Factors Associated with Early Postpartum Hemorrhage of Singleton Pregnancy in Maharat Nakhon Ratchasima Hospital

Objective:To determine factors associated with early postpartum hemorrhage(PPH) of singleton pregnancy who delivered in Maharat Nakhon Ratchasima Hospital.Materials and methods: A cross-sectional, descriptive case-control study was conducted. One thousand nine hundred and fifty medical records of singleton pregnancies in Maharat Nakhon Ratchasima Hospital during 1 January 2007 to 31 December 2009 were reviewed. Cases: controls were matched 1:4. The collected data were analyzed to determine factors associated with early PPH by univariate analysis and multiple logistic regression analysis.Results:There were 390 pregnancies with early PPH, and 1,560 pregnancies without early PPH. The significant factors associated with early PPH were tear of birth canal [Odds ratio(OR) 138.44, 95 %CI 59.32-323.07], coagulopathy (OR 82, 95 %CI 7.06-951.58), retained placenta (OR 47.08, 95 %CI 26.44-83.82), placenta previa (OR 31.76, 95 %CI 15.73-64.11), placental abruption (OR 7.59, 95 %CI 1.85-30.97), prolonged second stage of labor (OR 4.67, 95 %CI 1.79-12.17), intrapartum terbutaline use (OR 4.11, 95 %CI 1.02-16.49), history of dilatation & curettage (OR 3.98, 95 %CI 1.49-10.62). Only one factor, Bachelor’s degree education (OR 0.45, 95 %CI 0.2-0.95) was protective factor to early PPH.Conclusion: Regarding to the strategic care and management to decrease early PPH, special care and awareness should be focused on the pregnant women with history of abnormal placentation, having factors predisposing to uterine atony, coagulopathy and patients with tear of birth canal

Maternal Risk Factors of Low Birth Weight at Maharat Nakornratchasima Hospital

Objective:To identify maternal risk factors associated with Low birth weight Infant (LBW)Materials & methods: Cross-sectional, descriptive case-control study. Six hundred and thirty three mothers who delivered single alive baby between 1 May and 31 August 2010 at the Obstetrics-Gynecology Unit, Maharat Nakhon Ratchasima Hospital were enrolled. The studied group was divided into 268 mothers who delivered newborn with birth weight equal to or less than 2,500 grams. The controlled group comprised of 268 mothers who delivered normal birth weight newborn. The univariate analysis was done. The factors which had statistic significant were included into multiple logistic regression model in order to evaluate the significance factors related with LBW (p < 0.05).Results :The significant factors that associated with LBW were family’s monthly income ≤10,000 Bath (p<0.05, 95 % CI 2.86-7.81), hard work intensity (p<0.05, 95 % CI 1.02-3.85), sleep 6-8 hours/day (p<0.05, 95 % CI 2.82-6.93 ), coitus in the last 3 months (p<0.05, 95 % CI 1.42-3.50) and delivery interval <2 years (p<0.05, 95 % CI 1.42-3.56 ). The protective factor is total weight gain more than 11 kilograms.Conclusion : The mother who have history of low family’s monthly income, hard work intensity, sleep 6-8 hours/day, had coitus in the last 3 months and short delivery interval ≤2 years had the significant risk factors for LBW. The preventive factors was the appropriate total weight gain

Gastrointestinal injuries during gynaecologic operations at a university teaching hospital in Thailand: a 10-year review

The objective of this study was to investigate the incidence of gastrointestinal injuries during gynaecologic operations, the management of such injuries and associated risk factors. This case-control study (1:4) examined patients who received gynaecologic operations from 2007 to 2016 in Ramathibodi Hospital. The study cases comprised patients who had gastrointestinal injuries, while the control cases comprised patients who had gynaecologic surgeries in the same period with matching the types of procedures. The 10-year incidence was 0.38% (104 cases of gastrointestinal injuries among a total of 27,520 cases). The most common injury site was the small bowel (43.3%). There were 102 cases (98%) of gastrointestinal injuries which were diagnosed intraoperatively and which were immediately repaired with successful outcomes. Logistic regression indicated that a pelvic adhesion, previous pelvic surgery and previous abdominal surgery were predictive risk factors associated with the injuries (odds ratios: 9.45, 3.20 and 11.84, respectively). An immediate consultation with a surgeon and surgical repair of the injury resulted in excellent outcomes.Impact statement What is already known about this subject? Gastrointestinal injury is a rare, but fatal complication of gynaecologic operations. The previous small study identified some risk factors such as surgical approach and pelvic surgery associated with the injury. What do the results of this study contribute? Our study identified the associated risk factors for gastrointestinal injury, including previous abdominal injury, pelvic adhesion and previous pelvic surgery. A previous abdominal surgery was the most associated risk factor. Patients with the history of abdominal surgery had an almost 4-fold higher odds ratio than the ones with previous pelvic surgery. Other factors, including endometriosis, ovarian cancer and subsequent oncological procedures, and surgical staging were less related to the gastrointestinal injury. What are the implications of these findings for clinical practice and/or further research? The knowledge is useful for pre-operative evaluation and preparation. Bowel preparation and consultation with surgeon are necessary for patients with these risk factors prior to their surgeries. Moreover, an immediate intra-operative surgical correction of the injury results in excellent outcomes

Effect of Vitamin E Supplement on Bone Turnover Markers in Postmenopausal Osteopenic Women: A Double-Blind, Randomized, Placebo-Controlled Trial

Vitamin E is a strong anti-oxidative stress agent that affects the bone remodeling process. This study evaluates the effect of mixed-tocopherol supplements on bone remodeling in postmenopausal osteopenic women. A double-blinded, randomized, placebo-controlled trial study was designed to measure the effect of mixed-tocopherol on the bone turnover marker after 12 weeks of supplementation. All 52 osteopenic postmenopausal women were enrolled and allocated into two groups. The intervention group received mixed-tocopherol 400 IU/day, while the control group received placebo tablets. Fifty-two participants completed 12 weeks of follow-up. Under an intention-to-treat analysis, vitamin E produced a significant difference in the mean bone resorption marker (serum C-terminal telopeptide of type I collagen (CTX)) compared with the placebo group (&minus;0.003 &plusmn; 0.09 and 0.121 &plusmn; 0.15, respectively (p &lt; 0.001)). In the placebo group, the CTX had increased by 35.3% at 12 weeks of supplementation versus baseline (p &lt; 0.001), while, in the vitamin E group, there was no significant change of bone resorption marker (p &lt; 0.898). In conclusion, vitamin E (mixed-tocopherol) supplementation in postmenopausal osteopenic women may have a preventive effect on bone loss through anti-resorptive activity

The effect of online video-assisted teaching program on medical students learning procedure of fractional curettage

Abstract Objectives Since 2020, with the entire world in crisis over the coronavirus pandemic (COVID-19), medical students have adapted to hybrid and distance learning. This study aims to compare the learning outcomes of students learning the procedure of fractional curettage in an online video-assisted teaching program to those of students learning the procedure in a traditional class. Methods A quasi-experimental study was conducted among fourth-year medical students who rotated to Obstetrics and Gynecology courses between April 2021 and October 2021. Participants in the first two rotations were enrolled in traditional classes, and the online video-assisted teaching program was introduced in the subsequent two rotations. Both study groups took OSCEs (objective structured clinical examinations), a pre-test and post-test with MCQs (multiple choice questions), and a confidence and satisfaction level questionnaire. Results A total of 106 fourth-year medical students, 54 in the traditional group and 52 in the online video-assisted teaching program, were recruited. The online video-assisted group showed a statistically better mean OSCE score (85.67 ± 11.29 vs. 73.87 ± 13.01, p < 0.001) and mean post-test MCQ score than the traditional group (4.21 ± 0.87 vs. 3.80 ± 0.98, p = 0.0232). Moreover, the mean difference between the two groups' pre and post-test MCQ scores was significantly different (0.96 ± 1.37 vs. 1.79 ± 1.50 in traditional and online video-assisted teaching program groups, respectively, P = 0.0038). The participants in the experimental group reported significantly greater confidence (P < 0.001) in performing the fractional curettage procedure. However, the mean satisfaction score was significantly higher in the control group (p = 0.0053). Conclusion The online video-assisted teaching program on the fractional curettage procedure, a necessary and skill-demanding procedure, is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students. We recommend that the video-assisted teaching program is another effectively procedural teaching method for medical students

Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis

Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings

Evaluation of Body Composition in Hemodialysis Thai Patients: Comparison between Two Models of Bioelectrical Impedance Analyzer and Dual-Energy X-Ray Absorptiometry

Background. Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with multifrequency technique is a practical and reliable tool. Objective. This cross-sectional study was aimed to compare the agreement of BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors. Methods. Body composition was measured by 2 BIA methods (InBody S10 and InBody 720) and DXA after a hemodialysis session. A total of 69 measurements were included. Pearson’s correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively. Results. The correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r=0.95, fat-free mass index (FFMI): r=0.78) and also between DXA and InBody 720 (FMI: r=0.96, FFMI: r=0.81). Comparing to DXA, the means of each body composition measured by InBody S10 method were not significantly different in each gender, but differences were found in FM, %FM, and FMI measured by InBody 720. Conclusions. In maintenance hemodialysis patients, the measurement of body composition with DXA and both BIA methods had highly significant correlations; practically, BIA method could be used as an instrument to follow FM and FFM and to measure the edematous stage. Further studies with large populations are warranted