Thai Journal of Obstetrics and Gynaecology

Secondary Primary Cancers in Cervical Cancer Survivors: A review

Tharangrut Hanprasertpong — 2025-12-02

Cervical cancer (CC) continues to pose a significant global health burden, with human papillomavirus (HPV) infection, smoking, and other factors contributing to its development. Advances in CC screening, vaccination, and treatment have improved survival; however, survivors remain at considerable long-term risk of developing second primary cancers (SPCs), which are associated with substantial morbidity and mortality. Treatments such as radiation and chemotherapy, along with persistent HPV infection and lifestyle factors like tobacco use, further contribute to SPC risk. This review summarizes current evidence on SPCs in CC survivors, focusing on their epidemiology, risk factors, impact on survival, risk assessment, and surveillance strategies.

Accuracy of 48-72 Hours Postpartum 75g Oral Glucose Tolerance Test for Diagnosis of Postpartum Diabetes Mellitus in Gestational Diabetes Mellitus

Pakprapa Chaipakdi — 2025-12-02

Objectives: This study aimed to evaluate the accuracy of an early 48–72 hours postpartum 75 g oral glucose tolerance test (OGTT) for the diagnosis of diabetes mellitus (DM) at 6–12 weeks postpartum in women with gestational diabetes mellitus (GDM).
Materials and Methods: This diagnostic study included 100 women with GDM who delivered at Hatyai Hospital between January and July 2024. Participants underwent a 48–72-hour postpartum 75 g OGTT and repeated the test at 6–12 weeks. Early results were compared with the standard 6–12-week test. Outcomes included sensitivity, specificity, accuracy, predictive values, and ROC analysis of the early postpartum OGTT for diagnosing DM.
Results: The 48–72-hour postpartum 75 g OGTT showed 79.3% sensitivity and 53.6% specificity for diagnosis of postpartum glucose intolerance. For DM diagnosis, it had 50% sensitivity, 89.1% specificity, and 98.6% negative predictive value. Receiver operating characteristic analysis of the early 2-hour post-OGTT identified a cut-off >182 mg/dl, with 90.0% sensitivity and 82.0% specificity for diagnosis of DM.
Conclusion: Although the early 48–72 hours 75 g OGTT cannot replace the standard 6–12 weeks 75 g OGTT, it is useful in identifying high-risk patients who require follow-up and in raising awareness to return for routine postpartum checkups. Additionally, the early 2-hour post-OGTT may be considered as an aid in the diagnosis of DM.

Accuracy of HbA1c Levels as a Screening Tool for Gestational Diabetes Mellitus in Pregnant Women Prior to 20 Weeks of Gestation

Chaiyawut Paiboonborirak — 2025-12-02

Objectives: To determine the diagnostic accuracy of hemoglobin A1c (HbA1c) measured before 20 weeks’ gestation as a screening tool for gestational diabetes mellitus (GDM) in high-risk pregnancies, and to evaluate whether adding HbA1c to the conventional two-step algorithm (50-g glucose-challenge [50 g GCT] test followed by the 100-gram oral glucose tolerance test [100 g OGTT]) improves early detection.
Materials and Methods: This retrospective study 282 pregnant women who met high-risk criteria for GDM. All participants underwent HbA1c measurement and a 50 g GCT at the first antenatal visit. Elevated HbA1c levels (≥ 5.7%) and/or abnormal GCT results (≥ 140 mg/dL) prompted patients to undergo a diagnostic 100g OGTT. Receiver operating characteristic curve analysis was used to identify the optimal HbA1c cutoff and to calculate sensitivity, specificity, PPV, NPV and accuracy. The screening performance of HbA1c was compared with 50 g GCT.
Results: Among 282 high-risk pregnancies, the overall prevalence of GDM was 29.8% (84/282), and 20.2% (57/282) were diagnosed before 20 weeks of gestation. Women with early-pregnancy HbA1c levels of 5.7–6.4% (38/282, 13.5%) had a significantly higher prevalence of GDM compared with those with HbA1c < 5.7% (71.1% vs 23.4%, respectively) and were more likely to require insulin therapy (13.2% vs 1.6%, p < 0.001). ROC analysis for HbA1c yielded an area under the curve of 0.716. Using an HbA1c threshold of ≥ 5.7% provided high specificity (92.9%) and overall accuracy (81.9%) but low sensitivity (38.6%), whereas the 50-g GCT demonstrated higher sensitivity (96.5%) with lower specificity (67.6%) and accuracy (73.4%).
Conclusion: HbA1c measured before 20 weeks in the 5.7–6.4% range could not replace glucose-based testing due to its limited sensitivity. However, with high specificity and an overall accuracy of 81.9%, it served as a valuable adjunct to the 50 g GCT within the two-step screening protocol, especially in cases where glucose loading was intolerant.

Anomalies Detected in Third Trimester – A prospective descriptive study

Noorjahan Thirunilath — 2025-12-02

Objectives: To detect the incidence of structural anomalies diagnosed by third trimester ultrasound after a normal anomaly scan and classify them according to major organ systems and types.
Materials and Methods: It was a prospective descriptive study of antenatal women who had a negative second trimester anomaly screening with a newly detected fetal anomaly in the routine third trimester ultrasound conducted in the Department of Obstetrics and Gynaecology of Government Medical College, Kozhikode over a period of 18 months from September 2020 to February 2022. These women were followed-up till delivery and neonatal outcomes were measured.
Results: The incidence of congenital anomalies detected in third trimester was 0.7% (110 cases in 15,560 deliveries). Majority of them were of urogenital system (32.7%) followed by cardiovascular system (21.8%). Commonest anomaly detected was hydronephrosis, followed by congenital diaphragmatic hernia, ventricular septal defect, ventriculomegaly and corpus callosal agenesis.
Conclusion: The ultrasound examination of third trimester is of additional benefit and can detect previously undiagnosed fetal anomalies especially development dependant anomaly like agenesis of corpus callosum and progressing anomalies like gastrointestinal and skeletal anomaly. This can help in subsequent management including counselling of parents, planning of place, time, mode of delivery and also to plan neonatal interventions.

Effectiveness of Lidocaine Spray Combined with Oral Paracetamol versus Oral Paracetamol Alone for Pain Reduction in Diagnostic Amniocentesis: A randomized controlled trial

Nattakan Jirattitipat — 2025-12-02

Objectives: To determine whether lidocaine spray at the amniocentesis puncture site, combined with oral paracetamol, reduced procedural pain compared with paracetamol alone.
Materials and Methods: We conducted a randomized, double-blind, placebo-controlled trial at a tertiary care hospital (August 2024–June 2025). A total of 192 pregnant women undergoing diagnostic amniocentesis were randomized equally into two groups. The intervention group (n = 96) received 10% lidocaine spray, and the control group (n = 96) received placebo spray identical in appearance. All participants received oral paracetamol. Pain intensity at needle insertion (visual analog scale (VAS), 0–10) was the primary outcome. Secondary outcomes included VAS at other time points (during aspirate amniotic fluid and needle withdrawal, 15 and 30 minutes), maternal anxiety (State-Trait Anxiety Inventory), and satisfaction.
Results: Baseline characteristics were comparable between groups. Pain scores were significantly lower in the lidocaine group at needle insertion (median 4, interquartile range (IQR) 2–5 vs 5, IQR 3–6, p = 0.016), needle withdrawal (median 2, IQR 0–3 vs 3, IQR 1–5, p = 0.003), at 15 minutes (median 0, IQR 0–2 vs 0.5, IQR 0–3, p = 0.031), and at 30 minutes (median 0, IQR 0–1 vs 0, IQR 0–1.5, p = 0.091). Anxiety scores were similar between groups, whereas satisfaction scores were higher in the lidocaine group (mean ± standard deviation = 4.40 ± 0.67 vs 4.06 ± 0.77).
Conclusion: Lidocaine spray combined with oral paracetamol significantly reduced pain during and immediately after the procedure, and increased maternal satisfaction. This simple, safe, and low-cost approach may enhance maternal comfort during diagnostic amniocentesis.

Impact of Obesity on Treatment and Survival Outcome in Epithelial Ovarian Cancer Patients: A 10-year retrospective study

Asavarak Sompohnmanas — 2025-12-02

Objectives: To assess the influence of women with obesity on surgical outcomes, chemotherapy side effects, and survival rates in Thai patients with epithelial ovarian cancer.
Materials and Methods: A retrospective review was conducted of the medical records of patients with epithelial ovarian cancer who underwent staging laparotomy at Siriraj Hospital between January 2008 and December 2017. Patients were categorized as patients without obesity (body mass index [BMI] < 25.0 kg/m²) or patient with obesity (BMI ≥ 25 kg/m²) according to the Western Pacific Regional Office BMI criteria. We compared patient demographics, surgical outcomes, chemotherapy complications, and survival data between the two groups.
Results: From an initial cohort of 444 patients, 18 were excluded, leaving 426 for analysis. The women with obesity group, representing 21.9% (n = 93) of the patients, exhibited a higher prevalence of diabetes mellitus (p < 0.0001), hypertension (p = 0.003), and dyslipidemia (p = 0.027) than the women without obesity group (78.1%, n = 333). Patients with obesity were significantly associated with increased postoperative complications, notably wound issues (adjusted odds ratio [OR] 6.175, 95% confidence interval [CI] 1.891–13.191; p < 0.001) and venous thromboembolism (adjusted OR 5.991, 95% CI 2.848–12.605; p < 0.001), but it correlated with fewer cases of neutropenia (p = 0.002) and reduced delays in chemotherapy (p = 0.015). There were no significant differences in progression-free survival (p = 0.135) or five-year overall survival (p = 0.923).
Conclusion: Thai women with obesity with epithelial ovarian cancer was linked to an increased risk of postoperative complications, increased chemotherapy tolerability, but did not affect survival outcomes.

The Effect of Cold Compression on the Surgical Site Post-Subdermal Contraceptive Implant Insertion to Reduce Bruising and Pain among Female Youth in Family Planning: Randomized controlled trial

Rattiya Chuchot — 2025-12-02

Objectives: To study the effectiveness of cold compression in reducing bruising and pain around the surgical site following subdermal contraceptive implantation among female youth.
Materials and Methods: Sixty participants aged 18–24 years who attended the family planning clinic for contraceptive implant insertion between March and July 2025 were randomly allocated into two groups. The intervention group (n = 30) received cold compression therapy combined with standard care. A cold compress was applied for 5 minutes before starting the procedure and for 20 minutes at 30 minutes, 7 hours and 18 hours after the procedure. Bruising was assessed at 7, 32, 80 and 152 hours post-procedure. The control group (n = 30) received standard nursing care. Pain was assessed using the visual analog scale (VAS) at 30 minutes, 60 minutes, 8 hours and 19 hours, with a final assessment at 32 hours, during which no cold compress was applied. Bruising and VAS scores were compared at corresponding time points.
Results: The mean size of bruising in the intervention group was significantly smaller than that in the control group at all assessed time points: 7, 32, 80, and 152 hours post-procedure (p = 0.002, < 0.001, < 0.001, and < 0.001, respectively). With comparable initial mean VAS scores, the intervention group also reported significantly lower pain levels than the control group post-procedure at 30 minutes, 60 minutes, 8 hours, and 19 hours (p = 0.039, < 0.001, 0.01, and < 0.001, respectively). However, no significant difference in pain levels was observed between the groups at 32 hours post-procedure, a time point when the intervention group did not receive cold compression.
Conclusion: This study demonstrated that cold compression for 5 minutes before inserting a subdermal implant and for 20 minutes three times within 24 hours was more effective in reducing bruising and pain than standard care. No adverse events were reported.

Adherence to Venous Thromboembolism Prophylaxis in High-Risk Gynecologic Cancer Patients during the Enhanced Recovery after Surgery Era

Sirada Tachatiemchan — 2025-12-02

Objectives: Venous thromboembolism (VTE) is a common complication in patients with gynecologic cancer, reducing survival and increasing the financial burden. This study aimed to assess the adherence to VTE prophylaxis and factors that influence physician decisions.
Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Siriraj Hospital, Thailand. We included patients with gynecologic malignancies undergoing abdominopelvic surgery who were at high risk for VTE (Caprini score ≥ 5). Patient demographics, clinical profiles, and the adherence of the physician to the thromboprophylaxis protocols were evaluated.
Results: From October 2023 to October 2024, 231 patients met the inclusion criteria. The median age was 59 years (interquartile range (IQR) 50–66) and the median body mass index was 24.4 kg/m² (IQR 21.1–28). Most patients (83.2%) had Caprini scores of 5 or 6. 219 (96.5%) patients received mechanical and/or pharmacological prophylaxis. However, only 50 patients (22%) received prophylaxis in accordance with the guidelines. The surgical route was the only factor significantly associated with guideline adherence.
Conclusion: The adherence rate to VTE prophylaxis in perioperative gynecologic malignancy patients was low (22%). Further research is needed to understand barriers to adherence and the clinical consequences of noncompliance.

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

Vorapong Phupong — 2025-11-04

This sixth issue of Thai Journal of Obstetrics and Gynaecology 2025 contains many interesting articles. The special article is “Secondary primary cancers (SPCs) in cervical cancer survivors: A review”. The contents included epidemiology, common risk factors, survival outcomes in SPCs and risk assessment and surveillance⁽¹⁾.