The effects of transdermal contraception on lipid profiles, carbohydrate metabolism and coagulogram in Thai women.

OBJECTIVE: To evaluate the effects of the contraceptive patch on lipid profiles, carbohydrate metabolism and coagulogram in Thai women. METHODS: Fifty healthy Thai women were assigned to use contraceptive patches. Blood chemistries test including liver function test, lipid profiles and coagulogram were evaluated at baseline, cycles 3 and 6. RESULTS: Total cholesterol, triglyceride and HDL were significantly increased, whereas LDL was slightly decreased. The ratio of total cholesterol/HDL and LDL/HDL significantly decreased when applying the patch. After discontinued use of contraceptive patch, the women whose blood tests present hypercholesterol during patch use showed a continuous decrease in blood results of total cholesterol level over 3 months. Moreover, mean fasting glucose, SGOT, SGPT and alkaline phosphate were decreased. No woman suffering from VTE in this study. CONCLUSIONS: The use of contraceptive patch does not exert a negative effect on carbohydrate metabolism, lipid profile, liver function test and blood coagulogram. However, further studies are required to elucidate the effect of the contraceptive on the patch user in long term.

Two regimens of misoprostol for treatment of incomplete abortion.

OBJECTIVES: Misoprostol shows promise for treatment of incomplete abortion. We evaluated 2 simple misoprostol regimens to estimate whether they were effective in treating incomplete abortion. METHODS: A total of 169 women was randomly assigned to either a single or double dose of 600 microg misoprostol. The women, who would have received a surgical evacuation of the uterus for incomplete abortion, were patients at 2 hospitals in Bangkok, Thailand. The 2 groups of women were compared for success of treatment (no need for surgical evacuation), side effects, and acceptability. RESULTS: Sixty-six percent of women in the single-dose group and 70% of women in the double-dose group had complete abortions with misoprostol. More than 90% of women in the single- and double-dose groups reported that the side effects were tolerable; frequency of side effects was similar between the 2 groups. Women found the treatment acceptable. Approximately 90% of women in both groups would recommend the treatment to a friend. Acceptability and efficacy were different at the 2 participating clinics. CONCLUSION: Misoprostol is an effective treatment for incomplete abortion. Simple regimens may be as effective as more complicated ones and a single dose of 600 microg should be further evaluated in larger trials.

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.

Prevalence of bacterial vaginosis among intrauterine device users in Thai women attending Family Planning Clinic, Siriraj Hospital.

OBJECTIVES: To determine the prevalence of BV among IUD users attending at Family Planning Clinic, Siriraj Hospital In addition, associated risk factors for BV were also explored. MATERIALS AND METHOD: This study was carried out from August through November 2003 at the Family Planning Clinic, Department of Obstetrics and Gynecology, Siriraj Hospital. A total of 300 IUD users were enrolled Bacterial vaginosis is defined by fulfillment of at least three of four findings according to Amsel's criteria. Prevalence and risk factors were determined. RESULTS: The overall prevalence of bacterial vaginosis according to the Amsel's criteria was 20.3% (95% CI 15.7-24.9%). The most common complaints were abnormal vaginal discharge (41.0%) and pelvic pain (41.0%), whereas 32% had no symptoms. The only significant factor associated with BV was duration of IUD use. Women with BV were more likely to have used IUD for a longer period than women without BV especially more than 15 years. (19.7% and 9.2% respectively, P = 0.017). CONCLUSIONS: Our findings showed rate of BV was prevalent among Thai women with IUD insertion. The only risk factor was long time duration of IUD insertion that health care providers should aware of the infection among these women. The influence of IUD use on the occurrence of vaginal flora changes and BV remained a controversial issue. Further study should be conducted to examine the issue in more detail, both among IUD users and other groups of women as well.

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.