Possible Role of Court-Type Thai Traditional Massage During Parturition: a Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Court-type Thai traditional Massage (c-TTM) applied during intrapartum may have some benefit other than pain relief. This study aimed to evaluate the effect of c-TTM during the first and second stage of labor, as well as pain alleviation in the first stage. METHODS: This was a randomized controlled trial study. Eligible participants were singleton pregnant mothers with cervical dilation between 3-5 cm and no medical complications. Both trial groups received the same routine antepartum care except for 1 hour additional c-TTM given to the experimental group when they were in the active phase of labor. The pain score was taken from the participants at the time before labor pains started, at the time of active labor, 1, 2, 3, and 4 hours after the intervention. Pain was recorded by the researcher using a visual analog scale. The primary outcome during the first and second stages of labor was compared between groups. Pain relief during the first stage of labor and analgesic drugs used were compared as a secondary outcome. This trial is registered under the identification number TCTR20171115003. RESULTS: Fifty-nine participants were enrolled and randomly assigned with 1:1 allocation to groups. The duration of first and second stage labor was significantly shorter in the experimental c-TTM than in the conventional control group (mean ± SD: 198.37 ± 62.80 minutes: 268.52 ± 137.81 minutes, p value =.02 and 17.54 ± 9.49 minutes: 23.35 ± 15.01 minutes, p value =.03, respectively). There was no difference of pain score between the groups. CONCLUSION: One hour of c-TTM can significantly decrease the duration of the first and second stages of labor. The pain score recorded is not statistically different between the groups.

Epithelial Ovarian Cancer with Endometriosis is not Associated with Menopausal Status: a Co-Association Study at Prapokklao Hospital

Objective: To determine any association between the menopausal status and epithelial ovarian cancer coexisting with endometriosis (EOC-E). In addition, the prevalence and possible risk factors were assessed. Methods: Medical records of 172 women with epithelial ovarian cancer between January 2011 and December 2016 at Prapokklao Hospital were reviewed and divided into two groups: EOC-E defined as the case group and without endometriosis (EOC-NE) as the control group. Results: The proportion of EOC-E was 18% (31/172). There were no significant differences between the two groups in baseline clinical characteristics and presenting symptoms except for history of smoking and abnormal uterine bleeding found more often in EOC-E cases. Most EOC-E were of clear cell histological type followed by endometrioid and serous types (35.5, 25.8 and 22.6 %; respectively). The clear cell type was 8 times more likely in the EOC-E than in the EOC-NE (OR 8.0, 95% CI 2.97-21.89, p-value <0.001) group. Nulliparity and smoking increased risk of EOC-E 2 and 7 times, respectively (OR 2.3, 95%CI 1.03-5.00, p-value 0.041 and OR 7.4, 95%CI 1.18-46.63, p-value 0.032). Conclusions: EOC-E are relatively common. Abnormal uterine bleeding is the only significant presenting symptom in the EOC-E as compared with the EOC-NE group. Endometriosis was a predictive factor for clear cell and endometrioid type I EOC. Menopausal status and age were not associated with a presentation of endometriosis with EOC

Does Endometriosis Hinder Successful Ovarian Debulking Surgery?

Background: Endometriosis has a significant effect on many aspects of women's lives, also increasing the risk of ovarian cancer. Although endometriosis is considered as a benign condition, it sometimes behaves like cancer. Methods: All medical records of epithelial ovarian cancer patients during January 2011 to December 2016 were reviewed. Recurrent cases were excluded. Data collected included age at diagnosis, parity, marital status, familial history of cancer, menopausal status, weight, height, smoking histroy, contraception, CA 125 level, result of surgery and pathological report. Results: One hundred and seventy-two medical records of patients with epithelial ovarian cancer (EOC) were included. Average age at diagnosis was 52.3 years. Epithelial ovarian cancer coexisting with endometriosis (EAOC) was found in nearly one-fifth of cases. Nullipara and smoking were associated with 2.3 and 8.3 fold higher risk of EAOC development (aOR 2.349, 95%CI 1.012-5.451; aOR 8.26, 95%CI 1.234-55.278; respectively). Age, familial history of cancer and coexistence with endometriosis were factors related to surgical outcome. More of EAOC group had optimal surgery compared to the non-EAOC group (61.3% and 41.8%) with statistical significance. Conclusion: Younger age, familial history of cancer and coexistence of endometriosis were factors related to optimal surgery. Success of optimal surgery is greater in EAOC than in non-EAOC patients. Coexistence of endometriosis does not hinder successful ovarian cancer debulking surgery.

Risk Factors for Incomplete Excision after Loop Electrosurgical Excision Procedure (LEEP) in Abnormal Cervical Cytology

Objective: To investigate the risk factors related to incomplete excision after loop electrosurgical excision procedure (LEEP) in abnormal cervical cytology. Methods: This retrospective cohort study was performed during September 2010 to February 2017. The study population was patients with abnormal cervical cytology who treated by LEEP at Prapokklao hospital, Chanthaburi. From the medical records, data were collected include age, menopausal status, parity, body mass index, HIV infection, history of smoking, cervical cytology and characteristics of LEEP histopathology such as number of specimen, size and glandular involvement. Risk factors were investigated using multivariable risk ratio from risk ratio regression. Result: Five hundred cases of LEEP were done during this period and 322 cases were analyzed. Complete excision of the LEEP specimens found nearly half of the cases (46.9%). Multiple pieces of specimen was the risk factor for incomplete excision of LEEP (adjusted risk ratio [aRR] = 1.29, 95% confidence interval [CI] = 1.06-1.58; P = 0.013). Conclusion: The number of specimen from LEEP more than one piece was the risk factor for incomplete excision. Alternative methods such as cold knife conization (CKC), needle excision of the transformation zone (NETZ) or contoured loop excision of the transformation zone (C-LETZ) should be justified when all lesions could not be operated by single sweep.

High Rate of Gangrenous Adnexal Torsion: Dilemma of a Missing Silent Cancer

Background: Adnexal torsion results in ischemia of structures distal to twisted pedicle and acute onset of pain is responsible for about 3% of all gynecologic emergencies. Ovarian torsion classically occurs in a pathological enlarged ovary, as with cancer, but diagnosis remains a challenge. Objective: Our purpose was to evaluate clinical risk factors predictive of torsion with gangrenous adnexa. Material and methods: A retrospective descriptive study and chart review of surgically proven ovarian torsion/adnexal torsion cases at the Obstetrics and Gynecology Department of Prapokklao Hospital, Chanthaburi, Thailand between January 2011 and December 2015 was conducted. Result: Seventy-eight cases were identified. Mean age at presentation was 35.5 years. The average maximum diameter of the ovarian tumors was 10.8 cm. The percentage of gangrenous ovarian cysts in this study was 46.2 (36/78). The precision to determine the pathological site by patient, physician and ultrasonography was 8.5, 24.2 and 83.3 percent, respectively with statistically significant variation. Conclusion: Ovarian/adnexal torsion remains a challenge condition especially in young nulliparous women. Sophisticated investigation does not guarantee ovary preservation. Combining clinical acumen, appropriate tests and detailed consideration may be the best practice at the present time.

Prevalence and Risk Assessment of Cervical Cancer Screening by Papanicolaou Smear and Visual Inspection with Acetic Acid for Pregnant Women at a Thai Provincial Hospital.

BACKGROUND: Cervical cancer is the second most common in Thailand, but the mortality rate may be rising yearly. It is a cancer that can be prevented by early screening for precancerous lesions, several methods being available. OBJECTIVE: To identify the prevalence of abnormal Papanicolaou (Pap) smears and lesions with visual inspection with acetic acid (VIA) in pregnant women and assess risk factors for this group. MATERIALS AND METHODS: This prospective study was performed at Prapokklao Hospital, Thailand during April-July 2016. All pregnant women of gestational age between 12-36 weeks who attended an antenatal clinic were recruited. All participants were screened for cervical cancer by Pap smear and VIA. If results of one or both were abnormal, colposcopic examination was evaluated by gynecologic oncologist. RESULTS: A total of 414 pregnant women were recruited. Prevalence of abnormal Pap smear and VIA were 6.0 and 6.7 percent, respectively. The most common abnormal Pap smear was low grade intraepithelial lesion (LSIL, 44%). Factors associated with abnormal Pap smear in pregnant women were low BMI, multiple partners and being a government officer. In pregnancy, Pap smear had higher sensitivity and specificity than VIA for detection of precancerous cervical lesion. Patients with young coitarche or more than 25 years of active sexual activity were high risk groups. CONCLUSIONS: Prevalence of abnormal Pap smear and VIA in pregnant women was 6.0 and 6.7 percent, respectively. Factors associated with abnormal Pap smear were coitarche, years of sexual activity, low BMI, multiple partners and being a government officer.

Colposcopy Requirement of Papanicolaou Smear after Atypical Squamous Cells of Undetermined Significance (ASC-US) by Follow-up Protocol in an Urban Gynaecology Clinic, a Retrospective Study in Thailand.

BACKGROUND: ASC-US cases are managed according to the current American Society for Colposcopy and Cervical Pathology (ASCCP) guideline in which a human papillomavirus (HPV) test and repeat Pap smear are performed in the next 1 year. Colposcopy in cases of positive high risk HPV and persistent ASC-US or more in subsequent Pap smear is recommended. The HPV test is more expensive and still not currently a routine practice in Thailand. OBJECTIVE: To identify the risk factors of persisted abnormal Pap smear and the colposcopic requirement rate in women with ASC-US. MATERIALS AND METHODS: During 2008-2013, this study was conducted in Prapokklao Hospital, Chanthaburi, Thailand. Participants were women who attended gynaecology clinic for cervical cancer screening. Women who had cytological reports with ASC-US were recruited. During the study period, 503 cases were enrolled. Colposcopic requirement was defined as those who were detected with an ASC-US or more in subsequent Pap smears up to 1 year follow-up. RESULTS: The colposcopic referral rate was 23.2 (85/365) percent at 12 months. Prevalence of cervical intraepithelial neoplasia (CIN) 2/3 was 3.3 (12/365) percent. Loss follow-up rate of subsequent Pap smear and colposcopic appointment were 27.4 (138/503) and 48.2 (41/85) percent, respectively. There was no invasive cancer. High risk factors for persisted abnormal Pap smears in subsequent test were premenopausal status, HIV infected patients and non-oral contraceptive pills (COC) users. CONCLUSIONS: Referral rate for colposcopy in women with ASC-US reports was rather high. Loss to follow-up rate was the major limitation. Immediate colposcopy should be offered for women who had high risk for silent CIN.

Anal papanicolaou smear in women with abnormal cytology: a thai hospital experience.

BACKGROUND: Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women. MATERIALS AND METHODS: This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups. RESULTS: HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively. CONCLUSIONS: Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.

ASSOCIATION BETWEEN MATERNAL BODY MASS INDEX AND WEIGHT GAIN WITH LOW BIRTH WEIGHT IN EASTERN THAILAND.

We conducted a retrospective study to determine the association between maternal body mass index and pregnancy weight gain with low birth weight newborns (LBWN) at Phrapokklao Hospital in eastern Thailand. We evaluated the files of 2,012 women who delivered at the hospital. Data obtained from the charts were parity, maternal age, body mass index (BMI), prepregnancy weight, weight gained during pregnancy, gestational age, hematocrit level, referral status, place of residence, fetal presentation, completion of antenatal care visits and maternal HIV infection. Sixty-five point two percent of subjects were aged 20-34 years old. Fifty-seven percent of subjects had a normal BMI and 13.2% were anemic. Thirty- seven point five percent, 32.9% and 29.6% gained too little, the correct amount and too much weight during pregnancy, respectively. Primiparity, too little weight gain and gestational age less than 37 weeks at delivery were all significantly associated with LBWN. Preterm babies were 25 times more likely to have a low birth weight than term infants (adjusted OR = 24.995; 95% CI: 16.824-37.133, p < 0.001). When maternal weight gain of any BMI group was inadequate, the subject had a 3.4 times greater risk (adjusted OR = 3.357; 95% CI: 22.114-5.332, p < 0.001) of having a LBWN. Primiparous women had a 1.7 times (adjusted OR=1.720; 95% CI: 1.182-2.503, p-0.005) greater risk of having a LBWN. The results from this study may be useful to plan maternal health programs for eastern Thailand.

Prevalence of abnormal anal cytology in HIV-infected women: a hospital-based study.

BACKGROUND: To study the prevalence of abnormal anal cytology by Papanicolaou (Pap) technique in HIV- infected women who attended a HIV clinic at Prapokklao Hospital, Chanthaburi, Thailand. MATERIALS AND METHODS: HIV-infected women who attended a HIV clinic at Prapokklao Hospital from March 2013 to February 2014 were recruited for anal Pap smears. Participants who had abnormal results of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal anal cytology. RESULTS: A total of 590 anal Pap smears were performed at HIV clinic of Prapokklao Hospital during the study period. There were only 13 patients who had abnormal Pap tests, which were: 11 ASC-US and 2 HSIL (high grade squamous intraepithelial lesion). The prevalence of abnormal anal Pap smears in HIV-infected women who attended HIV clinic at Prapokklao Hospital was 2.2 percent. Percentage of high risk HPV in patients who had abnormal Pap test was 88.9 (8/9). CONCLUSIONS: The prevalence of abnormal anal Papanicolaou smears in HIV-infected women who attended the HIV clinic at Prapokklao hospital was quite low in comparison to the earlier literature.