Misoprostol versus Placebo for Unsatisfactory Colposcopic Finding: A Randomized Controlled Trial

Objective: To assess the effectiveness of vaginal misoprostol for converting unsatisfactory to satisfactory colposcopy.Materials and Methods: Forty women with abnormal cervical cytology and unsatisfactory colposcopy who underwent colposcopic examination at colposcopic clinic Khon Kaen Hospital, between May, 2009 and June, 2010. Patients were randomly allocated to received either 200 μg misoprostol or placebo vaginally, and colposcopic examination were taken 4 hours later. The percentage of conversion to satisfaction result and the adverse effects were recorded.Result: There were 20 women in each misoprostol and placebo group. One patient was excluded from each group because of follow up problem. In misoprostol group, 13 out of 19 patients (68.4%) were converted into satisfactory colposcopy result compared with five out of 19 patients (26.3%) in placebo group. This effect was statistically significant difference (P=0.009). No serious adverse effects was reported in both groups. Conclusions: Two hundred micrograms of vaginal misoprostol was effective and safe to convert unsatisfactory to satisfactory colposcopy result

Hb A1c versus 50 grams Glucose Screening Test for Screening Gestational Diabetes Mellitus

Objective :To evaluate utility of HbA1c as a screening method for gestational diabetes mellitus (GDM) in high risk pregnant women.Material and Method:This diagnostic study was conducted at Khon Kaen Hospital between July 2012 and May 2013. Two hundred pregnant women with high risk of GDM underwent a conventional 50g glucose screening test (GST) and Hb A1c measurement as a new screening method at first antenatal visit. A gold standard diagnosis of GDM was 100g oral glucose tolerance test (OGTT) based on The National Diabetes Data Group (NDDG) criteria was performed next week. The optimal cut off value for Hb A1c was analyzed by receiver operating characteristic (ROC) curve.Results :The area under ROC curve of HbA1c to detect GDM was 0.75 (95%CI 0.67–0.84). Sensitivity and specificity of Hb A1c for screening GDM at 4.9%, 5.0% and 5.1% were 89.8% and 24.5%, 87.8% and 33.1% and 85.7% and 42.4%, respectively. The negative predictive value increased as the cut off values increased and reached 88.1%, 89.3% and 90.1% at Hb A1c 4.9%, 5.0% and 5.1%, respectively. Sensitivity and specificity of 50g GST at 140 mg/dL was 81.6% and 22.5%, respectively.Conclusion : The appropriate HbA1c cut off value for screening GDM was 5.0%. The sensitivity was higher than 50g GST at 140 mg/dL and high negative predictive value

Membrane Stripping to Reduce Postdate Pregnancy: A Randomized Controlled Trial

Objectives: To compare delivery before 40 weeks of gestation between the pregnant women who had membrane stripping and those with no intervention.Materials and Methods: One hundred and seventy-eight pregnant women, gestational age of 38 weeks or more who attended antenatal care clinic at Khon Kaen Hospital from January to July, 2016 were randomized into two groups: membrane stripping group and no intervention group. The proportion of pregnant women who delivered before 40 weeks of gestation was analyzed.Results: Baseline characteristics were similar between groups. The proportion of women who delivered before 40 weeks of gestation in membrane stripping group was significantly higher than no intervention group (69.3% VS 51.1%, p=0.01) (RR=0.6, 95% CI 0.4-0.9). There was no significant difference in cesarean section rate, maternal complications and neonatal outcomes between groups.Conclusion: Membrane stripping can reduce postdate pregnancy

Sublingual Misoprostol for Unsatisfactory Colposcopic Finding: A randomized controlled trial

Objectives: To assess the effectiveness of 200 μg sublingual misoprostol for converting an unsatisfactory to satisfactory colposcopic finding.Materials and Methods: Forty-two participants with abnormal cervical cytology and unsatisfactory colposcopic finding who underwent colposcopy between September 2016 and June 2017 were randomized into two groups; either misoprostol or placebo given sublingually. Second colposcopy was performed 2 hours later, and the conversion rate of unsatisfactory to satisfactory colposcopic finding of both groups was analyzed.Results: Baseline characteristics were similar between two groups. Conversion rate of unsatisfactory to satisfactory colposcopic finding in participants who received sublingual misoprostol was statistically significant higher than placebo group (80.9% vs 38.1%, p = 0.011, relative risk = 2.1, 95% confidence interval 1.18-3.80). There was no significant difference in adverse effect between groups.Conclusion: Two hundred micrograms of sublingual misoprostol, 2 hours before performing colposcopy can convert an unsatisfactory finding to a satisfactory one