Development and validation of the Menopause-specific Quality of Life Scale for menopausal Thai women.

OBJECTIVES: To develop a new instrument, the Menopause-specific Quality of Life Scale (MS-QoLS), for Thai women and to study the experience of menopausal aspects in peri- and postmenopausal Thai women. MATERIALS AND METHODS: Item generation was developed from a focus group discussion and in-depth interview, and the content validity index (CVI) was computed, using item relevance ratings by content experts. Items with CVI values higher than 0.7 were selected. The draft questionnaire was tested for language, format and content. The final questionnaire was administered and the construct validity and reliability were then assessed. RESULTS: Fifty-seven peri- and postmenopausal women participated in the focus group discussion and in-depth interview. Sixty-eight items across eight dimensions were generated based on content analysis result. The dimensions included Physical health, Psychological health, Sexual health, Daily activity, Family, Social, Treatment, and Economics. A total of 280 menopausal women were recruited from four collaborative hospitals for psychometric validation. After factor analysis, 22 items remained with six dimensions identified, that is, well-being, emotionality, anxiety/fear, family, social and sexual health. Cronbach's coefficient α of each domain was between 0.61 and 0.83. CONCLUSION: The Thai MS-QoLS was systematically developed and validated for peri- or postmenopausal women. The initial assessment of the questionnaire showed an acceptable level of validity and reliability.

Sonographic findings of uterus and ovaries in normal pre- and post-menopausal women.

To investigate the significant findings of ultrasonography before hormonal replacement therapy (HRT) was given in normal pre- and post-menopausal women. Sixty eight Thai pre- and post-menopausal women with no previous HRT were recruited into the study, They were divided into 22 pre-menopausal women (group I), 28 post-menopausal women of < or = 5 years (group II) and 18 post-menopausal women of > 5 years (group III). Their mean age was 48.2, 50.2 and 57.3 years, respectively. Myoma uteri was found in 10 (45.5%), 2 (7.1%) and 1 (5.6%) in group I, II and III. There were 2 (9.1%), 3 (10.7%), 3 (16.7%) cases of ovarian tumor in these three groups respectively. The detection rate of ovaries from ultrasound was 90.7 per cent in group I, 89.1 per cent in group II and III. The corpus to cervix ratio in the three groups was 2.3, 2.4 and 2.3, respectively. Uterine volume in nulliparous and multiparous pre-menopausal women was 56.6 ml and 74.2 ml, but in group II and III were 60.1 ml and 37.1 ml respectively. Endometrial thickness was significantly different in group I, II and III (7.2, 4 and 2.9 mm.) Left and right ovarian volume of group I was significantly larger than that of group II and group III. In conclusion, the ultrasonography is highly recommended to detect uterine and ovarian abnormalities before HRT is given in pre- and post-menopausal women.

Prophylactic oophorectomy of benign uterine disease in premenopausal women: 11 years review.

Between 1982 and 1992, 695 consecutive abdominal hysterectomies and prophylactic oophorectomies in premenopausal women for benign uterine diseases were performed in our department. The trend of prophylactic oophorectomy has declined since 1988 to a minimum in 1990. 60 per cent were 41-45 years of age, 28 per cent were more than 46 years, 12 per cent were 36-40 years. Uterine fibroid was the most frequent indication (77.7%), followed by adenomyosis (21.0%). Ovarian histologies revealed abnormalities only in 1.3 per cent of the removed ovaries, the remainder appeared to be normal.

An evaluation of glycosylated hemoglobin measurement by a colorimetric method as a screening test for gestational diabetes mellitus.

To assess the potential value of glycosylated hemoglobin measurement (HbA1) in screening for gestational diabetes mellitus (GDM), HbA1 by a colorimetric method, plasma glucose level 1 hr after 50 g oral glucose loading, and 3-hr 100 g oral glucose tolerance test (3-hr OGTT) were performed in 334 pregnant women at Ramathibodi Hospital. These subjects carried high risk factors of GDM. Gestational ages varied from 24 to 38 wks. Twenty-four cases were diabetic (7.2%) by O'Sullivan and Mahan's criteria (1964). As a screening test to select subjects for 3-hr OGTT, plasma glucose level 1 hr after 50 g oral glucose load (plasma glucose level 7.8 mmol/L and above) has sensitivity: 87.50 per cent, specificity: 64.19 per cent. HbA1 level of 5.60 per cent (upper 95% confidence limit of the mean) and above yield sensitivity: 66.67 per cent, specificity: 61.29 per cent. Thus, glycosylated hemoglobin measurement as a screening test for GDM is not as effective as the conventional 50 g oral glucose loading test.

Predictive value of 1 hour 50 g oral glucose load screening test for gestational diabetes mellitus compared to 3 hour oral glucose tolerance test in high risk pregnant women.

A prospective study for detecting gestational diabetes mellitus was undertaken to evaluate the use of one hour plasma glucose level after 50 g glucose loading test (1-hr GLT) as compared to the traditional 3-hours 100 g oral glucose tolerance test (3-hr OGTT) in 396 high risk cases. Each patient, had 1-hr GLT and 3-hr OGTT performed in a separate week. Forty-two cases (10.6%) who had abnormal 3-hr OGTT were classified as gestational diabetes (GDM). One hundred and sixty cases (40.4%) had an abnormal 1-hr GLT (plasma glucose level > or = 140 mg/dl). Thirty-six of these 160 cases (22.5%) had an abnormal 3-hr OGTT. In 236 women (59.6%) that had normal 1-hr GLT (plasma glucose level < 140 mg/dl) only 6 cases (2.5%) had an abnormal 3-hr OGTT. If 1-hr plasma glucose level > or = 150 mg/dl was used as the cutoff point, 110 cases (27.8%) were found to have abnormal 1-hr GLT, and 35 of these 110 cases (31.8%) had an abnormal 3-hr OGTT. Seven of 286 women (2.4%) that had normal 1-hr GLT (plasma glucose level < 150 mg/dl) had an abnormal 3-hr OGTT. The sensitivity and specificity of the 1-hr GLT when abnormal 3-hr OGTT was used as gold standard for detecting GDM were 85.7% and 65% respectively (BS > or = 140 mg/dl). Whereas the sensitivity and specificity were 83.3% and 78.8% respectively when plasma glucose level > 150 mg/dl was used as the cut point.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of human immunodeficiency virus type 1 (HIV-1) proviral DNA in breast milk and colostrum of seropositive mothers.

There is increasing evidence of vertical transmission of HIV-1 to infants through breast feeding of milk from HIV-1 infected mothers. It has been postulated that transmission occurs mainly via ingestion of infected cells in breast milk and colostrum. In this study, detection of HIV-1 proviral DNA was used to prove that cells from colostrum and milk do contain HIV. DNA were extracted from these cells of colostrum and milk of 18 seropositive mothers and amplified by nested PCR for HIV-1 gag and pol and 44 per cent were positive mostly by two primers. All ten negative control samples from seronegative mothers were negative. This study demonstrated the infectivity of breast milk and colostrum. Nevertheless, recommendation against breast-feeding should be weighed against poor alternatives in low socioeconomic families.

PIP: In Thailand clinicians gathered breast milk and colostrum samples (1 ml) at 1-10 days postpartum from 18 HIV-1 seropositive mothers at Ramathibodi Hospital and Maharaj Hospital and from 10 HIV-1 seronegative mothers at the same hospitals. Researchers used polymerase chain reaction to detect HIV-1 proviral DNA in cells in the breast milk and colostrum. Breast milk and colostrum samples from 44% of the HIV-1 seropositive women tested positive for HIV-1 DNA. The pol primers were superior to the gag primers. All of the colostrum samples of the HIV-1 seronegative women tested negative. These results suggest that HIV-1 seropositive lactating mothers can transmit HIV-1 via breast feeding after childbirth. The Obstetrics and Gynaecology Department at Ramathibodi Hospital in Bangkok advises HIV-1 infected mothers to not breast feed if there is a suitable alternative available. Health professionals should weigh breast feeding against poor alternatives in impoverished families.

Prevalence of positive anti-HIV in pregnant women at Ramathibodi Hospital.

Anti-HIV screening has routinely been done at the antenatal clinic in Ramathibodi Hospital since January 1990. The prevalence of positive anti-HIV during the first and second half of 1990, and the first half of 1991 are 0.056, 0.2, 0.24 per cent respectively. Twenty positive cases are now under counselling. Age range is between 18-35 years. Seventeen cases are from rural areas. Twelve of seventeen cases were from the north-eastern part of Thailand. Fifteen cases (71.4%) had their pregnancies terminated. This study shows that the prevalence of positive anti-HIV is increasing. Vertical transmission has already been known to be one of the most important and serious transmissions to newborns and infants. The data indicated that screening test for anti-HIV in pregnant women, previously regarded as a low risk group, should be reviewed and routinely done.

PIP: In 1990-1991, health workers at the prenatal clinic at Ramathibodi Hospital in Bangkok, Thailand, screened 12,067 women in the first trimester of pregnancy for antibodies to HIV. Most of the pregnant women were from middle class areas of Bangkok. 21 of the women tested positive for HIV (0.2%). All HIV-positive women and their husbands underwent counseling. HIV prevalence between January and June 1990 was 0.056% and rose 3-fold by July-December 1990 (0.2%) and 4-fold by January-June 1991 (in reference to 1 year earlier, 0.244%). The highest number of cases/month occurred in December 1990. 85% of the HIV-positive women were 20-30 years old, but the age range was from 18-35 years. 95% were second gravida. 38% were housewives. 81% (17) were from rural areas. 90% were married. 66% of husbands of these HIV-positive women also tested positive for HIV. 71% of the HIV-positive women opted for termination of pregnancy (menstrual regulation in 57% and hypertonic saline solution in 14%). These findings motivated the hospital physicians to recommend obligatory HIV screening of all pregnant women to manage the HIV-positive cases and to prevent HIV from spreading to their offspring.

Prospective study on premature labor with magnesium sulfate.

The efficacy of magnesium sulfate was evaluated as the primary tocolytic agent in the management of patients at risk for premature delivery. Fifteen patients presenting with premature labor between 28 and 35 weeks gestation, given titrated dose intravenously magnesium sulfate till uterine contraction ceased, were prospectively studied. All patients received an additional oral beta-mimetic agent once labor was arrested till 36 weeks gestation. All cases had intact membranes and no contraindications for tocolytic therapy. Tocolysis for more than 72 hours was achieved in 14 cases (93.3%). Delayed tocolysis of more than 7 days was achieved in 13 cases (86.7%). The mean dosage to achieve tocolytic effect was 3.17 g/hr (SD 0.08). The mean serum magnesium level to achieve such effect was 5.38 mg/dl (SD 0.88). Magnesium sulfate was found to be easy to administer and clinically efficacious with minimal adverse effects. It may be used as the first line of tocolytic therapy where beta-sympathomimetic drugs are contraindicated.

Diagnosis of placenta previa by ultrasonography: a review at Ramathibodi Hospital.

From 1,000 ultrasonographic examinations reviewed there were 80 (8%) done for the exclusion of placenta previa. Only 83.6 per cent of these had complete medical records and were the subjects of this study. The most common reason for requesting ultrasonography was antepartum hemorrhage (79.1%). False-positive and false-negative of the report were 16.7 per cent and at least 4.2 per cent respectively. Based on the theory of placental migration it can be recommended that a minor degree of placenta previa diagnosed in the early stage of pregnancy does not need follow-up scanning while the diagnosis of placenta previa totalis follow-up scanning is imperative. A judicious decision in the combined usage of ultrasonography and double-set-up technique can reduce the risk of brisk bleeding and unnecessary cesarean section.

Efficiency of modified medium for direct chromosome preparation of the chorionic villi.

The direct chromosome preparation from the CV is a reliable method for diagnosis of the gross chromosomal anomalies and could be completed in the shortest possible time. However, direct villi preparation does not always provide sufficient or good quality metaphases. The culture medium plays an important role in achieving a good success rate. We report the efficacy of our modified medium and compared it with Chang's. The modified medium showed slightly higher successful karyotyping (68.4%) than the Chang medium (65.4%). This success rate showed no statistically significant difference. The success rate enhanced up to 92.3 per cent using our modified medium when the CV was of good quality. The higher amount of CV did not lead to a higher success rate. Any amount more than 5 mg of the CV was sufficient for direct chromosome preparation.