Thai Journal of Obstetrics and Gynaecology

Evolution and Prospects of Educational Pathways in Invasive Prenatal Procedures

Mon, 26 Jan 2026 00:00:00 +0700

Invasive prenatal procedures (IPPs) are integral to the practice of perinatology. The most commonly performed diagnostic procedures include chorionic villus sampling, amniocentesis, and percutaneous umbilical blood sampling. These techniques require precise hand–eye coordination under real-time ultrasonographic guidance. Fetal therapeutic procedures demand even more advanced skills, combining real-time ultrasound guidance with endoscopic surgical techniques. Structured training is essential to minimize procedure-related complications, particularly among less experienced operators. Teaching methods generally include simulation, animal models, mentorship–apprenticeship, and curriculum-based workshops. Simulation-based training employs both low-fidelity box trainers and high-fidelity virtual reality systems. Animal model training offers several advantages over ex-vivo synthetic simulators. Pregnant sheep provide the most realistic model for training and for developing novel in-utero surgical techniques because of their suitable uterine volume and fetal size. However, the cost and ethical concerns remain major limitations. Mentorship–apprenticeship typically begins with observation, followed by hands-on training and progressive responsibility until independent performance. Hands-on workshops offer opportunities to refresh skills in infrequently performed procedures. The advent of non-invasive prenatal testing using cell-free fetal DNA analysis has significantly reduced the number of invasive diagnostic procedures. Consequently, training programs must adapt to these changing circumstances. This article aims to assess current training paradigms, identify existing gaps, and propose future directions for skill acquisition in IPPs.

Intriguing Review and Topics in First Issue of Thai Journal of Obstetrics and Gynaecology 2026

Vorapong Phupong — Tue, 30 Dec 2025 00:00:00 +0700

This first issue of Thai Journal of Obstetrics and Gynaecology 2026 contains many interesting articles. The special article is “Evolution and prospects of educational pathways in invasive prenatal procedures”. The topics included current landscape of training, gaps and needs, and future trajectory⁽¹⁾.

Anxiety and Depression in Women with Abnormal Cervical Cytology Referred for Colposcopy: A Study at Suratthani Cancer Hospital

Kanjana Kanthiya — Mon, 26 Jan 2026 00:00:00 +0700

Objectives: To evaluate the prevalence of anxiety and depression in women with abnormal cervical cytology referred for colposcopy at Suratthani Cancer Hospital and identify associated risk factors.
Materials and Methods: In this cross-sectional analytic study, all women with abnormal cervical cytology referred for colposcopy at Suratthani Cancer Hospital between January 2025 and March 2025. Participants completed the Thai version of the hospital anxiety and depression scale (HADS). A score ≥ 11 on the anxiety (HADS-A) or depression (HADS-D) subscale was considered clinically significant and identified factors that associated to this group by multivariable logistic regression analysis.
Results: Total one hundred ninety-five women were participants. The mean age was 42.2 years (standard deviation 10.0). Clinically significant anxiety (HADS-A ≥ 11) was present in 15.4% of participants, and depression (HADS-D ≥ 11) in 5.6%. The only factors that significant associated with anxiety was depression (p < 0.01) and independent predictors of depression with multivariate regression analysis were smoking (adjusted odds ratio (aOR) 7.6, 95% confidence interval (CI) 2.20–98.72), poor cervical cancer knowledge (aOR 24.98, 95%CI 2.78–224.67), and concurrent anxiety (aOR 23.0, 95%CI 4.3–121).
Conclusion: Psychological distress was common among women referred for colposcopy, with significant predictors including smoking, poor disease knowledge, and co-existing anxiety. Integrating mental health screening and patient education into colposcopy care could improve psychological outcomes and care engagement.

Efficacy of Oral Iron Supplementation in Anemic Pregnant Women with Normal and Abnormal Hemoglobin Typing

Wattanai Kosidapan, Natthanan Vilairuangchoovong — Mon, 26 Jan 2026 00:00:00 +0700

Objectives: To evaluate the efficacy of oral iron supplementation on the resolution of anemia and the improvement of hemoglobin (Hb) levels in anemic pregnant women with abnormal Hb typing results compared to those with normal Hb typing results.
Materials and Methods: A prospective cohort study was conducted among pregnant women diagnosed with anemia (Hb < 11 g/dL in the first and third trimesters, or < 10.5 g/dL in the second trimester). Participants were classified according to Hb typing results (normal vs abnormal) and received additional oral iron supplementation exceeding the standard prenatal dosage. Routine antenatal blood tests were performed before and after supplementation.
Results: A total of 66 participants were enrolled (31 in the abnormal Hb typing group and 35 in the normal group). After exclusion, 57 participants remained for analysis, including 29 in the abnormal group and 28 in the normal group. Baseline characteristics did not differ significantly between groups. Among them, 8 participants (27.59%) in the abnormal group and 20 participants (71.43%) in the normal group achieved resolution of anemia (p = 0.01). In the abnormal group, the overall Hb level increased slightly, with a mean change of 0.49 g/dL versus 1.87 g/dL in the normal group which was significantly difference (p < 0.001).
Conclusion: Additional oral iron supplementation did not significantly correct anemia in pregnant women with abnormal Hb typing who were most likely thalassemia carriers. However, a modest increase in Hb levels was observed. Further studies are warranted to determine the optimal regimen of iron supplementation to achieve greater improvements in Hb levels in this group of women.

Lidocaine Gel Combined with Ibuprofen Versus Ibuprofen Alone for Pain Relief during an Endometrial Biopsy; A randomized controlled trial

Kemmanut Tueman, Tanyalak Wongleucha — Mon, 26 Jan 2026 00:00:00 +0700

Objectives: To study the effect of 2% lidocaine gel in conjunction with ibuprofen for pain relief during endometrial biopsy.
Materials and Methods: Women who met the eligibility criteria were randomly allocated into two groups. The intervention group received 2% lidocaine gel (3 mL), while the control group received the placebo gel (3 mL). Both groups received oral ibuprofen 400 mg 30 minutes before the procedure. The pain score in each step of the procedure, starting from speculum insertion, grasping the cervix, during endometrial biopsy, immediately after the procedure, and 10 minutes after the procedure, was assessed by a 10-cm visual analogue scale. Any adverse effects were also recorded.
Results: Eighty-six women, 43 in each group, were recruited during July to December 2024. Baseline characteristics, including age, parity, and menopausal status, were not different in both groups. The mean pain score during endometrial biopsy in the intervention group (3.30 ± 2.09) was significantly lower than in the control group (5.33 ± 2.01) (mean difference -2.03, 95% confidence interval -2.91 to -1.15, p < 0.001). Pain scores at each step of the procedure in the intervention group were lower than in the control group but not statistically different. Adverse effects were not found, and the satisfaction of both patients and physicians was satisfied.
Conclusion: The addition of 2% lidocaine gel was effective in reducing pain during endometrial biopsy when compared to ibuprofen alone.

Maternal Factors Associated with Early Onset Neonatal Sepsis in Preterm newborns at Maharat Nakhon Ratchasima Hospital

Jidapa Eiamcharoenlap, Thitinant Samutchaikij — Mon, 26 Jan 2026 00:00:00 +0700

Objective: To investigate maternal factors associated with early-onset neonatal sepsis in preterm infants at Maharat Nakhon Ratchasima Hospital.
Materials and Methods: This retrospective case-control study included singleton preterm neonates born at Maharat Nakhon Ratchasima Hospital between gestational ages of 24–36+6 weeks, from 2021 to 2023, totaling 497 cases. The study population consisted of 166 preterm neonates diagnosed with early-onset neonatal sepsis (EONS) and 331 preterm neonates without sepsis (case-control ratio 1: 2). Maternal demographic and clinical data were obtained from medical records. Descriptive statistics summarized baseline characteristics, while multiple logistic regression model identified maternal factors associated with EONS. Associations were reported as odds ratio (OR) with 95% confidence intervals (CI), with p < 0.05 considered statistically significant.
Results: Maternal factors significantly associated with EONS included gestational age less than 34 weeks (OR 2.77, 95%CI 1.74–4.40, p < 0.001), chorioamnionitis (OR 3.33, 95%CI 1.21–9.17, p = 0.02), maternal white blood cell count greater than 15,000 cells/µL (OR 1.92, 95%CI 1.16–3.20, p = 0.012).
Conclusion: Gestational age < 34 weeks, maternal chorioamnionitis, and maternal leukocytosis were significant risk factors associated with EONS in preterm neonates. Awareness of these factors may help in early recognition and clinical management.

Oral Glucose Powder Solution versus 50% Intravenous Glucose Solution on Blood Glucose Levels and Satisfaction in the 50-gram Glucose Challenge Test: A randomized controlled trial

pailin pichaipaet, Purinat Jaitham, Kiattisak Kongwattanakul, Metha Songthamwat — Mon, 26 Jan 2026 00:00:00 +0700

Objective: To compare blood glucose levels and patient satisfaction during gestational diabetes screening between two oral glucose formulations: 50 grams of dissolved glucose powder in water versus 50% intravenous glucose solution diluted for oral intake.
Materials and methods: This randomized controlled trial was conducted from July 2024 to July 2025. A total of 208 pregnant women were randomly allocated into two equal groups. Group 1 (n = 104) received 50 grams of glucose powder dissolved in water, while Group 2 (n = 104) received 50% glucose solution intended for intravenous injection, also diluted in water. In both groups, the glucose solutions were prepared to a final volume of 300 mL and administered orally. All participants underwent the glucose screening test by drinking the assigned solution. Blood glucose levels were measured one hour after ingestion. The primary outcome was to compare the mean 1-hour post-load plasma glucose between the two groups. The secondary outcome was to compare patient satisfaction regarding the taste and ease of glucose solution consumption between the groups.
Results: There were no significant differences in baseline characteristics between the two groups. Similarly, there was no significant difference in 1-hour post-load plasma glucose. The mean blood glucose level was 119.22 mg/dL in the distilled glucose powder group and 121.25 mg/dL in the 50% intravenous glucose solution group (mean difference = -1.84, 95% confidence interval (CI) -8.62-4.95). There was no statistically significant difference in the proportion of positive glucose challenge test results between the groups (19.23% vs 24.03%, risk ratio 1.25, 95% CI 0.74-2.11, p = 0.703). However, the satisfaction score was significantly higher in the group that drank distilled glucose powder in water compared to the group that drank 50% intravenous glucose solution (p = 0.005).
Conclusion: The administration of 50 grams of glucose powder dissolved in water and 100 milliliters of 50% injectable glucose solution diluted to a total volume of 300 milliliters resulted in no significant difference in 1-hour post-load plasma glucose levels. However, the consumption of 50 grams of glucose powder was reported to result in ease of ingestion.

Survival Analysis and Proportion of Lymph Node Metastasis of Early-stage HPV-associated Endocervical Adenocarcinoma Based on Pattern

Mon, 26 Jan 2026 00:00:00 +0700

Objectives: To determine disease-free survival, disease-specific survival and lymph node metastasis in human papilloma virus (HPV) - associated cervical adenocarcinoma by pattern-based classification.
Materials and Methods: A total of 98 cases diagnosed with HPV-associated cervical adenocarcinoma that underwent pelvic lymph node dissection were retrospectively reviewed and reclassified according to the latest World Health Organization classification.
Results: Ninety-three were classified as usual-type adenocarcinoma (94.9%) and 5 (5.1%) as mucinous adenocarcinoma. 19 (19.4%), 32 (32.7%), and 47 (47.6%) cases as patterns A, B, and C, respectively. Lymph node metastasis was observed in 0% of pattern A tumors, 12.5% of pattern B tumors, and 31.9% of pattern C tumors. The 5-year disease-specific survival of patients with patterns A, B, and C tumors was 100%, 90.6%, and 63.8 %, respectively. The 5-year disease-free survival of patients with patterns A, B, and C tumors was 94.7%, 84.4%, and 57.4%, respectively. Patten C tumors were associated with worst disease-specific survival and disease-free survival: hazard ratio 8.82 (95% confidence interval (CI) 1.70 to 66.41) and 10.74 (95% CI 1.4 to 78.13), but the association disappeared after adjustment for clinicopathologic characteristics.
Conclusion: The 5-year disease-specific survival was 100% with no lymph node metastasis in patients with pattern A. Patients with pattern B and C are associated with higher risk of lymphovascular space invasion and lymph node metastasis.

The Association Between Low Pregnancy-Associated Plasma Protein-A levels and Adverse Pregnancy Outcomes

Mon, 26 Jan 2026 00:00:00 +0700

Objective: The primary objective was to evaluate the association between low pregnancy-associated plasma protein-A (PAPP-A) levels and preterm birth. The secondary objectives included assessing the relationship between low PAPP-A levels and other adverse pregnancy outcomes, as well as analyzing factors affecting PAPP-A levels.
Materials and Methods: Medical records of all women with singleton pregnancies undergoing the combined first trimester Down syndrome screening test between 11-14 weeks of gestation from January 2014 to December 2023 were reviewed. Baseline characteristics and pregnancy outcomes, including miscarriage, stillbirth, gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm delivery, and fetal growth restriction were compared between women with normal and low PAPP-A levels (< 0.4 multiples of median (MoM)).
Results: A total number of 2,023 women were enrolled, of whom 120 (5.9%) had low PAPP-A levels. Higher body mass index, multiparity, diabetes mellitus and hypertension negatively influenced PAPP-A levels. Women with low PAPP-A levels had significantly higher rates of preterm birth (15.8% vs 7.2%), gestational hypertension (12.5% vs 5.3%), and fetal growth restriction (10.8% vs 3.7%). At the 0.4 MoM cutoff, the sensitivity, specificity, NPV, and PPV for predicting preterm birth were 12.18%, 94.64%, 92.72%, and 16.10%, respectively. The area under the receiver operative characteristic curve was 0.597 for preterm birth, 0.578 for gestational hypertension, and 0.585 for fetal growth, respectively.
Conclusion: Low PAPP-A levels were significantly associated with preterm birth, gestational hypertension, and fetal growth restriction. However, the overall predictive performance was limited so PAPP-A should not be used as the sole indicator for clinical decision-making.