A modified LAVH to reduce urinary tract injuries: 102 consecutive case-series at Srinagarind Hospital, Khon Kaen University.

OBJECTIVE: To describe the technique and results of modified laparoscopically assisted vaginal hysterectomy (LAVH), especially, on the urinary tract injury. MATERIAL AND METHOD: One hundred two patients scheduled for modified LAVH between November 2007 and December 2010 were enrolled. RESULTS: The majority of patients were middle-aged. The median parity was two; 16 patients were nulliparous. Among the 39 patients who had undergone prior abdominal or pelvic surgeries, eight had a prior cesarean delivery. The majority of LAVH indication was leiomyoma with complications. The median uterine weight was 300 g (range 120 to 1,450 g). The median operating time was 105 min (range 50 to 365 min). One patient had repeated laparoscopic uterine artery electrocoagulation 12 hours after surgery. Two patients were re-admitted with pelvic inflammatory disease (PID) two to three weeks post-operatively. No bowel or urinary tract injuries were detected during intra- and post-operation. CONCLUSION: The modified LAVH presented here was a technique that showed a low incidence of urinary tract injury.

Effects of atosiban on uterine peristalsis following frozen embryo transfer: A randomized controlled trial.

OBJECTIVES: To compare the effects of atosiban (oxytocin antagonist) on uterine peristalsis and pregnancy outcomes in the frozen embryo transfer (FET) cycle. SETTING: Srinagarind Hospital, a university hospital, Khon Kaen, Thailand. DESIGN: A randomized, double-blinded, controlled trial. METHODS: Fifty infertile women were randomized into the atosiban (n = 25) and placebo group (n = 25). Women in the study group received intravenous atosiban 6.75 mg, 30 min before embryo transfer, and continued infusion at 18 mg/h for 1 h. The dose was reduced to 6 mg/h for another 2 h. Saline solution was applied in the placebo group. The uterine peristalsis frequency was measured by transvaginal ultrasound 30 min before and 3 h after the embryo transfer. RESULTS: The respective mean baseline uterine peristalsis frequency (time) in the atosiban and placebo group was 10.3 ± 2.4 and 9.2 ± 3.4. The respective duration of uterine peristalsis in the atosiban and placebo group after receiving the intervention was reduced to 7.9 ± 2.1 and 6.9 ± 2.7. The implantation rate and clinical pregnancy rate were not statistically significant different between atosiban group and placebo group (37.5% versus 31.0%, RR 1.21, 95%CI: 0.60-2.44 and 44% versus 36%, RR 1.22, 95%CI: 0.62-2.42, respectively). Subgroup analysis indicated that the clinical pregnancy rate in those >35 years of age was not significantly different between both groups (31.6% and 18.8 %, RR 1.68, 95%CI: 0.50-5.68). CONCLUSION: Adding atosiban in FET did not reduce uterine peristalsis but may benefit the advanced age group.

Incidence, causes and pregnancy outcomes of hydrops fetalis at Srinagarind Hospital, 1996-2005: a 10-year review.

OBJECTIVE: To identify the incidence and determine causes and pregnancy outcomes of hydrops fetalis at Srinagarind Hospital. STUDY DESIGN: A retrospective descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University. MATERIAL AND METHOD: A retrospective medical record review of all pregnant women and newborns who were diagnosed with hydrops fetalis at all gestational ages and delivered at Srinagarind Hospital between 1996 and 2005. RESULTS: During the period of study, the incidence of hydrops fetalis was 1.80 per 1,000 total births (82 cases of 45,499 total births). Thirty-nine cases (47.56%) were idiopathic, 30 cases (36.58%) were Hb Bart's hydrops fetalis, and three (3.66%) cases were caused by congenital infection. The others 10 cases (12.19%) were achondrogenesis, Turner syndrome, twin-to-twin transfusion syndrome, severe anemia with unknown primary cause, cystic hygroma, multiple congenital anomalies, and Rh isoimmunization. The mortality rate of hydrops fetalis in the present series was 98.78%. One case, caused by Rh isoimmunization, survived. Maternal complications were 30 cases (36.59%) consisting of preeclampsia, preterm labor, disseminated intravascular coagulopathy, placenta previa, and postpartum hemorrhage. CONCLUSION: The incidence of hydrops fetalis was 1.80 per 1,000 total births. The common known cause was Hb Bart's hydrops fetalis. The mortality rate of hydrops fetalis in the present study was very high.

Effect of sperm selection method by cumulus oophorus complexes and conventional sperm preparation method on sperm quality and DNA fragmentation for assisted reproduction techonology.

OBJECTIVES: To compare the effectiveness of sperm selection using cumulus oophorus complexes (COCs) and conventional sperm preparation methods on sperm quality and DNA fragmentation METHODS: Normal semen samples under the World Health Organization (WHO)'s 2010 eligibility criteria were collected and processed using conventional sperm preparation methods. The prepared sperm were divided into two groups. Spermatozoa in the study group were selected based on their ability to penetrate a layer of COCs. In the control group, spermatozoa were kept in culture medium under similar conditions. The selected-sperm were evaluated based on sperm quality and DNA fragmentation. RESULTS: Thirty normal semen samples were recruited. Spermatozoa that were able to passthrough the COCs had significantly higher sperm motility parameters than the control group (curvilinear velocity [VCL; 143.5 vs 122.2; P < 0.01], average path velocity [VAP; 83.6 vs 69.3; P < 0.01], straight-line velocity [VSL; 67.95 vs 60.45; P < 0.01]). The percentage of normal spermatozoa morphology in the COCs group was significantly higher than in the control group (21.70% vs 18.76%). In addition, there was significantly less DNA fragmentation in the COCs group than in the control group (18.83 vs 10.83). CONCLUSION: Spermatozoa selected using COCs were likely to be effective in terms of sperm quality and DNA fragmentation.

Prenatal prevention for severe thalassemia disease at Srinagarind Hospital.

OBJECTIVE: To evaluate the results and cost-effectiveness of prenatal prevention measurement in severe thalassemia diseases at Srinagarind Hospital. STUDY DESIGN: Descriptive study. SETTING: Antenatal care (ANC) Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. SUBJECTS: 1,498 thalassemic screened pregnant women first presenting at ANC Clinic at gestational age less than 17 weeks. MATERIAL AND METHOD: Medical records of thalassemic screened pregnant women between February 2002 and February 2005 were analyzed. Those with a value of mean corpuscular volume (MCV) less than 80 fl, or positive dichlorophenol indophenol precipitation test (KKU-DCIP Clear Reagent Kit) underwent hemoglobin (Hb) typing by high performance liquid chromatography (HPLC) together with thalassemia investigation (complete blood count, MCV and Hb typing) of their husbands and to identify couples at risk of 3 severe thalassemia diseases; Hb Bart's hydrops fetalis, homozygous, -thalassemia and, -thalassemia/ Hb E disease. Then they were advised to undergo DNA analysis and, if they had fetal risk, appropriate prenatal diagnosis was offered. MAIN OUTCOME MEASURE: Number of affected fetuses detected by prenatal diagnosis. RESULTS: Nine hundred and ninety six pregnant women (66.49%) were positive on screening. Of these, 642 (64.46%) had thalassemia investigation done with their spouses. There were 19 couples at risk (1.27% of total screened pregnant women) for having fetal severe thalassemia disease from initial laboratory results. Most of them were, -thalassemia/ Hb E diseases. We found only 10 pregnant women (52.63%) that had undergone prenatal diagnosis. The consequent results were two affected fetuses (20%), one was Hb Bart's hydrops fetalis, and the other was, o-thalassemia/ Hb E disease. In these cases, their parents decided to discontinue the pregnancy. Our prevention program could save 1.14 million bahts for the cost of treatment in two prevented severe thalassemia cases. CONCLUSION: The prenatal prevention program of severe thalassemia disease at Srinagarind Hospital can effectively detect affected fetuses and reduce severe thalassemia disease, which is a major health problem in Thailand.

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.

Contraceptive practices and pregnancy intendedness among pregnant adolescents.

BACKGROUND: Adolescent pregnancy is a major health problem in many developing countries. OBJECTIVE: To assess contraceptive practices and pregnancy intendedness in pregnant adolescents. MATERIALS AND METHODS: This study was prospectively conducted from September 2013 to June 2014. All consecutively pregnant women between 15 and 19 years old attending the Antenatal Clinic at Srinagarind Hospital and the Khon Kaen Branch of the Planned Parenthood Association of Thailand were invited for participation. Face-to-face interviews by trained interviewers using standardized questionnaires were carried out. Logistic regression was used to determine an adjusted odds ratio (aOR) and 95% confidence interval (CI) of independent predictors. RESULTS: Two hundred participants were enrolled. Mean age was 17.2 years. One hundred and eighteen (59.0%) were currently in school. Seventy-five (37.5%) participants had never used any contraceptive methods. Of the 125 participants who had ever used contraception, regular use of contraceptives was reported in only 21 participants (16.8%). Only two participants (1.0%) had ever used an intrauterine device or implant. Participants' age was a significant independent factor associated with non-use of contraceptives (aOR, 6.42; 95% CI, 2.94-14.04). Of the 200 participants, 132 (66.0%) declared that the pregnancy was unintended. Significant independent factors predicting unintended pregnancy were educational status (aOR, 6.17; 95% CI, 3.27-13.75) and participants' age (aOR, 5.76; 95% CI, 2.42-13.70). CONCLUSION: Non-use and use of contraceptive methods with high failure rates were major reasons leading to adolescent pregnancies. Participants' age was an independent factor predicting non-use of contraceptives. Educational status and age of the participants were significant factors predicting unintended pregnancy.

Pseudo-Meigs' syndrome secondary to subserous myoma uteri: a case report.

A 45 year-old Thai woman, gravida 5, para 5 presented with a huge pelvic mass as well as ascites and right pleural effusion. Right thoracocentesis was performed pre-operatively and malignant cells could not be detected on the cytological examination of the pleural fluid. Surgical exploration revealed a large pedunculated subserous leiomyoma of the uterus without malignant transformation. Total abdominal hysterectomy with bilateral salpingooophorectomy and appendectomy were performed. Both ascites and pleural effusion resolved post-operatively and did not recur during the 12-month follow-up. This case demonstrated the extremely rare case of pseudo-Meigs' syndrome caused by a subserous uterine leiomyoma.

Pulsatility index of the middle cerebral artery in normal fetuses.

OBJECTIVE: To establish the reference ranges of the middle cerebral artery pulsatility index (MCA PI) in normal fetuses between 20 and 37 weeks gestation. STUDY DESIGN: A descriptive study. SETTING: Antenatal Care Clinic, Outpatient department, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University. SUBJECTS: At least sixteen women of each gestational age with an uncomplicated singleton pregnancy between 20 and 37 weeks gestation. METHOD: All recruited pregnant women were enrolled for abdominal Doppler ultrasonography to determine fetal MCA PI for each week of gestational age. MAIN OUTCOME MEASURES: The MCA PI reference range for normal fetuses between 20 and 37 completed weeks of gestation. RESULTS: The MCA PI decreased as gestational age advanced from 1.97 (SD 0.48) at 20 weeks to 1.15 (SD 0.18) at 37 weeks. CONCLUSION: We established the reference ranges of the fetal MCA PI for reference use in our Antenatal Care Clinic.

Knowledge-attitude-practice of sexual intercourse of post-menopausal women using hormone replacement therapy.

OBJECTIVE: To study knowledge, attitude, practice and concern related to sexual intercourse of post-menopausal women using hormone replacement therapy. MATERIAL AND METHOD: One hundred and thirty subjects were included in the study from the 1st of May 2000 to the 31st of August 2000 at the Menopause Clinic, Srinagarind Hospital, Khon Kaen. All subjects were interviewed by a researcher with structured questionnaires. RESULTS: Sixty seven per cent of the subjects had an acceptable level of knowledge, whereas, 87.7 per cent thought that they could have sexual intercourse similar to what they had in their pre-menopausal period. It was found that 85.4 per cent and 88.5 per cent of the subjects had either less or absent sexual desire and less sexual activity, respectively. In terms of their concern, 73.9 per cent of the subjects were not worried about sexual intercourse. CONCLUSION: The majority of the post-menopausal women using hormone replacement therapy had a good level of knowledge and attitude concerning sexual intercourse. Although most of them had decreased sexual desire and activity, this sexual activity did not cause them concern.

Comparison of the accuracy of ultrasonic fetal weight estimation by using the various equations.

OBJECTIVE: To compare the accuracy of ultrasonic fetal weight estimation using the Hadlock's, Shepard's, Tongsong's and Hansmann's equations. MATERIAL AND METHOD: The analytical-cross sectional study was conducted on 102 pregnant women who were admitted for delivery in the Labor Room at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between January 1, 1999 and June 30, 1999. The fetal parameters, including biparietal diameter, abdominal circumference, transverse trunk diameter and femur length, were measured by ultrasound. The estimated fetal weight was calculated by those four equations. The mean absolute error was calculated from the absolute of the difference between the estimated fetal weight and the actual birth weight. RESULTS: The mean absolute error and standard deviation of the estimated fetal weight by the Hadlock's, Shepard's, Tongsong's and Hansmann's equations were 8.09 +/- 4.18, 7.94 +/- 4.63, 7.77 +/- 3.70 and 7.83 +/- 4.35 per cent respectively and there were no statistically significant differences at 95 per cent confidence interval (p>0.05). CONCLUSION: Apart from having comparable accuracy in the estimation of fetal weight to those of Hadlock, Shepard and Tongsong, Hansmann's equation employed at Srinagarind Hospital was more convenient to use than the others.

Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy.

BACKGROUND: The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH). METHODS: This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature ≥38°C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity. RESULTS: In total, 199 women underwent LAVH during the study period. They had a mean age of 46±6 years, a mean body mass index of 24.0±3.2 kg/m(2), a mean surgical duration of 134±52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5±2 days, and a mean postoperative hospital stay of 3±2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%). The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days. CONCLUSION: This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis.