The Effect of Umbilical Cord Clamping, Cutting and Milking in Term Infants Delivered by Cesarean Section: A randomized controlled trial

Objectives:To investigate the effect of umbilical cord milking (UCM) and immediate umbilical cord clamping (ICC) in term infants delivered by cesarean section.Materials and Methods:This investigation’s design was a randomized controlled trial. One hundred and ten term pregnant women were recruited and allocated equally in the study and control groups. The study group (UCM) undertook umbilical cord milking toward the infant five times in 30 seconds after the umbilical cord was immediately clamped at a 20 cm, length from the newborn. The control group (ICC), by contrast, underwent immediate umbilical cord clamping without milking at 2 cm from umbilicus as the standard manner. Neonatal outcomes such as neonatal hematocrit (Hct) at 48 hours after birth, microbilirubin level, respiratory rate and length of stay in hospital were recorded.Results:Neither neonatal outcomes nor neonatal Hct at 48 hrs revealed statistical differences between the two groups. There were no serious maternal and fetal complications in either group. The two groups showed no significant differences in demographic and operative data.Conclusion: UCM at a point 20 cm from umbilicus had no effect in raising the Hct level at 48 hours following birth and no harmful effect in the term newborn delivered by cesarean section

Comparison between Lidocaine Spray and Oral Paracetamol for Pain Reduction during Amniocentesis in Second Trimester Pregnancy; A Randomize Controlled Trial

Objective: The aim of this study was to compare the efficacy of lidocaine spray and oral paracetamol on pain reduction in pregnant women in the second trimester during amniocentesis. Materials and Methods: This was a prospective randomized-controlled trial study conducted at Maternal and Fetal Medicine unit, Thammasat University Hospital, Pathum Thani, Thailand between June 2022 and April 2023. Participants were pregnant women who underwent amniocentesis during gestational age between 15 and 20 weeks. They were allocated into three groups namely lidocaine, paracetamol and control groups. Subjects in lidocaine group received 8 puffs of 10% lidocaine (80 mg) spray onto the marked puncture site for five minutes before amniocentesis and ingested 1 placebo tablet 1 hour before procedure. Paracetamol group ingested 650 mg paracetamol orally 1 hour before amniocentesis and received 8 puffs of normal saline spray on the marked puncture site. Control group received 8 puffs of normal saline spray onto the marked puncture site for five minutes before amniocentesis and ingested 1 placebo tablet 1 hour before amniocentesis. Expected pain (Te), during procedure (T0), 15 and 30 minutes after procedure (T15 and T30) were evaluated based on 10-cm visual analog scale (VAS). Results: A total of 510 pregnant women were recruited and divided equally (170 cases per group). Mean maternal age was 36.1 years old. Demographic characters of three groups were comparable. Lidocaine had more pain reduction than paracetamol and control group at T0, T15 and T30 (at T0: 3.06±2.16 vs 3.96±2.42 vs 3.92±2.35, P value < 0.001, T15: 1.12±1.38 vs 1.92±1.47 vs 1.98±1.87, P value < 0.001, T30: 0.64±0.95 vs 1.33±0.97 vs 1.09±1.44, P value < 0.001). However, paracetamol had no significant difference in pain reduction compared to control group. Conclusion: Lidocaine spray before amniocentesis had more efficacy on pain reduction during amniocentesis, 15 and 30 minutes after procedure

Acetaminophen / Tramadol Rectal Suppository for the Relief of Perineal Pain after Normal Vaginal Delivery: A randomized controlled trial

Objectives: To compare the effectiveness of acetaminophen /tramadol rectal suppository and placebo for pain relief after vaginal deliveryMaterials and Methods: Two hundred parturients who delivered vaginally were recruited. Twelve cases were excluded. Cases were randomly divided into two groups; study and control group. Acetaminophen/tramadol was given to the study group and placebo in control group immediately after vaginal delivery. Pain level was measured by visual analogue scale (VAS) at immediate, 6, 12 and 24 hours after delivery. Side effects and additional analgesic medication (acetaminophen) were recorded.Results: A total of 188 parturients were enrolled. Study and control groups consisted of 98 and 90 cases, respectively. Mean age of cases in this study was 27 years old. Forty percent of cases were nulliparous. All subjects were full term pregnancy with normal body mass index and equally demographic character. Pain score measured by VAS in both groups had no significant difference at all times (0, 6, 12 and 24 hours after delivery). There was no adverse event in this study.Conclusion: Acetaminophen/tramadol rectal suppository could not relieve perineal pain after normal vaginal delivery when comparing to placebo

Efficacy of Music Therapy and Zingiber officinale Roscoe Aromatherapy for Reducing Pain during the First Stage of Labor: A Randomized Controlled Trial

Objective: To study the pain-reducing effect of music therapy and aromatherapy with ginger essential oil (GEO; Zingiber officinale Roscoe) in the first stage of labor. Materials and Methods: This randomized controlled trial was conducted from May to October 2022 in the delivery room of Thammasat University Hospital in Thailand. Participants were nulliparous pregnant women who came with actual labor pain and cervical dilation of 3 cm. They were divided into three groups: control, music, and aromatherapy. The control group received intrapartum care according to hospital guidelines, while participants in the music group listened to a "Musical Journey through Pregnancy" music playlist, and the aromatherapy group inhaled GEO. A visual analog scale was used for pain assessment every 2 hours. Interventions and pain assessment continued until the end of the first stage of labor or until cesarean section was indicated. Results: Three hundred pregnant women were recruited. The mean age of the participants was 27.7 years old, and no difference in BMI among the three groups. Participants in the music and aromatherapy group had statistically significantly less labor pain than participants in the control group when cervical dilation was between 4 and 7 cm (6,1±0.7, 1.9±0.7, 2.6±0.4 when cervical dilation was 4-5 cm and 8.0±0.7, 2.8±0.4, 3.6±0.3 when cervical dilation was 6-7 cm in the control, music, and aromatherapy groups, respectively (p < 0.001). However, at cervical dilation of 8-10 cm, there was no difference among the three groups regarding labor pain. Both intervention groups had significantly shorter labor time and less estimated blood loss during vaginal delivery than the control group (p < 0.001). Conclusion: Music and aromatherapy decreased labor pain, labor time, and estimated blood loss compared to the control group

Effects of N-Acetylcysteine Supplementation on Semen Analysis, Hormonal Profile and Spontaneous Pregnancy Rate in Idiopathic Infertile Men: Before and After Clinical Trial

Objective: To compare sperm quality and quantity, hormonal profiles and spontaneous pregnancy rates before and after administering a 3 months course of N-Acetylcysteine (NAC) Material and Methods: This prospective clinical trial was conducted at the Infertility Unit of the Obstetrics and Gynecology Department at Bhumibol Adulyadej Hospital, Thailand. The study period was from June 1, 2023 to September 30, 2023. Subjects were idiopathic infertile males aged between 20 and 50 years old. All subjects received 600 mg of NAC orally per day. Semen analysis (SA) and male hormonal profiles (MHP; testosterone, LH, FSH and prolactin) were performed before and three months after NAC administration. Demographic, clinical characters and laboratory change were recorded. Results: The 92 participants were recruited. The mean age of couples was 34.5 years old. The average duration of infertility was 3.6 years. Increase of semen volume (2.1 vs 2.4 ml, p < 0.001), semen concentration (30.5 vs 43.1 x 106/mL, p < 0.001), total motility (59.57 vs 72.38 %, p < 0.001), progressive motility (59 vs 69.8 %, p < 0.001), normozoospermia (60 vs 83 %, p < 0.001), testosterone (452.8 vs 479.0 ng/dL, p = 0.038), LH (4.6 vs 5.3 mIU/mL, p = 0.004) and FSH (4.4 vs 4.6 mIU/mL, p = 0.009) were observed after three months of NAC administration. No changes in sperm morphology and prolactin level. One-third (27/92) of each participant’s spouse conceived spontaneously. Conclusion: NAC potentially enhances male hormonal profiles, sperm quality and quantity with an impressive spontaneous pregnancy rate

Recurrence Rate and Risk Factors for the Recurrence of Ovarian Endometriosis after Laparoscopic Ovarian Cystectomy

The aim of this study was to identify the recurrence rate and risk factors for the recurrence of ovarian endometriosis (OE) after laparoscopic cystectomy. This was a retrospective cross-sectional study. Subjects were OE cases who underwent laparoscopic ovarian cystectomy at Bhumibol Adulyadej Hospital (BAH). The period of this study was from January 2008 to December 2017. Ovarian histopathology and at least one-year follow-up after surgery were the prerequisite requirements. A total of 106 OE cases were included in the study. Subjects were classified into recurrence and nonrecurrence groups. It comprised of 24 and 82 cases, respectively. The mean age of the participant was 32.4 years old. The demographic characters of both groups were comparable. The recurrence rate after laparoscopic OE surgery in the present study was 22.6% (24/106). The average largest diameter of OE in the present study was 54.5 mm. Postoperative medical treatment (OR 3.15, 95% CI 1.14-8.74, p=0.02) and postoperative pregnancy (OR 2.86, 95% CI 1.03-7.93, p=0.04) were associated factors for recurrence decrement. The recurrence rate of OE after laparoscopic cystectomy was 22.6%. Postoperative medical treatment and postoperative pregnancy were a significant factor that lowered OE recurrence

Incidence of Fetal Myocardial Hypertrophy in Mother with Diabetes Mellitus by Using Cardio-Spatiotemporal Image Correlation (STIC) M-Mode

Kobporn Sapanont,1 Wiyada Luangdansakul,1 Monyada Pleankong,1 Buppa Smanchat,1 Kornkarn Bhamarapravatana,2 Komsun Suwannarurk3 1Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand; 2Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, ThailandCorrespondence: Wiyada Luangdansakul, Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, 10220, Thailand, Tel +66-2-5347314, Email [email protected]: The aim was to demonstrate the prevalence of fetal myocardial hypertrophy (FMH) in diabetes mellitus (DM) pregnant women using spatio-temporal image correlation (STIC) M-mode.Material and Methods: This prospective descriptive study was conducted at Bhumibol Adulyadej Hospital (BAH) Royal Thai Air Force between April and December 2022. Participants were singleton DM pregnant women with gestational age (GA) between 18 and 40 weeks who had antenatal care and delivery at BAH. DM screening was randomized blood sugar obtained from all participants. All participants underwent fetal heart exams by four-dimension ultrasound with STIC M-mode.Results: One hundred and forty-five participants were recruited and classified as pregestational (PDM) and gestational DM (GDM) at 31 and 114 cases, respectively. The mean age of participants was 31.7 years old. Fasting blood sugar (FBS) of PDM was significantly higher than GDM (105.1 vs 87.0 mg%). GDMA2 had more elevated FBS than GDMA1 (p < 0.001). PDM had significantly greater FBS and two-hour postprandial blood sugar (2hr-PP) than GDM (105.1/87.0 and 151.5/117.9 mg%, respectively). FBS and 2hr-PP of GDMA2 were more than GDMA1 with statistical significance. Good glycemic control of GDM was significantly better than PDM. GDMA1 had better glycemic control than GDMA2 with statistical significance. Four-fifth (115/145) of participants had FMH. FMH and estimated fetal weight among PDM and GDM were comparable. Both good and poor glycemic control had similar FMH. Neonatal outcomes of FMH or non-FMH infants were similar.Conclusion: The prevalence of FMH in diabetic pregnant women was 79.3%. Glycemic control had no correlation to FMH.Keywords: STIC-M, gestational diabetes mellitus, pregestational diabetes mellitus, interventricular septal thicknes

Maternal and Neonatal Complications of Methamphetamine Use during Pregnancy

Background. Methamphetamine abuse has been a significant problem in Thailand. The methamphetamine abuse problem also affects pregnant women. The study of pregnancy outcomes among methamphetamine users during pregnancy is currently limited. Objective. To determine maternal and neonatal complications among methamphetamine-abusing parturients. Materials and method. This historical cohort study was conducted at Bhumibol Adulyadej Hospital (BAH), Bangkok, Thailand, between January 2017 and December 2019. The total number of women was 206 who were equally divided into a study and control group. Pregnant women who tested positive for methamphetamine in urine tests during the intrapartum period were compared to the control group with no history of drug abuse. Results. Maternal outcomes: gestational hypertension was found to be significantly increased in the study group compared to the control group at 14.6 vs. 1.0% (OR 17.4, 95%CI 2.5-134.3). Preeclampsia with and without severe features were found at higher rates in the study group without statistical significance. There were no eclamptic cases in this study. Neonatal outcomes: preterm birth rate of pregnant women who have tested positive in their urine methamphetamine test was significantly higher than in the control group (33.3%, 11.7%, OR 3.7, 95%CI 1.8-7.7). Average birth weight in the study and control group was 2779.1 ± 486.7 and 3049.5 ± 510 gm, respectively (p value < 0.001). Low APGAR score rates of both groups also had no significant difference. Conclusion. Methamphetamine use during pregnancy increased both maternal and neonatal complications in terms of gestational hypertension, preterm birth, and average birth weight

Possibility of using superoxide dismutase and glutathione peroxidase as endometriosis biomarkers

Sophapun Ekarattanawong,1 Chamnan Tanprasertkul,2 Charintip Somprasit,2 Pholasit Chamod,1 Rattana Tiengtip,1 Kornkarn Bhamarapravatana,1 Komsun Suwannarurk2 1Department of Preclinical Science, 2Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand Objective: To study the possibility of using superoxide dismutase (SOD) and glutathione peroxidase (GPx) as combined preoperative biomarkers for endometriosis. Participants and methods: Female patients aged between 18 and 45 years old who came to the Gynecology outpatient clinic, Thammasat University Hospital, during September 2013&ndash;2016 with the complaint of gynecologic symptoms suspected of endometriosis, and who were positively diagnosed with endometriosis, were included in this study. All patients underwent conservative laparoscopic ovarian cystectomy with histopathological report. The control group consisted of healthy females of reproductive age who came to the outpatient clinic. The plasma SOD and GPx were measured from blood samples with commercial kits. A receiver operating characteristic curve was generated for plasma activity of SOD, GPx, and combined tests. The cutoff values were selected at the most appropriate sensitivity and specificity. Result: All 36 cases were included in this study. Mean ages of patients in the patient and control groups were 33.1 and 28.6 years old, respectively. SOD and GPx activities of disease and control group were 6.15 and 8.11, 463.9 and 472.34 nmole/min/mL unit, respectively. The sensitivity and 1&ndash;specificity of the combined test were calculated at 0.78, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value being 68.75, 80.77, 76.50, 69.23, and 80.33, respectively. Conclusion: A combination testing of SOD and GPx can possibly be used as preoperative biomarker for endometriosis. Keywords: superoxide dismutase, SOD, glutathione peroxidase, GPx, endometriosis, laparoscopy, endometriosis biomarke