Outcome of cesarean scar pregnancy treated with local methotrexate injection.

Local injection of methotrexate (MTX) has been widely used for caesarean scar pregnancy (CSP), but the optimal candidate remains undetermined. The aim of this study is to determine the risk factors associated with treatment failure among patients who received a single dose of local MTX. This is a retrospective cohort study. Clinical information was compared between treatment success vs. failure groups. Risk factors related to treatment failure were also investigated with multivariate analysis. Of 47 patients diagnosed with CSP, 30 received local MTX injection. The initial serum ß- human chorionic gonadotropin (hCG) level in the failure group was significantly higher than in the success group (p = 0.048), and the cut-off value was 47,000 mIU/ml. The rate of type 2 position of the gestational sac in the failure group was significantly higher than in the treatment success group (p = 0.031). A high initial serum ß-hCG level (≥ 47,000 mIU/ml) was identified as the independent risk factor for treatment failure (adjusted odds ratio = 21.9; 95% confidence interval = 1.3-383.1). Type 2 gestational sac position and a higher level of ß-hCG at diagnosis appear to be associated with poor outcomes after local injection of a single dose of MTX.

Socioeconomic inequalities in post-natal health checks for the newborn in Vietnam.

BACKGROUND: The newborn and child death associated with inadequate post-natal health checks continued to be a significant issue across the world. This study aimed to assess the socioeconomic inequalities in post-natal health checks for the newborn in Vietnam in 2014. METHODS: We used the secondary data from the Multiple Indicator Cluster Survey in 2014. We included women aged 15-49 years who had a live birth within two years of the time of the interview. We estimated the concentration index to measure socioeconomic inequalities post-natal health checks for the newborn. We conducted multiple logistic regression analysis to identify factors associated with post-natal health checks for the newborn. RESULTS: Overall, the proportion of post-natal health checks for the newborn in Vietnam was 89.1%. The concentration index of post-natal health checks for the newborn was positive at 0.06. It indicated that the newborns in the rich households were more likely to get post-natal health checks as compared to in the poor households. The common factors significantly associated with the higher percentage of post-natal health checks for the newborn were women belonging to the Kinh and Hoa ethnic, higher education, and wealthier groups. CONCLUSION: Socioeconomic inequalities in post-natal health checks for the newborn in Vietnam were not strong, but it still existed. Thus, we recommended that policy efforts to increase access to post-natal health services for poor women. In addition, there is a need to improve access to post-natal health services for women belonging to minor ethnic group and low education.

Standard and optimal cut-off values of serum ca-125, HE4 and ROMA in preoperative prediction of ovarian cancer in Vietnam.

OBJECTIVES: To evaluate the validity of serum CA-125, Human Epididymis protein 4 (HE4) and Risk of Malignancy Algorithm (ROMA) at standard and optimal cut-offs, in preoperative prediction of epithelial ovarian carcinoma (EOC) in Vietnam. SUBJECTS AND METHODS: Cross-sectional, descriptive study on 277 patients with ovarian masses hospitalized at the OBGYN Departments, Hue University Hospital and Hue Central Hospital, Vietnam, from 01/2016 to 11/2017. All patients had measurements of serum CA-125 by Elecsys 2010 system and HE4 by immunoassay ARCHITECT® HE4 kits; ROMA calculated, and preoperative malignancy risk estimated. Matching these values to postoperative histopathology resulted in the preoperative prediction values. RESULTS: There were 30 (10.8%) cases of EOC. Median values of CA 125, HE4, and ROMA of EOC and benign tumors were 214.20 U/ml, 18.91 U/ml; 90.00 pmol/l, 39.80 pmol/l; and 55.20%, 4.80%, respectively. The sensitivities and specificity of CA125, HE4, and ROMA to distinguish between malignant and benign tumors at standard cut-offs were 83.3% and 78.5%; 50% and 98.38%; 80.0% and 84,6%, and those at optimal cut-offs were 83.3% and 86.6%; 80.0% and 91.5%, 86.7% and 88.7%, respectively. AUCs of CA-125, HE4, and ROMA were 0.872, 0.894, 0.912; and those for the post-menopausal group were 0.900, 0.894 and 0.924, respectively. CONCLUSION: Serum CA 125 and HE4 levels and ROMA have good validity in the diagnosis of EOC, of which ROMA gives the best result. The ROMA index should be applied in clinical practice to help in the assessment and management of patients with suspected ovarian cancer.

The value of visual inspection with acetic acid and Pap smear in cervical cancer screening program in low resource settings - A population-based study.

This study aims to determine the diagnostic values of visual inspection with acetic acid (VIA) and Pap smear in a cervical cancer screening program at a community level in Vietnam. A cross-sectional analysis was obtained, including 1034 women of reproductive age from Thua Thien Hue Province, Vietnam from 09/2012 to 09/2013. Samples were taken from cervixes for Pap smear testing, followed by visual inspection with acetic acid. Subjects with abnormal VIA and/or positive cytology results were invited for colposcopy and biopsy. Histologic confirmed cervical intraepithelial neoplasia (CIN2+) served as gold standards for diagnostic values analysis. Abnormal VIA results were recorded in 87 cases (7.7%). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of VIA for CIN2+ were 88.8%, 43.8%, 63.4%, 51.2% and 83.3%, respectively. Diagnostic values of Pap smear were 58.0%, 85.2%, 69.9%, 83.3% and 61.3% for its sensitivity, specificity, accuracy, PPV and NPV, respectively. VIA yielded high sensitivity but its accuracy is still limited in pre-cancerous lesions during cervical cancer screening. The Pap smear has acceptable sensitivity and specificity, but its false-negative rate is still high. We recommend a combination of different tests to increase the efficiency of screening in our community.