Randomized controlled trial of mefenamic acid vs paracervical block for relief of pain for outpatient uterine curettage.

OBJECTIVE: To compare the efficacy of mefenamic acid vs paracervical block for pain relief during and after fractional curettage. MATERIAL AND METHOD: Between January 1 and July 31, 2002, the authors enrolled 87 patients with abnormal uterine bleeding, who requested fractional curettage at the Outpatient Gynecologic Clinic, Srinagarind Hospital, Khon Kaen University. A simple randomization procedure was used to distribute the patients into a control group comprising 44 patients given a paracervical block and a treatment group comprising 43 patients given mefenamic acid (500 mg) 2 hours before starting the procedure. OUTCOME MEASURES: Pain was scored using a visual analogue scale (VAS range, 0 to 10). RESULTS: The median pain scores of the treatment types during endocervical, endometrial, immediately after, and 30 minutes after, fractional curettage were 2.5 vs 3.0 (p = 0.42), 6.5 vs 7.5 (p = 0.19), 4.0 vs 3.5 (p = 0.20) and 1.5 vs 1.0 (p = 0.17), respectively. The rate of complications was 6.8% (3 in 44) in the paracervical lignocaine injection group. CONCLUSION: The efficacy of pain relief for fractional curettage using oral mefenamic acid (500 mg) two hours before the procedure was not statistically different from the paracervical block, but there were fewer side effects. Mefenamic acid should be considered an alternate pain relief during fractional curettage.

Rubella antibodies in normal pregnant women at Srinagarind Hospital, Khon Kaen, Thailand.

BACKGROUND: Rubella infection in pregnant women, especially in the first trimester, can result in serious neonatal morbidity and mortality. To stem a series of rubella outbreaks in Thailand (in 1967, 1974 and 1978), the Ministry of Public Health launched the National Expanded Program on Immunization (EPI) in 1986. The Mump-Measles and Rubella (MMR) vaccine was given to all graduated primary school girls. OBJECTIVE: To determine the immune status to rubella in healthy pregnant women visiting the Antenatal Care Clinic (ANC) at Srinagarind University Hospital. DESIGN: Descriptive study. SETTING: Antenatal Care Clinic at Srinagarind Hospital. MATERIAL AND METHOD: Between January15 and May 17, 2004, 150 normal pregnant women (between 15 and 40 years of age) were included. After a complete history was taken and a physical examination performed, informed consent was signed; serum was collected for testing for rubella antibodies at the same time as routine prenatal check up in normal pregnant women including CBC, red blood cell indices, Rh blood group, VDRL, HBs Ag, andAntiHIV The ELISA technique was used to detect maternal rubella IgG antibodies. OUTCOME MEASURE: Rubella IgG antibody level. RESULTS: Three-quarters (112/150) of the pregnant women had immunity to rubella, 7% (11 cases) were indeterminate and 18% (27 cases) had no immunity. CONCLUSION: The cost of screening for rubella IgG antibodies was 150 baht using the HAI technique and 350 baht/case using the ELISA technique. The latter is more available but twice as expensive, so repeating rubella immunization for all high school females would be more cost effective and provide more certain protection.

Effectiveness of vaginal douching on febrile and infectious morbidities after total abdominal hysterectomy: a multicenter randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of vaginal douching with 1 per cent povidone-iodine in reducing febrile and infectious morbidities after total abdominal hysterectomy (TAH). METHOD: The authors conducted a randomized controlled trial in 300 patients undergoing elective TAH in three hospitals in Northeast Thailand: a university, a regional and a general hospital. The patients were randomly allocated to the intervention or control groups. Patients in the intervention group received pre-operative vaginal douching with 1 per cent povidone-iodine while patients in the control group did not. External evaluators not apprised of the intervention assessed febrile and infectious morbidities. RESULTS: 300 patients were enrolled in the study. The incidences of febrile morbidity in patients with and without pre-operative vaginal douching were 25 and 35 per cent, respectively, though not statistically significant (risk difference -9.6%, 95% CI -19.9%, 0.8%, adjusted odds ratio 0.6, 95% CI 0.3%, 1.0%). A statistically significant difference in infectious morbidity was found between the groups (8 vs 19%, risk difference -10.0%, 95% CI -17.8%, -2.2%, adjusted odds ratio 0.4, 95% CI 0.2%, 0.9%). CONCLUSION: Pre-operative vaginal douching with 1 per cent povidone-iodine significantly reduces infectious morbidities after TAH.