Survey on knowledge, attitude, acceptance and related factors among pregnant women in Thailand regarding antenatal thalassaemia screening.

Thalassaemia is a common haematologic health condition in Southeast Asian countries (SEA) including Thailand. Reducing the birth of new thalassaemia cases is an effective method to control disease. The background level of knowledge and attitude of pregnant women on the disease influences their decision to perform antenatal screening. Unfortunately, the information about pregnant women's knowledge and attitude on antenatal thalassaemia screening in a developing country such as Thailand is lacking. We therefore conducted this cross-sectional study to examine patients' knowledge and to evaluate the factors which influence the patient's knowledge and attitude on antenatal thalassaemia screening. 1006 pregnant women who attended antenatal care at the Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand were enrolled. We found that women's knowledge on antenatal thalassaemia screening is low. A maternal age of ≥35 years was associated with a higher level of knowledge. A higher level of education and multigravidity, a family history of thalassaemia and a positive level of attitude were found more likely to have higher scores for knowledge. A higher level of education and level of knowledge score were also more likely to have a positive attitude score, but multigravidity negatively affected the attitude score. Effective counselling should be monitored among women with a lower levels of education, those with no family history of thalassaemia, and in primigravidas. Lastly, a concurrent Down syndrome screening or foetal sex determination may be useful incentives to encourage the decision to undergo screening. Impact statement What is already known about this subject? Screening for the paternal and maternal thalassaemia carrier status is important for reducing the incidence of severely thalassaemia-affected children. Poorer education and receiving genetic counselling for the first time were the predictive factors for the low post-counselling knowledge in genetic counselling before second trimester genetic amniocentesis. What do the results of this study add? Pregnant women's knowledge of antenatal thalassaemia screening was low. We found that pregnant women aged ≥35 years had a higher level of knowledge. Women with a higher level of education, multigravidity, the presence of a family history of thalassaemia and a positive attitude were more likely to have higher scores for knowledge. A higher level of education and level of knowledge score were also more likely to have a positive attitude score but multigravidity negatively affected the attitude score. The encouraging factors, such as an adjunctive Down syndrome screening or foetal structural screening or foetal sex determination may be useful as the incentive tools. What are the implications of these finding for clinical practice and/or further research? The awareness of a possible incorrect understanding is important for the antenatal counselling in the developing countries. Intensive monitoring of effective counselling using a post-counselling test should be scheduled. The methods of effective counselling for antenatal thalassaemia in developing countries should be evaluated.

Nipple Pain Incidence, the Predisposing Factors, the Recovery Period After Care Management, and the Exclusive Breastfeeding Outcome.

BACKGROUND: Nipple pain is the most common complaint of breastfeeding mothers during the immediate postpartum period. Persistent nipple pain is associated with low breastfeeding rate at 6 months postpartum. OBJECTIVE: To further explore the incidence of nipple pain, associated predisposing factors, time for recovery after management, and the impact on exclusive breastfeeding rates. MATERIALS AND METHODS: Included in this study were 1,649 singleton, pregnant women who delivered and had their 1-week follow-up at the breastfeeding clinic during the period of January 2013 to December 2015. The mothers who experienced nipple pain were analyzed for the incidence, the predisposing factors, and the recovery period after care management. The breastfeeding outcome comparison of both, mothers with and without pain, was measured by the exclusive breastfeeding rate at the sixth week postpartum. RESULTS: The incidence of nipple pain was at 9.6% by day 7. A predisposing factor of nipple pain was primiparity (relative risk = 1.8, 95% confidence interval 1.3-2.5). The reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%), and oversupply (4.4%). The recovery period after care management was 1-2 weeks. There were no statistically significant differences between the 6-week exclusive breastfeeding rates of the mothers with nipple pain with treatment and the mothers without nipple pain. CONCLUSION: Persistent nipple pain was a common problem. The active management, including early detection and treatment, would help the mothers recover within a 2-week period and there was no significant difference of exclusive breastfeeding rates between the mothers who had early care management and the mothers without nipple pain.

The Effect of Ginger on Breast Milk Volume in the Early Postpartum Period: A Randomized, Double-Blind Controlled Trial.

BACKGROUND: In Thailand, ginger is a popular natural galactagogue among breastfeeding women. However, there has never been evidence to support the effectiveness of ginger in increasing the breast milk volume. OBJECTIVES: To compare breast milk volume on the third and seventh day postpartum between lactating mothers who receive 500 mg dried ginger capsules twice daily with those receiving placebo. MATERIALS AND METHODS: A randomized, double-blind controlled trial was conducted. Women who deliver a term baby were randomly assigned to receive dried ginger or placebo for 7 days postpartum. Breast milk volume was measured on third day postpartum using test weight method for a period of 24 hours and on seventh day postpartum using 1 hour milk production. We also compared the third day serum prolactin level between the two groups. RESULTS: Data from 63 women were available for analysis, 30 from the ginger group and 33 from the placebo group. The two groups were similar regarding baseline characteristics. Women in the ginger group have higher milk volume than the placebo group (191.0 ± 71.2 mL/day versus 135.0 ± 61.5 mL/day, p < 0.01). However, the seventh day milk volume in the ginger group does not differ from the placebo group (80.0 ± 58.5 mL versus 112.1 ± 91.6 mL, p = 0.24). The mean serum prolactin levels were similar in both groups (321.5 ± 131.8 ng/L in the ginger group, and 331.4 ± 100.7 ng/L in the placebo group, p = 0.74). No side effect was reported in this study. CONCLUSION: Ginger is a promising natural galactagogue to improve breast milk volume in the immediate postpartum period without any notable side effect.

Effect of Obesity and Early Breastfeeding Initiation on Exclusive Breastfeeding Rates.

Objective: To compare the 6-week postpartum, exclusive breastfeeding rates between obese mothers and mothers with a normal body mass index (BMI), with early breastfeeding initiation. Material and Method: The subjects were 415 singleton, postpartum, obese mothers who delivered without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok province between the years of 2013 through 2015 and the same number of matched normal body mass index mothers. The early breastfeeding initiation of both the obese mothers and the normal BMI mothers was recorded. The exclusive breastfeeding rates were collected at the second day postpartum. Following discharge, telephone follow-ups were used for the collection of breastfeeding data at the 7th, 14th day and six weeks postpartum. The exclusive breastfeeding rates of the obese mothers were analyzed and compared with the exclusive breastfeeding rates of normal BMI mothers at the 2nd, 7th, 14th day and 6 weeks postpartum. The data was analyzed by Chi-square, relative risk and 95% confidence interval. Results: At the 2nd, 7th, 14th day and 6th week postpartum; the exclusive breastfeeding rates of the obese mothers' group were 94.5, 71.1, 64.8 and 51.3%, respectively. The exclusive breastfeeding rates of the normal BMI mothers' group for the same periods were 95.7, 79.3, 75.4 and 63.1%, respectively. There are statistically significant differences between the exclusive breastfeeding rates of the obese mothers' group and the normal BMI groups at the 7th day, 14th day and 6th week postpartum. In the situation of early breastfeeding initiation, the exclusive breastfeeding rates of the obese mothers at the 2nd, 7th, 14th day and 6th week postpartum were 96.3, 77.0, 71.2 and 58.4%, respectively. The exclusive breastfeeding rates of the normal BMI mothers who had early breastfeeding initiation were 96.2, 81.3, 77.4 and 67.2% at the 2nd, 7th, 14th day and 6th week postpartum, respectively. No significant differences were seen between the two groups in the exclusive breastfeeding rates at the 2nd, 7th and 14th day postpartum. Conclusion: The obesity had negative effect on exclusive breastfeeding rates during six weeks postpartum after mothers' discharge. But the exclusive breastfeeding rates of both the obese and normal BMI mothers were not significantly different during two weeks postpartum in early breastfeeding initiation situation. The obese mothers could be advised about early breastfeeding initiation.

Pelvic Retroperitoneal Cellular Leiomyoma: A Case Report.

Leiomyomas are common benign gynecological tumors and usually arise in the uterus. The retroperitoneal cellular leiomyoma, one of the unusual manifestations, is a rare tumor. Diagnosis and treatment are challenges. We report a case of 65-year-old women presented with an asymptomatic mass beneath the right posterior vaginal mucosa. CT imaging revealed heterogeneous mass 6 cm in the pelvic cavity abutted lower segment of uterus, cervix, and vagina. The provisional diagnosis was subserosal cervical leiomyoma. She underwent exploratory laparotomy. Intra-operative, a normal size uterus was found separately from retroperitoneal pelvic mass at the level of internal os. Histological report confirmed cellular leiomyoma later Total hysterectomy, bilateral salpingoophorectomy and completely excision of tumor were achieved with good outcome. Our patient represents the rare case of retroperitoneal cellular leiomyoma, which is hardly identified from internal examination and preoperative imaging. Surgical removal is essential for pathological diagnosis and treatment.