Thai Journal of Obstetrics and Gynaecology

A Comparison of Conventional Outpatient and Instrumental Intraoperative POP-Q Measurements in Patients Undergoing Vaginal Surgery for Pelvic Organ Prolapse

Kreaingsak Sirisakpanich, Karmonpob Wechchasart — Mon, 01 Jul 2024 00:00:00 +0700

Objective: To compare the differences of Pelvic Organ Prolapse Quantification (POP-Q) measurements obtained preoperatively at the outpatient setting and intraoperatively with instrumental traction during full anesthetization in patients undergoing vaginal reconstructive surgery.

Materials and Methods: Retrospective chart review of 98 women having undergone vaginal POP repair for ≥stage II uterovaginal prolapse during September 2014 and March 2020 at Phramongkutklao Hospital was conducted. Patients’ baseline characteristics, history of POP and anti-incontinence surgery, clinical manifestations, POP stage, pessary use, and pre- and intra-operative POP-Q measurements were recorded. At preoperative outpatient setting, POP-Q examination was performed during maximal Valsalva. Intraoperatively, it was performed with instrumental cervical traction after full anesthetization. All POP-Q measurements were interpreted for prolapse location and severity according to the standardized POP-Q system.

Results: Mean age was 72.08 years, with 98% being postmenopausal. Mean BMI was 25.08 kg/m². Most had vaginal deliveries with median parity of 3. All manifested with bulge symptom while 79.6% complained of voiding difficulty. 96 out of 98 presented with advanced stage prolapse. Among these, 20 patients were treated with vaginal pessary during the waiting period for POP surgical repair. POP-Q measurements (Ba, Ap, Bp, C, D, GH, and PB) obtained during intraoperative instrumental traction significantly demonstrated more prolapse severity when compared with those obtained during outpatient setting. No changes were found when evaluating point Aa.

Conclusion: POP-Q measurements obtained during conventional outpatient examination provides less prolapse severity when compared with those measured during intraoperative instrumental traction after full anesthetization.

Accuracy of the Combined First Trimester Down Syndrome Screening Test and the Optimum Range of the Cut-off Point for Intermediate-risk Identification: Twelve years’ experience

Mon, 01 Jul 2024 00:00:00 +0700

Objectives: This study aimed to determine the performance of the combined first trimester Down syndrome screening test and the appropriate cut-off points for intermediate-risk identification.
Materials and Methods: This was a retrospective study conducted from May 2019 to May 2021. All the medical charts of women with singleton pregnancy who had a first-trimester combined screening test performed between 2007 - 2018 were reviewed. A total of 3,928 women with singleton pregnancy were included in the final analysis. Data regarding neonatal outcomes were recorded, and a telephone follow-up was performed with the women who had given birth elsewhere. Statistical analysis was performed using SPSS version 18.0 software.
Results: With a high-risk cut-off point of 1:250, the test had a sensitivity of 75%, and a specificity and accuracy of 94%. When an intermediate-risk cut-off point between 1:500 and 1:1,000 was applied, the specificity and accuracy increased to 83% - 90%. When using a cut-off point between 1:251 and 1:1,000, the specificity and accuracy was 83%, while the rate of intermediate risk was 11.6%.
Conclusion: Our combined first-trimester screening test had a detection rate of 75%, and a high specificity and accuracy of 94%. The recommended cut-off point for intermediate risk was between 1:251 and 1:1,000, since this offered good specificity and accuracy with an acceptable rate of intermediate risk.

Comparing the Different Antenatal Nutritional Counseling Methods Regarding Proper Gestational Weight Gain during the Second Trimester: A randomized, controlled trial

Sukanya Sareerat, Kittipong Kongsomboon, Tharangrut Hanprasertpong — Mon, 01 Jul 2024 00:00:00 +0700

Objectives: To compare the two different antenatal nutritional counseling styles [computer-assisted instruction (CAI) and routine, casual, individual (RCI)] regarding the proper gestational weight gain (GWG) of healthy pregnant women during the second trimester, and to identify the factors influencing the level of pregnant women’s GWG.
Materials and Methods: This was a randomized, controlled study comparing the number of pregnant women in the CAI and RCI groups who had a proper GWG during the four-week period.
Results: There were 70 and 80 participants in the CAI and RCI groups, respectively. The basic characteristics of the two groups at the beginning of the study were similar. The rate of the participants who had an appropriate GWG according to their pre-pregnancy BMI in both groups was comparable (p = 0.656, 0.307, 0.111, and 0.524 among the underweight, normal-weight, overweight and obese women, respectively). The number of participants who had an appropriate GWG was 50.0%, 47.8%, 23.1%, and 20.0% in the CAI group and 37.5%, 58.3%, 58.3%, and 50.0% in the RCI group. The GWG per week according to the participants’ pre-pregnancy BMI was comparable in both groups (p = 0.585, 0.292, 0.087, and 0.614 in the underweight, normal-weight, overweight, and obese women, respectively). The multiparous women had a significantly increased possibility of having an appropriate GWG (p = 0.013).
Conclusion: Antenatal nutritional counseling using CAI was shown to be comparable to RCI in trying to achieve an appropriate GWG. The multiparous individuals had significant factors for having an appropriate GWG.

Comparison of the Efficacy between Conjugated Equine Estrogen versus Nonsteroidal Anti-inflammatory Drug for the Cessation of Uterine Bleeding among Contraceptive Implant Users: A randomized controlled trial

Salinee Polyota, Reuthairat Tungmunsakulchai, Thumwadee Tangsiriwatthana — Thu, 20 Jun 2024 00:00:00 +0700

Objectives: To evaluate the effect of conjugated equine estrogen and nonsteroidal anti-inflammatory drugs on the controlling of abnormal uterine bleeding in hormonal subdermal implant users.
Materials and Methods: Between July 2022 and April 2023, participants with etonogestrel subdermal implants who complained of abnormal uterine bleeding were randomly allocated into two groups. The study group (n = 32) received 0.625 mg of conjugated equine estrogen orally twice a daily for five days, while the control group (n = 32) received 500 mg of mefenamic acid orally three times a daily for five days. The duration of bleeding cessation was evaluated.
Results: Baseline characteristics including age, BMI, duration of implant use, endometrial thickness, and pattern of bleeding were not statistically different in both groups. The duration of bleeding cessation was significantly shorter in the conjugated equine estrogen group (5.9 ± 3.4 vs 7.9 ± 3.9 days, mean difference 2.0 days (95%CI 0.01 to 0.02, p < 0.05)).
Conclusion: Conjugated equine estrogen was more effective than mefenamic acid in controlling abnormal uterine bleeding in etonogestrel subdermal implant use.

Prevalence of Depressive Symptoms among Thai Reproductive-Aged Woman with Polycystic Ovary Syndrome and Associated Factors

Mon, 01 Jul 2024 00:00:00 +0700

Objectives: This study aimed to determine the prevalence of depressive symptoms among Thai reproductive-aged woman with polycystic ovary syndrome (PCOS) and to identify factors associated with depression in this population.
Materials and Methods: A cross-sectional, questionnaire-based study was conducted at the Gynecologic Endocrinology Unit of Siriraj Hospital. The study enrolled women with PCOS between February 2022 and April 2023. The women were aged 18-45 years and met the revised Rotterdam 2003 criteria for PCOS. Participants with a prior psychiatric diagnosis or history of psychiatric medication use were excluded. Information was gathered about their background and recorded signs and symptoms of PCOS. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression and its severity. This study, scores of 9 or more indicated depressive disorder.
Results: A total of 193 PCOS women participated, with a mean age of 26.1 ± 5.4 years. Most participants exhibited oligomenorrhea (96.9%) and hyperandrogenism (93.8%). The prevalence of depression was 39.9%, with severity categorized as mild (28.0%), moderate (11.4%), and severe (0.5%). Univariate analysis identified that being a student, having no savings from income, the presence of acanthosis nigricans, and hyperandrogenism were significantly associated with depression. Multiple logistic regression analysis further revealed that only the absence of savings was significantly associated with depression in this population.
Conclusion: The prevalence of depression in Thai PCOS women, as categorized by the PHQ-9, was 39.9%. A lack of savings from income was a significant factor associated with depression in Thai reproductive women with PCOS.

Validity and Reliability of Thai Version of the Overactive Bladder Questionnaire Short form (OAB-q SF) in Women with Overactive Bladder

Thanawat Sangnucktham, Suvit Bunyavejchevin, Purim Ruanphoo — Mon, 01 Jul 2024 00:00:00 +0700

Objectives: To study the validity and reliability of Thai version of the OAB-q SF and the correlation of Thai version OAB-q SF to Thai version OAB-q.
Materials and Methods: During December 2017 to February 2018, after IRB approvement, 46 Thai patients diagnosed as having OAB attending a Female Pelvic Medicine and Reconstructive Surgery clinic at King Chulalongkorn Memorial hospital were recruited. Patients’ characteristics were recorded. The self- answered, Thai version of the OAB-q SF was administered on two occasions, at the day of recruitment and at 2 weeks apart (by mail). Thai version of OAB-q was administered only at the first visit.
Results: Mean ± standard deviation of age was 65.63 ± 11.64 years, and their mean body mass index (BMI=-0987 was 26.25 ± 8.13 kg/m2. Most women were treated for OAB more than 6 months (47.9%). Behavioral modification was used to treat in all patients. Oral medication was administered in 54.35% of patients. Cronbach’s alpha of the OAB-q SF was 0.80 and 0.93 for symptom-bother and HRQL domains, respectively. The ICCr of symptom bother scale and HRQL were 0.90 and 0.94. The content validity index was equal to 1. Pearson correlation of the total score of the OAB-q SF and OAB-q was 0.95 for the first visit questionnaire.
Conclusion: Thai version of the OAB-q SF showed good psychometric properties (reliability and validity) for measuring the OAB symptom severity and HRQL. There was very strong correlation between Thai version of OAB-q SF and OAB-q.

Update on Amniocentesis

Jitti Hanprasertpong, Tharangrut Hanprasertpong — Mon, 01 Jul 2024 00:00:00 +0700

Amniocentesis is a common prenatal diagnostic procedure. All steps before, during and after the procedure are essential and should be carefully performed. Moreover, there are several interesting and update aspects. This article aims for updating of amniocentesis in pregnant women with specific conditions, such as those infected with human immunodeficiency virus (HIV), those taking antiplatelet medications (such as aspirin), those who are obese, those who are infected with hepatitis B, and those experiencing a twin pregnancy.

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

Vorapong Phupong — Mon, 01 Jul 2024 00:00:00 +0700

This fourth issue of Thai Journal of Obstetrics and Gynaecology 2024 contains many interesting articles. The special article is “update on amniocentesis”. This article aims for updating of amniocentesis in pregnant women with specific conditions, such as those infected with human immunodeficiency virus, those taking aspirin, those who are obese, those who are infected with hepatitis B virus, and those experiencing a twin pregnancy.

Mesonephric-like Adenocarcinoma Arising from the Ovary: A Case Review and Treatment Considerations

Mon, 01 Jul 2024 00:00:00 +0700

Mesonephric-like adenocarcinomas (MLAs) are a rare classification of pathologic cancers. These clinically high-grade cancers exhibit a distinct propensity for distant metastasis, notably in the lungs, often diagnosed at advanced stages (II–IV) according to The International Federation of Gynecology and Obstetrics (FIGO), and clinical course is unclear. A 62-year-old woman was diagnosed as a left ovarian tumor, magnetic resonance imaging (MRI) revealed a 68 mm nodule confined to the left ovary with no evidence of pelvic cavity invasion. After surgery, the patient was diagnosed with FIGO stage IIIA1(ii) mesonephric-like adenocarcinoma. Homologous recombination deficiency (HRD) status and breast cancer 1/2 (BRCA1/2) were negative. Postoperatively, the patient received six sessions of taxotere and cyclophosphamide (TC) chemotherapy as an adjuvant chemotherapy with no recurrent lesions. There are few reports that the positive rate of HRD score and the efficacy of poly adenosine diphosphate (ADP) - ribose polymerase inhibitors (PARPi) remain unclear. Adjuvant chemotherapy using carboplatin and paclitaxel after complete surgery has shown promising results with a low risk of recurrence. Further accumulation of cases and studies on regimens, including long-term prognosis and maintenance therapy are needed.

Twin Pregnancy Presenting with Hydatidiform Mole and Co-existing Living Fetus with Ovarian Venous Thrombosis: A case report

Mon, 01 Jul 2024 00:00:00 +0700

Background: This case was a twin pregnancy with a complete hydatidiform mole (CHM) and a co-existing fetus. Gestational trophoblastic neoplasia (GTN) and ovarian venous thrombosis (OVT) were diagnosed during the postpartum period.
Case: A 25-year-old pregnant woman, gravid 2, para1-0-0-1 presented with vaginal bleeding. Ultrasonography showed multi-cystic placenta separated from a normal placenta and a living fetus. The patient had a vaginal delivery at 31+5 weeks of gestation. Placental histology described a CHM and negative p57(kip2) immunohistochemistry. Post-molar GTN was diagnosed after one month of delivery. Low-risk GTN was diagnosed with OVT. Clinical symptoms subsided after administrating of single-agent methotrexate and an anticoagulant and without complication during one year follow-up.
Conclusion: CHM with a co-existing fetus needs imaging, prenatal genetics, and pathological plus p57 immunohistochemistry for diagnosis.