Thai Journal of Obstetrics and Gynaecology

Intriguing Review and Topics in Fourth Issue of Thai Journal of Obstetrics and Gynaecology 2026

2026-06-24T15:10:28+07:00

Thai Journal Obstetrics and Gynaecology is in the Q3 journal rankings from CiteScore rank (#158/218, 27th percentile) in category: Obstetrics and Gynecology from Scopus database in year 2025 with cites scores 0.9. Thai Journal Obstetrics and Gynaecology has been accepted for inclusion in the Scopus database since July 2019. Previously, Thai Journal Obstetrics and Gynaecology received the Q4 journal rankings from CiteScore rank (#158/176, 10th percentile) in category: Obstetrics and Gynecology from Scopus database in year 2020 with cites scores 0.1⁽¹⁾. SJR score and H index are also increased from 0.117 to 0.237, and 1 to 5 in Obstetrics and Gynaecology category from Scimago Journal & Country Rank year 2020 to 2025, respectively⁽¹⁾.

Docosahexaenoic Acid and Preterm Birth

2026-06-30T15:43:50+07:00

Docosahexaenoic acid (DHA) is an omega−3 polyunsaturated fatty acid. DHA can be synthesized from a-linolenic acid or directly derived from maternal milk (breast milk), cold-water fatty fish such as salmon, fish oil, or algae oil. DHA has mechanisms that may help reduce the risk of premature birth, smaller for gestational age infants, and preeclampsia. Pregnant women should receive at least 200 mg of DHA per day. Several studies have found that low plasma DHA levels during pregnancy increase the risk of premature birth, and DHA supplementation during pregnancy (1,000 mg per day) has been shown to be effective in preventing premature birth and early preterm delivery in cases of low DHA levels.

Analysis of Trends, Causes, and Risk Factors of Maternal Mortality in Sakon Nakhon Hospital: A 22-year retrospective study (fiscal years 2003 to 2024)

2026-06-30T15:43:59+07:00

Objectives: To analyze the trends, causes, and contributing risk factors of maternal mortality at Sakon Nakhon Hospital over a 22-year period.
Materials and Methods: A retrospective review was conducted utilizing hospital records of maternal deaths. Data sources included inpatient medical charts, antenatal care (ANC) records, and documentation from maternal mortality review conferences. The variables collected encompassed maternal demographic characteristics, gravidity, parity, number of ANC visits, gestational age at initiation of ANC and at the time of death, location of ANC services, pre-existing comorbidities, causes and timing of maternal death, and assessments based on the Three Delays Model. Additionally, to evaluate the impact of healthcare system changes, maternal mortality rates and associated characteristics were compared before and after the implementation of the 2020 health service reform.
Results: Between fiscal years 2003 and 2024, a total of 87,041 live births and 83 maternal deaths were recorded at Sakon Nakhon Hospital, yielding an overall maternal mortality rate (MMR) of 95.36 per 100,000 live births. A temporal trend analysis revealed a decline in MMR from 106.77 per 100,000 live births prior to 2016 to 56.17 during the period 2017–2019. However, the MMR subsequently increased to 82.02 in the period 2020–2024 after the health service reform. Among the maternal death cases, only 28% of women received at least four quality antenatal care (ANC) visits, while another 28% had no ANC visits at all. Common comorbidities identified included extremes of maternal age (adolescents and women of advanced maternal age) and diabetes mellitus. Notably, 12% of the cases had no documented comorbidities. A shift in the leading causes of maternal death was observed over time, with obstetric hemorrhage predominating prior to 2016, and non-obstetric medical complications emerging as the leading cause in subsequent years. The Three Delays Model Analysis showed that the majority 47% had delay in decision to seek care while another 38% had delay in reaching health care and 15% had delay in receiving quality care.
Conclusion: The MMR declined in the period 2017–2019 and subsequently increased in the period 2020–2024 after the health service reform. Enhancing early access to and the quality of antenatal care, conducting systematic evaluations for maternal comorbidities, and ensuring timely referral to appropriate levels of care are critical strategies for reducing maternal mortality. The observed changes in maternal death patterns following 2020 suggest that the decentralization policy implemented that year may have had implications for the effectiveness of the obstetric referral system. Further investigation is warranted to evaluate the policy’s impact on maternal health outcomes.

Attitudes toward Menopause and Menopausal Hormone Therapy among Thai Women Aged 40 Years Old and Above: A hospital-based study

2026-06-30T15:44:03+07:00

Objectives: To assess attitudes and associated factors toward menopause and menopausal hormone therapy among Thai women aged 40 years old and above.
Materials and Methods: A cross-sectional observational study was conducted in Thai women aged 40 years old and above who visited the Gynecological Outpatient Department at Phramongkutklao Hospital between 1 March and 30 June 2023. A self-administrated questionnaire was used to collect the baseline characteristics and attitudes toward menopause and menopausal hormone therapy. The questionnaires were validated and confirmed for reliability (Cronbach alpha r = 0.8).
Results: Three hundred women were enrolled in the study. The mean of the participants’ age was 54.42 ± 9.11 years. Almost two-thirds of the participants (196/300) were in post-menopausal status. Thirteen percent were current users of menopausal hormone therapy. About three-fifths of the participants agreed with “Going through menopause does not change much,” (58%) and almost two-thirds agreed with “Menopausal hormone therapy is appropriate for some women,” (63%). In contrast, the phrases, “I felt mentally and emotionally humiliated when menopause started” and “Menopausal hormone therapy should be avoided,” had the highest disagreement rates, with 82.3% and 27.3% of participants disagreeing, respectively. The mean ± standard deviation menopause and menopausal hormone therapy attitude scores out of 30 were 19.75 ± 5.24 and 16.1 ± 3.31, respectively. Moreover, for menopause attitudes, the participants aged 50-59 years had lower scores than younger participants (p = 0.04), while those who lived in rural areas had significantly higher scores than those in urban areas (p = 0.017).
Conclusion: The women aged 40 years old and above who visited Phramongkutklao Hospital in the present study had quite positive attitudes about menopause and menopausal hormone therapy. Age and living area were the factors associated with menopause attitude.

Association between Alpha-fetoprotein Levels during the Second Trimester of Pregnancy and the Incidence of Low Birth Weight Infants at Sunpasitthiprasong Hospital

2026-06-30T15:43:52+07:00

Objectives: To evaluate the association between maternal serum alpha-fetoprotein (MSAFP) levels during the second trimester and low birth weight (LBW) incidence, at Sunpasitthiprasong Hospital.
Materials and Methods: This retrospective cohort study included 1,937 pregnant women who underwent chromosomal abnormality screening between June 2021 and May 2025. Data from medical records included maternal baseline characteristics, antenatal history, quadruple test results, and delivery outcomes. Univariable and multivariable analyses were performed using logistic regression. Predictive performance of MSAFP for LBW was assessed by receiver operating characteristic curve analysis.
Results: The mean age of pregnant women was 28.5 ± 5.4 years. Birthweight less than 2,500 grams was observed in 10.9% of infants. The quadruple test was positive in 7.4% of cases. The median MSAFP levels were 34.36 ng/mL (interquartile range, IQR 26.94, 45.30), converting to 1.01 multiple of median (MoM) (IQR 0.83, 1.28). MSAFP levels were significantly higher in the LBW group compared to the non-LBW group (median 37.33 vs 34.12 ng/mL). In multivariable analysis, MSAFP in ng/mL, MoM, and > 2.0 MoM was significantly associated with LBW (adjusted odds ratios 1.01, 1.34, and 2.52 respectively). However, serum AFP demonstrated low predictive performance for LBW (area under the curve = 0.566).
Conclusion: MSAFP levels were significantly correlated with LBW, with higher levels observed in pregnancies with LBW. However, its predictive performance was low, limiting clinical utility. Elevated MSAFP may indicate risk to LBW but should be evaluated alongside other maternal and biochemical factors for effective risk assessment.

Local Wound Infiltration of Bupivacaine with Dexamethasone versus Bupivacaine Alone for Postoperative Pain after Total Abdominal Hysterectomy: A randomized controlled trial

2026-06-30T15:43:56+07:00

Objectives: To assess the effectiveness of adding dexamethasone to bupivacaine for local wound infiltration in reducing postoperative pain post total abdominal hysterectomy (TAH) for benign gynecologic conditions.
Materials and Methods: A double-blind, randomized controlled trial enrolled women undergoing TAH for benign gynecologic conditions. All participants received local wound infiltration with 20 mL of 0.5% bupivacaine (100 mg). The intervention group additionally received 8 mg of dexamethasone, while the control group received normal saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS) at 2 (baseline), 6, 12, 18, and 24 hours postoperatively. Data were analyzed using a linear mixed model. A p value < 0.05 was considered statistically significant.
Results: Fifty-two participants (26 per group) were enrolled between November 2024 and April 2025. Within-group analysis demonstrated a statistically significant reduction in VAS scores over time (p < 0.05). Between-group comparison showed significantly lower VAS scores at 12 hours postoperatively in the intervention group compared to the control group (4.3 ± 1.0 vs 5.9 ± 1.3, mean difference 1.6; 95% CI (0.33, 2.23), p = 0.009). There were no significant differences observed in total postoperative morphine consumption (12.7 ± 3.2 mg vs 13.6 ± 3.1 mg, p = 0.313) or adverse events between the groups.
Conclusion: Addition dexamethasone to bupivacaine for local wound infiltration significantly decreased postoperative pain following TAH for benign gynecologic conditions, with a notable difference at 12 hours compared to bupivacaine alone. However, there was no clinical difference in postoperative morphine use.

Neonatal Sepsis and Outcomes of Maternal Group B Streptococcus Colonization in Preterm Birth

2026-06-30T15:43:58+07:00

Objectives: To evaluate the association between maternal group B Streptococcus (GBS) colonization in preterm birth and neonatal outcomes.
Materials and Methods: A single-center retrospective paired cohort study was conducted at Chonburi Hospital, Thailand, from January 2014 to December 2024. Pregnant women admitted with preterm labor and delivery who underwent recto-vaginal swab culture were included. Pregnant women were categorized into two group based on GBS cultured status. Maternal and neonatal outcomes were compared between group. For adjusted analyses, GBS-positive mothers were matched 1:1 with GBS-negative mothers by year of recto-vaginal swab collection and gestational age at delivery. Logistic regression was performed to identify independent risk factors for neonatal sepsis in paired cohort.
Results: Among 3,895 women with preterm delivery, 114 mothers (2.9%) were colonized with GBS, accounting for 123 neonates. In the unpaired analysis, neonatal sepsis did not differ significantly between neonates born to GBS-positive and GBS-negative mothers (33.9% vs 36.5%, p = 0.556). The rate of stillbirth occurred more among GBS-positive mothers. In the paired cohort of 114 matched maternal pairs and their neonates, maternal GBS colonization was not independently associated with neonatal sepsis or other neonatal morbidities. Multivariable analysis identified lower gestational age and birth weight between 1.5–2.5 kg as an independent risk factors for neonatal sepsis.
Conclusion: Maternal GBS colonization in preterm birth was not an independent risk factor for neonatal sepsis. Neonatal sepsis was primarily related to prematurity-associated factors, while stillbirth was more frequent among GBS-positive mothers.

Prevalence, Perception and Factors Associated with Postpartum Depressive Symptoms among Mothers in a Tertiary Hospital, Surat Thani Province, Thailand

2026-06-30T15:43:54+07:00

Objectives: This study aimed to examine the prevalence of a high Edinburgh Postnatal Depression Scale (EPDS) score (screening-positive postpartum depressive symptoms) and perceptions of postpartum depression (PPD), as well as associated factors within the first 72 hours after delivery.
Materials and Methods: A cross-sectional study was conducted at the Suratthani Hospital in Thailand. Using simple random sampling, 420 postpartum women were assessed within the first 72 hours after delivery between May and August of 2025. Participants completed a self-administered structured questionnaire covering socio-demographic, obstetric, and partner characteristics. Participants’ perceptions postpartum were measured by the Postpartum Depression Literacy Scale (PoDLiS). Depressive symptoms were screened using the Thai EPDS, within which, a total score ≥ 11 defined a high EPDS score. Variables significant in bivariable analyses were entered into multivariable logistic regression. Statistical significance was set at p < 0.05. Crude odds ratios (ORs) were reported for bivariable (unadjusted) analyses, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported for multivariable logistic regression.
Results: The prevalence of a high EPDS score within the first 72 hours after delivery was 14.5%. In multivariable analysis, unintended pregnancy (aOR 1.92, 95% CI 1.10, 3.36), antenatal anxiety (aOR 3.05, 95% CI 1.70, 5.49), and household income ≤ 15,000 THB/month (aOR 2.01, 95% CI 1.09, 3.71) were independently associated with a high EPDS score. In bivariable (unadjusted) analysis, high risk perception during pregnancy was associated with a high EPDS score (OR 7.84, 95% CI 2.12, 29.01, p = 0.001), whereas moderate risk perception showed no significant difference versus low (OR 2.55, 95% CI 0.76, 8.53, p = 0.171). Obstetric and neonatal characteristics including mode of delivery, birthweight, neonatal intensive care unit admission, and pregnancy complications were not significantly associated with a high EPDS score.
Conclusion: The prevalence of high PPD scores was 14.5%. Unintended pregnancy, antenatal anxiety, and household income signaled higher risk, supporting targeted screening in antenatal care and repeat screening at 4–6 weeks, with prompt psychoeducation and mental-health referrals.

The Cerebro-placental-uterine Ratio at Gestational Age 28-32 Weeks in Predicting Small for Gestational Age among High-Risk Singleton Pregnancies

2026-06-30T15:44:01+07:00

Objectives: The primary aim of this study was to evaluate the performance of the cerebro-placental-uterine ratio (CPUR) (middle cerebral artery pulsatility index (PI)/umbilical artery PI/ mean uterine artery PI) in predicting small for gestational age. The secondary aim was to evaluate pregnancy outcomes in high-risk pregnancies.
Materials and Methods: This prospective cross-sectional study included 238 high risk singleton pregnancies at 28-32+6 weeks gestation. The participants received antenatal care and delivered at Rajavithi Hospital between January 2024 and November 2024. The estimated fetal weight (EFW), middle cerebral artery pulsatility index (MCA PI), umbilical artery pulsatility index (UAPI), and uterine artery pulsatility index (UtA PI) were obtained, and the cerebroplacental ratio (CPR) and CPUR were calculated. An adverse pregnancy outcome was defined as fetal small for gestational age (SGA), APGAR scores at 5 minutes less than 7, stillbirth, neonatal intensive care unit (NICU) admission within 48 hours of life, preeclampsia, or preterm birth.
Results: Among the 238 non-consecutive pregnant women included in the study, 3.4% had fetuses that were small for gestational age, which constituted the primary outcome. The CPUR was highly reliable in predicting SGA (area under the curve = 0.827, 95% CI 0.713, 0.942, p = 0.002), a cutoff value of less than 2.355 yielded a sensitivity of 100%, a specificity of 55.7%, a positive predictive value of 7.3%, and a negative predictive value of 100%. CPUR showed a significant association with preterm delivery (including both early and late preterm). There was no correlation between CPUR and preeclampsia, stillbirth, NICU admission, and APGAR scores at 5 minutes less than 7.
Conclusion: CPUR may be a novel indicator for predicting for SGA and preterm delivery in high-risk pregnancies.