The study of cycle control, side effects and acceptability of transdermal patch use in Thai women in Siriraj Hospital.

Objective: To evaluate the efficacy, cycle control of menstruation, side effects, and acceptability of the contraceptive patch in Thai women. Methods: In this noncomparative study, 60 healthy Thai women were treated with contraceptive patches. Assessments of the efficacy, cycle control, side effects, and acceptability were performed at baseline, cycles 1, 3 and 6. Results: The Mean age of the participants was 25.8 years. A total of 50 women completed 6 cycles providing 300 woman-months of use, with the women who withdrew from the study providing a further 5 woman-months of use for a total of 305 woman-months. There were no pregnancies during the study, neither method nor participant failures. Withdrawal bleeding was regular and predictable, with a low incidence of unscheduled bleeding. The most frequent adverse event was breast tenderness, headache, skin irritation, hair loss, nausea, and acne. Most of the users were satisfied with the contraceptive patch. Conclusion: The contraceptive patch provided effective contraception with excellent cycle control, and was well tolerated with good compliance. This convenient approach to contraception appears highly acceptable in Thai women.

Prevalence of bacterial vaginosis in Thai women attending the family planning clinic, Siriraj Hospital.

OBJECTIVES: To investigate the prevalence of bacterial vaginosis (BV) among Thai women attending a family planning clinic and to evaluate the association of BV with potential risk factors. MATERIAL AND METHOD: A cross sectional prevalence study was conducted among 800 women attending the family planning clinic, Siriraj Hospital, between August and December 2003. BV was diagnosed according to Amsel's criteria. Prevalence and risk factor models were compiled and statistically analyzed RESULTS: Among the low risk population acquiring sexually transmitted diseases, the prevalence of BV was 14.6% (117 of 800). Asymptomatic disease was recognized in up to 47.9% (56 of 117). BV was significantly more prevalent among those who used douching inside the vagina [OR = 3.98 (1.85-8.33), p < 0.01] and high a prevalence among IUD users [OR = 1.84 (1.22-2.79), p < 0.01]. Although not statistically significant, BV tended to be more prevalent among women with a lower age at first intercourse, higher numbers of lifetime partners, higher frequency of sexual intercourse and current smokers. CONCLUSION: BV is a relatively high prevalent condition. The two potential risk factors, douching inside the vagina and IUD use, can be demonstrated, adding to be more concerned about the inappropriate practice of douching and more consideration in IUD users. The other potential risk factors, the impact to adverse reproductive outcomes and the prevention of BV need further studies, particularly in various Thai populations.

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.

Abortion : A case report of an abortion performed legally following a decision of the abortion committee with reference to Section 305 (2).

We report a 15-year-old woman who presented with an allegation of having been raped, with subsequent pregnancy due to the failure of postcoital emergency contraception. This case demonstrates a medicolegal perspective of how to approach the raped case and how to be safe for both the patient and the doctor to participate in an abortion legally. The management of sexually transmitted disease and termination of unwanted pregnancy is documented as well as the patient's psychological reactions in coping with the incidents.

Misoprostal use for therapeutic abortion in Siriraj Hospital: the year 2000.

OBJECTIVE: To evaluate the efficacy and the adverse effects of misoprostal usage for therapeutic abortion in Siriraj Hospital. STUDY DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHOD: A consecutive series of 101 therapeutic abortions was performed in the Department of Obstetrics & Gynecology, Siriraj Hospital in the year 2000. The patients were interviewed for general information and registered, as well as in-patient data. Any adverse events were recorded and collected from the inpatient record file. All data were analyzed statistically. RESULTS: 42 therapeutic abortions were conducted in association with misoprostal usage. Misoprostal was used for cervical ripening in 8 patients with a good outcome. 31 therapeutic abortions were induced by misoprostal alone regimen. A higher success rate (74.1%) was correlated with higher gestational age. 27 out of 31 cases were second trimester abortion. The induction to abortion interval was 18.0+/-10.5 hours (range 5-48). No factor, including age, weight, total dose of misoprostal use, nulliparity and viability of the fetus, could be demonstrated to affect the misoprostal activity defined by induction to abortion interval. There was no serious adverse event, except for severe abdominal cramping (26.2%) and fever (14.3%). CONCLUSION: Misoprostal alone can be used with caution for abortion induction especially in second trimester abortion.

Prevalence of actinomyces in cervico-vaginal smears of intrauterine device users.

A total of 300 Papanicolaou smears from current intrauterine device (IUD) users who attended the Family Planning Clinic of Siriraj Hospital from 2 November 1996 to 10 March 1997 were screened for actinomyces. The overall prevalence rate of actinomyces was 14 percent. Insert IUDs produced a significantly higher infection rate compared with metallic IUDs. The infection rate was also found to increase in direct relation to the duration of IUD use. Findings such as other infectious agents and symptoms are also discussed. The treatment of actinomyces with serious complications poses a management problem for the clinician when actinomyces is reported in a routine smear. Our findings lead us to question the practicality of earlier recommendations of IUD removal and/or antibiotic therapy.

The efficiency of low dose combined oral contraceptives for postponement of menstruation in Thais.

A randomized double blind clinical trial was carried out at the Division of Family Planning, Siriraj Hospital in order to study the efficiency of low dose oral contraceptive pills, containing 0.03 mg ethinyl estradiol and 0.15 mg levonorgestel, for postponement of menstruation. Sixty hralthy women with previous regular menstruation were randomly assigned to one of two study groups. Thirty women in the control group received 10 capsules of a placebo and the other 30 women in the study group received 10 capsules that contained the oral contraceptives. The women in both groups began taking the in doses of one capsule per day for three days before the expected date of menstruation. The characteristics of both groups were comparable. The number of women who expected postponement of their menstruation were recorded together with the side-effects. The results showed that oral contraceptive pills taken three days before the expected date of menstruation could postpone menstruation significantly (27/30 vs 2/30, p< 0.05). The major side-effects were headache (10 percent) and nausea (13.3 percent).

A study of menopausal symptoms in women attending the menopausal clinic at Siriraj Hospital.

The study of menopausal symptoms leading women to attend the menopausal clinic at Siriraj Hospital was carried out between January 1993 and December 1994. These 310 women, with the mean age of 49.7+ 7.0 years, were interviewed. Surgical menopausal, natural menopausal and perimenopausal women were encountered in 40.6%, 31.3% and 28.1% respectively. The mean age of menopause, as recalled memory was 47.5+ 5.3 years. The three most common symptoms presented were hot flushes (46.8%), muscle/bone pain 34.5%), and nervous (24.8%) while the least common one was dry skin (2.6%). Symptoms, with statistically significant difference (P<0.05) encountered among the three groups were headache/dizziness which mostly presented among perimenopausal women (32.2%), vaginal dryness and dyspareunia which mostly presented among natural menopausal women (39.2% and 30.9% respectively).

A comparative trial of the three copper IUDs in nulliparous women.

A comparative trial concerning the uses of the Nova T, Multifold short and Mini Cu-7 devices in nulliparous women with 30 in each group was carried on at the Family Planning Research Center of the Department of Obstetrics and Gynecology at Siriraj Hospital in Bangkok, Thailand. After a two-year experimental period, 50% Nova T users, 40% Multiload short users and 46.7% Mini Cu-7 users continued to use these IUDs; and 20% Nova T users, 26.7% Multiload short, and 26.7% Mini Cu-7 discontinued their use as they wished to have babies for the first time. The study did not find pelvic inflammatory disease or sexually transmitted disease. At insertion time, no pain was so extensive that an analgesic tablet was needed. The study only found two women (6.7 pregnancies per 100 IUD users) become pregnant with the IUD in situ in the Mini Cu-7 group in the first 6 months of use and the net cumulative rate is still 6.7 pregnancies per 100 IUD users after the two-year period of use, and the rate of pregnancy with the IUD in situ of the other two groups was totally negative. The results of the study show that there is no statistical significance in the rate of pregnancy, expulsion and bleeding or pain. In conclusion, these three kinds of Copper IUDs are equally effective and of the same favorable qualities. All three can be used in nulliparous women.