Review of postpartum contraceptive practices at Chiang Mai University Hospital: implications for improving quality of service.

OBJECTIVE: To evaluate the acceptance rate and patterns of contraceptive use among postpartum women. SUBJECTS AND METHODS: The records of 1,009 postpartum women attending the Family Planning Clinic at Chiang Mai University Hospital, Thailand, during January to December 2009 were reviewed. RESULTS: Mean age was 28.2 ± 5.7 years (range 15-48). Almost all 920 women (91.2%) practiced breastfeeding. The acceptance rate of contraception was 97.6%. The types of contraceptive used were: depot medroxyprogesterone acetate, 387 (38.4%); progestin-only pills, 262 (26.0%); tubal resection, 201 (19.9%); male condom, 78 (7.7%); oral combined pills, 49 (4.9%); intrauterine device, 5 (0.5%); implant, 3 (0.3%). Among women undergoing tubal resection, 29 (14.4%) were ≤24 years of age. Significant independent predictors for using long-acting reversible contraception were young age and little or no formal education. CONCLUSION: The acceptance rate of contraception in this study was high. However, the following issues need to be evaluated: compliance of women using progestin-only pills, awareness of long-acting reversible contraception as an alternative option in women considering sterilization, and interventions to promote the use of intrauterine devices and implants.

Patient satisfaction with the service at Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To evaluate patient satisfaction of service at the Menopause Clinic and to identify factors affecting patient satisfaction. MATERIAL AND METHOD: Cross sectional descriptive study was conducted at the Menopause Clinic, Maharaj Nakorn Chiang Mai hospital. Three hundred twenty six subjects were included. The questionnaire consists of two parts, demographic and patient satisfaction. The patient satisfaction was evaluated in five aspects. RESULTS: The overall patient satisfaction level was good (mean 4.2 +/- 0.71). The satisfactions about service behavior quality of care and health information were in excellent level (mean 4.29 +/- 0.69, 4.25 +/- 0.65, and 4.26 +/- 0.69, respectively). The satisfaction about clinic facilities/conveniences and medical expense were in good level (mean 3.83 +/- 0.79 and 3.87 +/- 0.75). There are three variables that could affect patient satisfaction: Occupation and level of education affected satisfaction in medical expense aspect (p < 0.001 and p < 0.05) and number of visits affected the clinic facilities/convenience aspect (p < 0.05). CONCLUSION: Some patient characteristics affected the patient satisfaction. However, system and structure of service in different setting hospitals are of concerned.

Mammographic change in hysterectomized women on 0.625 mg/day of conjugated equine estrogen.

OBJECTIVE: To compare the mammographic change before and after conjugated equine estrogen (CEE) 0.625 mg/day in hysterectomized women. DESIGN: A retrospective descriptive study. SETTING: Menopause clinic, Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: Dedicated mammograms and demographic data of 66 women who had been hysterectomized were reviewed. Post surgical menopausal women were recruited for the study. CEE 0.625 mg/day was given just after the operation. The baseline mammography was done before the initiation of HRT and they were compared with the follow-up mammography performed 12-18 months after therapy. The degree of increase in mammographic density was classified as follows: minimal changes (10-25% increased density), moderated change (26-50% increased density), and marked change (> 50% increased density). RESULTS: The mean age +/- SD was 47 +/- 4.3 years old. The mean duration +/- SD of hormone used was 13.5 +/- 2.4 months. The most common indication for operation was myoma uteri (43.9%). On the baseline mammogram, 5 cases had cystic change and one case had a small circumscribed solid mass suspected to be fibroadenoma. On the follow-up mammograms, there were 2 cases (3.0%) detected to have significantly increased breast density. One was moderately increased and the other was markedly increased, but cystic changes and one fibroadenoma were not changed. CONCLUSION: CEE has little effect on increased mammographic density.