Prevalence of ovarian mass and diagnostic performance of ultrasonography pattern recognition among women at the Gynaecologic Ultrasonography Unit at University Hospital in Thailand.

The aim of this retrospective study was to determine the prevalence of ovarian masses and calculate the diagnostic performance of the pattern recognition approach in ovarian pathology. A total of 1001 patients diagnosed with ovarian mass were included, of which 92.6% were diagnosed with ovarian pathology and the presence of a pathological result, while 7.4% of cases were diagnosed with functional ovarian cyst. The prevalence of ovarian malignancy was 15%. A specific ultrasound diagnosis was suggested in 62.9% of all cases, while sonographers did not explicitly provide a diagnosis in remaining cases. A subjective assessment showed 80.3% sensitivity (95% confidence interval (CI) 68.7-89.1) and 97.6% specificity (95% CI 96-98.6) in differentiating between benign and malignant ovarian masses. The sensitivity and specificity for the diagnosis of endometriotic cyst were 77.03% and 90.63% and 63.19% and 94.3% for mature cystic teratoma, respectively. In conclusion, assessment showed good performance in differentiating between benign and malignant ovarian mass and it was possible to diagnose several specific ovarian tumours. Impact StatementWhat is already known on this subject? Pattern recognition is an acceptable method for classifying ovarian mass, which exhibits specific morphological features on grey-scale ultrasonography, and can be used to predict nature and histological type.What do the results of this study add? Even in the hands of an expert examiner, there were a number of cases in which the diagnoses could not be specifically stated. Pattern recognition correctly classified 90.3% of ovarian masses as either benign or malignant and correctly provided specific histologic diagnoses after exclusion of unspecified diagnosis in 80.6% of all cases. The diagnostic performance of this approach was high in differentiating between benign and malignant ovarian mass and in diagnosing some specific ovarian pathologies.What are the implications of these findings for clinical practice and/or further research? A subjective assessment is simple and easy to use in clinical practice and has shown promising results in classifying benign and malignant ovarian mass. Moreover, it can also be used to make some specific diagnoses. However, specialised and experienced gynaecological ultrasound examiners are required to provide the most accurate diagnosis. Therefore, criteria to describe ultrasound features and convincing operators to make a definite diagnosis as often as possible should be encouraged. A prospective study to verify diagnostic performance of pattern recognition or comparing with other ultrasonographic diagnostic tools should be considered.

Preoperative Evaluation of the ADNEX Model for the Prediction of the Ovarian Cancer Risk of Adnexal Masses at Siriraj Hospital.

INTRODUCTION: Distinguishing benign adnexal masses from malignant tumors plays an important role in preoperative planning and improving patients' survival rates. The International Ovarian Tumor Analysis (IOTA) group developed a model termed the Assessment of Different NEoplasias in the adneXa (ADNEX). OBJECTIVE: Our objective was to evaluate the performance of the ADNEX model in distinguishing between benign and malignant tumors at a cutoff value of 10%. METHODS: This was a prospective diagnostic study. 357 patients with an adnexal mass who were scheduled for surgery at Siriraj Hospital were included from May 1, 2018, to May 30, 2019. All patients were undergoing ultrasonography, and serum CA125 was measured. Data were calculated by the ADNEX model via an IOTA ADNEX calculator. RESULTS: Of the 357 patients, 296 had benign tumors and 61 had malignant tumors. The area under the receiver operating characteristic curve for using the ADNEX model was 0.975 (95% confidence interval, 0.953-0.988). At a 10% cutoff, the sensitivity was 98.4% and specificity was 87.2%. The best cutoff value was at 16.6% in our population. CONCLUSIONS: The performance of the ADNEX model in differentiating benign and malignant tumors was excellent.

10% lidocaine spray for pain control during intrauterine device insertion: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Various medications have been investigated for their efficacy in pain reduction during intrauterine device (IUD) insertion, but there is currently no standard recommendation. This study aimed to investigate the efficacy of 10% lidocaine spray in reducing pain during copper-containing intrauterine device (Cu-IUD) insertion. METHODS: This study was a randomised, double-blind, placebo-controlled trial. Reproductive-age women were randomised at a 1:1 ratio into 10% lidocaine spray or placebo spray group. A 10 cm visual analogue scale (VAS) was used to evaluate pain during several steps of the IUD insertion procedure, and after the procedure. RESULTS: One hundred and twenty-four women were included and 62 women were randomised in each group. Baseline characteristics between groups were similar. The 10% lidocaine spray group demonstrated significantly lower median VAS immediately after IUD insertion than the placebo group (2.95 (IQR=1.00-5.63) vs 5.00 (IQR=3.35-7.00), respectively; p=0.002). Similarly, women receiving 10% lidocaine spray reported significantly lower median VAS than those receiving placebo during tenaculum use and uterine sounding. The maximum median VAS occurred immediately after Cu-IUD insertion. The proportion of women who reported VAS≥4 during uterine sounding and after IUD placement was significantly lower in the 10% lidocaine group than in the placebo group (p<0.05). Median change in VAS from baseline to IUD placement was significantly different between 10% lidocaine spray group and placebo group (1.85 (IQR=0.08-4.03) vs 3.6 (IQR=2.40-5.80), respectively; p=0.004). CONCLUSION: 10% lidocaine spray was found to be an effective local anaesthetic method for reducing pain during insertion of Cu-IUD. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT03870711.

Comparison of change in body weight between contraception containing 30-µg ethinylestradiol/2-mg chlormadinone acetate or 30-µg ethinylestradiol/3-mg drospirenone: a randomised controlled trial.

Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-µg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-µg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.

Prevalence and associated factors of breastfeeding in women with gestational diabetes in a University Hospital in Thailand.

Background: Gestational diabetes mellitus (GDM), which is a medical complication that develops during pregnancy, is associated with several long-term health problems. Despite several benefits of exclusive breastfeeding (EBF), including reduction in long-term health problems in mothers with GDM, few studies have investigated breastfeeding in women with GDM and information in the Thai population is lacking. The aim of the study was to determine the prevalence of breastfeeding and the factors associated with breastfeeding during the first six months postpartum in women with GDM. Methods: A questionnaire-based prospective study was conducted during November 2014 to June 2017. Study participants were first interviewed on the second day post-delivery, and then by telephone at 6 weeks, 3 months and 6 months postpartum. Breastfeeding assessment based on infant feeding practice in the last 24-h period was classified according to World Health Organization definitions. Results: A total 229 women were enrolled in this study. Prevalence of any breastfeeding at 24 h, 6 weeks, 3 months, and 6 months postpartum was 28.8% (n = 66), 94.3% (n = 214), 71% (n = 154), and 49.8% (n = 104), respectively. Prevalence of EBF was 35.9% (n = 78) at 3 months, and 23% (n = 48) at 6 months after delivery. Maternal intention to breastfeed for 6 months was an independent predictor for both 6 months EBF (RR 16.38; 95% CI 2.29, 116.99) and any breastfeeding (RR 2.65; 95% CI 1.65, 4.25). Breastfeeding initiation within 24 h postpartum (RR 1.38; 95% CI 1.08, 1.76) and being a government officer or private business owner (RR 1.66; 95% CI 1.03, 2.68) were independent predictors of any breastfeeding and EBF for 6 months, respectively. Conclusion: The prevalence of breastfeeding in Thai women with GDM was lower than the national and global target goal. Maternal intention to breastfeed for at least 6 months and breastfeeding initiation were important factors associated with 6 months' breastfeeding. In order to improve the breastfeeding rate and duration, health care providers should support women's feeding decision, emphasize the benefits of breastfeeding to enhance breastfeeding intention, seek to remove or minimize barriers to the initiation of breastfeeding and reduce mother-infant separation time.

Accuracy of anti-Müllerian hormone and total follicles count to diagnose polycystic ovary syndrome in reproductive women.

OBJECTIVE: Recently, there was a new recommendation of ultrasonographic criteria to diagnosis polycystic ovary syndrome (PCOS). In addition, serum anti-Müllerian hormone (AMH) was proposed as a surrogate marker for diagnosis of PCOS, but AMH cut-off level for diagnosis of PCOS is unclear. This study aimed to investigate the accuracy of serum AMH and evaluate new ultrasonographic criteria, follicle number per ovary (FNPO) threshold ≥ 25 follicles and ovarian volume (OV) > 10 mL, for diagnosis of PCOS. MATERIALS AND METHODS: A cross-sectional study was conducted. Fifty-five PCOS women and sixty-three normal ovulatory, non-hyperandrogenic women were recruited. Transvaginal or transrectal ultrasonography was performed in all participants to evaluate follicle number and OV. Serum AMH was evaluated in both study groups. RESULTS: The mean age of the participants was 25.1 ± 5.3 years old in PCOS group and 29.7 ± 7.2 years old in control group. Mean AMH, FNPO and OV in PCOS women were significantly higher than those in non-PCOS women. The area under the receiver-operating characteristic (ROC) curve of AMH was 0.903. The threshold of AMH at 4.7 ng/mL offered the best compromise between 80% sensitivity and 77.8% specificity. The appropriated threshold values for FNPO, follicle number per cross-section (FNPS) and OV were 15 follicles, 7 follicles and 6.5 mL, respectively. Serum AMH level was significantly positively correlated with FNPO, FNPS and OV in both PCOS and control groups. In PCOS women, serum AMH showed strongly correlation with FNPO (r = 0.53, p < 0.001) and weakly correlation with total testosterone (r = 0.283, p = 0.036). CONCLUSION: Serum AMH had a good diagnostic performance for diagnosis of PCOS presenting with oligo/anovulation and hyperandrogenism. AMH threshold at 4.7 ng/mL was the best compromise level for diagnosis of PCOS. FNPO ≥15, FNPS ≥7 and OV ≥ 6.5 mL were reliable threshold for detecting polycystic ovaries in women with frank manifestation of PCOS.

Comparison of OSTA index and KKOS scoring system for prediction of osteoporosis in postmenopausal women who attended Siriraj Menopause Clinic.

OBJECTIVE: To compare diagnostic performance of the Osteoporosis Self-Assessment Tool for Asians (OSTA) index and Khon Kaen Osteoporosis Study (KKOS) scoring system with standard measurement of bone mineral density (BMD) by dual energy X-rays absorptiometry (DEXA) for screening osteoporosis and to determine osteoporosis risk factors in postmenopausal women who attended the Siriraj Menopause Clinic, Siriraj Hospital SUBJECTS: Four hundred forty one postmenopausal women who attended the Siriraj menopause clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand and had BMD measurement by DEXA and had a diagnostic test were included in the study MATERIAL AND METHOD: The data were collected from medical records. Subjects who met the inclusion criteria, without exclusion criteria were collected data and calculated for OSTA index and KKOS score. Both indices at < or = -1 were classified as high risk of osteoporosis. Sensitivity, specificity, PPV NPV and AUC of OSTA index, and KKOS score were compared Risk factors for osteoporosis were analyzed. RESULTS: The prevalence of osteoporosis was 19.7%, 18.8% for osteoporosis of lumbar spine, 2.3% for osteoporosis of femoral neck, and 2% for osteoporosis of total hip. The OSTA index in identifying osteoporosis at least one site of femoral neck, total hip or lumbar spine at original cut point of < or = -1 had sensitivity and specificity of 51.7% and 77.4% respectively and KKOS at original cut point of < or = -1 had sensitivity and specificity of 56.3% and 71.8% respectively Sensitivity of OSTA index was 80% at femoral neck, 77.8% at total hip, and 49.4% at lumbar spine. KKOS had sensitivity at femoral neck, total hip and lumbar spine of 80%, 77.9%, and 54.2% respectively. Specificity of KKOS at femoral neck, total hip and lumbar spine were slightly lower than OSTA index. Age > or = 65 years, family history of osteoporosis, and history of fracture at age > 45 years found to be risk factors for osteoporosis with odd ratio of 9.0, 2.7, and 5.3 respectively. CONCLUSION: Both OSTA index and KKOS scoring system had good performance in identifying osteoporosis of femoral neck and total hip but both indices had low sensitivity in identifying osteoporosis of spines. The authors recommend using OSTA index for screening osteoporosis because it is comparable in diagnostic performance and OSTA is more convenient and simpler than KKOS scoring system.