Thai Journal of Obstetrics and Gynaecology

Potential of Pravastatin for the Prevention and Treatment of Preeclampsia

2025-03-20T15:19:49+07:00

Preeclampsia (PE) is a severe pregnancy complication affecting 5–10% of pregnancies worldwide and remains a leading cause of maternal and neonatal morbidity and mortality. Although low-dose aspirin is widely used for prevention, its efficacy is limited, necessitating the development of novel therapeutic strategies. This review examines the potential of pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, as a preventive and therapeutic agent for PE.
Pravastatin exerts pleiotropic effects, including upregulation of placental growth factor, suppression of soluble fms-like tyrosine kinase-1, and anti-inflammatory and antioxidative properties. Preclinical studies demonstrate its ability to mitigate PE-like symptoms in animal models, whereas clinical studies suggest its potential to reduce the incidence of severe PE in high-risk pregnancies. However, its effectiveness is limited when administered after 35 weeks of gestation, and its optimal dosage remains undetermined.
Building on existing clinical evidence, well-designed large-scale randomized controlled trials are crucial to establish the safety and efficacy of pravastatin in PE prevention. Further research is needed to evaluate its potential for reducing long-term cardiovascular risk in women with a history of PE. An ongoing clinical trial in Japan (jRCTs031230067) aims to address these gaps and contribute to future PE prevention strategies.

Intriguing Review and Topics in Third Issue of Thai Journal of Obstetrics and Gynaecology 2025

2025-04-30T09:29:04+07:00

This third issue of Thai Journal of Obstetrics and Gynaecology 2025 contains many interesting articles. The special article is “Potential of pravastatin for the prevention and treatment of preeclampsia”. The authors reviewed the risk factors of preeclampsia, pathophysiology, current preventive strategies for preeclampsia, and pravastatin as a novel approach for preeclampsia prevention and treatment⁽¹⁾.

Efficacy of Heat Patch Applied on Lower Back for Reducing Postoperative Pain after Cesarean Delivery: A randomized controlled trial

2024-11-05T11:49:07+07:00

Objectives: To study the efficacy of using a heat patch to reduce postoperative pain after cesarean delivery.
Materials and Methods: Women who underwent cesarean delivery under a spinal block were randomly allocated into two groups, comprising one group who received a heat patch and one who received standard postoperative care. The heat patch group received a 40-degree Celsius heat patch applied to the lower back (dermatome T10 to L1) 6 hours postoperatively, while the control group received standard postoperative pain control. The primary outcome was assessed based on postoperative pain scores at 8 hours using a 10-cm visual analogue scale (VAS).
Results: Seventy-eight postoperative women, 39 in each group, were recruited between September 2023 and March 2024. The heat patch group expressed significantly less postoperative pain than the control group 8 hours after cesarean delivery (3.5 ± 0.3 vs 4.7 ± 0.4; mean difference 1.2; 95%CI: 0.4-2.1; p = 0.006). The time to first ambulation in the heat patch group was significantly shorter than the control group (1,073 ± 267.7 min vs 1,261.9 ± 205.3 min; mean difference 189 min; 95%CI: 81.4-296.6; p < 0.001). The heat patch group required fewer additional analgesic drugs compared to the control group (56.4% vs 82.1%; p = 0.014). No adverse events were reported.
Conclusion: A heat patch applied on the lower back resulted in significantly reduced pain 8 hours after cesarean delivery.

Efficacy of Preoperative Tranexamic Acid Administration for Intraoperative Blood Loss Reduction in High-risk Cesarean Delivery: A randomized controlled trial

2024-11-04T09:45:35+07:00

Objectives: To evaluate the efficacy of preoperative tranexamic acid (TXA) in reducing intraoperative blood loss in high-risk cesarean deliveries.
Materials and Methods: A randomized controlled trial was conducted with 50 pregnant women with gestational age over 34 weeks and a high risk of postpartum hemorrhage (PPH) (e.g., previous cesarean delivery, fetal macrosomia, and placenta previa) who underwent cesarean delivery using spinal anesthesia. The intervention group received one gram of TXA intravenously before skin incision, and 0.9% sodium chloride solution was used in the placebo group. The primary outcome was the measurement of intraoperative blood loss.
Results: The TXA group showed significantly lower intraoperative blood loss when compared to the placebo group (495.8 ± 294.6 ml vs 925.6 ± 448.9 ml, mean difference: -429.8 ml, 95% confidence interval (CI): -645.8 to -213.9, p < 0.001). The incidence of blood loss > 1,000 ml was also significantly lower in the TXA group (8% vs 36%, relative risk = 0.22, 95% CI: 0.05 to 0.92, p = 0.039), and fewer significantly decreased hemoglobin levels were observed in the TXA group in comparison with the placebo group (1.1 ± 7.0 g/dL vs 6.9 ± 9.6 g/dL, mean difference: -5.7 g/dL, 95% CI: -10.5 to -0.9, p = 0.020). There was no difference in the requirement for additional uterotonic drugs (8% vs 28%, p = 0.065). No serious adverse effects were observed in this study.
Conclusion: TXA effectively reduced intraoperative blood loss in women at high risk of PPH who underwent cesarean deliveries.

Incidence of Chemotherapy-induced Severe Neutropenia in Nadir Period in Gynecologic Cancer Patients Receiving Carboplatin and Paclitaxel

2024-12-06T11:35:39+07:00

Objectives: This study aimed to determine the incidence of chemotherapy-induced severe neutropenia in the nadir period among gynecologic cancer patients receiving carboplatin and paclitaxel.
Materials and Methods: This prospective cohort study recruited 150 gynecologic cancer patients receiving carboplatin and paclitaxel. Complete blood counts were collected before receiving chemotherapy and during the nadir period of each cycle, followed until discontinuation of the regimen or completion of six cycles, to evaluate the incidence of severe neutropenia.
Results: A total of 793 cycles were analyzed in 150 patients. Severe neutropenia occurred in 366 cycles and 111 patients during the nadir periods, with 46.2% per cycle and 74.0% per patient, respectively. The incidence tended to increase in later cycles. The prior use of granulocyte-colony stimulating factor was 2.9%. The incidence of febrile neutropenia was 4.7%. No additional treatment for severe neutropenia was provided in 80.2%. Postmenopausal status and an initial white blood cell count below 7,000 cells/μL were significant risk factors for severe neutropenia. Additionally, an initial absolute neutrophil count (ANC) below 5,000 cells/μL was a significant risk factor for febrile neutropenia.
Conclusion: Despite severe neutropenia being relatively common during the nadir periods, the majority did not receive further management and subsequently recovered. Furthermore, the incidence of febrile neutropenia was low. Therefore, evaluation of ANC in nadir periods should be selectively performed in patients at risk for severe and febrile neutropenia.

Lidocaine-Prilocaine Cream versus Placebo in Conjunction with Lidocaine Injection for Pain Relief during Episiotomy Repair after Normal Vaginal Delivery

2024-12-27T12:59:12+07:00

Objectives: To study the efficacy of lidocaine-prilocaine cream versus placebo in conjunction with lidocaine injection in relieving pain during episiotomy repair.
Materials and Methods: Postpartum women who underwent restrictive episiotomy with second-degree perineal tears from August 2023 to February 2024 were randomly allocated into two groups. In the intervention group, lidocaine-prilocaine cream was applied around the episiotomy wound in conjunction with lidocaine injection, while in the control group, placebo cream was applied instead. The primary outcome was pain intensity during episiotomy repair using a 10-cm visual analogue scale (VAS).
Results: Ninety women were randomly assigned into two groups (45 in each group). Pain score during lidocaine injection in the lidocaine-prilocaine cream group was significantly lower compared to the control group (2.45 ± 2.49 vs 3.71 ± 2.73; mean difference (MD) -1.26, 95% confidence interval (CI) -2.07 to -0.46, p = 0.002). Pain scores during perineal muscle repair and perineal skin repair in the lidocaine-prilocaine cream group were significantly lower than the control group (1.95 ± 2.13 vs 3.13 ± 2.34; MD -1.19, 95%CI -2.11 to -0.27, p = 0.012 and 1.87 ± 2.12 vs 3.82 ± 2.86; MD -1.95, 95%CI -2.95 to -0.95, p < 0.001, respectively). Perineal wound complications were not significantly different between groups (p = 0.556). No adverse reactions were found.
Conclusion: Lidocaine-prilocaine cream in conjunction with lidocaine injection effectively reduced pain during lidocaine injection, perineal muscle repair, and perineal skin repair without adverse reaction.

Prevalence and Associated Factors of Sexually Transmitted Infection among Female Sexual Assault Victims attending the Police General Hospital

2025-01-15T10:38:12+07:00

Objectives: To assess the prevalence of sexually transmitted infections (STIs) and identify factors associated with STIs among female sexual assault victims.
Materials and Methods: A retrospective analysis of medical records for sexual assault victims at the Police General Hospital was conducted over the period from January 2018 to December 2022.
Results: Among 1,006 female victims, 12.33% tested positive for at least one STI, with Chlamydia trachomatis (6.66%) and Neisseria gonorrhoeae (2.88%) being the most common. Notably, chlamydia positivity dramatically increased in 2022, while other infections, including syphilis, hepatitis B & C, human immunodeficiency virus have shown minor variations over the years. The 10–19 age group, the largest demographic, had the highest STI prevalence (14.54%). Multivariate analysis identified pyuria as a strong independent predictor of STIs (adjusted odds ratio 4.85, p < 0.001)
Conclusion: STIs are prevalent among younger female victims, with Chlamydia trachomatis being the most common. Pyuria were strongly associated with STI risk, with routine urinalysis serving as a valuable diagnostic clue.

The Effectiveness of Cryotherapy in Reducing Postoperative Pain in Cesarean Delivery, Pfannenstiel Skin Incision: A randomized controlled trial

2024-11-20T09:47:44+07:00

Objectives: To evaluate the effectiveness of cold pack gel in reducing postoperative pain after cesarean delivery, Pfannenstiel skin incision.
Materials and Methods: This study was a randomized controlled trial. There were 48 post-cesarean patients who were divided into two groups; group 1 (n = 24) received cold pack gel and group 2 (n = 24) received no treatment. The standard postoperative analgesic medicine and care were used in both groups. The primary outcome was to compare the postoperative pain score using the numerical rating scale (NRS) at 6, 12 and 24 hours after operation. The secondary outcomes were to compare the amount of opioid used, length of hospital stay and side effects in both groups.
Results: The cold pack gel significantly decreased the amount of postoperative opioid consumption (mean opioid used 8.33 ± 19.03 mg vs 25.00 ± 32.97 mg, mean difference was 16.67 mg (95% confidence interval 8.56-24.76). However, the cold pack gel insignificantly decreased pain after cesarean delivery which mean NRS of intervention and control group at 6 hours, 12 hours, 24 hours postoperation were 3.96 ± 1.71 vs 4.92 ± 2.06, 2.62 ± 1.47 vs 3.29 ± 1.46 and 2.17 ± 1.24 vs 2.67 ± 1.66, respectively. There was no significant side effect from cold pack gel use.
Conclusion: The cold pack gel could reduce postoperative opioid use without any serious side effects. However, the postoperative pain scores were not decreased. It can be used as an additional multimodality care in post-cesarean delivery care.

The Efficacy of Antenatal Perineal Massage in Reducing Postpartum Anal Incontinence: A randomized controlled trial

2024-12-18T10:01:19+07:00

Objectives: This study evaluated the efficacy of antenatal perineal massage (APM) in reducing postpartum morbidities, particularly anal incontinence (AI).
Materials and Methods: A randomized controlled trial was conducted at Rajavithi Hospital, Bangkok, from October 2023 to April 2024. Nulliparous women with singleton pregnancies were randomly assigned to the APM or control group using block randomization. Participants in the APM group performed a daily 5-minute perineal massage on themselves from 34–36 weeks of gestation until delivery. Both groups received standard prenatal, intrapartum, and postpartum care. The primary outcome was AI incidence at 3 months postpartum, assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20). Secondary outcomes included intrapartum variables, urinary incontinence, and dyspareunia.
Results: 106 women were randomized into two groups of 53 each. After exclusions, 37 participants per group were analyzed. At 3 months postpartum, AI incidence was lower in the APM group (32.43%) compared to the control group (56.76%), though not statistically significant (p = 0.061). The APM group showed significantly reduced AI severity (p = 0.017) and fecal incontinence incidence (p = 0.030).
Conclusion: Although the reduction in AI incidence was not statistically significant, the findings suggested potential clinical benefits that warrant further investigation. APM significantly reduced fecal incontinence incidence and AI severity without increasing maternal or neonatal complications. These findings support incorporating APM into routine prenatal care to reduce postpartum morbidities.

The Efficacy of Oral Ginger Powder in Prevention of Postoperative Ileus after Benign Gynecologic Hysterectomy: A randomized controlled trial

2024-12-16T10:01:43+07:00

Objectives: To assess the efficacy of oral ginger powder for prevention of postoperative bowel ileus in benign gynecologic abdominal hysterectomy.
Materials and Methods: A randomized, double-blind, placebo-controlled trial was conducted. Benign gynecologic patients who underwent abdominal hysterectomy were allocated into two groups: the experimental group received oral ginger capsules, and the control group received placebo capsules. Postoperative bowel ileus was measured by using time to first flatus as a primary outcome.
Results: Fifty-six patients were randomized to the ginger group (n = 28) and the placebo group (n = 28). The ginger group had significantly less time to first flatus than the control group (29.5 ±10.0 vs 38.9 ±8.6 hours, mean difference (MD) 9.31 hours, 95% confidence interval (CI) 4.2-14.3, p < 0.001). The ginger group also had significantly less time to first defecation than the control group (45.8 ±9.1 vs 58.5 ±14.7 hours, MD 12.6 hours, 95%CI 4.5-20.8, p = 0.003). According to the Kaplan-Meier graph, the median time to first flatus (50%) of the ginger group was 26.5 hours (95%CI 21.1-32.5) and that of the control group was 39.33 hours (95%CI 31.7- 44.7) (p = 0.007). Median time to defecation (50%) of the ginger group was 44.7 hours (95%CI 42.0-47.6) and that of the control group was 59.7 hours (95%CI 51.7-64.7) (p = 0.012). No serious adverse effects were reported.
Conclusion: Oral ginger powder could reduce postoperative bowel ileus in benign gynecologic abdominal hysterectomy.