Efficacy of Music Therapy on Immediate Postpartum Episiotomy Pain: A randomized controlled trial

Objectives: To evaluate the effectiveness of music therapy in alleviating immediate postpartum episiotomy wound pain. Materials and Methods: A randomized controlled trial was conducted to evaluate the efficacy of music therapy in alleviating immediate pain from an episiotomy wound. Uncomplicated singleton vaginal delivery women with the second degree or less episiotomy wound at Delivery and Postpartum Inpatient Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Thailand were enrolled into the study. Visual analog scale (VAS) scoring was used for comparing pain levels.Results: One hundred postpartum women were enrolled in our study. Baseline characteristics such as age, degree of episiotomy wound tear were similar between both groups. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of the 2nd hour after finish of episiotomy wound repairing process [24.0 millimeters (8.3-41.5) and 36.5 millimeters (20.0-53.3), p < 0.001]. The median pain VAS score was statistically significantly lower in the music group than in the control group at the end of 6th hour after finish of episiotomy wound repairing process [12.0 millimeters (3.0-21.0) and 22.0 millimeters (15.0-38.0), p < 0.001] Conclusion: Music therapy is effective for reducing the perceived immediate postpartum pain of an episiotomy wound

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

Suitable of annual health check-up programs as divided by age of 35 years(ความเหมาะสมของโปรแกรมตรวจสุขภาพประจำปี ตามเกณฑ์อายุ 35 ปี)

Annual health check-up program is useful for early detection of diseases, which will facilitate successful treatment and improve prognosis. In addition, it helps reducing the cost of treatment. For the government officers, the annual check-up fee is paid, according to age groups, by The Comptroller General’s Department, Ministry of Finance. However, the tests include in the check-up programs may not appropriate for person of less than 35 years of age. The objective of this study was to evaluate how suitable the health check-up program as divided by age of 35 years due to the regulations of The Comptroller General’s Department, Ministry of Finance. The study design was cross-sectional. Data were collected from 466 persons who visited the health promotion center, Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center from July, 2007 to December, 2008. The dataset of fasting blood sugar, blood lipid, renal function, liver function, and blood uric acid were divided into two groups: less than 35 years and equal to or over 35 years. Qualitative data and quantitative data were compared by Chi-square test and T-test, respectively at p-value of less than 0.05. The results showed that 57.1% of subjects were female. The average age was 43.9 years. The values of blood pressure, waist circumference, chest X-ray, stool occult blood, and fasting blood sugar were significantly different between two age groups. Fasting blood sugar, blood lipid, renal function, liver function, and blood uric acid were not statistical difference between age 35 years. In conclusion, hypertension, abdominal obesity, abnormal chest X-ray, stool occult blood, and high blood sugar were mostly found at older age. It was recommended that the health check-up program which be select by age 35 years old, should be adjusted

Stress and depressive symptoms related excessive daytime sleepiness in Thai medical students, Srinakharinwirot University (อาการแสดงของความเครียดและอารมณ์ซึมเศร้าที่สัมพันธ์กับความง่วงมากกว่าปกติในนิสิต คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ)

Excessive daytime sleepiness (EDS) is a common sleep disorder in general population which can lead to serious consequences including traffic and industrial accidents, decreased productivity, and interpersonal problems. Besides sleepiness, EDS is also related to depression and stress. The objective of this study was to determine the symptoms of stress and depression in medical students that associated to excessive daytime sleepiness. Cross-sectional study was performed. The questionnaires which composed of the diagnostic screening test for depression in Thai population: Health-Related Self-Reported (HRSR) Scale, Suanprung stress test and Epworth sleepiness scale were sent to 646 medical students of all classes at Srinakharinwirot University during February, 11th 2008 to March, 4th 2008. Categorical variables were analyzed using the Chi-square test or Fisher exact test. For binary response variables, odds ratio and significant explanatory variables were identified through logistic regressions. A two-tailed p-value of less than 0.05 was considered significant. EDS was not associated to class, gender and body mass index, but it was associated to depression and stress with odds ratios of 3.3 and 2.8, respectively (

Accuracy and factors influencing Leopold’s manoeuvres in determining vertex presentation during late third trimester of pregnancy

This prospective descriptive study was conducted for examine the accuracy of Leopold’s manoeuvres in determining vertex presentation and to identify factors which may influence the accuracy. Pregnant women gestational age more than 34 weeks were examined using Leopold’s manoeuvre for foetal presentation, and findings confirmed on subsequent ultrasonographic (US) examinations. Our study found Leopold’s manoeuvre for foetal presentation determination during the late third trimester of pregnancy has high sensitivity but low specificity. Accuracy of performance of Leopold’s manoeuvre for foetal presentation and lie were 89 and 96%, respectively. The sensitivity, specificity and PPV for vertex presentation diagnosis were 93.2, 30 and 94.9%, respectively. A larger foetal abdominal circumference decreased the accuracy of performance of Leopold’s manoeuvre (Adjusted OR 0.821, 95% CI 0.703–0.959, p = .013). Using an AC cut-off value of ≥33.01 cm, the sensitivity, specificity, PPV and NPV for accurate vertex presentation diagnosis were 54.3, 57.6, 91 and 13%, respectively.IMPACT STATEMENT What is already known about this subject? Leopold’s manoeuvre is a method for assessing fetal presentation. Previous studies have found the overall accuracy of Leopold’s manoeuvre to be 63–88%. What the results of this study add? Leopold’s manoeuvre has high sensitivity but low specificity. Increased fetal AC influences the accuracy of Leopold’s manoeuvre. What the implications are of these finding for clinical practice and/or further research? Fetal non-vertex presentation and fetal AC ≥33.01 cm measured by ultrasonographic examination during late third-trimester pregnancy should be followed for determine the fetal presentation by ultrasonographic examination, patient’ counselling and planning the route of delivery for non-vertex presentation in case of emergency. Further investigations about the cost effectiveness of universal ultrasonographic examination for fetal presentation determination in late third-trimester pregnancy are needed

Efficacy of a 28-compartment pillbox for improving iron supplement compliance in healthy pregnant women: a randomised controlled trial

A randomised controlled trial was conducted. The primary objective was to evaluate the efficacy of a pillbox for increasing iron supplement compliance by comparing the proportion of pregnant women who had no remaining iron tablets between pregnant women attending ANC who were given a pillbox to use and women with no pillbox in four-week period between ANC visits. The secondary objective was to evaluate the reasons for poor compliance and possible factors associated with the non-compliance. One hundred and ninety pregnant women were enrolled, 95 participants were randomised into each of the groups. The proportion of pregnant women who had no remaining iron tablets at the end was statistically significantly lower in the pillbox group than in the control group [53.3% and 23.1%, respectively, p < .001, RR2.308 (95% CI 1.515 − 3.517)]. The most common reason given for having of iron tablets remaining was forgetfulness. The visual analog scale (VAS) scores indicated that patient’s responsibility feeling, duration of sleep each day and presence of a handicapped or small child in care significantly influenced the proportion of pregnant women who had remaining iron tablets at the end in both groups. We concluded that a pillbox was found to be an effective tool for improving pregnant women’s compliance with taking their iron supplements.IMPACT STATEMENT What is already known about this subject? Antenatal care (ANC) influences maternal and neonatal outcomes. The incidence of anaemia in pregnant women is reported to be around 42% and approximately 50% result from iron deficiency. Maternal anaemia increases the risk of foetal low birth weight, preterm birth, perinatal mortality, stillbirth and maternal mortality. What do the results of this study add? The 28–compartment pillbox is effective for improving iron supplement compliance in healthy pregnant women. Forgetfulness is the most common reason given for having remaining iron tablets. The lower score on the visual analog scale of patient’s feeling of responsibility, long duration of sleep a day and the presence of a handicapped or small child in their care were significantly associated with having remaining iron tablets. What are the implications are of these finding for clinical practice and/or further research? The 28–compartment pillbox can be implied to routine antenatal care for improving iron supplement compliance in healthy pregnant women. Health care providers should be reminded to encourage compliance with iron supplement prescription in pregnant women who are at risk of poor compliance as indicated by low VAS of the patient’s feeling of responsibility, long duration of sleep in a day and pregnant women who have responsibility to take care of handicapped or small children

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