrnwuwnuf,trtninifinTnnarunnwilntnit
-;
d
aJ
iln D gilUn 1 U.ft. - U.n. 2538
tr.t .37
o"Qt.37
it'llat4ttofl::tl
inr*rTqunr:lfiur
't02
T','ltl
asur{ilfr?rlo't
z1r|,t6
rTuodasn::sr,
nau{ufiorilnh,fluqo
n1rtfr.rrflsnmn::ln:
T''IU
?1U
I
I1U/q
A
11U/S
nr:ao$lu
nr:*nr*r:rnf,u
nr:in:rrI:nrjifr'ud
fruarnr:ul:l6uf
339/473
18
1
255/sol
17/18
133
6/6
7/7
l'ru
6uz:rs
rTuqnfiili'oflu
:1U
{r$s{oraiilqunrl
t ( v
n:\t
nT{
nT.)
flT.t
f.,t,lnnTTn/fiflnn1T
0rr?oilfr'{nnao
-i
slT':Qu3
t?.:TgrJ!tTtl$?n
rrruruun:ounit
rdndufiflnnr:
srr'rccrun1il
la
€l?.t
72
275/366
34
1
205/251
1 3 /1 4
105
5/5
3/3
fr.9,37
94
283/393
:
202/236
1 6 /1 6
106
16/16
4/4
sl.o.37
tr.t.37
fr.4.37
1,745/725
1,562/912
1,729/A93
162
157
188
431
427
440
535
488
502
878/923
610/653
614/662
.1',]U$l,f,nl91
I
qr
a
114fl1flnU1?',luUfiRfi
9,
ou/n1J
23,806/23,806
23,710/23,710
22,097/22,097
t14ffiJf,n1*1:1Unflil
I
fiu/RTit
12,303/1,061
1,513
13,338,/
tTO.t/nT.l
31/44
13,233/1,344
40/114
qu1
q -i
a
a
)v
,
Inq1fln!]1fi0il?nsu
stnlaofinTrn
a
I
e
as
J1lIfl .tt ff :lJRNnilnu
AEAdAA
I
$t
n.a.37
e
A
A
4
A
n:.1
n?.t
nt.1
RT.'
o:{
RT.T
iral
so?Rirr.l tuflto
A
AA
oo?fi!truu.tu.o.
AUAEQA
oo?osuouonrfiuu
e
A
q
A
d
J
flnu'l9rvttgn tilfi tu.ixrfl
T?n
e
a
a$v
oo?nlrutl|flil8.:0ntffu
dedf!
flo?flqut'tnilo
fi:{
td
nluqunrru
fi.o.37
184
284
219
363
218
181
305
344
256
674
631
515
359
365
422
151
91
47
56
37
40
q.n.37
dltrtxffn::Hfiur{
n1gfl1ltu"tu9l
a1a?u"luo
tr.:r.37
t:n
ofr?fisu ft.lt.Yl.
a
11/16
vt.g.37
s.ot,37
flu,/fl?{
1,335
850
768
flil/nr.t
432
381
322
14
17
43
fil+
Vol. 12 No. 7 Jan. - Mar. L995
J Prapokklao Hosp CIin Med Ed,ucat Center
o1$flanslrtelrt
o.o.37
tr.t .37
4v
U''ltl.)
111.r1U/n0:
2 7/ 1 , 4 1 1. 5
23/ 1,499,6
23/ 1,495.5
1Jl.t'lU/RflT
2/8,036
2/ 10,660
2/7,872
30,/6,622.35
29/6,239
qv
u'ttTRluuon
z
u'ru1
lJ1{1U/nOT
AAA
1J%'11{,/nO't
lJtl.:![n:n:N
Jvr,i ^vrv
:?u u'l?1?[:.JytzuRsl
to
lJ1*',lU
rirlfiir alun''rro.rfi
a
fruyrunr:rufiEro?,r
9r
I
E A
A
tJflfi1[3.J0ff{SA
ll
-vro
ur:vluoto
28l6,905.68
5/17,80O
62
9/25,200
64
189,790.55
184,833.'17
274,17O.49
285,026.50
289,306.99
IJ'1YI
84,522.79
95,235.95
104,473.82
4.a37
tI.Et.37
s.o.37
7,530
9,270
10 , 15 0
70
50
fl6tr
NSS#rrur^rn
flsl:
Tuberculint:too
Tuberculin
test 1:1,ooo
Waterfor injection
Haemodialysis
solution
Sodiumnitroprusside
50 mg
Cocain too/o
dsl:
0.05
0.05
no:
0.t0
o.12
.|,105
|
-
n0t
X
A o
nv
ol
189,647.70
lV fluid 11 lju1u
Dextrose 5o/o
CPD solution
Ringerlactate
:'1il tJ1u ?'lfto,ln tdo n fl ao to
1/35,2OO
u"tvl
u111
o'rilnAnsrJ?1flo1nrdo
qy.
fi.o.37
q
u"l[tR'ru[1{
u'1u']
I
59
flq:
50
a0T
qn
2,100
50
1,400
50
1,300
2,900
3,500
3 , 10 0
fl9lT
1,350
flgr:
680
755
nnE
0.10
1,365
390
flor
fl9tt
RSlt
14,660.15
1 6 . 1 5 0t.7
16,405.15
a
O
o.t lgo1g liln1:rHasl
v^
gll.{uun1T0.ro0l
u''l?1
162,000
174,318
179,510
ildo'ttN0flJto
a,
u'tyl
544,190
588,565
598,765
:.JT:14U9r[O
U'1YI
382,190
414,247
419,255
IAEA
-Vlu
.v
60
nrffirpinl#lnwtmnun'rrrnfnilfrn lxwarunnrsrlnnil
fli n ntiuii t ,t.n. - fi.n. zssa
Reportfor Nosocomial
Infection,
Prapokklao
Hospital
Nosocomial lnfection for October-December tg94
6fl- 3y
A1167-
No. of discharge 9,236 case
lnfection rate 4.06 %
Ward
r.c.u.
Medicinet
Medicinez
Medicine3
Medicine+
Pediatric t
Pediatricz
Nursery
Pediatricspecial
Newborn
PICU
Ob&Gyn t
Ob&Gyn z
Ob&Gyns
Ob&Gyn+
Ob&Gynspecial
Orthopedict
Orthopedic2
v|tfl]*YtvrTnu
surgeryrvrilisni
Surgeryz
Surgerys
Surgerya
Kasemsan
Sawusdichai
Psychiatry
Song
Eye&ENT
Total
Patient
dischaqe
(case)
Nosocomial
infection
(case)
108
617
646
514
474
373
241
441
93
1,293
72
428
285
496
617
350
307
273
101
797
375
696
381
70
67
155
75
237
22
14
1o,582
3to
6
20
6
10
3
42
9
3
7
4
0
5
2
8
19
13
0
31
31
13
'17
2
3
0
0
0
Nosocomial
infection
(case)
32
16
7
29
7
14
3
46
16
3
8
4
0
1
2
8
21
17
0
35
35
14
19
3
4
0
0
0
Attack rate
(xl
29.63
2.59
1.08
5.64
1.47
3.75
1.24
10.43
't7.20
0.23
11.J1
0.93
0
1.41
0.32
2.28
6.84
6.23
0
7.53
9.33
2.01
4.98
4.28
5.97
0
0
0
3.54
Vol. 12 No. 1 tan. - Mar. 1995
E
o
N6:trtv)O€tstrrO
(arO@
NclN
Fdt
o
r-rortr)ec!On'
E
J Prapokklao
t-
c
J
rt)
s
|r)(rrFsfOrOOC\JOO@Otf
c
J
a
R'tl
EE
H
EE
.E18
c
o
o
c
glE
;E
)o
=
EeE
9e8
8t
6O
c
.9
o
o@ooNoooo
F
oo
oc
(a
-sfO|r)OO.t(o-OC')O-(r)(g
_FtO
Ep,E
)o
=
OOOFOOOOF
9ig
5
A
.9
E
o
.9
o
o
E$
6l
a
(Y'
(y)e(rTOJO(r)NOOOOOOS
F
o
FOOOOOOOOOoOOH
.E
J
f
o
(v)
rO
FOIOIFOTTNFOFOGtO)(o
o
s,E
-g
I
(f)ta
ql
F
I
c)
rJ)
tr
fo
eOOeOOOOOOOOa)To
FNIOc)OJ-(O-€
-N
;3E
s
EE
$EE
c)OOOOOSIO:l
.9
al,tog)
(f)FFoooarooooFoa
=
o(r)(f)0(o@ooo
o
c!rQ(9|,).r)t0O@r$(DOdl
rotra.)s
N!iNFr
o
oooo(Dooof"
d
J
o
o
b
vro
o
61
Hosp Clin Med Educat Center
f
L
O(f)(r)OOOFO(o
(|)
ooooooooo
oJc)AIOOOOOOoOOOFT
t9
F F
s
E
o
(,
o
o
o
oooooooooooooo
z
,2
c
o
2
=
q
ooGloooooN
z
o
G
:
.s
o
(a
e
2
t9
NF$-O-eOl(OFOo)OfrT
ta
.s
a
o
c
o
F-F.O-O)FOOto
OOOOOOOOOOOe-N
e
E
FOOO<O-O(r)bOJ
.s
c
o
E
J
o
c
o
E
o
o
o
o
G
=c
NqIf--OOOTOTOFc)@FH
A,
r€
o
c
G
C
=
F
=
rnroh*.-:
o _P
e$x -E.ig
aEFE;g;8i
,lI.J$c')FrO
(o
$'ilg!s!gF
a
t<
't77enr(uin1#fnatunnuttmin6frn
TxnarunnrstJntn#
62
ild n atiufi t u.n.- fi.n. zrsa
Number of Antibiotic Therapy in Nosocomial Infection
No. of AnUbiotics
Ward
Total
s*
r.c.u.
19
30
38
2
5
44
13
2
153
3
13
20
0
2
36
12
4
90
Medicine
Pediatric
Newborn
Ob&Gyn
Surgery
Orthopedic
Other ward
Total
1
I
13
21
1
6
41
9
2
5
0
6
6
4
0
24
'l
tol
0
0
2
32
59
a7
3
21
124
38
7
375
0
1
1
0
2
1
0
0
5
o
0
0
0
0
2
Cost of Antibiotic Used for Nosocomial Infection
Dose
Antibiotic/cost per unit
Pediatric (lCU)
inj 1 mg
Amikacinsulphate
inj 1 mg
Ampicillin-B
inj 1 mg
Ampicillin
inj 1 mg
Cefotaxime
inj 1 mg
Ceftazidime
inj 1 mg
Cloxacillin
Syr.ro,oooU
Colistin
inj 1 amp
Co-trimoxazole
mg
Fosfomycin
inj I
inj 1 mg
Gentamicin
lmipenam+cilastatin
sodium inj 1 mg
Ketoconazole(zoo)
1 tab
Medicine
Amikacinsulphate
Ampicillin
Ampicillin(zso mg)
Ampicillin(soo mg)
Aztreonam
Cefotaxime
Ceftazidime
Ceftriaxonedisodium
inj
inj
inj
inj
inj
inj
1
1
1
1
1
1
1
1
mg
mg
cap
cap
mg
mg
mg
mg
=
=
=
=
=
=
=
=
=
=
=
=
0.15
6.00
0.013
0.19
0.30
0.017
0.14
28;00
0.088
0.087
1.10
11.43
1,984 mg
baht
48
mg
baht
mg
baht
2,040
89,440 mg
baht
72,132 mg
baht
66,520 mg
baht
baht 1,260,000 U
2 amp
baht
1,400 mg
baht
baht
532 mg
14,940 mg
baht
1
tab
baht
Total
297.60 baht
288.00 baht
26.52 baht
16,993.60 baht
21,639.60 baht
1,130.84 baht
17,64 baht
56.00 baht
123.20 baht
46.28 baht
16,434.00 baht
11.43 baht
Total
25.400.77 baht
2,377.50 baht
22,100.00 baht
4s.00 baht
92.00 baht
13,515.00baht
27,180.00 baht
72,300.00 baht
58,050.00 baht
0.15
0.13
baht
baht
15r85O
't70,000
mg
mg
1.50
2.30
0.265
0.18
0.30
0.43
baht
baht
baht
baht
baht
baht
30
40
51,000
151,000
241,000
135,000
cap
cap
mg
mg
mg
mg
Vol. 12 No. 1 lan. - Mar. 1995
J Prapokklao
Antibiotic/cost per unit
Hosp CIin Med Educat Center
Dose
Cefazolinsodium
inj
Ciprofloxacin
inj
Cloxacillin
inj
(zso)
Cloxacillin
Chloramphenicol
inj
Co-trimoxazole
inj
Fosfomycin
inj
Gentamicin
inj
lmipenam+cilastatin
sodium inj
Metronidazole
Norfloxacin
Tarivid
Pen G. Sodium
inj
Piperacillin
Sodium
inj
1
i
1
1
1
1
1
1
1
1
1
1
1
1
mg
mg
mg
cap
mg
tab
mg
mg
mg
tab
tab
tab
mU
mg
0.265
3.50
0.017
1.4o
0.013
0.73
0.088
0.087
1.10
0.27
4.00
13.50
3.10
0.11
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
11,000
5,800
160,000
44
4,ooo
120
15,000
5,060
4g,2so
4
72
60
790
43,000
63
Total
mg
mg
mg
cap
mg
tab
mg
mg
mg
tab
tab
tab
mii
mg
495.00 baht
20,300.00 baht
2,720.00 baht
61.60 baht
52.00 baht
87.60 baht
1,320.00 baht
440.22 baht
47,575.00 baht
1.08 baht
288.00 baht
810.00 baht
2,449.00 baht
4,730.00 baht
Total
276,989.00 baht
4,2s0 mg
97 cap
115,ooo mg
299 cap
53,000 mg
15,000 mg
92,OOO mg
49,000 mg
3o,ooo mg
P8
cap
4 1 , O O O mg
2,600 mg
28
cap
455,OOO mg
291 cap
8
amp
416 tab
20,000 mg
41,440 mg
14,OOO mg
b8 tab
B4
tab
3,ooo mg
7
tab
509 mU
41,000 mg
14
tab
637.50 baht
145.50 baht
1,495.00 baht
687.70 baht
9,540.00 baht
2,700.00 baht
27,600.00 baht
2,250.00 baht
12,900.00baht
512.00 baht
s33.00 baht
9, t00.00 baht
924.00 baht
7,735.00 baht
1,018.50 baht
224.oo baht
303.68 baht
1,760.00 baht
3,605.28 baht
2,520.00 baht
15.66 baht
460.00 baht
4,680.00 baht
2s.oo baht
1,577.90 baht
4,5t0.00 baht
1s9.00 baht
Surgery
AmikacinSulphate
Amoxycillin(zso)
Ampicillin
Ampicillin(soo)
Cefotaxime
Cefoxitin
Ceftazidime
CefazolinSodium
CeftriaxoneDisodium
Cephalexin(zso)
Chloramphenicol
Ciprofloxacin
Ciprofloxacin(zso)
Cloxacillin
Cloxacillin(soo)
Co-trimoxazole
Co-trimoxazole
Fosfomycin
Gentamicin
Metronidazole
Metronidazole
Nalidixicacid
Netilmicin
Norfloxacin
P.G.S.
PiperacillinSodium
Tarivid
lmg
1 cap
InJ l m g
1 Cap
inj 1 m g
inj 1 m g
inj 1 m g
inj 1 m g
inj 1 m g
1 cap
inj 1 m g
inj l m g
1 cap
inj 1 m g
1 cap
inj 1 amp
inj 1 tab
inj 1 m g
inj l m g
inj 1 m E
1 tab
1 tab
tnJ 1 m g
1 tab
InJ 1 m u
inj
1mg
1 tab
InJ
o.1s baht
1.s0 baht
0.013 baht
2.30 baht
0.18 baht
0.18 baht
0.30 baht
0.045 baht
0.43 baht
4.00 baht
0.013 baht
3.50 baht
33.00 baht
0.017 baht
3.50 baht
28.00 baht
0.73 baht
0.088 baht
0.087 baht
0.18 baht
0.27 baht
2.50 baht
1.s6 baht
4.00 baht
3.10 baht
0.11 baht
13.50 baht
Total
97,606.72 baht
64
Tffinrgailnitf,nuttmnantrnfnilfinlxnnutanttJnrnit
Antibiotic/cost per unit
Ob & Gyn
Amoxycillin(zso)
Ampicillin
Ampicillin(soo)
Cloxacillin(soo)
Cloxacillin(zso)
Co-trimoxazole
Gentamicin
Metronidazole
Metronidazole
Kanamycin
P.G.S.
Orthopodic
Amikacin
Ampicillin
CefazolinSodium
Cefotaxime
Ceftriaxonedisodium
Cephalexin(zso)
Chloramphenicol
(soo)
Chloramphenicol
Cloxacillin
Cloxacillin(soo)
Clindamycin
Co-trimoxazole
Gentamicin
Metronidazole
Metronidazote(zoo)
Piperacillinsodium
Tetracychine(zso)
flii e ntiufrt u.n. - fi.n. zsse
Dose
inj
inj
ini
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
inj
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
i
1
1
1
1
1
1
I
1
1
1
1
cap
mg
cap
cap
cap
tab
mg
tab
mg
mg
mU
1.50
0.13
2.so
3.s0
1.40
0.73
0.087
o.27
0.18
0.01
3.'r0
mg
mg
mg
mg
mg
cap
mg
cap
mg
cap
mg
tab
mg
mg
tab
mg
cap
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
136
n,o2o
335
64
118
92
9,3M
69
6,400
2,500
t
Total
cap
mg
cap
tab
ml
tab
mg
tab
mg
mg
mii
204.00 baht
3,772.60 baht
770.50 baht
224.00 baht
165.20 baht
67.16 baht
8'r2.93 baht
18.63 baht
1,152.00 baht
2s.00 baht
3.10 baht
Total
7,215.12 batrt
1,800.00 baht
1s6.00 baht
7,245.00 baht
14,220.00 baht
12,900.00 baht
992.00 baht
988.00 baht
2.60 baht
8,636.00 baht
1,288.00 baht
288.00 baht
484.72 baht
2,369.88 baht
6s8.80 baht
0.81 baht
12,320.00 baht
3.52 baht
0.15
0.013
0.045
0.18
0.43
4.00
0.013
0.65
0.017
3.50
0.48
0.73
0.087
0.18
0.27
0.11
baht
baht
baht
baht
baht
baht
mg
baht
baht
baht
baht
baht
baht
baht
baht
baht
12,000 mg
12,000 mg
161,000 mg
79,000 mg
30,000 mg
248 cap
76,000 mg
o.44
baht
8
4
cap
508,000
368
600
664
27,240
3,660
3
112,OOA
mg
cap
mg
tab
mg
mg
tab
mg
cap
Total
64.353.33 baht
13,000 mg
16,000 mg
24,000 mg
52,000 mg
8,ooo mg
109,000 mg
76,000 mg
2,400 mg
2,070.00 baht
2,o8o.oo baht
1,o8o.oo baht
9,360.00 baht
3,440.00 baht
32,700.00 baht
9E8.00 baht
8,400.00 baht
66.00 baht
t.c.u.
Amikacin
Ampicillin
Cefazolinsodium
Gefotaxime
Ceftrio<onedisodium
Ceftazidime
Chloramphenicol
Ciprofloxacin
Ciprofloxacin(zso)
inj
inj
inj
inj
inj
inj
1
1
1
1
1
1
inj 1
inj
1
1
mg
mg
mg
mg
mg
mg
mg
mg
tab
=
=
=
=
=
=
=
=
=
0.15
0.13
0.045
0.18
0.43
0.03
0.013
3.50
33.00
baht
baht
baht
baht
baht
baht
baht
baht
baht
2
tab
Vol. 12 No. I Jan. - Mar. L995
Antibiotic/cost
J Prapokklao
per unit
Cloxacillin
Co-trimoxazole
Fosfomycin
Gentamicin
Dose
inj
1
,|
inj
inj
fmipenam+Cilastatinsodium inj
Netilmycin
inj
Netromycin
inj
P.G.S.
inj
1
1
1
1
1
1
Pen V. (zso)
1
Piperacillinsodium
Hosp Clin Med Educat Center
inj
1
mg
tab
mg
mg
mg
mg
mg
MU
tab
mg
0.017
0.73
0.088
0.087
1.10
1.56
1.56
3.10
0.60
0.11
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
82,000
214
4,000
4,040
139,500
1,500
3,OOO
1,374
985
104,000
mg
tab
mg
mg
mg
mg
mg
mU
tab
mg
65
Total
j,394.00 baht
rc6.22 baht
352.00 baht
351.48 baht
153,450.00baht
2,340.00 baht
4,680.00 baht
4,259.40 baht
591.00 baht
11,44O.OObaht
Total 239.198.10 baht
Pediatric
Amikacin
Ampicillin
Amoxycillin
Aztreonam
Ceftazidime
Cefotaxime
Ceftriaxone disodium
Chloramphenicoled.
Cloxacillin
Cloxacillin
Gentamicin
inj
inj
syr.
inj
inj
inj
inj
inj
syr.
inj
lmipenam+cilastatin
sodium inj
Ketoconazole
Nalidixicacid
Norfloxacin
P.G.S.
inj
Tarivid
1
1
1
1
1
1
1
1
1
I
1
1
1
I
't
1
I
Sawusdichi
Tarivid
Kasemsan
Gentamicin
Pen V. (zso)
mg
mg
ml
mg
mg
mg
mg
vial
mg
ml
mg
mg
tab
tab
tab
mE
tab
tab
inj
'l
mg
1
tab
0.15
0.013
0,25
0.265
0.30
0.19
0.43
15.00
0.017
o.27
0.087
1.10
11.43
2.50
4.00
3.10
13.50
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
baht
13.50 baht
0.087 baht
0.06 baht
10,64s
28,460
60
4,800
10,320
27,439
27,000
2
38,885
1,160
3,196
5,064
4
2
101
38.8
48
2
3,680
80
mg
mg
ml
mg
mg
mg
mg
vial
mg
ml
mg
mg
tab
tab
tab
ml
tab
1,596.75 baht
369.98 baht
1s.00 baht
1,272.00baht
3,096.00 baht
5,213.4't baht
11 , 6 1 0 . 0 0b a h t
30.00 baht
661.04 baht
313.20 baht
278.05 baht
5,570.40 baht
45.72 baht
5.00 baht
404.00 baht
120.28 baht
648.00 baht
Total
31,248.83 baht
tab
27.00 baht
Total
27.OO baht
mg
tab
320.16 baht
48.00 baht
Total
36e.16 baht
66
nftnrgufnnFlnawnnuxternin1frn
Inxarunnftrhntndt
ild n atiufrt a.n. - fr.n.zssa
Antibiotic/cost per unit
New bom
AmikacinSulphate
Ampicillin
Cefotaxime
Chloramphenicoled
Cloxacillin
Gentamicin
Dose
inj
inj
inj
Syr.
inj
I
1
1
1
1
1
mg
mg
mg
1t?O
ml
mg
=
=
=
=
=
=
0.15
0.013
0.19
15.00
0.27
0.087
baht
baht
baht
baht
baht
baht
378
17,220
2,520
1
60
617.
mg
mg
mg
1J10
ml
mg
Total
(tn;eaion)u"*\'H
Numberof rotat Antibiottcs
Drug
Ampicillin
Ampicillin
Ampicillin
Amikacin
Aztreonam
BenzathinePenicillinG
Cefotadm
Cefota)dm
Cefoxitin
Cefazolin
Ceftriaxone
Ceftriaxone
Ceftrio(one
Ceftriaxone
Ceftazidine
Chloramphenical
Ciprofloxacin
Clindamycin
Cloxacillin
Cloxacillin
Co-trimoxazole
Gentamicin
Gentamycin
lmipenem+Gilastatin
Kanamycin
Lincomycin
Metronidazole
Netilmicin
Netilmicin
PenicillinG Sodium
PenicillinG Sodium
Piperacillin
Streptomycin
Spectinomycin
No
lgm
50o mg
250 mg
5OO mg
i.2 mii
t
t
gm (o)
gm (l-)
lgm
lgm
r
gm(o)
t
gm (L)
2so ms (o)
2so ms (L)
lgm
1gm
100 mg
1s0 mglml
1gm
500 mg
10
40
mg/2ml
mg/2ml
1gm
300 mg/zml
100 ml
100 mg
150 rng
1 mii
5 mii
2gm
1gm
5,700
300
1,950
620
260
90
650
910
394
2,600
760
1,938
30
40
1,559
1,2s0
40
210
6,400
850
l,ooo
1,400
12,ooo
520
250
210
1,570
100
350
3oo
2,200
340
50
2
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vial
vld.
vial
vial
vial
vial
vial
vial
vial_
viat
vial
vial .
vial
vial
vial
Total
Total
56.70
223.86
478.80
15.00
16.20
53.68
baht
baht
baht
baht
baht
baht
844.24 baht
]wP
Cost (batrt)
85,500
4,2OO
17,550
12,300
82,420
8,550
139.650
146,510
82,740
130,000
376,2O0
620,'160
43s0
3,800
545,650
21,25O
20,240
52,500
222,800
11,200
35,000
7,000
120,000
328,900
5,000
2,400
141,300
20,500
103,900
2,7OO
44,000
86,020
400
370
3,485,060
'g?
Vol. 12 No. 1 lan. - Mar. 1995
J PrapokklaoHosp Clin Med Educat Center
67
Perinatal Mortality
October tgg+
Number of Still Birth = 1t
cases
=
Still Bitth Bate
24.2s births
Total Number of Death
11 cases
Total Number of Delivery = 453 cases
Perinatal Mortality Rate
No Age
1
2
3
4
5
6
1
8
9
10
11
37
28
43
38
16
30
21
25
34
30
22
Parity
0-0-0-0
0-0-0-0
1-0-1-1
2-0-0-0
0-0-0-0
0-0-0-0
0-0-0-0
0-0-0-0
0-0-l-0
l-0-0-1
0-0-0-0
24.28,/1,0o0births
ANC
Gest. VDRL Del.
rs(rontu)
r (:lrr.)
z (:nr.)
e (ao.)
t (rwe.)
o (:r,rr.)
o (tvie.)
12 (ro.)
o (:r,rt.)
z (:fls.)
a (oo.)
er
2a
28
2s
2s
30
33
40
27
38
44
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
Wt
Sex
Type of Death
M
M
F
F
M
1,750 M
F
2,500
2,850 F
F
2,060
v/E 3,ooo F
c,/s 3,500 F
NL
NL
NL
NL
NL
a/A
NL
NL
F/E
A
A
A
A
A
A
A
A
I
1,05O
1,100
1,100
1,200
't,4oo
I
I
Gause of Death
Maceratedstill birth
Specificcondition(DM in mother)
(Phcenta
Asphyxia
previa,prolapse
cord)
Macerated still birth
Maceratedstill birth
Maceratedstill bir.th
Maceratedstill birth
Maceratedstill birth
Congenital
(Hydrops
malformation
fetalis)
Congenital
(Hydrocephalus)
malformation
Congenital
(Anencephaly)
malformation
November 1994
Number of Still Birth = 2
Still Birth Rate = 4.27
Total Number of Death
2 cases
=
Total Number of Delivery
468 cases
Perinatal Moftality Rate
4.27,/1,000
births
No Age
1
2
25
20
Parity
ANC
Gest. VDBL Del.
1-o-1-1 s (rns.)
r-o-o-1 s (na.)
30
28
-ve
-ve
NL
NL
Wt.
Sex
Type of beath
1,350 M
t,7oo M
A
A
cases
births
Gause of Death
Maceratedstill bifth
Maceratedstill birth
December 1994
= I Case
Total Number of Delivery = 439 cases
Total Number of Death
= 20.50,/1Q00 births
Perinatal Mortality Rate
No Age
1
2
3
4
5
6
7
8
I
Parity
39
30
31
17
20
23
37
18
3-0-0-3
4-0-0-4
0-0-0-0
0-0-0-0
0-0-0-0
1-0-0-1
1-0-0-1
0-0-0-0
22
0-0-0-0
Number of Stiil Birth = 9
cases
Still Bitth Rate = 2o.so bitihs
ANC
Gest. VDRL Del.
e (:nr.)
z (:nr.)
Wt
Sex
32
28
t (:t^to.) 32
33
rr (:r^rr.)34
a (ro.) 43
1 (nniln) 2 8
z (se.) 33
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
M
C/S 3,450
B/A 1,600 M
C/S 1,050 M
NL 2,OOO M
M
NL 2,500
NL 3,700 M
C/S 1,150 M
NL 2,470 M
(no.) 36
-ve
NL
4
2,0s0
M
Type of Death
A
A
A
A
I
I
I
I
Cause of Death
Maceratedstill birth
Maceratedstill birth(Unknowncaused)
Macerated still birth
Maternal carbamate poisoning
Cong. Anomaly(Anencephag)
Asphyxia (vAS)
Prematurity(Sepsis)
Prematurity(Sepsis)
Sepsis with complex heart dis.
u. r8nd tlrnul
e, u.lgorrnfin
g.
u. rar,l.€i.OsFn
rirorfiuCrucirfiDl
4
1.
5.
u, uanlrrs
u. lurso{ thnsl
7.
u. lrrsrerfi
a. u, runlari
g.
u. ltrfrr rJuauri
E.
1tl.
u. darordudn
u, rffirt'ruarrd
1 e . u. lrrst
11.
13.
u, udrrmosl
14
1 El.
u, r,irf,rr
u. ii.r6a.rod.
u. uhdiimtfi:r
17,
rirurfirrdeurirrin
r5.
€Ro
lN
Effective and well tolerated in
respiratory tract infections
PRESCRIBII|G
IilFONNAfl
OT
Composition :
Tablet : Eachtabler contains 1.5 M.l.U. (500 mg| Spiramycin
Syrup : Each 5 mt Contains0.375 M.t.U. lt 25 mg) Spiramycin
Indications :
The indicationsare based on the antibacterialactiviw
and the
pharmacokinetlccharacteristicsof spiramvcin.Thev -take into
accountthe clinicalstudiesconductedwith this druo'and its place
in the range-of antibacteriat products currently avaiiibte. They are
limited to infectibns due to the organisms defrned above as tieing
sensitive,particularlyin the following clinicalsituations:.E.N.T;
bronchopulmonary.stomatological,cutaneous,qenital lpafticularlyprostatic)and bone infections;rhe prophytaxisoimeninj&occal
meningitisin contactsubjects;chemoprophylaxis
of recurrencesof
rneumatrc tever; toxoplasmosis in pregnant women and in
rmmunodepressed
subjects,when leukopeniacontraindicatesthe
prescriptionof pyrimethamineor a suphonamide.
Dosage & Administration
Contraindicatlons :
Allergy to spiramycin.
:
Tablets ; Adults: I tabtettaken3 time5daily.Rovamycin500 can
be prescribed safelyto pregnant women.
Children weighing more than 20 kq: I tabtet {i.e. L5
MIU)per l0 kg of bodyweighr perday. ro be div-idedin 2 or 3 doses.
For severecases{adults} : I tablet 4 times daily.
R€ady-to use syrup :_tnfan-rsand chtldren <20 kg : 50:l 00 mgl
kg !ody- weighvday I I 50, 000-300. 0 00 t.U./kg bodiyweighvdatl
tn z or 3 otvtoeoooses.
Thesedoes not need to be modified in patientswith renal impatrment, because of the absence of renal excretion of the active
molecule
Adverse Reactions / Side Effects :
Gastrointestinaleffects : nausea, vomiting and diarrhoea are unAtlergic skin reactions occur rar-ely.
loqmol
urat .sptramyctn ts remarkably well tolerated ancl serious roxtc
reacttonsare.extremelyrare. sideeffects occur in a smallproDortion
or casesano Inctude gastric upset, diarrhea and skin reattiohs such
as untcafla.
Enterit6 due to suppression of the normal bacterial flora of the
rnresnne..orstatning of teeth, common untoward reactions with
letracyciltnes, have not occurred as a result of treatment with
Spiramycin. Good toterance to this antioioiiJ nas-f,"i-n'iupo.t"o
even when given continuously for some months.
Interactlons
:
No interactions have been reponed to date, in panicular with
theophyltine and the vasoconsirictor ergot atkaloidileiqotarnrne,
dihydroergotamine).
Ctverdos-ge :
no reponed case of overdosage, shoutd this occur.
y.!!"^llulg]t
Symplomarc supportive measuresshould be taken.
Storage Conditions :
Store at room temperature.
Pack size:
Bottle of | 00 tabtets
Bottle of I OOmt.
FurtherinlormatisB available
on requesttromRHoNE-pouLENcRoRERLTD.,po. Box693BMc Banokotloooo
a,
4.,
oillttt?|il'ln.lio'|fl
CV
'U
.raA-
(dssrnat1nu)
uSunorilslroruS0rn
o.lno
,h
lU
aunullnulu
4U
VC
r?uflol?l Novo NoKDtsK
MONOTARD
HM.
ACTRAPID
HM.
ACTRAPHANE
HM.SONA
RETARD
NPH.
(Regular
NEUTRAL
Insulin)
'Laaw?
aunullnrnu nvntan DUMEX
It
ELYZOL
INFUSION
1OO
ML.
STESOLID
RECTAL
TUBE
SPONGOSTAND
,l-altC/?
aunufl'rnu'tununarr,lcl
It
FLUOTHANEDIPRIVAN
TENORMIN
SORBITRATE
HIBISCRUB
oy
ae
anilu?lx['1nl5
orn
663 uoaoouqonuu4qu5nzz ws:luuonqornw'1
f
tnS. 3l l -5738-9, 3l 1-2929
'tt
C)r
atuur^fl'lrn%'lu
.lt
ln'lftfirndo trrh1rdanlntqlvrdoor nrflaamv
99qq
-d_clu+a,s,C
[o6t.?. lot [tJtn6o6fl lonlilu{u merury{o6uun
lnil.
qq
c.r gg
g
q'
e,g
&
v
+
.1n"1
Tlnn{yr? d tnrJrlvl?{Fttuil? 5l'lerd?u1j6[611?s
I
Mulsanic'
(Sucralfate)
o Nonsystemic
Cytoprotective
Agent
o Maintains
the normaldigestive
environment
r HighlyEtticacy
2 gm bid
Fortreatment
1 gm bid
ForMaintenance
Orifinel Researchby
CHUGAI PHARMACEUTICAL CO.,LTD. Tokyo,Japan
Furiherinlormationavailablgon request.
SiamPharmaceuiical
Co.,Ltd.
l7ll1 SOI CHOKEGHAIRUAMMITR,
vlEHAVADI-RANGSITROAD BANGKOK 10900,THAII-AND.Tel. 276tO2o
E--*.
DOSANAC'
F
-DI
GEL 7o/o
. RELIEVES
PAIN
O REDUCED
INFLAMMATION
O AVOIDTHESIDEEFFECTS
DUETO
ORALNSAIDsTHERAPY
4
F
rOR TREATMENTOF TRAUMATICINFI.AMMATIONOF TENDONS , LIGAMENTSMUSCLEAND JOINTS
SiamBheasach.Co.,
Lrd.
6ii'fn
}'6FO;;-;h
123 SOI CHOKECHAIRUAMMITRVIBMVADT.RANGSITBOAD BANGKOK 1O9OO,
THAILAND.TEI, 27610N
-
I'
{,t
,\l
I
UL4EAXI+I
*,ooro.n,o*X'',
Inp,esonrof&tacramnaso
High d€oroe of Statility
t
r^rK { ffi:iffitr,3*:'fl#
-
It
\Z
Wide Ep€ctsumactivity against gEm
nsgalive baebria (eg. N.meningitidie
N.gononhoae and most ot Enterlbactdiac€ee)
G@d actjvity agsinst gram positive
Sfeptococci. p€.ticillines€ and
rcnpenicillina* producingslaphytocGci
PACKING500 mg. viat, 1 gm. viat.
M4or rn€Eboliteis microbktogi€l active
. -^-.
iridrn
Jtffi
Manufacturedby:Siam BheasachCo., Ltd. Bangxok,
Thaitand.
AgenrSiamPharmaceulical
Co.,Lld, Bangkok,
Thaitand.
Tet.2761o2o
-.- ar.
lii
b
ftlflDnuunu'In15
u6rinlllfslGtgd
tffs:mdlng)
uiunuiirntirflur
drrTn
ZADITEN
PARLODEL
HYDERGINE
MTACALCIC
adr
o
-
U"I**N,llldtltil€An€
.3
c
e
Q'lnO
NAI'SINTRADING
LIIIITED
COMPANY
&G.dc
su 15 olfirtuotqll.ilursrot
srcls ouurilAutnrtnrlqriu nqlrnn"r10330
15th MANEEYA
CEMERBUILDING.
.518/5
PLOENCN.Iff
RD.,PATUMWAN
BANGKOK]0330,THAILAND,
a zsaazoo
fr rnu{ruilraer$r n"tudtnu arcrXi rJturil rlil s
B@sst
Soldion
set
Pediatic
Solution
set
Donor
set
Pediatric
Vein
Scalp
Cudown
Tube
{uvru,{ruri'rsH6nriilri liltn'l o'lgfi rJegrrnnd rl
Bloodbag
xfi*o Aggregate
Filterset
Hyperalimentalion
bag
Blood
Tubing
Sets
Hollow
FiherDidyza
"
99tov
?t1{ilud?u01R9l
rorduuv,h*trryfrrto
t
U
9.d
oagn?'letiltr€ox['t6
q1n
USl'N
r
d
.,,Y
tr. roa. [ou. Insol6l{ olno|
9ror
fl ltt{llo'lf{?['l u
ql
Tienam
Cefoxin
HB vax ll
Clinoril
Sinemet25/250
uoil
amigaur?nT
os
PharMaland
-g.ccov
il6n?r il16&r1$AUA(1982)elno
nuurtiupr?unf
ts/s6il{ r ztanqnrvruf
rilnrl:st?Fln?[tnv{l 1o2oo
rm?{rfiilauilail
tn6. 3ee-22oo(o ors) FAX :396-L622
O DePuVo Hdalthcare
Lrd.af,H#[gillg
RRem"o,""
o
o
ISOREIT O }ilFELAT OFAilOPSI}I
ACTIGHLOR O MEDilIL O SUIIIDIN
d
d
.
U_J
-F._
_c
o
Q,
uqlfl,$[u.ilaltilqnfl tuula,fl5ffinn
zzz/1 nrrrraf'lNrat donnu'lirqr{il?ueJlsovr;sl,tot nq$ntr{eJil'l}$orlozoo
?s1nl:UytyttJylila ilg1u1n tn6{s 'tnlxglnufit
Ado/vA
fisrrunyrd fr'oorarcnrila{
ililurlril1r{n{
A€Ato
dnulf{16{arur141Tfirno
l1-gerrErf
fl'tnn'luu5ytild 4nfllunuNul
uffi uen'lru'lurf;auf Nnfiilil
|l
281863 1, 2821242, 2801527
FAX :
2810250
---_-_-----l--
:'r-
^
B8nrns?urtnrrfin$aih
ci,*i'n
*"1u@Tunffim
Ue:flmffinmHj
-Ue
HSnn&|'ttfi'Uag}.R'ttt
t
PTNRACTLGINOPALIfXAilAUTOL-
NTNATTPICI.Irr
LEDSNLE
ilrlrrocllY*
AnrsroconT*
il€unlumaagr$t*C*i $crn u?fn ltsr ur fi a rlun ilyr s {r fi'n
*u rt ore'ptruaeunfind rsr nuuilmJL?nu1{fnnqlwrn.rror so
(rs rtTs) do 30,3I',gztilflrt zir-3Tee
tnafnd 231-37r0