Prenatal prevention for severe thalassemia disease at Srinagarind Hospital.

OBJECTIVE: To evaluate the results and cost-effectiveness of prenatal prevention measurement in severe thalassemia diseases at Srinagarind Hospital. STUDY DESIGN: Descriptive study. SETTING: Antenatal care (ANC) Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. SUBJECTS: 1,498 thalassemic screened pregnant women first presenting at ANC Clinic at gestational age less than 17 weeks. MATERIAL AND METHOD: Medical records of thalassemic screened pregnant women between February 2002 and February 2005 were analyzed. Those with a value of mean corpuscular volume (MCV) less than 80 fl, or positive dichlorophenol indophenol precipitation test (KKU-DCIP Clear Reagent Kit) underwent hemoglobin (Hb) typing by high performance liquid chromatography (HPLC) together with thalassemia investigation (complete blood count, MCV and Hb typing) of their husbands and to identify couples at risk of 3 severe thalassemia diseases; Hb Bart's hydrops fetalis, homozygous, -thalassemia and, -thalassemia/ Hb E disease. Then they were advised to undergo DNA analysis and, if they had fetal risk, appropriate prenatal diagnosis was offered. MAIN OUTCOME MEASURE: Number of affected fetuses detected by prenatal diagnosis. RESULTS: Nine hundred and ninety six pregnant women (66.49%) were positive on screening. Of these, 642 (64.46%) had thalassemia investigation done with their spouses. There were 19 couples at risk (1.27% of total screened pregnant women) for having fetal severe thalassemia disease from initial laboratory results. Most of them were, -thalassemia/ Hb E diseases. We found only 10 pregnant women (52.63%) that had undergone prenatal diagnosis. The consequent results were two affected fetuses (20%), one was Hb Bart's hydrops fetalis, and the other was, o-thalassemia/ Hb E disease. In these cases, their parents decided to discontinue the pregnancy. Our prevention program could save 1.14 million bahts for the cost of treatment in two prevented severe thalassemia cases. CONCLUSION: The prenatal prevention program of severe thalassemia disease at Srinagarind Hospital can effectively detect affected fetuses and reduce severe thalassemia disease, which is a major health problem in Thailand.

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.

Pseudo-Meigs' syndrome secondary to subserous myoma uteri: a case report.

A 45 year-old Thai woman, gravida 5, para 5 presented with a huge pelvic mass as well as ascites and right pleural effusion. Right thoracocentesis was performed pre-operatively and malignant cells could not be detected on the cytological examination of the pleural fluid. Surgical exploration revealed a large pedunculated subserous leiomyoma of the uterus without malignant transformation. Total abdominal hysterectomy with bilateral salpingooophorectomy and appendectomy were performed. Both ascites and pleural effusion resolved post-operatively and did not recur during the 12-month follow-up. This case demonstrated the extremely rare case of pseudo-Meigs' syndrome caused by a subserous uterine leiomyoma.

Comparison of the accuracy of ultrasonic fetal weight estimation by using the various equations.

OBJECTIVE: To compare the accuracy of ultrasonic fetal weight estimation using the Hadlock's, Shepard's, Tongsong's and Hansmann's equations. MATERIAL AND METHOD: The analytical-cross sectional study was conducted on 102 pregnant women who were admitted for delivery in the Labor Room at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between January 1, 1999 and June 30, 1999. The fetal parameters, including biparietal diameter, abdominal circumference, transverse trunk diameter and femur length, were measured by ultrasound. The estimated fetal weight was calculated by those four equations. The mean absolute error was calculated from the absolute of the difference between the estimated fetal weight and the actual birth weight. RESULTS: The mean absolute error and standard deviation of the estimated fetal weight by the Hadlock's, Shepard's, Tongsong's and Hansmann's equations were 8.09 +/- 4.18, 7.94 +/- 4.63, 7.77 +/- 3.70 and 7.83 +/- 4.35 per cent respectively and there were no statistically significant differences at 95 per cent confidence interval (p>0.05). CONCLUSION: Apart from having comparable accuracy in the estimation of fetal weight to those of Hadlock, Shepard and Tongsong, Hansmann's equation employed at Srinagarind Hospital was more convenient to use than the others.

Knowledge-attitude-practice of sexual intercourse of post-menopausal women using hormone replacement therapy.

OBJECTIVE: To study knowledge, attitude, practice and concern related to sexual intercourse of post-menopausal women using hormone replacement therapy. MATERIAL AND METHOD: One hundred and thirty subjects were included in the study from the 1st of May 2000 to the 31st of August 2000 at the Menopause Clinic, Srinagarind Hospital, Khon Kaen. All subjects were interviewed by a researcher with structured questionnaires. RESULTS: Sixty seven per cent of the subjects had an acceptable level of knowledge, whereas, 87.7 per cent thought that they could have sexual intercourse similar to what they had in their pre-menopausal period. It was found that 85.4 per cent and 88.5 per cent of the subjects had either less or absent sexual desire and less sexual activity, respectively. In terms of their concern, 73.9 per cent of the subjects were not worried about sexual intercourse. CONCLUSION: The majority of the post-menopausal women using hormone replacement therapy had a good level of knowledge and attitude concerning sexual intercourse. Although most of them had decreased sexual desire and activity, this sexual activity did not cause them concern.