Incidence and Risk Factors of Postoperative Febrile Morbidity among Patients Undergoing Myomectomy.

Background and Objectives: To identify the incidence, causes, and independent predictors of postoperative febrile morbidity among patients undergoing myomectomy. Material and methods: Medical records of patients who had undergone myomectomy at Chiang Mai University Hospital between January 2017 and June 2022 were comprehensively reviewed. The clinical variables, including age, body mass index, previous surgery, leiomyoma size and number, the International Federation of Gynecology and Obstetrics (FIGO) fibroid type, preoperative and postoperative anemia, type of surgery, operative time, estimated blood loss, and intraoperative antiadhesive use, were analyzed as a predictive factor of postoperative febrile morbidity. Results: During the study period, 249 consecutive women were reviewed. The mean age was 35.6 years. The majority of women had FIGO fibroid type 3-5 (58.2%) and type 6-8 (34.2%). Febrile morbidity was noted in 88 women (35.34%). Of them, 17.39% had a urinary tract infection and 4.34% had a surgical site infection, whereas the causes in the majority of cases (78.26%) could not be identified. The significant independent risk factors for febrile morbidity were abdominal myomectomy (adjusted odds ratio: aOR, 6.34; 95% CI, 2.07-19.48), overweight women (aOR, 2.25; 95% CI, 1.18-4.28), operation time of more than 180 min (aOR, 3.37; 95% CI, 1.64-6.92), and postoperative anemia (aOR, 2.71; 95% CI, 1.30-5.63). Conclusions: Approximately one-third of women undergoing myomectomy experienced febrile morbidity. The cause could not be identified in most cases. The independent risk factors included abdominal myomectomy, overweight, prolonged operation time, and postoperative anemia. Of them, abdominal myomectomy was the most significant risk factor.

Factors Associated with Development of High-Grade Squamous Intraepithelial Lesions of the Uterine Cervix in Women Younger than 30 Years

Objective: To determine the factors associated with the increased risk of developing high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30 years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP) between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzed the factors associated with the development of HSIL by comparing two age groups between women aged < 30 years and those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. age at sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitted diseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated with the increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results: During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years (control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexual partners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007) and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the development of HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status and underlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiple sexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women younger than 30 years. Cervical cancer screening should be considered in young women with such factors.

Factors affecting pregnancy rates after microsurgical reversal of tubal sterilization.

The aim of this study was to determine the prognostic factors and pregnancy rates after microsurgical reversal of tubal sterilization. Patients undergoing tubal anastomosis from 2001 to 2008 were included. Relevant data were extracted from their medical records. Pregnancy outcomes were ascertained by responses to mailed questionnaires and telephone contact. A total of 98 patients were identified. We found that the mean duration of follow-up was 67 ± 28 months. Fifty-five patients conceived (pregnancy rate 62.5%; 95% confidence interval [CI] 52 to 72.8%). Of these, 50 were intrauterine and 5 were tubal pregnancies. Life-table analysis estimated cumulative pregnancy rates to be 30.7%, 39.8%, 49%, and 53.7% at 6, 12, 18, and 24 months after reversal, respectively. Age at the time of reversal was the only significant prognostic factor multivariate model. We concluded that age of the patient at the operation is the most important prognostic factor.

Gender differences in infertility-related stress and the relationship between stress and social support in Thai infertile couples.

OBJECTIVE: To study infertility-related stress among men and women and to examine its relationship with the level of perceived social support. MATERIAL AND METHOD: The Fertility Problem Inventory (FPI) and the Personal Resource Questionnaire (PRQ) were translated into Thai and used to assess the level of infertility-related stress and perceived social support, respectively, in 238 infertile subjects. RESULTS: The global FPI scores for men and women were 154.2 +/- 18.3 and 154.7 +/- 22.6, respectively (p > 0.05). There was no significant difference in their perceived social support (PRQ scores = 137.8 + 14.0 and 134.0 +/- 16. 7 respectively). A significant negative correlation (r = -0.1894; p < 0.001) existed between global stress and social support in women, but not in men. CONCLUSION: Thai infertile couples experienced a high level of stress. Unlike previous studies from Western countries, there was no gender diference in infertility-related stress.

Clinical, endocrine and ultrasonographic features of polycystic ovary syndrome in Thai women.

AIM: To study the prevalence, reproductive hormone profiles and ovarian sonographic appearance of Thai women with polycystic ovary syndrome (PCOS). METHODS: One thousand and ninety-five women were screened for oligomenorrhea/amenorrhea, and the clinical symptoms of hyperandrogenism. Ovarian morphology and volume were assessed by ultrasonography in diagnosed cases. Blood was taken for the measurement of the follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, androstenedione, dehydroepiandrosterone and 17-hydroxyprogesterone. RESULTS: The prevalence of PCOS was 5.7%. The mean age of women with PCOS was less than that of non-PCOS cases (27.4 +/- 6.5 and 31.1 +/- 6.4 years, respectively; P < 0.0001). Abnormal uterine bleeding and infertility were the leading presenting symptoms. The mean ovarian volume in women with PCO appearance was 9.22 +/- 4.36 mL compared to 6.53 +/- 3.31 mL in those without this appearance (P = 0.04). Hyperandrogenemia was confirmed in 23 of the 62 cases (37.1%). CONCLUSIONS: The prevalence and clinical presentations of Thai women with PCOS were similar to those in other reports. However, hirsutism, elevated testosterone level and acanthosis nigricans were uncommon in our population. Serum androstenedione was a more sensitive indicator of hyperandrogenemia than total testosterone. Further research is needed to clarify whether there is an ethnic difference in endocrine profiles and risks of metabolic syndrome.

Quality of life and risk factors that affect the quality of life of Thai female physicians.

OBJECTIVE: To study the quality of life (QOL) and risk factors that affect QOL of Thai female physicians. MATERIAL AND METHOD: The Thai version of the briefform of WHO quality of life assessment instrument (WHOQOL-BREF-THAI) and risk assessment questionnaires were mailed to 1700 randomly selected female physicians. RESULTS: The authors obtained a response rate of 41.9%. Most physicians were married (57.3%), they worked 57.3 hours/week, and had a mean income of 64,622 baht/month. The prevalence of obesity was 12.6%. Most (99.3%) did not drink alcohol, 69.6% avoided high cholesterol and afat diet, 65.8% consumed a balanced diet, and 55.9% included vegetables and fruit in half of their meals. The majority (62.2%) exercised for less than 30 min/day. They used a safety belt (92.1%) or crash helmet (87.5%) when driving a motor vehicle. Regarding their current health, 8.9% had hearing problems, 6.1% had diabetes, 3.3% had glaucoma, and 1.8% had hypertension. CONCLUSION: Most female physicians had fair to good QOL scores. They were health and safety conscious. These aspects can be used in a campaign to promote a healthier life-style for Thai women.