Thai Journal of Obstetrics and Gynaecology

Editorial

Vorapong Phupong — 2024-02-29

This second issue of Thai Journal of Obstetrics and Gynaecology 2024 contains many interesting articles. One special article is “Lifestyle Factors and the Risk of Endometrial Cancer: A Review”. The contents include the impact of lifestyle factors such as diet, obesity, alcohol, physical activity and smoking on the risk of endometrial cancer.

The quality of Thai Journal of Obstetrics and Gynaecology (TJOG) has been improved. In the year 2023, TJOG received the Q3 journal rankings (149/203 journals) with SJR score 0.158 in Obstetrics and Gynaecology category from Scimago Journal & Country Rank 2022. TJOG has been indexed in many databases: Scopus, TCI, ASEAN Citation Index, DOAJ, EuroPub, and Google Scholar. The Editorial Board of TJOG looks forward to continuously raising the quality of the TJOG.

Diagnostic accuracy of the foetal umbilical artery, middle cerebral artery Doppler indices and cerebroplacental ratios for predicting adverse perinatal outcomes in pregnancy-induced hypertension

Pakprapa Chaipakdi — 2024-03-01

Objectives: This study aimed to evaluate the accuracy of the foetal umbilical artery, middle cerebral artery Doppler indices and cerebroplacental ratios to predict adverse perinatal outcomes in pregnancy-induced hypertension.

Materials and Methods: This study was a diagnostic test. The study population comprised 76 women with singleton pregnancies (32-40 weeks gestation) diagnosed with pregnancy-induced hypertension who were admitted to Hatyai Hospital between December 2020 and November 2022. Diagnostic accuracy for all Doppler measurements was evaluated using sensitivity, specificity, accuracy and positive likelihood ratio (LR+) analysis.

Results: The umbilical artery pulsatility index (UA PI) had the highest sensitivity for predicting adverse perinatal outcomes at 80% for predicting neonatal intensive care unit (NICU) admissions (p = 0.044), though the Umbilical arterial systolic/diastolic (UA S/D) ratio, The fetal middle cerebral artery pulsatility index (MCA PI) and cerebroplacental ratio (CPR) were poor predictors of NICU admissions (p > 0.05). The MCA PI could better predict all perinatal outcomes with LR+ 4.29 (p = 0.003).

Conclusion: The UA PI had the highest sensitivity for the detection of adverse perinatal outcomes (NICU admission). Furthermore, the MCA PI was the better predictor of perinatal outcomes.

Ibuprofen and Intraperitoneal Lidocaine Instillation for Relieving Intraoperative Pain during Postpartum Tubal Ligation via Minilaparotomy: A Randomized Controlled Trial

Jen Sothornwit — 2024-03-01

Objectives: This randomized study evaluated the effects of preemptive ibuprofen, intraperitoneal lidocaine instillation, or both for pain relief during postpartum tubal ligation (PPTL) via minilaparotomy.
Materials and Methods: Ninety-two heathy mothers who opted for PPTL were randomized into four groups and received either 400 mg of oral ibuprofen and intraperitoneal instillation of 20 ml of isotonic sodium chloride solution (Group I), oral placebo and intraperitoneal instillation of 20 ml of 1% lidocaine 20 ml (Group L), both ibuprofen and intraperitoneal instillation lidocaine (Group IL), or placebo and intraperitoneal isotonic sodium chloride solution (Group P).
Results: The mean intraoperative numerical rating scale (NRS) in group IL was significantly lower than in group P (mean difference -2.48, 95% CI -4.47 to -0.49, p = 0.007). No significant difference was found in the intra-operative NRS between groups I and L when compared to group P (mean difference -1.61 [95% CI -3.60 to 0.38], and 0.70 [95% CI -1.29 to 2.69], respectively), nor was there any significant difference in pain score immediately or one-hour post-operation.
Conclusion: Preemptive ibuprofen and intraperitoneal lidocaine instillation alone did not provide effective pain relief for postpartum tubal resection. However, multimodal analgesia using both agents was effective as intra-operative (but not post-operative) pain control.

Knowledge, Attitudes, Practices and Mental Health Impact of COVID-19 to Pregnant Women in 2020 to 2021

Panfan Wongkittithaworn — 2024-03-01

Objectives: To evaluate and compare the knowledge, attitudes, practices and mental health impact of COVID-19 (Coronavirus disease, COVID-19) on Thai pregnant women and to identify the factors associated with these outcomes

Methods: A self-administered questionnaires and Thai GHQ-28 (Thai General Health Questionnaire, Thai GHQ-28) was given to pregnant women ages 18 and above who attended antenatal care at Songklanagarind Hospital between July-September, 2020 and July-November, 2021. Three hundred and sixty women were recruited in each period. The knowledge, attitudes, practices, mental health status and factors associated with the outcomes were analyzed.

Results: The participants with good knowledge (score 12-15) increased from 27.5% in 2020 to 42.5% in 2021. Factors associated with good knowledge are high education, government or state enterprise employee, high income and survey in 2021. Positive attitudes (≥ 4/5 items) were unchanged between the two periods (65.3% vs 67.5%). Most of the women had good practices (> 8/10 items) and these were improved significantly in 2021 (78.9% vs 87.2%). Factors associated with good practices were high education, high income, good knowledge scores and survey in 2021. The COVID-19 outbreak had mild negative impact on mental health. Only 0.83% of participants in 2020 and 3.89% of those in 2021 had Thai GHQ-28 scores > 6 that needed additional psychological support. Factors associated with the mental health problems were marital status, increased severity and numbers of infected cases in 2021.

Conclusions: Knowledge and practices about COVID-19 infection improved from 2020 to 2021. Pregnant women have low incidence of mental health problems.

Prevalence of Cervical High-risk Human Papilloma Viral Infection in Pregnant Women at HRH Maha Chakri Sirindhorn Medical Center, Thailand

Manuschai Kulpomsirikul — 2024-03-01

Objectives: To determine the prevalence of high-risk human papilloma viral (HR-HPV) infection and the factors associated with HR-HPV infection among Thai pregnant women.
Materials and Methods: This cross-sectional study was conducted at the HRH Princess Maha Chakri Sirindhorn Medical Center from May 1, 2022 to January 31, 2023. The data were collected through primary HPV testing, liquid-based cytology (LBC), and a questionnaire.
Results: Overall, 188 pregnant women participated in the study. The mean age was 28.91 years old. The prevalence of HPV infection was 12.7% (24/188), and the two most common types were HPV 52 (6/188, 3.1%) and HPV 16 (5/188, 2.66%). No case of HPV type 18 infection was detected. Abnormal cervical cytology smears were detected in 21 samples (11.17%). The women who had multiple partners had a significantly higher risk of HR-HPV infection compared to the group who had only a single partner (p < 0.05).
Conclusion: The prevalence of HR-HPV infection during pregnancy in Thai women was 12.7%. Having multiple partners was found to be the greatest risk factor in this study. Primary HPV testing at a prenatal visit may be an option to improve screening coverage and could be considered in future cervical cancer screening programs.

Prevalence of Depression and Associated Factors in Postmenopausal Thai Women during the COVID-19 Pandemic

Nutsuda Phunbunmee — 2024-03-01

Objectives: To determine the prevalence of and factors associated with depression in postmenopausal Thai women during the COVID-19 pandemic.
Materials and Methods: The study was conducted from April to December 2022. Depression was diagnosed using the Thai Depression Inventory. Self-questionnaires assessed sociodemographic data; COVID-19 knowledge, attitudes, and preventive practices; and Thai Depression Inventory scores.
Results: The study assessed 271 women (175 natural postmenopausal; 96 surgical postmenopausal). The depression prevalence was 9.6% overall, 8.6% in natural menopause, and 11.5% in surgical menopause. No severe major depression was observed. The prevalence of mild depression was significantly higher in the surgical postmenopausal group (11.5%) than in the natural postmenopausal group (4.0%, p = 0.022). In the natural postmenopausal group, the prevalence of less than major depression and major depression were 4% and 0.6%, respectively, whereas it was not present in the surgical postmenopausal group. Women with superior knowledge or attitudes had a lower prevalence. Those with high levels of preventive behavior had a higher prevalence but without significance. Prevalence significantly increased with low household income and medical disease, especially chronic kidney disease.
Conclusion: The prevalence of depression in postmenopausal Thai women during COVID-19 was 9.6%. Low household income and chronic kidney disease were significant predictors.

Risk Assessment of Endometrial Hyperplasia and Cancer in Premenopausal Women with Abnormal Uterine Bleeding

Morakot Suwanwanich — 2024-03-01

Objectives: Our goal was to develop an endometrial sampling protocol for the early detection and treatment of endometrial hyperplasia and endometrial cancer (EH/EC) in premenopausal women experiencing abnormal uterine bleeding.
Materials and Methods: A prospective cohort study on premenopausal women with abnormal uterine bleeding who underwent endometrial sampling was conducted at Ratchaburi Hospital. Each patient’s risk factors and conducted clinical assessments, including pelvic examinations and transvaginal ultrasound were documented. To determine the likelihood of EH/EC, univariate and stepwise logistic regression analyses were used.
Results: Among 200 eligible premenopausal women with abnormal uterine bleeding who received endometrial sampling, histological analysis identified EH in 14 women (7%) and EC in 7 women (3.5%). Stepwise logistic regression revealed a significant association of EH/EC with a body mass index of 30 kg/m2 or higher, tamoxifen usage, and an endometrial thickness exceeding 10 mm (p = 0.004, 0.041, and 0.001, respectively). The presence of two or three of these risk factors significantly increased the association with EH/EC (p < 0.001).
Conclusion: Obesity, tamoxifen usage, and endometrial thickness greater than 10 mm were strong indicators of EH/EC. Endometrial sampling is recommended for patients exhibiting more than one of these risk factors.

The Influence of Types of Gestational Diabetes Mellitus, Self-management, Social Support, and Risk Perception on Health-related Quality of Life in Pregnant Women with Gestational Diabetes Mellitus

Ratchakan Phummanee — 2024-03-01

Objectives: This study aimed to investigate the factors influencing the health-related quality
of life (HRQoL) in pregnant women with gestational diabetes mellitus (GDM).
Materials and Methods: Participants were 140 pregnant women with GDM who were receiving antenatal care at King Chulalongkorn Memorial hospital, Bangkok. Data were collected to obtain information including the self-management questionnaire, the social support questionnaire, perceived risk of GDM questionnaire, and gestational diabetes mellitus questionnaire-36 (GDMQ-36). Data were analyzed by using descriptive statistics, Pearson’s product-moment correlation, point biserial correlation, and multiple linear regression.
Results: The results showed that the participants had diagnosed with GDMA1 and GDMA2
equal to 45.7% and 54.3%, respectively. The HRQoL of the participants were 62.06 and influenced by self-management, social support, and risk perception. The HRQoL would be increased if pregnant women had self-management effectively (β = 0.236, 95% confidence interval (CI) 0.201 to 0.586, p < 0.001), received social support (β = 0.222, 95% CI 0.199 to 0.672, p < 0.001), and received information in a proper level (β = -0.644, 95% CI -0.982 to -0.689, p < 0.001).
Conclusion: Improving HRQoL of pregnant women with GDM, health care providers should encourage pregnant women to have effective self-management, receive social support, and perceive the risks of GDM at an appropriate level.

Lifestyle Factors and the Risk of Endometrial Cancer: A review

Tharangrut Hanprasertpong — 2024-03-01

Endometrial cancer (EC) is among the most prevalent gynecologic cancers worldwide, experiencing a significant surge in incidence of approximately 60% over the past three decades. Addressing this growing burden involves three primary strategies: EC screening, lifestyle modification, and chemoprevention. Compelling evidence underscores the role of healthy lifestyle changes embracing a nutritious diet, abstaining from alcohol consumption, and regular physical activity (PA) in mitigating not only the risk of cardiovascular diseases but also overall non-cancer mortality in the general population. Moreover, heightened attention from researchers in recent decades has focused on understanding the connection between adopting healthy lifestyle factors and diminishing the risk of various cancers. In the case of EC, current epidemiological findings highlight that modifiable factors such as PA and diet may be linked to a reduced risk of this cancer. This review aims to comprehensively examine and synthesize the latest evidence pertaining to the influence of lifestyle factors and behaviors on the risk of EC, shedding light on actionable insights for risk reduction and preventive measures.

Malignant Phyllodes Tumour in a Pregnant Woman Masquerading Clinically as an Abscess: A case report

Shalini Bahadur — 2024-03-01

Phyllodes tumors (PT) are rare breast tumours comprising of < 1% of all breast tumours that arise from the stromal connective tissue of the breast. These tumors usually affect the adults of fifth and sixth decade and are rarely found in the pediatric or young age group. PT presents as a rapidly growing discrete palpable mass. Histologically, they are classified as benign, borderline, and malignant on the basis of histological features, mitotic index, necrosis, and infiltrative growth pattern. Malignant PT is a rare entity in pregnancy. We present a case of 27-year-old multigravida with one live male child and a term still born who presented to the outpatient department during antenatal visit with a rapidly growing breast lump early in the 25th week of gestation. Malignant PT becomes difficult to diagnose in a pregnant woman as lactation changes and clinical appearance can mask this diagnosis. A multidisciplinary approach is needed in such cases because there is a high recurrence rate and metastases when tumors are large, bulky with involved surgical margins.