Cervical cancer in pregnancy.

Carcinoma of the uterine cervix is one of the most common malignant neoplasms among women and remains the leading female malignancy in Thai women. Cervical cancer diagnosed during pregnancy remains a therapeutic challenge for physicians. Pregnant women should have cervical cytology screening at their first prenatal visit. In cases of cytological abnormality, colposcopy is indicated. Cervical conization is used for the diagnostic role only. The management of invasive cancer depends on the gestational age at diagnosis, stage of disease, patient’s desire of pregnancy, ethics and religious beliefs including family and decision making by multidisciplinary teams.

Appropriate interval for repeat excision in women undergoing prior loop electrosurgical excision procedure for cervical neoplasia.

The objective of the present study was to evaluate the impact of intervals on complications and pathological examination in women undergoing a repeat loop electrosurgical excision procedure (LEEP) for cervical neoplasia. During October 2004 and January 2007, 78 women who had undergone repeat LEEP at Chiang Mai University Hospital, were prospectively evaluated. The mean age was 47.5 years (range; 27-69 years). The mean duration of uncomplicated vaginal bleeding was 4.4 days (range; 1-20 days). The occurrence of persistent vaginal bleeding was noted in 9 women. Among 78 women, 2 (2.56%) and 7 (8.97%) experienced intraoperative and postoperative hemorrhage, respectively. Six (7.69%) had postoperative infection. These complications were not significantly different from those observed in women undergoing first LEEP in the same period (P=0.56). There was no significant difference in the incidence of perioperative complications and the incidence of non-evaluable cone margins among women who undergoing repeat LEEP within 4-6 weeks, between 6-8 weeks, and more than 8 weeks after first LEEP. In conclusion, repeat LEEP could be safely performed 4-12 weeks after the first procedure without any impact on pathological specimen examination.

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.