Prevalence of pregnancy with placenta previa in Siriraj Hospital.

Objective: To determine the prevalence of pregnancy with placenta previa in Siriraj Hospital. Methods: This study conducted a retrospective review of in-patients medical records of a total of 843 singleton deliveries in Siriraj Hospital with gestational age ≥28 weeks during January to February 2009. Data on baseline characteristics of pregnant women, pregnancy course and the outcomes during delivery were collected. Placenta previa was diagnosed by ultrasonographgy and /or direct visualization of placental location during cesarean section. Results: The mean age of the population was 28.4 ± 6.0 years old. Most of these delivered at term gestation (87.4%). The modes of delivery were normal vertex delivery, emergency cesarean section and elective cesarean section which presented in 60.5%, 26.5% and 12.1% of pregnancies respectively. The prevalence of placenta previa was 0.7% (6/843). The factor significantly associated with placenta previa was previous uterine curettage (p = 0.001). The significant outcomes of pregnancy with placenta previa were maternal blood loss >500 mL (P = 0.008) and baby’s APGAR score at 1st minute ≤7 (p = 0.006). Conclusion: The prevalence of pregnancy with placenta previa in Siriraj Hospital was 0.7%.

Use of feminine hygiene products in Thai women.

Objective: To determine the prevalence and explore the knowledge, attitude and practice of using feminine hygiene products in Thai women. Methods: A survey was conducted between May and August 2009 in 400 Thai women between the ages of 20-35 who attended at Siriraj Gynecological clinic. Questionnaires dealing with knowledge, attitudes and practice were completed and data were collected and analyzed. Results: The mean age of participants was 28.5 + 4.2 years. The prevalence of participants who have ever used feminine wash and vaginal douche were 70.5% and 14.25%, respectively. To get rid of an unpleasant odor, and feeling clean and fresh were the most common reasons for using both products. The most common timing of using feminine wash was after period, after bath and when having unpleasant odor, whereas having leucorrhea and unpleasant odor were noted in vaginal douche group. Significant association between use of vaginal douche and an experience of sexual intercourse was observed (P < 0.05). Conclusion: Use of feminine hygiene products, especially feminine wash, was quite popular in Thai women. To get rid of unpleasant odor as well as to feel clean and fresh were common reasons for using this product. Recommendations by gynecologists about appropriate use of feminine hygiene products should be carefully considered in daily practice.

Maternal body mass index at term does not predict the severity of preeclampsia.

OBJECTIVE: Maternal pre-pregnancy weight is a risk of developing preeclampsia. Whether it is also associated with the disease severity is still elusive. This retrospective cohort was to determine the association between body mass index (BMI) at term and severity of preeclampsia. MATERIAL AND METHOD: BMIs on the delivery date of 229 patients were analyzed with various indicators of the disease severity. The corrected BMI (cBMI), calculated by an exclusion of feto-placental unit, was additionally analyzed. RESULTS: Neither maternal BMI nor cBMI correlated with the disease severity (p = 0.15 and 0.36). Patients who did and did not require MgSO4 do not have different BMI or cBMI (p = 0.12 and 0.23). Neonatal weight from severe disease arm does not differ from those with mild disease (p = 0.51). Counter-intuitively the correlations between birth weight and maternal BMI were stronger in the severe compared to the mild group (p = 0.0 and 0. 03). CONCLUSION: Neither BMI nor cBMI at the time of delivery predict the severity of preeclampsia or the need for seizure prophylaxis. Birth weight of the baby born from preeclamptic mother might be affected by multiple factors.

Ultrasonographic characteristics in patients clinically diagnosed with threatened abortion.

OBJECTIVE: To determine ultrasonographic appearances in pregnant women clinically diagnosed with threatened abortion. DESIGN: Cross-sectional study. MATERIAL AND METHOD: Seven hundred and seventy six pregnant women clinically diagnosed with threatened abortion and receiving ultrasonographic examination were enrolled Data on ultrasonographic characteristics were obtained from records at the Maternal-fetal Medicine unit. Pregnancy outcomes were reviewed from medical records. RESULTS: The ultrasonographic findings demonstrated 328 (42.3%) viable pregnancy, 178 (22.9%) embryonic death, 176 (22.7%) anembryonic pregnancy, 25 (3.2%) incomplete abortion, 24 (3.1%) complete abortion, seven (0.9%) molar pregnancy, four (0.5%) ectopic pregnancy, and 34 (4.4%) inconclusive finding. Two hundred and sixty viable pregnancies were available for follow-up and revealed that 229 (88.1%) eventually delivered while 31 (11.9%) ended up with abortion. The two groups were not significantly different regarding age, parity, history of abortion, and gestational age at diagnosis. CONCLUSION: Ultrasonographic findings in patients clinically diagnosed with threatened abortion demonstrated viable pregnancy in nearly half of the cases. Transvaginal ultrasonography is useful in establishing definite diagnosis and appropriate treatment among these patients.

Pregnancy outcomes in methamphetamine abuse mothers.

Objective: The objective of this study was to determine the outcomes of pregnancy in methamphetamine abuse mothers. The history of methamphetamine abuse, other abused drugs and some abuse behaviors of mothers were also studied. Methods: Cross sectional analytical study of 182 mothers with a history of methamphetamine abuse during pregnancy and the outcomes were reviewed. Data was collected from in-patient files of Siriraj Hospital between 1 January 2000 and 31 December 2003. Those mothers who miscarried were excluded from the study. Characteristics of the patients, antenatal care records, histories of methamphetamine abuse, modes and outcomes of delivery such as preterm labor, birth weight, Apgar score, length and head circumferences were recorded. Subsequent analysis of 50 teenage mothers and 100 mothers over 20 years were compared. Data was analyzed and descriptive statistics, Chi-square test and unpaired t-test were used where appropriate. Results: Of all 182 mothers, 65.9% did not attend ANC and 43% were nulliparous. Percentages of preterm and low birth weight were 6.6% and 24.2% respectively. Sexually transmitted diseases were quite prevalent. There was a high positive anti-HIV rate of 6.6% in this group. Neonatal asphyxia (Apgar < 7) at 1 min was found in 4.9% of the infants. The average birth weight, head circumference and fetal length were 2813.5 + 456.3 gm., 32.0 + 2.1cm. and 48.4 + 2.7 cm. respectively. Most of the mothers abused methamphetamine less than one year with a dose of 1 tab per day. Multiple substance abuse was noticed. 47.9% of the patients smoked cigarettes and 12.7% consumed alcohol during pregnancy. Maternal characteristics and pregnancy outcomes were not different when subsequent analysis was performed to compare between 50 teenage mothers and 100 mothers over 20 years of age. Conclusion: The results showed some adverse outcomes of pregnancy from mothers with methamphetamine abuse. Poor ANC, high positive anti-HIV rates, high percentage of low birth weights and smaller head circumferences of the newborns were observed in this study. The prevalence of preterm was low without clear explanation. The age of the mothers had no additional role on these adverse outcomes although there was a trend of higher low birth weight and preterm among teenage mothers.

The correlation of lactating women's breast size and breast milk production.

Objective: To evaluate the correlation between lactating womenûs breast size and breast milk production. Methods: 53 normal primiparous women with neither breastfeeding problems nor having drugs that affected milk production who delivered vaginally at Siriraj Hospital, Bangkok, Thailand were enrolled. On the 3rd day after delivery, breast size and breast milk volume were recorded by the same investigator at 3 hr after the last breastfeeding. Results: The means of breast size and breast milk volume in this study were 13.5 ± 3.7 cm and 47.8 ± 18.3 ml, respectively. Regarding to the Pearson correlation test, breast milk volume had no significant correlation with breast size (rs= -0.112, p > 0.05), but showed a negative correlation with the maternal age (rs= -0.27, p < 0.05). Conclusion: There is no significant correlation between breast milk volume and breast size. The small breast size woman should be counseled and reassured to get more confidence in breast feeding.

Risk factors of retained placenta in Siriraj Hospital.

OBJECTIVE: To identify risk factors associated with retained placenta after vaginal delivery. DESIGN: Case-control study. MATERIAL AND METHOD: Medical records of 234 pregnant women whose gestational age > or =28 weeks were reviewed. Cases comprised of 78 women with retained placenta after vaginal delivery and controls comprised of 156 women with spontaneous placental delivery. Associated risk factors were examined Chi-square test and logistic regression analysis were used for analysis of data. RESULTS: Cases were significantly older than controls (29.3 +/- 6.4 vs. 27.0 +/- 6.4 years respectively, p = 0.01). Cases were likely more significant than controls to have a previous history of uterine curettage (20.5% vs. 6.4% respectively, p = 0.001) and premature rupture of membranes (35.9% vs. 22.4% respectively, p = 0.029). Between the two groups, there were no differences in gestational age, parity, previous abortion, induction of labor, oxytocin, and pethidine usage. Logistic regression analysis showed that independent risk factors for retained placenta were age (adjusted OR 1.06, 95% CI 1.01-1.11), previous uterine curettage (adjusted OR 4.2, 95% CI 1.7-9.9), and PROM (adjusted OR 2.2, 95% CI 1.2-4.1). CONCLUSION: Maternal age, previous uterine curettage, and PROM were independently associated with increased risk of retained placenta. The condition should be aware of among pregnant women with such risk factors.

Rate of abnormal results from repeated screening tests for gestational diabetes mellitus after normal initial tests.

OBJECTIVE: To evaluate the rate of abnormal results of repeated screening tests for gestational diabetes mellitus when initial tests were normal and related factors. SUBJECTS: Six hundred women who had clinical risk factors for gestational diabetes mellitus (GDM) who attended the antenatal care clinic at Siriraj Hospital before 24 weeks of gestation, between January and June 2005 were recruited All had normal screening test. MATERIAL AND METHOD: All subjects were followed throughout their pregnancies. All received repeated screening and confirmatory test at 28-32 weeks ofgestation. All data of screening and confirmatory test results were collected and analyzed. RESULTS: Six hundred pregnant women who had normal screening test for GDM were enrolled Eighty-seven cases failed to take the second screening test. Of the remaining 513 cases, 154 (30.0%, 95% CI 28.2%-36.3%) had abnormal results in repeated screening tests. Among them 20 cases (3.9%) were diagnosed as GDM. Pregnant women who were > or =30 years old or had result of 50 g GCT > or =120 mg/dl had significant increased risk for abnormal repeated screening tests. CONCLUSIONS: Pregnant women with clinical risk of GDM should receive repeated screening tests when they are 28-32 weeks of gestation. Higher risk was observed among women > or =30 years old or those with a result of 50 g GCT > or =120 mg/dl.

Usage of prophylactic antibiotics in uncomplicated gynecologic abdominal surgery in Siriraj hospital.

OBJECTIVE: To determine the rate of prophylactic antibiotics usage in uncomplicated gynecologic abdominal surgery in Siriraj Hospital, before and after guideline implementation. MATERIAL AND METHOD: Two hundred and fifty-eight women who underwent elective gynecologic surgery for a benign condition were enrolled. The patients were divided into two groups, before and after guideline implementation (control and study group). Medical records of these women were reviewed to determine the rate of prophylactic antibiotics usage, rate of postoperative infection, and antibiotics cost. RESULTS: The most common prophylactic antibiotics used were Cefazolin (41.9%), Cefoxitin (36.4%), and Augmentin (9.7%). Rate of single dose of cefazolin usage were not significantly different between the two groups (10.1% and 12.4% respectively, p = 0.482). However, the rate of postoperative oral antibiotic usage was significantly decreased (31.8% and 14.7% respectively, p = 0.001). The reduction of oral antibiotic usage was significant among staff only. The rate of postoperative infection between control and study groups, as well as between single and other antibiotic prophylaxis were similar. Had a single dose of cefazolin been administered to all patients, the antibiotics cost would have been reduced by 102,012 Baht or 91.8%. CONCLUSION: Rate of a single dose of cefazolin usage as antibiotic prophylaxis in gynecologic surgery was similar to before guideline implementation. However, postoperative oral antibiotics usage decreased significantly, especially among the staff.

Prevalence of bacterial vaginosis in Thai pregnant women with preterm labor in Siriraj hospital.

OBJECTIVE: To study the prevalence of bacterial vaginosis (BV) in pregnant women with preterm labor in Siriraj hospital. MATERIAL AND METHOD: A cross-sectional study of 158 pregnant women with suspected preterm labor was performed between January and July 2005. The subjects enrolled in the present study were between 28+0 and 36+6 menstrual weeks. BV blue test was performed on the vaginal fluid collected from lower one- third of vagina. RESULTS: The prevalence of BV in women in the preterm labor group was 25.8% compared to 14.1% in the preterm contraction group (p = 0.07). CONCLUSION: Compared with preterm contractions a higher prevalence of BV was found in the pregnant women with preterm labor. Given that a quarter of pregnant women with preterm labor tested positive for BV, it might be appropriate to perform this test in the triage setting.

Maternal height and the risk of cesarean delivery in nulliparous women.

OBJECTIVES: To evaluate the relationship between maternal height of < 155 cm and the risk of caesarean delivery due to cephalo-pelvic disproportion (CPD) among nulliparous women. DESIGN: Retrospective cohort study MATERIAL AND METHOD: A total of 660 term (GA > or = 37 weeks), uncomplicated singleton nulliparous pregnant women were enrolled on admission to labour room. The patients were divided into two groups based on maternal height, < or = 155 cm (440 cases) as control and < 155 cm (220 cases) as study group. The medical records of these women were reviewed. Various baseline clinical characteristics were collected. Intrapartum characteristics and maternal and neonatal outcomes were recorded. RESULTS: The rate of caesarean section of all indications was only slightly higher among study group than control group (16.4% and 13.7% respectively, p = 0.514). No significant difference was observed in the rate of caesarean delivery due to CPD (7.3% and 10.5% in control and study group respectively, p = 0.376). The rate of caesarean delivery due to CPD was highest among those with height < 150 cm (p < 0.001). Mean birth weight was significantly lower among study group than control group (2,927.7 +/- 368.1 g and 3,068.4 +/- 358.5 g respectively, p < 0.001). Low birth weight (< 2,500 g) was significantly higher among study group than control group (10.9% and 3.2% respectively, p < 0.001). CONCLUSION: Term singleton nulliparous pregnant women with maternal height < 155 cm were not associated with a greater likelihood of caesarean section for CPD. However, mean birth weight was significantly lower and low birth weight was significantly increased among mothers with short stature.

Transabdominal ultrasound in the assessment of postvoid residual urine volume in patients after hysterectomy.

OBJECTIVE: To evaluate the correlation between assessment of postvoid residual urine by transabdominal ultrasound and catheterization in patients after radical or transvaginal hysterectomy. MATERIAL AND METHOD: A cross-sectional study was conducted and 46 patients were enrolled after they had radical and transvaginal hysterectomy. After surgery, urinary catheter was indwelled. After catheter removal and the 3rd private voiding, the patients were sent for transabdominal ultrasound assessment of PVR at the Division of Maternal-Fetal Medicine. Complete drainage of bladder with standard catheterization was then performed and catheterized urine volume was recorded. PVR was calculated from previously published equation and compared with actual PVR from catheterization. RESULTS: Mean age of the patients was 55.9 years. The most common diagnoses were procidentia uteri (23.9%), Carcinoma of cervix stage 1b1 (23.9%), and prolapsed uteri grade 2 (21.7%). Radical hysterectomy with pelvic node dissection and vaginal hysterectomy with anterior colporhaphy and posterior colpoperiniorhaphy was performed each in 50% of cases. Mean duration of urinary catheter indwelling was 7.17 days for those underwent radical hysterectomy and 5 days for vaginal hysterectomy. The calculated PVR was significantly correlated with catheterized urine volume with correlation coefficient 0.93 (p < 0.001). If the usual cutoff of PVR > 100 ml was used to determine the necessity of re-indwelling catheter, among those with calculated PVR from ultrasound measurement < 100 ml, still 30% actually had actual PVR of > 100 ml. Among those with calculated PVR from ultrasound measurement >100 ml, all actually had actual PVR of > 100 ml. CONCLUSION: PVR estimation by ultrasound significantly correlated with actual PVR. This could reduce the process of repeat catheterization and give more comfort to the patients when the PVR is > 100 ml.

Adverse pregnancy outcomes in gestational diabetes mellitus.

OBJECTIVE: To evaluate adverse pregnancy outcome in women diagnosed with gestational diabetes mellitus (GDM) at Siriraj hospital. STUDY DESIGN: Cross- sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: One hundred and sixty two women who were diagnosed with GDM and who received treatment following clinical practice guideline at Siriraj hospital were enrolled. Data were abstracted from medical record regarding adverse pregnancy outcomes of both the mothers and their infants. RESULTS: The most common clinical risk for GDM was age > or = 30 years (116 cases, 71.6%), followed by family history of diabetes mellitus (81 cases, 50%) and obesity (47 cases, 29%). Majority of the women were GDM class A1 (156 cases, 96.3%) and only six cases (3.7%) were GDM class A2. Maternal complications were found in 35 cases (21.6%) and the most common complications were postpartum hemorrhage (17 cases, 10.5%), mild preeclampsia (6 cases, 3.7%) and severe preeclampsia (3 cases, 1.9%). The most common neonatal complication was hypoglycemia (111 cases, 68.5%). This occurred in all infant of GDM class A2 mothers. Macrosomia was found in 29 cases (17.9%). No significant differences in maternal and neonatal complications were found between GDM class A1 and class A2. CONCLUSION: Women with GDM who were diagnosed and treated following treatment guidelines demonstrated no severe maternal and neonatal complications.

Non-compliance to clinical practice guideline for screening of gestational diabetes mellitus in Siriraj Hospital.

OBJECTIVE: To evaluate the rate of non-compliance to Clinical Practice Guideline (CPG) for screening of Gestational Diabetes Mellitus (GDM) and related factors in Siriraj Hospital. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: One-hundred-and-fifty-nine pregnant women at risk for GDM and who delivered at Siriraj Hospital were enrolled Data were collected from history and medical records including base line characteristics, clinical risk factors of GDM, and compliance to guideline. Rate of non-compliance and related factors were evaluated RESULTS: The rate of non-compliance to GPG for screening of GDM at Siriraj Hospital was 22% (95%CI 16.3%-29.1%). The rate was highest among women who had AnteNatal Care (ANC) at a private clinic (82.1%), followed by the private cases in the hospital (40%). Those who received ANC at the hospital had the lowest non-compliance rate of 6.6%. The most common neglected risk factor was maternal age > or = 30 years. Significant higher compliance was found among women with 2 or more clinical risk factors compared to those with only 1 risk factor (p = 0.028). CONCLUSION: The rate of non-compliance to CPG for screening of GDM at Siriraj Hospital was 22%. Highest non-compliance rate was found among the private cases. The most common neglected risk factor was maternal age > or = 30 years.

Uterine sarcomas in Siriraj Hospital (1991-2005).

Objective: To study the incidence, clinical characteristics, treatments and outcomes in patients with uterine sarcomas at Siriraj Hospital. Methods: A medical record search of patients treated at Siriraj Hospital from January 1991 to December 2005 was performed for clinical characteristics and treatments. Survival curves were generated using Kaplan-Meier method. Results: Sixty uterine sarcomas were diagnosed during a 15-year period. The mean age was 49.3 years (range 27-74; SD 10.6). Abnormal bleeding was the most common presenting symptom (40%). Only 11.7% of the cases could be diagnosed preoperatively. Of 60 patients, 37 (61.6%) had leiomyosarcoma (LMS), 9 (15%) had malignant mixed mullerian tumor (MMMT), and 14 (23.3%) had endometrial stromal sarcoma (ESS). The distribution by FIGO staging was as follows: stage I: 47.5%, stage II: 15%, stage III: 17.5%, and stage IV: 20%. The treatment was mainly hysterectomy with adjuvant chemotherapy. The median follow-up time was 25 months. The five-year survival rate was 55.4%. Conclusion: The incidence of uterine sarcoma at Siriraj Hospital was 4.4% of uterine malignancies. The most common histologic type was leiomyosarcoma (61.6%). The common presenting symptoms were uterine bleeding and pelvic mass. In most cases, the treatment modality was surgery combined with chemotherapy. The overall 5-year survival rate of the studied group was 55.4%.

Menopausal symptoms and knowledge towards daily life and hormone replacement therapy among menopausal women in Bangkok.

OBJECTIVE: To evaluate prevalence and intensity of menopausal symptoms, knowledge towards daily life and hormone replacement therapy (HRT) among natural menopause women in Bangkok. DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHOD: One hundred and sixty two natural menopause women who attended the health seminars or exhibitions except topics about menopause and HRT in Siriraj Hospital from March - June 2005. Targeting women were asked to fill out the structured questionnaires. Data concerning personal history, menopausal symptoms, knowledge of menopause, HRT and daily life in menopause were collected. RESULTS: A total of 148 questionnaires (91.4%) were completed for the analyses. Of 148 women, 141 (95.3%) had menopausal symptoms. The most common and most severe menopausal symptom was muscle and joint pains (84.5% and 23.0%, respectively). The majority of the women understood correctly regarding knowledge about menopause issue and daily life during menopause (80.6% and 89.2%, respectively). Although 51.1% of the women showed their knowledge about HRT correctly, only 8.1% were currently using HRT. The main reasons for this low percentage of HRT use were ability to tolerate the menopausal symptoms (49.0%) and lack of correct knowledge about HRT (48.9%). CONCLUSION: The most common and also the most severe menopausal symptom in natural menopause women was muscle and joint pains. Most of them demonstrated their correct understandings about menopause issue and daily life in menopause and half of them demonstrated their correct understandings about HRT.

Prevalence and risk factors for residual cervical neoplasia in subsequent hysterectomy following LEEP or conization.

OBJECTIVES: The purposes of the present study were to determine the prevalence of residual disease in the hysterectomy specimens following cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP) and to evaluate the predictive factors for residual disease. DESIGN: Descriptive study SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital. SUBJECTS: A total of 120 patients who underwent hysterectomy after either LEEP or CKC. MATERIAL AND METHOD: The medical records of 120 women were reviewed to estimate the prevalence of residual disease.. The patients' characteristic and pathologic parameters were analyzed for the risk factors of residual disease. Chi square test and Student t test were used for statistical analysis. RESULTS: Of the 120 patients, 46 cases had residual disease in their hysterectomy specimens so the prevalence was 38.3% (95% CI 29.5, 47.2). Invasive cervical cancer was found in the hysterectomy specimens in 4 cases (8.7%). Only ectocervical margin was the predictive factor of residual disease in the hysterectomy specimen (p = 0.002). Age, conization pathologic findings, glandular involvement, endocervical margin status, stromal invasion, and endocervical curettage results were not predictive factors for residual disease in the hystectomy specimens. CONCLUSION: Residual disease was found in 38.3% of hysterectomy specimens after conization. Also undiagnosed invasive cervical cancer was found. Careful examination for residual disease in hysterectomy specimens should be performed, especially among those with positive cone margin.

Maternal grief after abortion and related factors.

OBJECTIVE: To investigate maternal grief after abortion and the factors that might relate to the intensity of maternal grief. DESIGN: Cross-sectional, descriptive study. SUBJECT: 132 women who attended the abortion clinic, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Thailand. METHOD: The subjects were asked to complete the questionnaires including demographic characteristics, history of previous pregnancy, and Perinatal Grief scales, two weeks after abortion. The data was then analyzed to determine maternal grief and related factors of grief intensity. RESULTS: There were 7 women with severe grief intensity (5.3%), 50 with moderately grief intensity (37.9%) and 75 with mild grief intensity (56.8%). The factors associated with PGS scores were low income, had had ultrasonography, gestational age of > 16 weeks and methods of treatment. CONCLUSION : Grief is worldwide among women who have recently aborted. The related factors with grief intensity can be used for screening psychological problems of the women who experience abortion. If found, the physicians can closely observe and help them to work through their coping mechanism and prepare them to get another successful pregnancy in the future.

Accuracy of Nugent's score and each Amsel's criteria in the diagnosis of bacterial vaginosis.

OBJECTIVE: To determine the diagnostic accuracy of Nugent's score and each Amsel's criterion in the diagnosis of bacteria vaginosis (BV), considering Amsel's criteria as the gold standard. DESIGN: Cross-sectional, descriptive study (diagnostic test) Setting: Family planning clinic, Siriraj Hospital, Mahidol University. SUBJECTS: A total of 217 women who attended the Family Planning Clinic at Siriraj Hospital between August and December 2003. METHOD: Pelvic examination was performed on each participant. Samples of vaginal discharge was tested for BV infection using both Amsel's criteria and Nugent's score. Interpretation was made blinded without knowledge of each test result. Using Amsel's criteria as a gold standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Nugent's score and each of Amsel's criteria were estimated. RESULTS: Considering Amsel's criteria as the gold standard, Nugent's score showed a sensitivity of 65.6% (95%CI 46.8%, 80.8%), specificity of 97.3% (95%CI 93.5%, 99.0%), positive predictive value (PPV) of 80.8% (95%CI 60.0%, 92.7%), negative predictive value (NPV) of 94.2% (95%CI 89.7%, 96.9%) and accuracy of 92.6% (95%CI 88.1%, 95.6%). Both vaginal pH and whiff test demonstrated 100% sensitivity. However, vaginal pH showed lower specificity than the whiff test (58.9% and 97.3% respectively). CONCLUSION: Nugent's score might not be suitable to use as a screening test for diagnosis of BV due to its low sensitivity. The whiff test is the best clinical criteria of Amsel's criterion in the diagnosis of BV due to its high sensitivity and specitivity.

Incidence of gestational diabetes mellitus diagnosed before 20 weeks of gestation.

The objectives of this study were to determine the incidence of gestational diabetes mellitus (GDM) before 20 weeks of gestation and evaluate associated risk factors. A total of 1200 pregnant women who started their antenatal care at Siriraj Hospital before 20 weeks of gestation and were at risk of developing GDM were enrolled. A 50-gram glucose challenge test was used as a screening method and 100-gram oral glucose tolerance test was used to diagnose the condition. All women were screened during their first visit and again at 28-32 weeks of gestation. The results showed that the incidence of GDM diagnosed before 20 weeks of gestation was 5.3% (95% CI 4.1-6.7%), and another 4.9% were diagnosed during 28-32 weeks. This demonstrated the usefulness and effectiveness of the current guideline for GDM screening that approximately half of women with GDM could be diagnosed early in their pregnancies. The 2 independent risks for developing GDM before 20 weeks of gestation were age > or = 30 years and GDM in previous pregnancy (adjusted OR 2.5, 95% CI 1.3-5.0, and 7.1, 95% CI 1.8-27.6, respectively). This specific group of women should be counseled regarding the importance of early GDM screening during their pregnancy.