The Prevalence of Group B Streptococcus in First and Third Trimester Pregnancy

Objective: To determine and compare the prevalence of group B streptococcus in first and third trimaster pregnancy in Thai woman attending antenatal clinic, HRH princess Maha Chakri Sririnhorn Medical Center, Nakorn-nayok province. Materials and Method: This study was carried out from October 2002 through May 2005 at antenatal clinic, HRH princess Maha Chakri Sririnhorn Medical Center, Nakorn-nayok province. 286 pregnant women were enrolled. Vaginal discharge was collected in first and third trimester and cultured.The prevalence of group B streptococcus was determined. Results: The prevalence of group B streptococcus in first trimester pregnancy was 4.5 % (13 cases) third trimester was 1.7 % (5 cases). In all women who group B streptococcus was detected at first trimester only have 2 cases maintained at third trimester. Conclusion: The prevalence of group B streptococcus in Thai women at Nakorn-nayok was low. There was difference between the prevalence of group B streptococcus in first and third trimester

Accuracy of Preoperative Sonographic Adnexal Fixation for Prediction of Pelvic Adhesion in Gynecologic Surgery

Objectives: To assess the accuracy of preoperative sonographic adnexal fixation for prediction of pelvic adhesion in gynecologic surgery.Materials and Methods: This was a descriptive study of 106 gynecologic patients who were scheduled for elective abdominal surgery. Preoperative sonographic adnexal fixation was done. The accuracy of transvaginal ultrasonographic findings suspecting pelvic adhesion, including at least one side of adnexal fixation, in predicting intraoperative adnexal adhesion was calculated. Pelvic adhesion risk factors were also collected.Results: Sonographic adnexal fixation was found in 81 adnexa. Ipsilateral adnexal adhesion was found intraoperatively in 78 adnexa of this study. Overall, pelvic adhesion prediction based on ultrasonographic finding had an accuracy, sensitivity, specificity, positive and negative predictive values of 74.4, 69.2, 77.7, 66.7 and 79.7 percent respectively. History of pelvic infection and dysmenorrhea were positively correlated with pelvic adhesion (Adjusted OR, 3.50; 95%CI, 1.26-9.75; p = 0.016 and adjusted OR, 2.47; 95%CI, 1.37-4.46; p = 0.003 respectively). However, combined a history of pelvic infection and dysmenorrhea with an ultrasonographic finding showed the most correlation with pelvic adhesion.Conclusion: Preoperative adnexal fixation on transvaginal ultrasonography accurately identified patients with pelvic adhesions. Furthermore, history of pelvic infection and dysmenorrhea could increase the ability to predict pelvic adhesion

Prevalence and Risk Factors of Mild Cognitive Impairment in Menopausal Women at HRH Princess Maha Chakri Sirindhorn Medical Center

Objective:To assess the prevalence and risk factors associated with mild cognitive impairment (MCI) in Thai menopausal women.Materials and Methods: The eligible menopausal women were asked during a face-to-face interview to participate in the Thai Montreal Cognitive Assessment (Thai MoCA) test at HRH Princess Maha Chakri Sirindhorn Medical Center. Cognitive impairment was defined as a test’s score of 24 or less. Univariate and multivariate analyses were performed to determine the variable associated with positive Thai MoCA test. Results:The authors found that 20 of the 120 participants were cognitively impaired. The significant associated risk factors were low education (adjusted odd ratio: 3.7; p= 0.03) and the number of concomitant medical diseases. The adjusted odd ratios for one, two and three diseases were 18.0, 42.1 and 88.9 respectively.Conclusion: The prevalence of MCI in menopausal women was 16.7 %. Early detection of this problem in vulnerable group will benefit to their cognitive performance

New agents for treatment of pelvic endometriosis (ยาชนิดใหม่สำหรับการรักษาเยื่อบุโพรงมดลูกเจริญผิดที่ในอุ้งเชิงกราน)

Endometriosis is an estrogen dependent disorder that needs long term treatment. The primary goal of treatment is to alter the growth and activity of endometriotic lesions by inhibiting ovulation and/or inducing atrophic endometrium. Increasing knowledge of the pathogenesis of endometriosis at the molecular and cellular levels has given the opportunity to develop new therapeutic agents. Which have greater efficacy and flexibility than traditional treatments. The new agents are classified as anti-estrogen, anti-progesterone, angiogenesis inhibitors, immunomodulating agents and anti-inflammatory drugs. This review focuses on the new experimental approaches to the medical treatment of pelvic endometriosis

Medical Therapy in Pelvic Endometriosis (การรักษาด้วยยาในภาวะเยื่อบุโพรงมดลูกเจริญผิดที่ในอุ้งเชิงกราน)

Pelvic endometriosis is a frequently encountered gynecologic disorder in female patients. It is the leading cause of pelvic pain and infertility. Pelvic endometriosis is classified into 3 groups according to its gross pathology as follow, pelvic peritoneal endometriosis, ovarian endometrioma and rectovaginal nodule. Differential diagnosis from other diseases can be performed by laboratory studies, imaging studies and laparoscopy. The treatments of this condition compose of medical and surgical treatment. At present, various medical therapies are available. However, the mainstay for long term treatment is hormonal suppression agents. The current medical management of pelvic endometriosis is reviewed in this article

Building the pelvic endometriosis knowledge base software

The objective of this study is to develop a software-based medical expert system supporting the diagnosis of pelvic endometriosis. This system was developed to facilitate the creation of knowledge and inference engine. The diagnostic process used the interactive backward chaining inference algorithm. The medical knowledge data base was represented as production rules which represented in tree structures. The system was designed to interact with users in question information format. The clinical data from medical records of Gynecological out-patient clinic at HRH Maha Chakri Sirindhorn Medical Center were applied to the system by physician retrospectively. In this study, 35 medical records of women diagnosed with pelvic endometriosis were reviewed. The three most common presenting symptoms were dysmenorrhea, chronic pelvic pain and infertility, respectively. All of the patients were investigated with transvaginal sonography. Twenty-one patients had no histological studies. The clinical data of 30 patients accounted for 85.7 % were recorded successfully to the medical expert system. The diagnosis of these patients from the system corresponded with the previous data from the medical records of established pelvic endometriosis. Taken together, these data suggest that this medical expert system is a good tool to facilitate the decision making process in the diagnosis of pelvic endometriosis

Sonographic Lower Uterine Segment Thickness to Predict Cesarean Scar Defect in Pregnant Women

Objective: To study the validity of sonographic lower uterine segment (LUS) thickness in predicting intraoperative cesarean scar defect (CSD) and thin incision sites in term pregnancy.  Methods: This was a cross-sectional study involving 111 full-term pregnant women who were scheduled for repeat cesarean delivery from April, 2019 to January, 2020. The sonographic myometrial LUS thickness was measured prior to surgery. The cesarean scar was assessed using the morphologic classification system as either grade 1 (a normally formed LUS), grade 2 (a thin LUS, but without visible content), or grade 3 (a thin LUS with visible content). Then, the ophthalmic caliper was used to measure the incision site’s uterine-wall thickness. The correlations between the sonographic measurements and intraoperative findings were reported. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: There were two cases (1.8%) of grade 3 CSD. The overall correlation between the sonographic and intraoperative incision-site thickness showed r=0.559 with p-value < 0.001. The sonographic cut-off value of 1.5 mm could predict CSD and a thin incision-site uterine wall with sensitivity, specificity, PPV, NPV of 50.0%, 90.8%, 9.1%, 99.0%, and 37.5%, 94.6%, 54.5%, 90.0%, respectively. A receiver operating characteristic curve was generated to determine the optimum cut-off value at 2.5 mm with a sensitivity of 76.5% and a specificity of 73.3%. The area under the curve was 0.8 (a 95% confidence interval, 0.718-0.885). Conclusion: Abdominal sonography is a valuable tool for the preoperative prediction of CSD. A myometrial LUS thickness of more than 1.5 mm is associated with a lower likelihood of cesarean scar dehiscence