Fractional CO2 laser treatment for women with stress predominant urinary incontinence: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: To evaluate the efficacy of vaginal CO2 laser in women with stress predominant urinary incontinence (SUI) compared with the sham treatment. METHODS: A randomized controlled trial with sham treatment was conducted between January 2019 and April 2021. Women with predominant SUI were recruited and randomized into two groups: the CO2 laser group (n = 29) and the sham group (n = 30). The International Consultation on Continence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to evaluate the efficacy at 3 months postoperatively. All participants in both groups were advised to perform pelvic floor muscle training (PFMT) after the intervention. RESULTS: A total of 59 women were studied. A total of 29 women were included in the CO2 laser group and 30 women were included in the sham group. The baseline scores of the ICIQ-UI SF were similar in both groups. A significant improvement in urinary incontinence scores was found in both groups 3 months after treatment (p < 0.001). However, there were no statistically significant differences between the two groups at 3 months (p = 0.8281). There were no changes in bladder neck descent or levator hiatal area immediately after intervention or 3 months after completion of treatment in either group. Most participants who received the active intervention reported mild vaginal pain during the procedure that resolved spontaneously at the end of treatment. CONCLUSIONS: Fractional CO2 laser treatment does not provide any benefit over the sham technique in alleviating SUI symptoms. The improvement in SUI symptoms in both groups might be related to PFMT. This study was registered with the Thai Clinical Trial Register (TCTR20190131004).

Discontinuation rate and adverse events after 1 year of vaginal pessary use in women with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: To ascertain the rate of discontinuation after vaginal pessary use among pelvic organ prolapse patients. METHODS: We enrolled women suffering from pelvic organ prolapse who opted to use vaginal pessary as the first line of treatment and were fitted with a pessary at the urogynecological clinic in Khon Kaen University's Srinagarind Hospital (Thailand) during the period between 2010 and 2016. Patients' medical records were retrospectively reviewed. Patients were contacted by telephone if there were missing data or if more information was required. RESULTS: One hundred and forty women were included. The median age was 71.5 years (interquartile = 65.0, 77.0) and normal vaginal parity was 4.0 (interquartile =3.0, 6.0). The mean ± SD of BMI was 23.5± 3.6 kg/m2. Most of the women enrolled in the study (97.9%) were postmenopausal and many were at an advanced stage of prolapse (73.6%). Support pessaries were the most common treatment (95.0%). The discontinuation rate of pessary use after 1 year was 16.1%. The most common reason for discontinuing the vaginal pessary was frequent expulsion (26.3%). Abnormal vaginal discharge was the most common adverse effect after pessary insertion (17.1%). Lower BMI and history of hysterectomy were the significant risk factors for discontinuation of pessary use (0.76 [95%CI 0.62-0.93] and 15.89 [95%CI 1.67-151.02] respectively). CONCLUSIONS: The discontinuation rate of pessary use in the case of pelvic organ prolapse was low after 1 year. Abnormal vaginal discharge was the most common adverse side effect. Lower BMI and history of hysterectomy were factors significantly associated with the discontinuation.

Prophylactic antibiotics for manual removal of retained placenta in vaginal birth.

BACKGROUND: Retained placenta is a potentially life-threatening condition because of its association with postpartum hemorrhage. Manual removal of placenta increases the likelihood of bacterial contamination in the uterine cavity. OBJECTIVES: To compare the effectiveness and side-effects of routine antibiotic use for manual removal of placenta in vaginal birth in women who received antibiotic prophylaxis and those who did not and to identify the appropriate regimen of antibiotic prophylaxis for this procedure. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014). SELECTION CRITERIA: All randomized controlled trials comparing antibiotic prophylaxis and placebo or non antibiotic use to prevent endometritis after manual removal of placenta in vaginal birth. DATA COLLECTION AND ANALYSIS: There are no included trials. In future updates, if we identify eligible trials, two review authors will independently assess trial quality and extract data MAIN RESULTS: No studies that met the inclusion criteria were identified. AUTHORS' CONCLUSIONS: There are no randomized controlled trials to evaluate the effectiveness of antibiotic prophylaxis to prevent endometritis after manual removal of placenta in vaginal birth.

Knowledge, Attitude, and Practices (KAP) Survey Towards Pelvic Floor Muscle Training (PFMT) Among Pregnant Women.

OBJECTIVE: To assess knowledge, attitude, and practices (KAP) of pelvic floor muscle training (PFMT) among Thai pregnant women. PATIENTS AND METHODS: One hundred and ten Thai pregnant women who attended the antenatal clinic of a tertiary care hospital were recruited. They were classified as "aware" if they could recognize PFMT. Questionnaires regarding the participants' attitudes and practice toward PFMT were subsequently collected from "aware" group. RESULTS: The mean ±SD of age and gestational age were 30.5 ±5.4 years and 20.8 ±10.8 weeks, respectively. Sixty-one participants (55.5%) recognized PFMT, but only seventeen (27.9%) correctly answered all of the questions, which is classified as perceptive. There was no association between their educational level and PFMT knowledge (p = 0.63). Most of them (98.4%) understood that PFMT can be performed during pregnancy and believed that PFMT did not affect the pregnancy outcomes. However, only 10.7% of the aware women performed PFMT irregularly during pregnancy. CONCLUSION: Half of the pregnant women in this study were aware of PFMT. The majority of women felt that PFMT had positive effects on their health, emotions, sex, and quality of life. Education concerning PFMT and motivation to maintain the adherence of practicing the exercises are required.

The outcomes of midline versus medio-lateral episiotomy.

BACKGROUND: Episiotomy is the surgical enlargement of the vaginal orifice by an incision of the perineum during the second stage of labor or just before delivery of the baby. During the 1970s, it was common to perform an episiotomy for almost all women having their first delivery, ostensibly for prevention of severe perineum tears and easier subsequent repair. However, there are no data available to indicate if an episiotomy should be midline or medio-lateral. We compared midline versus medio-lateral episiotomy for complication such as extended perineal tears, pain scores, wound infection rates and other complications. METHODS: We conducted a prospective cohort including 1,302 women, who gave birth vaginally between April 2005 and February 2006 at Srinagarind Hospital - a tertiary care center in Northeast Thailand. All women included had low risk pregnancies and delivered at term. The outcome measures included deep perineal tears (including perineal tears with anal sphincter and/or rectum tears), other complications, and women's satisfaction at 48 hours and 6-weeks postpartum. RESULTS: In women with midline episiotomy, deep perineal tears occurred in 14.8%, which is statistically significantly higher compared to 7% in women who underwent a medio-lateral episiotomy (p-value < 0.05). There was no difference between the groups for other outcomes (such as blood loss, vaginal hematoma, infection, pain, dyspareunia, and women's satisfaction with the method). The risk factors for deep perineal tears were: midline episiotomy, primiparity, maternal height < 145 cm, fetal birth weight > 3,500 g and forceps extraction. CONCLUSION: Midline compared to medio-lateral episiotomy resulted in more deep perineal tears. It is more likely deep perineal tears would occur in cases with additional risk factors.

Premenstrual syndrome (PMS) among high school students.

BACKGROUND: Premenstrual syndrome (PMS) is a common health problem among adolescents. OBJECTIVE: To assess the prevalence of PMS in Thai high school students. MATERIALS AND METHODS: This was a prospective study conducted among menstruating high school students in Khon Kaen, Thailand, from September to December, 2015. Participants were asked to prospectively complete an anonymous questionnaire, which included information about demographic data, menstrual patterns, and symptoms to be recorded on a daily calendar of premenstrual experiences according to the diagnostic criteria proposed by the American College of Obstetricians and Gynecologists. All of the data were prospectively recorded for 90 consecutive days. RESULTS: Of the 399 participants, 289 (72.4%) completed the self-report questionnaire. Eighty-six participants (29.8%; 95% CI, 24.5%-35.4%) reported having PMS. The most common somatic and affective symptoms among participants with PMS were breast tenderness (74.4%) and angry outbursts (97.7%). There were significant differences between the PMS and non-PMS groups, and PMS was associated with various problems related to educational activities, including lack of concentration and motivation, poor individual work performance, poor collaborative work performance, and low scores. However, there were no significant differences regarding interpersonal relationships between the PMS and non-PMS groups. CONCLUSIONS: PMS is a common menstrual disorder among Thai high school students. The most common symptoms reported in this study were angry outbursts and breast tenderness.

Appropriateness of antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital.

OBJECTIVE: To evaluate the rate of appropriate prophylactic antibiotic use in gynecologic surgery at Srinagarind Hospital. DESIGN STUDY: Prospective descriptive study. SETTING: Srinagarind Hospital, Khon Kaen University, Thailand. MATERIAL AND METHOD: Medical records of 250 women who had undergone gynecologic surgery at Srinagarind Hospital during August 2004 and February 2005 were evaluated. The criteria of appropriate prophylactic antibiotics were based on ACOG recommendation 2001. Data on demographic information, surgery procedure and antibiotic use during surgery were extracted from these medical records and analyzed. MAIN OUTCOMES: Rate of appropriate prophylactic antibiotic use and type of inappropriate use. RESULTS: Two hundred and fifty women had undergone gynecologic surgery during the study period. There were 168 total abdominal hysterectomy (TAH), 12 vaginal hysterectomy (VH), 30 salpingooophorectomy (SO), 3 myomectomy, 30 diagnostic laparoscopy and 7 laparoscopic ovarian cystectomy (LOC). Twenty private staff and twenty residents conducted these operations. The overall rate of appropriate prophylactic antibiotic use was 75.2% (95% CI 69.28-80.33). Main type of inappropriate use were multiple doses and indication not fulfilled. The overall rate of appropriate antibiotic prophylaxis among surgeries conducted by private staff was 53.19% (95% CI 42.66-63.46) and the overall rate of appropriate antibiotic prophylaxis among surgeries conducted by residents was 88.46% (95% CI 82.13-93.83). The rate of early post operative infection between both groups was not different (p = 0.529). There was no drug complication in all subjects. CONCLUSION: The overall rate of appropriate antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital was 75.2% (95% CI 69.28-80.33). Residents used prophylactic antibiotics more appropriately than private staff.

Reagent strip testing is not sensitive for the screening of asymptomatic bacteriuria in pregnant women.

The objective of the study was to assess the diagnostic performance of the reagent strip in screening for asymptomatic bacteriuria in pregnant women using urine culture as a gold standard. This study comprised 204 asymptomatic pregnant women who attended their first antenatal care at Srinagarind Hospital, Khon Kaen University from April 1, 1999 to June 30, 1999. Women with symptoms of urinary tract infection, antibiotic treatment within the previous 7 days, pregnancy-induced hypertension, bleeding per vagina and history of urinary tract diseases were excluded. Urine specimens were collected by clean catched midstream urine technique for urinalysis, reagent strip test and urine culture. Diagnostic performance of reagent strip in terms of sensitivity, specificity, positive and negative predictive value was analyzed. Urine reagent strip test had a sensitivity of 13.9 per cent, a specificity of 95.6 per cent, a positive predictive value of 46.1 per cent, a negative predictive value of 80.6 per cent in detecting asymptomatic bacteriuria in pregnant women.

Effectiveness of vaginal douching on febrile and infectious morbidities after total abdominal hysterectomy: a multicenter randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of vaginal douching with 1 per cent povidone-iodine in reducing febrile and infectious morbidities after total abdominal hysterectomy (TAH). METHOD: The authors conducted a randomized controlled trial in 300 patients undergoing elective TAH in three hospitals in Northeast Thailand: a university, a regional and a general hospital. The patients were randomly allocated to the intervention or control groups. Patients in the intervention group received pre-operative vaginal douching with 1 per cent povidone-iodine while patients in the control group did not. External evaluators not apprised of the intervention assessed febrile and infectious morbidities. RESULTS: 300 patients were enrolled in the study. The incidences of febrile morbidity in patients with and without pre-operative vaginal douching were 25 and 35 per cent, respectively, though not statistically significant (risk difference -9.6%, 95% CI -19.9%, 0.8%, adjusted odds ratio 0.6, 95% CI 0.3%, 1.0%). A statistically significant difference in infectious morbidity was found between the groups (8 vs 19%, risk difference -10.0%, 95% CI -17.8%, -2.2%, adjusted odds ratio 0.4, 95% CI 0.2%, 0.9%). CONCLUSION: Pre-operative vaginal douching with 1 per cent povidone-iodine significantly reduces infectious morbidities after TAH.

A placebo-controlled, double-blind, randomized study of single-dose intravenous diclofenac for pain relief after a cesarean section.

BACKGROUND: This study was conducted to avoid the pain of an intramuscular injection of diclofenac after a cesarean section, by modifying it to an intravenous infusion by diluting it with 5% dextrose in 100 mL of water. OBJECTIVE: The aim of this study was to determine the efficacy of a single-dose modified diclofenac being given intravenously, instead of intramuscularly, for pain relief after a cesarean section. STUDY DESIGN: A double-blind, randomized controlled trial was conducted. PARTICIPANTS: We enrolled 30 patients who underwent cesarean sections with Pfannenstiel skin incision. METHODS: All patients received 2.2-2.5 mL of 0.5% bupivacaine with 0.2 mg morphine for spinal anesthesia. The participants were equally and randomly allocated to two groups to receive intravenous diclofenac or placebo at 12 hours postoperatively. Both groups received the same regimen for postoperative pain control. MAIN OUTCOME MEASUREMENTS: The severity of postoperative pain was measured directly using a verbal numerical rating scale (0-10) and a pain-relief scale (1-4), and indirectly from the amount of tramadol used. RESULTS: The characteristics of the two groups of patients were similar. The mean postoperative pain relief at 24 hours in the study group was better than that in the control group (3.14 ± 0.66 vs. 2.13 ± 0.99; p < 0.05). The severity of postoperative pain at 24 hours and the amount of tramadol used were not different between groups. CONCLUSION: Intramuscular diclofenac (75 mg), modified by diluting it with 5% dextrose in 100 mL of water, for intravenous administration in combination with spinal morphine (0.2 mg) provided good analgesia after a cesarean section within 24 hours when assessed by the pain-relief scale; however, the mean pain intensity was not different.

From research to practice: the example of antenatal care in Thailand.

The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems.