Thai Journal of Obstetrics and Gynaecology

Intriguing Review and Topics in Sixth Issue of Thai Journal of Obstetrics and Gynaecology 2024

Vorapong Phupong — 2024-10-25

This sixth issue of Thai Journal of Obstetrics and Gynaecology 2024 contains many interesting articles. The special article is “Effects of cigarette smoking on pregnancy outcomes”. The authors reviewed the effect of cigarette smoking on general and reproductive health, pregnant women and fetus, and the benefit of cigarette smoking cessation⁽¹⁾.

Effects of Cigarette Smoking on Pregnancy Outcomes

Jitti Hanprasertpong — 2024-10-29

Cigarette smoking increases several health risks, including maternal and neonatal adverse outcomes if done during pregnancy. Ectopic pregnancy, placenta previa, abruptio placenta, preterm premature rupture of membranes, low birthweight (less than 2500 grams), intrauterine growth restriction, intrauterine fetal death, neonatal respiratory and gastrointestinal disease, need of transfer of newborn to a neonatal intensive care unit (NICU), and more than 7 days NICU admission of the newborn and neonatal infection have been reported to have increased risk in cigarette-smoking pregnant women. Risks of adverse pregnancy outcomes were found to be dose-dependent, with the highest risk found among heavy smokers (more than/equal to 20 cigarettes per day).

Severe Uterine Hemorrhage Resulting from Uterine Arteriovenous Malformation: A catastrophic scenario

Nur Izzati Ayub — 2024-10-29

Background: Abnormal uterine bleeding (AUB) is often challenging to diagnose in the emergency department (ED) due to its various causes. Uterine arteriovenous malformation (AVM) is a rare but significant gynaecological emergency that is frequently missed. It typically manifests as sudden and heavy vaginal bleeding, posing a potential life-threatening risk that requires immediate attention.
Case: A 40-year-old, para 3-0-0-3, woman presented to the ED with severe vaginal bleeding. Despite rapid resuscitation, she experienced hemodynamic instability. Uterine AVM was suspected based on colour Doppler pelvic ultrasound and later confirmed by angiography. Successful treatment was achieved with uterine artery embolization with complete resolution of the bleeding.
Conclusion: This case highlights the importance of early recognition and rapid resuscitation in treating uterine AVM with multidisciplinary team approach as a life-saving measure. Transcatheter arterial embolization is highly effective and preferred for preserving fertility in women. Timely intervention is crucial in managing this gynaecological emergency.

Fournier’s Gangrene in a Pregnant Woman with Genital Herpes: A case report

Jun Jiet Ng — 2024-11-04

Genital herpes is a viral infection caused by herpes simplex virus. Most of the literature on genital herpes in pregnancy focused on the transmission of the herpes simplex virus to the newborn and the majority of disseminated genital herpes had been reported as encephalitis, hepatitis and pneumonia. In this case report, the genital herpes was complicated with secondary infection and disseminated rapidly through the perineal subcutaneous tissue which is also known as Fournier’s gangrene. In females, Fournier’s gangrene is rare, and it is even rarer in pregnant women. There are only a few cases reported worldwide. To our best knowledge, this is the first case of genital herpes in pregnancy that progressed to Fournier’s gangrene. This case report also highlighted the long-term complications of Fournier’s gangrene.

Difference between Paired Umbilical Arteries Doppler Velocimetry Indices in Singleton Pregnancy

Akegapot Anantaworapot — 2024-10-29

Objectives: To assess variance between paired umbilical artery Doppler velocity indices in pregnancies at 18-37 weeks.
Materials and Methods: We enrolled 450 women with singleton pregnancies, aged 18-37 weeks, between April 2023 and January 2024. They underwent Doppler transabdominal ultrasound to assess both umbilical arteries in a free-floating loop of umbilical cord. We recorded umbilical artery Doppler pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio for each umbilical artery.
Results: 418 women were analyzed. Mean PI, RI, and S/D ratio at each gestational age (18 - 37 weeks) significantly differed between paired umbilical arteries (p < 0.05). Discrepancies > 10% in PI, RI, and S/D ratio between the two umbilical arteries were observed in 48.6%, 23.9%, and 56.7% of cases, respectively. Discrepancy > 20% were observed in 12.7%, 2.6%, and 22% of cases, respectively.
Conclusion: Significant differences existed in PI, RI, and S/D ratio between the two umbilical arteries. As gestational age advances, there was a gradual decrease in the PI, RI, and S/D ratio. The mean difference in the S/D ratio between the two umbilical arteries tended to decrease as gestational age increased. Further considerations are necessary to determine whether the nomogram values, derived from measuring only one umbilical artery, should be based on higher or lower values, or if they should consider a specific relationship between the two umbilical arteries.

Effectiveness and Safety of Amniotomy after Cervical Ripening by Foley’s Catheter Balloon on Induction of Mid-Trimester Fetal Death in Utero: A randomized clinical trial

Mohammed K. Ali — 2024-10-29

Objectives: To explore the value and safety of amniotomy after cervical ripening by Foley catheter balloon on termination of mid-trimester fetal death in utero.
Materials and Methods: The study was a randomized clinical trial conducted at Assiut Woman’s Health Hospital, Egypt, from November 2021 to June 2023 on non-scared uterus women with mid-trimester fetal death in utero (18-26 weeks). Participants were subjected to Foley catheter balloon insertion and then assigned to group I: Amniotomy group or group II: No amniotomy group according to the randomization. The main outcome was the mean interval (hours) between Foley catheter balloon expulsion to complete abortion. The outcome variables were analyzed using an independent sample t-test, Mann-Whitney U, and Chi-square test.
Results: Sixty women were included in the study. The balloon expulsion to abortion time was shorter in the amniotomy group than the no amniotomy group with a statistically significant difference (6.89 ± 2.02 hours vs 9.22 ± 1.98 hours, p < 0.001). The mean dose of oxytocin was higher in the no amniotomy group than in the amniotomy group with a statistically significant difference (76.61 ±15.78 IU vs 57.55 ±16.88 IU, p < 0.001). No statistically significant differences were found between groups as regards the rate of complications.
Conclusion: Performing amniotomy after using a Foley catheter balloon for cervical ripening during induction of mid-trimester fetal death in utero in a non-scarred uterus reduced the time to abortion as well as the oxytocin dose and the procedure was relatively safe.

Efficacy of Intravenous Dextrose-containing Fluid in Reducing Labor Duration of Pregnant Women: A randomized controlled trial

Wanatchaporn Puttakul — 2024-10-29

Objectives: To evaluate the efficacy of dextrose-containing intravenous fluid and normal saline intravenous fluid in reducing labor duration in pregnant women.
Materials and Methods: In this randomized controlled trial, 164 low-risk term singleton pregnant women with gestational age of 37-42 weeks presenting with labor pain at Sanpasitthiprasong Hospital were equally randomized to receive either 1) dextrose-containing intravenous fluid (5%D/N/2) or 2) (NSS) at a rate of 120 ml/hr. Primary outcome was total labor time, defined as duration during active phase plus second stage. Duration of latent phase, active phase, first stage and second stage of labor and maternal and neonatal outcomes were also assessed
Results: Demographics, gestational age, cervical dilatation at the time of randomization and augmentation were comparable between the two groups. Total labor time was significantly shorter in dextrose group than NSS group (median 177.0, interquartile range 110.0, 258.0) and 206.5 (138.5, 298.3), p = 0.033). Active phase duration was significantly shorter in dextrose group (median 160.0 (100.0, 240.0) and 187.5 (127.3, 281.3), p = 0.029). There was no difference in latent phase, second stage, and third stage duration. Rates of cesarean delivery and maternal complications were comparable between the two groups. Transient tachypnea of the newborn was significantly higher in NSS group than dextrose group (29.3% and 9.8%, p = 0.002). There was no between-group difference in neonatal outcomes including birthweight, Apgar scores, and neonatal hypoglycemia.
Conclusion: Dextrose-containing intravenous fluid administered during intrapartum may shorten total labor time especially active phase duration, without increasing maternal and neonatal complications.

Prevalence of Vitamin D Deficiency in Thai Women with Uterine Fibroids

Duangrudee Peetinarak — 2024-10-29

Objectives: To determine the prevalence and associated factors of vitamin D deficiency in Thai women with uterine fibroids.
Materials and Methods: A cross-sectional observational study was conducted on 181 Thai women aged 21-49 diagnosed with at least one uterine fibroid with a diameter of 10 mm or greater by ultrasound. The volume of uterine fibroids was calculated using the ellipsoid volume formula. Serum concentrations of 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, and calcium were measured. Then, the participants were stratified into three groups according to their vitamin D status.
Results: The prevalence of vitamin D deficiency in Thai women with uterine fibroids was 69.6%. The mean serum concentrations of 25(OH)D, parathyroid hormone, and calcium were 18.8 ± 5.8 ng/ml, 47.9 ± 17.8 pg/ml, and 9.2 ± 0.5 mg/dl, respectively. Neither serum 25(OH)D levels nor serum calcium levels were significantly associated with total uterine fibroid volume (crude mean difference (MD) = -0.01, 95% confidence interval (CI) = -0.02, 0.2, p = 0.949, crude MD = -0.19, 95%CI = -0.48, 0.1, p = 0.193, respectively). However, there was a significant association between serum parathyroid hormone (PTH) levels and total uterine fibroid volume (Adjusted MD = -0.02, 95%CI = -0.06, -0.001, p = 0.006).
Conclusion: Although a high prevalence of vitamin D deficiency was observed among Thai women with uterine fibroids, no significant association was found between low serum 25(OH)D levels and the presence of uterine fibroids.

The Efficacy of Vibrational Anesthesia in Reducing Pain and Anxiety among a Single Rod Contraceptive Implant Recipient: A single-blinded randomized controlled trial

Namphung Nawasirodom — 2024-10-29

Objectives: To evaluate the effectiveness of vibration anesthesia in reducing pain and anxiety in the group receiving single rod contraceptive implant recipient (SRCI).
Materials and Methods: This study was a single-blinded, randomized, controlled trial. Forty-five women were randomly assigned to the experimental group and forty-five women to the control group. The control group had SRCI using the standard method. However, the experimental group received vibrational anesthesia during the implantation. The study variables were general information, the numeric rating scale, and the state-trait anxiety inventory (STAI) form Y-1 questionnaire.
Results: The median pain score of the experimental group was 2 (1-2), while that of the control group was 4 (3-4). There was a statistically significant difference (p < 0.01) in the pain scores. Thirty-six cases (80.0%) in the experimental group showed low anxiety levels compared to no cases in the control groups (p < 0.01). No adverse events were reported.
Conclusion: Vibrational anesthesia during SRCI may reduce pain and anxiety among the recipients.

The Incidence and Risk Factors of Obstetrics anal Sphincter Injuries at King Chulalongkorn Memorial Hospital during 2017-2019

Tanapat Manee — 2024-10-29

Objectives: To study the incidence and risk factors of OASIS during 1 January 2017 to 31 December 2019
Materials and Methods: A retrospective study of all pregnant woman with vaginal delivery (6,714 cases) at King Chulalongkorn Memorial Hospital during 2017-2019 were conducted. We collected the data of all pregnant women who delivered in our hospital since 1 January 2017 to 31 December 2019, using International Classification of Diseases, Tenth Revision (ICD 10) codes for data extraction and review. The case group comprised of pregnant women with an OASIS (third- degree and fourth-degree perineal laceration). The control group comprised of pregnant women delivered vaginally without OASIS.
Results: The incidence of OASIS was 6% (403/6,714). The significant risk factors are nulliparity vs multiparity (adjusted odds ratio (aOR) 3.0, 95% confidence interval (CI) 2.3-4.0, p < 0.01), obesity vs normal BMI (aOR 0.5, 95%CI 0.3-0.7, p < 0.01), forceps extraction vs spontaneous delivery (aOR 4.5, 95% CI 3.1-6.5, p < 0.01), occiput posterior vs occiput anterior position (aOR 2.3, 95%CI 1.2-4.3, p = 0.01), median episiotomy vs no episiotomy (aOR 2.3, 95%CI 1.3-4.3, p = 0.01), staff vs nurses (aOR 11.1, 95%CI 5.0-25.0, p < 0.01), residents vs nurses (aOR 13.3, 95%CI 5.9-30.2, p < 0.01), and medical student vs nurses (aOR 3.5, 95%CI 1.3-9.6, p = 0.01).
Conclusion: The risk factors of OASIS were nulliparity, occiput posterior postition, forceps extraction, median episiotomy, residents and staffs (as the operators). The protective factors were obesity and nurses. Preventive strategies for these factors are advocated.