Is International or Asian Criteria-based Body Mass Index Associated with Maternal Anaemia, Low Birthweight, and Preterm Births among Thai Population?—An Observational Study.

An observational study was conducted in the four southernmost provinces of Thailand aiming at determining the effect of international or Asian criteria-based body mass index (BMI) in predicting maternal anaemia, low birthweight (LBW), and preterm births among pregnant Thai women and the change in haemoglobin (Hb) level during pregnancy. Maternal anaemia was defined as a haemoglobin (Hb) level of <11 g/dL. Anaemia was detected in 27.4% and 26.9% of 1,192 pregnant women at their first prenatal visit and the third trimester respectively. The proportions of overweight and obese women according to the Asian criteria-based pre-pregnancy BMI were higher than the international criteria-based BMI (22.4% and 10.1% vs 15.5% and 3.4% respectively). No significant difference between pre-pregnancy BMI and pregnancy BMI at the first prenatal visit was demonstrated (mean±standard deviation=21.8±4.0 vs 22.8±4.1). Underweight women had a significantly higher prevalence of maternal anaemia, LBW, and preterm birth compared to women with normal weight. Overweight and obese women at pre-pregnancy by the Asian criteria-based BMI had a lower prevalence of anaemia. The Hb levels did not change significantly over time. In addition to BMI, maternal age, parity, and late prenatal visit were independently associated with maternal anaemia, low birthweight, and preterm birth. Underweight pregnant women classified by international or Asian criteria-based BMI increased the risk of maternal anaemia, low birthweight, and preterm birth.

Epidemiology and the effect of treatment of soil-transmitted helminthiasis in pregnant women in southern Thailand.

This study aimed to assess the current situation of STH in pregnant women, explore factors associated with STH and evaluate the effects of its treatment. A cohort study was conducted in four southernmost provinces. All pregnant women who presented at their first prenatal care visit at participating hospitals were interviewed by trained health care providers and their stool specimens were examined for Ascaris lumbricoides, Trichuris trichiura and hookworm eggs. Women with STH were treated with 400 mg of albendazole after 14 weeks of gestation and treatment outcomes were evaluated three weeks after treatment. Of 1,063 pregnant women, STH were detected in 190 patients (17.9%) without seasonal variation for a combined infection of 21.6%. Ascaris, hookworm and Trichuris were detected in 10.3, 5.7 and 6.3%, respectively. The cure rate with a single dose was 92% but was 100% when repeated treatment was given as a three-day course. The risk of infection was higher in Muslim women, those with a family income < or = USD300/month, those bathing outside the house and those with no knowledge of STH. These results showed that southern Thailand is still an endemic area for STH and there appears to be no seasonal variation in incidence. Although the cure rate for treatment with albendazole was good, the low cure rate and egg reduction rate for trichuriasis needs to be considered.

Sexual functioning in postmenopausal women not taking hormone therapy in the Gynecological and Menopause Clinic, Songklanagarind Hospital measured by Female Sexual Function Index questionnaire.

OBJECTIVE: To study sexual functioning and attitudes towards sexuality in postmenopausal women. MATERIAL AND METHOD: A cross-sectional study was conducted among 219 healthy postmenopausal women with a uterus, aged 45-55 years, and not taking hormone therapy, who attended the gynecological and menopause clinic, Songklanagarind Hospital. The Female Sexual Function Index (FSFI) questionnaire was used as the instrument. RESULTS: The median age at enrollment and menopause age of women were 52 and 49, respectively. All the women had engaged in sexual intercourse. Sixty nine percent reported being sexually active once or twice in the previous four weeks, 27.9% three to four times and 3.1% more than four times. The mean total FSFI score was 20.4 while the proportion of women with female sexual dysfunction based on FSFI overall scores of 26.5 or less was 82.2%. Almost all the women displayed a positive attitude towards sexuality. Ninety six percent reported having sex in menopause as a natural normal part of life, 95% regarded having sex to make their partner happy whereas 77% regarded sex as a way to make themselves happy. CONCLUSION: Sexual dysfunction in postmenopausal women was rather high. However, they were still satisfied with their sexual relationship and had a positive attitude towards sexuality.

Effect of audit and feedback on the accuracy of diagnosis summary for gynecological conditions in Songklanagarind Hospital, Songkhla Province, Thailand.

OBJECTIVE: To assess the effect of an audit and feedback intervention on the accuracy of the diagnosis summary in the medical records of gynecologic patients in Songklanagarind Hospital. MATERIAL AND METHOD: An audit was conducted on the medical records of 468 gynecologic patients that visited between January 2006 and March 2007. They were divided into non-malignant and malignant conditions both before and after the planned intervention. RESULTS: The accuracy of the summary of the diagnosis for non-malignant conditions was better than malignant conditions. The correction to the principle diagnosis in medical records of patients with malignant conditions increased significantly from 16.7% to 42.9% (p < 0.001) after the audit and feedback. In medical records of non-malignant conditions, corrections to the principle diagnosis and any complications also significantly increased from 72.0% to 82.0% (p = 0.01) and 76.0% to 90.7% (p = 0.002), respectively. CONCLUSION: Audit and feedback is effective for improving the accuracy of the diagnosis summary for gynecological conditions but malignant conditions need more improvement strategies.

Attitudes, beliefs, and expectations of gynecological patients toward postoperative pain and its managementt.

OBJECTIVE: To examine the attitudes, beliefs, and expectations of gynecological patients regarding postoperative pain and management. MATERIAL AND METHOD: A prospective study performed in 112 patients undergoing major gynecological surgery, using a preoperative questionnaire regarding expectations toward postoperative pain and management and a postoperative questionnaire regarding actual pain experience, attitudes, and beliefs about pain and management. RESULTS: The majority expected (92%) and experienced (89%) postoperative pain at moderate to very severe levels. The median visual analog scales (VAS) of expected and maximum experienced pain were 6.4 and 6 6, respectively. Ninety-eight percent reported at least moderate pain relief from the analgesics administered. Ninety-two percent were satisfied with their pain management. A significant number held misconceptions about postoperative pain and its management. CONCLUSION: Patients should be preoperatively advised regarding postoperative pain and management. Misunderstandings should be corrected to improve the quality and adequacy of postoperative pain management.

Diagnosis summary and coding of obstetric conditions in the government hospitals in Pattalung Province, the effects of audit and feedback.

OBJECTIVE: Assess the effects of audit and feedback through a seminar on the obstetric summary and coding system with respect to the International Classification of Diseases, Tenth Revision (ICD-10) and to determine factors associated with the error of summary and coding audit. MATERIAL AND METHOD: The medical records of 1,629 and 1,337 women with obstetric conditions admitted to one provincial and nine district hospitals in Pattalung Province, Southern Thailand, were evaluated before and after a seminar, respectively. RESULT: The error of coding audit among cases with normal conditions and those with abnormal conditions after the seminar was reduced significantly from 40.7 to 13.0% and from 81.8% to 61.2%, respectively (p < 0.001). A seminar was a significant factor to reduce the errors of summary and coding. In contrast, the incorrect diagnosis summary, abnormal obstetric conditions and the district hospital were significantly associated with the increase of the coding errors. CONCLUSION: The audit and feedback was moderately effective on summary and coding audit but the clinical significance of error reduction in abnormal obstetric conditions was marginal, thus intensive intervention, evaluation, and monitoring are necessary.

Antenatal care providers' practices and opinions on the services of antenatal syphilis screening in Ulaanbaatar, Mongolia.

The objectives of this study were to review antenatal syphilis screening and to assess antenatal care providers' practices and opinions in Ulaanbaatar, Mongolia. A cross-sectional study on antenatal syphilis screening was conducted. The study settings were all 16 antenatal care clinics, and a random selection of 30 family units from six districts in Ulaanbaatar, Mongolia. Interviews were conducted with 150 antenatal care providers and 27 antenatal care heads/leaders. Antenatal syphilis screening in Ulaanbaatar was complex. Most pregnant women had antenatal care at family units or antenatal clinics, but syphilis blood testing could be performed only in some district general hospitals. Syphilis positive-screening cases were referred to the venereologists for confirmation of results, appropriate treatment, contact tracing, and follow-up. The providers agreed with the need for syphilis screening in pregnant women but identified as constraints the limited time for performing the screening due to late antenatal visit, women's lack of knowledge, poverty, and geographic barriers. The practice of providers varied, and the opinion on a one-stop service was positive. The main conclusions concerning the failure of universal antenatal syphilis screening were limited accessibility and feasibility of the service, and the ignorance of both women and providers on the importance of screening. It was agreed that decentralization of antenatal syphilis screening would improve the system.

Development of Postpartum Depression Screening Scale (PDSS): a Thai version for screening postpartum depression.

To validate a Postpartum Depression Screening Scale (PDSS) for screening postpartum depressive disorder in Songkhla Thai population, a screening test was conducted. A Thai version of the PDSS was developed using back translation and pre-tested on a prospective cohort of 400 postpartum women at 6-8 weeks from November 2003 to September 2004 in a university hospital, Southern Thailand. The diagnosis of postpartum depression was determined using DSM-IV diagnostic criteria for minor and major depressive disorders. The alpha reliability for the total PDSS was 0.9. The recommended cut-off scores of 51for screening major or minor depressive disorders and of 90 for screening major depressive disorder Area under the receiver operating characteristics (ROC) curve was 0.8 for major and minor depressive disorders and 0.9 for major depressive disorder In conclusion, this is a useful and beneficial instrument as there is no other Thai version validated instrument for postpartum depression.

Changing physician's practice on antenatal corticosteroids in preterm birth.

This study aimed to monitor the change of practice in antenatal corticosteroids use in preterm birth, assess how physicians would prescribe and identify factors associated with such a prescription. Medical records were reviewed quantitatively and current attending physicians were interviewed qualitatively. Multiple logistic regression with random effect model was used for analysis. The results revealed that antenatal corticosteroid use in preterm births initially doubled after the evidence became available and tripled after the evidence was disseminated. The antenatal corticosteroid use among women having a gestational age less than 34 weeks increased significantly from 41% to 71% and 73%, respectively (p < 0.01). A gestational age of 34 weeks or more or a higher cervical dilatation at admission reduced the use of corticosteroids significantly. In conclusion, physician's practice changed based on the evidence. The education for the early recognition of labor and guidelines on the use of antenatal corticosteroids should be implemented.

Positive predictive value of clinical diagnosis of endometriosis.

OBJECTIVE: To determine the positive predictive value of the combined symptoms of severe dysmenorrhea with the sign of tenderness and/or nodularity of the cul-de-sac and/or uterosacral ligament(s) in diagnosing endometriosis clinically. MATERIAL AND METHOD: In this prospective study, 116 patients with severe dysmenorrhea, after excluding urinary and gastrointestinal disease, underwent pelvic examination by the same investigator. Women having adnexal mass on pelvic examination were excluded Tenderness, and also nodularity, of the cul-de-sac, right and left uterosacral ligament were recorded separately. The laparoscopist did not know the findings of the pelvic examination. The diagnosis of endometriosis was made visually when lesions were typical and all other lesions were biopsied. RESULTS: The prevalence of endometriosis was 78.4%. Tenderness, nodularity, tenderness and nodularity, and also tenderness or nodularity of cul-de-sac and/or uterosacral ligament(s) were all statistically significantly associated with the presence of endometriosis (P = .048, .005, .004, and .004 respectively). The positive predictive values were 85.5%, 94.0%, 94.6% and 86.7%, respectively. CONCLUSION: The positive predictive value of severe dysmenorrhea with nodularity of the cul-de-sac and/or uterosacral ligament(s) was 94.0%.