Incidence of fetal bradycardia and effect of placental injury on fetal heart rate during second-trimester genetic amniocentesis.

A prospective study was conducted for comparing the incidence of fetal bradycardia and level of fetal heart rate change following a second-trimester genetic amniocentesis with and without placental injury. A total of 257 and 495 participants in injured and non-injured groups were analysed. The incidence of fetal bradycardia following amniocentesis was not statistically different between the two groups (1.17%, [95% CI 0.24, 3.37] and 0.20%, [95% CI 0.005, 1.12]) in injured and non-injured placenta groups, respectively; p = 0.118). The mean change in baseline fetal heart rate before and after amniocentesis was also not significantly different between the two groups (p = 0.844). No fetal death or pregnancy loss occurred within 4 weeks after the procedure. All 4 bradycardia participants were normal and healthy and had an appropriate weight for their gestational age. We conclude that placental injury during a second-trimester genetic amniocentesis due to advanced maternal age poses only a low risk of fetal bradycardia, and there is no evidence of differences between subjects with injured and non-injured placenta in the changes in fetal heart rate.

Pregnancy outcomes in Southeast Asian migrant workers at Southern Thailand.

This retrospective study was conducted to determine the pregnancy outcomes and identify predictive factors of adverse outcomes in pregnant migrant workers who delivered at Songklanagarind Hospital from January 2002 to December 2012. Two hundred and forty migrant worker pregnancies were enrolled. Pre-eclampsia, gestational diabetes mellitus, pre-term birth and foetal intrauterine growth restriction found were 15, 7.9, 13.7 and 3.7%, respectively. No stillbirth was found. Apgar score was

Splenectomy and surgical cytoreduction in epithelial ovarian cancer: a review.

Surgical cytoreduction and platinum/taxane combination chemotherapy are the mainstay for the treatment of epithelial ovarian cancer patients. In order to minimise the tumour mass before chemotherapy, cytoreductive surgery is usually performed first. Currently, a splenectomy is included as part of surgical cytoreduction in epithelial ovarian cancer, but it is rarely performed. A splenectomy is also performed as part of secondary cytoreduction surgery. Although there are many reports on surgical techniques, safety and associated clinical outcomes of a splenectomy as a standard adjunct of ovarian cytoreductive surgery, most evidence is from case(s) reports, with only a few studies. Thus, we conducted a review of the literature on this unusual procedure in the context of primary and secondary cytoreduction of epithelial ovarian cancer to assess the published evidence for its efficacy and safety.

Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy.

We determined the prevalence of sexual dysfunction in women with early-stage cervical cancer who had undergone radical hysterectomy in three institutions of Thailand. An interview was conducted according to the structured questionnaire composing of seven domains of sexual function: frequency, desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia. From 105 women included in the study, mean age was 45.3 +/- 7.8 years. Seventy-five (71.4%) were in premenopausal period. Eight out of 105 women (7.6%) never resumed their sexual intercourse after radical hysterectomy, 97 women resumed their sexual intercourse during 1-36 months postoperation (median, 4 months). Dyspareunia was increased in approximately 37% of women, while the other six domains of sexual function were decreased, ranging from approximately 40-60%. Of interest, only 10.5% of these cervical cancer women had some information of sexual function from medical or paramedical personnel, 17.1% obtained it from other laymen or public media, and 61.9% had never had it from any resources. Our conclusion is-sexual dysfunction is a common problem after cervical cancer treatment, but it has not been well aware of. These findings may necessitate health care providers to be more considerate on this problem.

Accuracy of intraoperative frozen section in diagnosis of ovarian tumors.

OBJECTIVE: To determine the accuracy of intraoperative frozen section diagnosis of ovarian tumors according to malignancy status. MATERIAL AND METHOD: From May, 1999 to October, 2004 at Songklanagarind Hospital, a total of 229 ovarian specimens were transferred from the operating room to the Department of Pathology for intraoperative frozen section. All cases of deferred diagnosis and disagreement between frozen and permanent paraffin section were reviewed. RESULTS: Intraoperative frozen section diagnosis of all 229 ovarian specimens revealed 54.1% benign tumors, 8.3% borderline tumors, 30.6% malignant tumors, and 7% deferred diagnoses. The final paraffin section diagnoses revealed 52.4% benign tumors, 9.2% borderline tumors, and 38.4% malignant tumors. Mean tumor diameter of the agreement cases were 12.58 +/- 5.39 cm, disagreement cases were 17.64 +/- 6.83 cm, and deferred cases were 19.33 +/- 6.50 cm. The mean diameter of mucinous tumors was significantly different comparing between disagreement cases to agreement cases and deferred cases to agreement cases. The overall accuracy was 89.7%. Sensitivity was highest in the benign group at 98.2% and lowest in the borderline group at 57.1%. The sensitivity and specificity for benign, borderline, and malignant tumors were 98.2%, 57.1%, 86.1%, and 87.0%, 96.4%, 98.5%, respectively. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for benign, borderline, malignant tumors were 89.5%, 63.2%, 97.1% and 97.8%, 95.4%, 92.3%, respectively. CONCLUSION: Intraoperative frozen section diagnosis appears to be an accurate technique for the histopathologic diagnosis of ovarian tumors. However, limitations in use of frozen section must be recognized such as large specimens, especially mucinous subtype. Regular re-evaluation or consultation concerning disagreements between frozen section diagnosis and final permanent paraffin diagnosis should be conducted by both surgeons and pathologists as part of quality assurance to determine the most appropriate intraoperative management for patients with ovarian tumors.