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Background: Premature neonates are susceptible to anemic problems with low iron storage. Delayed cord clamping (DCC) has been studied and its beneficial value has been supported by existing research in newborns with very low birth weights. But there were only few data pertinent to late preterm infants., Objective: To investigate the effect of delayed cord clamping (DCC) as compared with immediate cord clamping (ICC) on the hematocrit level at 48 hours in late preterm neonates after vaginal delivery., Material and Method: The design consisted of a randomized controlled trial. One hundred pregnant women who were admitted because of preterm labor (GA 34-36(+6) week) in active phase were recruited and allocated into two groups, designated as the ICC and DCC groups. The DCC were defined as the case in which patients underwent the umbilical cord clamping at 120 seconds after birth. At 48 hours after delivery, both the hematocrit (Hct) and microbilirubin (MB) levels of newborns were determined. Also, neonatal and maternal complications were recorded., Result: Eighty-six neonates were analyzed. There were no statistical differences in the baseline data of maternal symptoms and newborns between the two groups. Neonates in the DCC group had a significantly higher hematocrit level than the ICC group (55.4% and 47.6%, respectively: p = 0.02). The MB level in the DCC group was also significantly higher than in the ICC group (9.4% and 8.6 mg %, respectively: p = 0.04). However, phototherapy and length of hospitalization in both groups were not different. There were no serious maternal and fetal complications in either group., Conclusion: The DCC procedure could raise the Hct level in the late preterm newborns without serious adverse effects. But more evidence is needed to explore the possible benefit of this procedure.

Objective: To assess the effect of the different scheduled gestational age for a repeat elective cesarean section (CS) on emergency cesarean section rate and adverse pregnancy outcomes in pregnant women with history of previous CS., Material and Method: A prospective cohort study of singleton pregnant women who had a history of CS and were scheduled for a repeat elective CS to be performed. The cases were divided into two groups of which the elective CS was appointed at 38 or 39 weeks of gestation as study and control groups, respectively. Emergency cesarean section rate, maternal and neonatal complications were defined as main outcomes., Results: Of 415 scheduled elective repeat cesarean deliveries performed at 38 weeks of gestation or later, 209 were scheduled between 38 0/7 and 38 6/7 weeks (study group), and 206 were scheduled between 39 0/7 and 39 6/7 weeks (control group). Most of the cases had one previous cesarean delivery. The emergency CS rate before schedule in the study group was significantly less than in the control group (15.3% vs. 51%, p<0.001). Spontaneous labor pain was a major factor to have unplanned delivery. The maternal intra-operative complications were significantly increased in women who had emergency cesarean before schedule compared to elective CS on scheduled in 38 weeks group (25% vs. 12.9%, p<0.001) and 39 weeks group (31.4% vs. 14%, p<0.001). The major intra-operative complication was uterine atony. There were no statistically significant differences in maternal post-operative and neonatal complications in scheduled elective CS in 38 and 39-week group. Transient tachypnea of the newborn (TTNB) was higher in elective CS at 38 week compared to emergency CS., Conclusion: The emergency CS rate in 39 weeks gestation group was significantly higher than 38 weeks group. The incidence of adverse maternal intra-operative complications was statistically difference with emergency CS when compared to elective CS in case and control groups. Recommendation of elective repeated CS at GA39 weeks may be suitable only under some circumstances. The number of prior CS is one of factors that should be considered.

Background: Cervical cancer is the second most common of malignancy found in Thai women. Human papillomavirus (HPV) infection is a major cause. The objective of the present study was to evaluate the prevalence of HPV infection and association with abnormal cervical cytology in Thai women., Materials and Methods: This study was conducted at the Gynecologic Clinic, Thammasat University, Pathum Thani, Thailand. A total of 2,144 cases who underwent annual cervical cancer screening by co-testing (liquid based cytology and HPV testing, DNA versus mRNA) during the priod from July 2013 to June 2016 were recruited in this study., Results: Prevalence of positive high risk (HR) HPV DNA and mRNA test were 19.7 and 8.4%, respectively with a statistically significant difference. Majority of cases of abnormal cytology in this study were atypical squamous cells of undetermined significance (ASC-US). In patients with ASC-US, positive HR HPV DNA was greater than in the mRNA group (10.1 and 4.5%, p<0.001). Nonetheless, there was no significant difference in participants with cervical intraepithelial neoplasia (CIN). HPV mRNA test had slightly lower sensitivity but higher negative predictive value (NPV) than the DNA test to detect abnormal cytology during cervical cancer screening (p<0.001). Both HPV test (DNA and mRNA) had equally efficacy to detect high grade precancerous lesion or higher (CIN 2+)., Conclusions: Prevalence of HR HPV DNA and mRNA were 19.7 and 8.4 percent, respectively. NPV of HPV mRNA was higher than DNA test. Both tests had equal efficacy to detect CIN 2+ with sensitivity and specificity of 63% vs 55.7% and 83% vs 92%, respectively.

Purpose: To study the prevalence of CIN2+ diagnosis in women with atypical Papaniculoau (Pap) smears to suggest appropriate management option for Thai health care., Materials and Methods: Data from all patients with liquid based cytology with human papillomavirus (HPV) testing between May 2013 - May 2016 were collected from medical records. Women with atypical cervical Pap smears were recruited. Results for age, HPV testing, HPV 16, 18, 45 and other genotypes tested, colposcopic examination and histopathological assessment were all collected. Atypical smears were defined as atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot be exclude high grade squamous intraepithelial lesion (ASC-H)., Results: A total of 2,144 cases were recruited. Twenty six women with ASC-US on cytology had high risk (HR) HPV detection while eight cases with ASC-H had HR-HPV (40.0% VS 72.7%, p=0.005). Among the 26 women with ASC-US cytology and positive HR-HPV, HPV type 16 (n=8, 30.8%), type 18 (n=1, 3.8%), type 45 (n=1, 3.8%) and other HPV types (n=17, 65.4%) were found. Eight women with ASC-H and positive HR-HPV demonstrated type 16 (n=6, 75%) and other HPV types (n=2, 25%). Fifty seven women with ASC-US had normal colposcopy, CIN1 and CIN2+ at percentages of 80.7 (46/57), 14.0 (8/57) and 5.3 (3/57), respectively. In the ASC-H group, 7 out of 10 women had normal colposcopy and three (30%) had CIN2+ results., Conclusions: In women with ASC-US cytology, immediate colposcopy is highly recommended. HPV testing can be performed if colposcopy is not an available option because there was high prevalence (5.3%) of CIN2+ in our findings. ASCCP recommendations for ASC-H that colposcopy should be performed on all ASC-H cases regardless of HPV result are thereby supported by the findings of this investigation.

Background: Cervical cancer is the second most common in Thailand, but the mortality rate may be rising yearly. It is a cancer that can be prevented by early screening for precancerous lesions, several methods being available., Objective: To identify the prevalence of abnormal Papanicolaou (Pap) smears and lesions with visual inspection with acetic acid (VIA) in pregnant women and assess risk factors for this group., Materials and Methods: This prospective study was performed at Prapokklao Hospital, Thailand during April-July 2016. All pregnant women of gestational age between 12-36 weeks who attended an antenatal clinic were recruited. All participants were screened for cervical cancer by Pap smear and VIA. If results of one or both were abnormal, colposcopic examination was evaluated by gynecologic oncologist., Results: A total of 414 pregnant women were recruited. Prevalence of abnormal Pap smear and VIA were 6.0 and 6.7 percent, respectively. The most common abnormal Pap smear was low grade intraepithelial lesion (LSIL, 44%). Factors associated with abnormal Pap smear in pregnant women were low BMI, multiple partners and being a government officer. In pregnancy, Pap smear had higher sensitivity and specificity than VIA for detection of precancerous cervical lesion. Patients with young coitarche or more than 25 years of active sexual activity were high risk groups., Conclusions: Prevalence of abnormal Pap smear and VIA in pregnant women was 6.0 and 6.7 percent, respectively. Factors associated with abnormal Pap smear were coitarche, years of sexual activity, low BMI, multiple partners and being a government officer.

Purpose: To study clinical factors related to adequacy of transformation zone (TZ) components in cervical smears., Materials and Methods: Medical and Papanicolaou (Pap) smear reports from Thammasat University Hospital, Thailand during January to December 2015 were collected. Demographic data was reviewed by attending physicians and impact of clinical factors onTZ adequacy was primary outcome. A total of 3,251 smears were reviewed. Finally, 2,098 smears met The inclusion criteria and enrolled into this study., Results: Average age and bodyweight of participants in this study were 43.0 years and 60.0 kg, respectively. Ninety seven percent of smears were classified as satisfactory for evaluation according to the Bethesda system 2001. Adequacy (group A) and inadequacy (group B) of TZ were equal in percentage (50.9/46.0). Prevalence of abnormal cervical cytology was 4.4%. Percentages of abnormal Pap smears in group A and B were 7.3 and 1.4, respectively (p<0.001). Factors associated with increased adequacy of TZ were old-age (≥ 50 yr), nulliparity, within 3-months postpartum, history of TZ inadequacy and abnormal smears. Sexually transmitted disease (STD), hormonal usage, previous cryotherapy and smears collected by staff were associated with inadequacy of TZ., Conclusions: Collection of cervical specimens should be carefully performed. STD history, hormonal usage and previous cryotherapy are risk factors for TZ inadequate specimens.

Objective: To study postoperative pain relief in major gynaecological surgery by perioperative parecoxib administration in Thammasat University Hospital., Material and Method: This double-blind randomized controlled clinical trial was conducted in Thammasat University Hospital, Pathumthani, Thailand from October 2013 to May 2014. One hundred and twenty patients who underwent elective gynaecological surgery were randomized assigned to study and control groups. Study group (n = 60) received 40 mg parecoxib and control group (n = 60) received placebo at 1 hour before surgery. The postoperative visual analog scale (VAS) at 3, 6, 12 and 24 hours, frequency of meperidine consumption in 24 hours and side effects of parecoxib were recorded., Results: VAS of study group after operation at 3, 6, 12 and 24 hours was significantly lower than control group. Meperidine consumption in placebo group was significantly higher than study group (27.50 ± 19.36 and 48.75 ± 28.15 mg, respectively; p < 0.001). There was no side effect from parecoxib in this study., Conclusion: Intravenous postoperativeparecoxib injection could relief pain and reduced meperidine consumption. Parecoxib could be safely used in gynaecological surgery for postoperative pain relief

Objective: To compare maternal and neonatal complications ofgestational diabetes mellitus (GDM) between conservative and systematic management., Material and Method: This retrospective cohort study was conducted at Thammasat University Hospital, Thailand. GDM subjects who were diagnosed and treated from October 2004 to March 2007 were classified as the conservative management group (CMG). The participants who were diagnosed and treated from April 2007 to September 2009 were classified as the systematic management group (SMG). SMG was ambulatory-managed per standard protocol by a multidisciplinary team (physician, diabetes nurse case manager nutritionist and pharmacologist)., Results: There were 87 and 118 subjects in CMG and SMG, respectively. Mean age and body mass index before pregnancy in CMG and SMG were not statistical different. Oral glucose tolerance tests (50 and 100 gram) were similar in both groups. The prevalence of GDM A2 was 57.5 and 55.1% in CMG and SMG, respectively. Mean gestational age at DM clinic consultation and number of hospital admission of SMG was less than CMG (p < 0.001). Neonatal hypoglycemic episode in SMG was less than CMG (1.7 vs. 10.3; p = 0.007). Postpartum 75-gram glucose tolerance test appointments and percentages of underwent in SMG were more than CMG (p < 0.001). Other composite maternal and neonatal outcomes were not different in either group., Conclusion: Systematic management by a multidisciplinary team conducted according to a practical guideline has the benefit of neonatal hypoglycemia reduction and hospital admission included postpartum DM surveillance increments.

Objective: To study the effects of a promoting self-efficacy program on the oral contraceptive used behavior among adolescent mothers., Material and Method: This is a quasi-experimental study which based on a pretest-posttest design with group comparison. The participants were primiparous adolescent mothers aged 15-19 years who attended at antenatal care clinic, delivered and came for postpartum check-up at 6 weeks after delivery at Thammasat University Hospital from December 2013 to March 2014., Results: Sixty adolescent mothers were selected through inclusion criteria and divided equally to study and control group. Study group participated in the effects of the promoting self-efficacy program combined with standard nursing care. Control group received only standard nursing care from the same nursing staff Demographic data of both groups had no statistical difference. Mean scores on oral contraceptive self-efficacy (OCSE) and oral contraceptive used behavior (OCUB) ofstudy group were higher than control group with a statistical significance (p < 0.001) at 12 weeks postpartum., Conclusion: Adolescent mothers had a high risk of unintended pregnancy due to inconsistent oral contraceptive usage. Promoting self-efficacy program regarding oral contraceptive behavior should be integrated to standard nursing care practice. This program could encourage adolescent mothers to engage correct and continuous oral contraceptive usage.

A cardiac twin or twin reversed arterial perfusion (TRAP) sequence is a rare unique complication of monozygotic multiple pregnancy. In this disorder, there is a normally formed donor (the pump twin) who has features of congestive heart failure (CHF) as well as a recipient (the acardiac twin) who lacks a well-defined a heart structure. Also evident are other structures, namely the TRAP sequencefrom pump to acardiacfetus via single artery-to-artery and vein-to-vein anastomoses directly between the two cords or indirectly on the chorionic plate. Overall, the perinatal mortality rate for the pump twin is 35-55%. Prenatal diagnosis and prognosis factors can be examined through ultrasound. The optimal management of a cardiac twin pregnancies is controversial. The expected treatment of acardiac anomaly presently relies on maximizing the chance ofterm delivery and preventing CHF in the healthy pump twin or interrupting vascularization between the two twins. This article reported the experience of acardiac twin management in Thammasat University Hospital and reviewed the current knowledge ofthe condition, prenatal diagnosis, prognosis factor and management options focusing on conservative management compared to invasive treatment.

Background: Metastatic malignant melanomas to the uterus are extremely rare; to our knowledge, no more than 13 cases have been reported to date., Case Report: A 44-years-old multigravida woman presented with a black and irregular surface mass at medial aspect of left thigh. There was also an enlarged left groin node. Wide excision with lymph node dissection revealed malignant melanoma. Further examination found a huge pelvic mass with left deep vein thrombosis consequent by pressure effect. Chest and complete abdominal computed tomography revealed an enlarged, fibroid uterus with pressure effect at left common iliac vein. A total abdominal hysterectomy and bilateral adnexectomy were performed. Intra-operative finding was scattered hyperpigment spots at surface of the uterus and its tumor Histopathological report showed metastatic malignant melanoma involving myometrium and uterine serosa. Diagnosis of stage IV malignant melanoma (uterine metastasis) was achieved. The patient was counseled about her diagnosis, stage, prognosis and further treatment., Conclusion: Uterine metastatic malignant melanoma was a rare condition. This report represents the first case of a cutaneous malignant melanoma involving a uterine leiomyoma in Thailand.

Objective: To investigate the recurrence rate and disease-free interval between laparoscopy versus laparotomy for the conservative surgery of endometrioma., Material and Method: A retrospective cohort study was conducted. The medical records of reproductive women who underwent conservative ovarian cystectomy surgery (laparoscopy or laparotomy) for endometrioma at Thammasat University Hospital were retrieved. The patients were followed through 24 months to evaluate the recurrence of endometrioma. Propensity scoring was used to adjust for confounding by indication and confounding by contraindication. Model for competing time to event was used in analysis., Results: One hundred and twenty-eight and 114 patients were enrolled in laparoscopy and laparotomy groups, respectively. Mean age and body weight in laparotomy group were statistically higher than those in the other group were. Mean height and body mass index were, however not statistically different in either groups. In addition, the stage of disease and bilaterality in both groups were comparable. Diameter ofendometrioma in laparotomy group was significantly larger than that in laparoscopy group (7.0 ± 2.5 vs. 6.2 ± 1.8 cm, respectively; p = 0.004). After adjusting for propensity scoring, the endometrioma recurrence rate was significantly higher in laparoscopy group as compared to laparotomy group (27.3% vs. 14.9%, respectively; p = 0.02). However, the cumulative rate of pregnancy after surgery was not statistically different (4.7% vs. 4.4%, respectively; p = 1.0)., Conclusion: The present study has demonstrated that the surgical technique has a strong impact on the recurrence or disease-free interval. Laparoscopy might not eradicate the disease pathology as effectively as open laparotomy in some situations, such as in cases with complexity of disease.

Background: Bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growthfactor (VEGF), has been approvedfor concurrent treatment with first line chemotherapy in advanced epithelial ovarian cancer., Case Report: A case of an advanced stage epithelial ovarian cancer (EOC) receiving a combination of bevacizumab, carboplatin andpaclitaxel chemotherapy was reported. A 44-year-old woman was presented with abdominal discomfort and distention for 4 months. Bilateral 12 cm diameter ovarian tumors were diagnosed as FIGO stage IIIc after surgical staging operation. Histopathology report showed the mixed type of serous and endometriod adenocarcinoma. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery every 3 weeks. Bevacizumab (7.5 mg/ m2) was concurrently administered with chemotherapy every 3 weeks startingfrom the 2nd cycle. A complete remission was achieved after the end of the chemotherapy treatment. Bevacizumab was continued for one year after the completion of the standard chemotherapy. Bone marrow suppression, hypertension and proteinuria were not found during Bevacizumab treatment. At bevacizumab treatment completion, a platinum-sensitive recurrent ovarian cancer was diagnosed at the two weeks postprogram routine check-up. The patient was counseled to start second line chemotherapy treatment and has yet to come back with her decision., Conclusion: Combination of bevacizumab, carboplatin and paclitaxelfor first line chemotherapy in advanced EOC in this case had no serious side effects and need further study.

Background: In the years 2014, coverage rates of cervical cancer screening in Nakornnayok province accounted to 76.5%. This was lower than the government's specified goal of 80%. Community health volunteers are members of a Thai healthcare alliance established to help promoting healthcare service communication and collaboration at the primary level. Such village health volunteers (VHVs) are established in most villages., Objective: To assess the knowledge and attitudes of cervical cancer screening among VHVs., Materials and Methods: The subjects were 128 VHVs from four Nakornnayok sub-districts; namely KlongYai, Chomphol, Buangsan and Suksara, Thailand. The study was conducted from December 2014 to January 2015. The questionnaire was designed to assess the knowledge and attitude of cervical cancer screening provided by the VHVs. In addition, cervical cancer screening coverage rates of each area were collected. The demographic data, scores of knowledge, attitudes, practices and the cervical cancer screening coverage rates were analyzed by one-way ANOVA., Results: The questionnaire reliability was assessed as 0.81. The total knowledge and attitude scores were 10 and 15 points. The mean knowledge scores of KlongYai, Chomphol, Buangsan and Suksara were 6.8, 7.0, 6.5 and 9.0 points, respectively. The VHVs had a high level of overall knowledge about cervical cancer screening. The mean attitude scores were 12.4, 13.2, 13.4 and 13.1 points. VHVs had a positive attitude to the promotion of cervical cancer screening at the overall level. The percentages of VHVs promoting cervical cancer information in respective districts were 72.2, 94.3, 94.9 and 50.0. However, the cervical cancer screening coverage rates were 62.4%, 34.7%, 80.3% and 47.3% respectively., Conclusions: The knowledge, attitudes and percentages of promoting information of cervical cancer screening among VHVs in the four sub-districts were high but did not correlate with the cervical screening coverage rates for each area. VHVs needed to understand socio-cultural beliefs of the women in the target population and design suitable strategies to encourage higher cervical screening coverage.

Purpose: To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-grade cervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap) smears., Materials and Methods: Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASC- US and LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013 and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists. Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained from colposcopic-directed biopsy as a gold standard., Results: VIA testing was positive in 54/150 (36%) pre-menopausal women and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing, 15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43 (44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had high- grade CIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIA testing, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Out of 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3 (6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2% and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80% and 93.3% in post-menopausal women)., Conclusions: VIA testing may be used as a screening tool for detecting high-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order to lower the rate of colposcopy referral.

Background: ASC-US cases are managed according to the current American Society for Colposcopy and Cervical Pathology (ASCCP) guideline in which a human papillomavirus (HPV) test and repeat Pap smear are performed in the next 1 year. Colposcopy in cases of positive high risk HPV and persistent ASC-US or more in subsequent Pap smear is recommended. The HPV test is more expensive and still not currently a routine practice in Thailand., Objective: To identify the risk factors of persisted abnormal Pap smear and the colposcopic requirement rate in women with ASC-US., Materials and Methods: During 2008-2013, this study was conducted in Prapokklao Hospital, Chanthaburi, Thailand. Participants were women who attended gynaecology clinic for cervical cancer screening. Women who had cytological reports with ASC-US were recruited. During the study period, 503 cases were enrolled. Colposcopic requirement was defined as those who were detected with an ASC-US or more in subsequent Pap smears up to 1 year follow-up., Results: The colposcopic referral rate was 23.2 (85/365) percent at 12 months. Prevalence of cervical intraepithelial neoplasia (CIN) 2/3 was 3.3 (12/365) percent. Loss follow-up rate of subsequent Pap smear and colposcopic appointment were 27.4 (138/503) and 48.2 (41/85) percent, respectively. There was no invasive cancer. High risk factors for persisted abnormal Pap smears in subsequent test were premenopausal status, HIV infected patients and non-oral contraceptive pills (COC) users., Conclusions: Referral rate for colposcopy in women with ASC-US reports was rather high. Loss to follow-up rate was the major limitation. Immediate colposcopy should be offered for women who had high risk for silent CIN.

Background: Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women., Materials and Methods: This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups., Results: HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively., Conclusions: Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.

Objective: To determine demographic data and physical health consequences of Child Sexual Assault (CSA) victims at the Police General Hospital (PGH)., Material and Method: The medical records of CSA age one to 12 years at PGH between January 1, 2012 and December 31, 2012 were retrospectively reviewed., Results: Of 124 child victims, 120 (96.8%) were female andfour (3.2%) were male, aged between one and 12 years (mean, 8.12 ± 3.54 years). Most of assailants were acquaintance or boyfriend The majority of victims had no body injury, 114 (91.9%). Genital injuries offemale victims were found in 40.8% of the cases and commonly seen at hymen. Anal injury was found in one case. Sexual transmitted infections included gonococcal 12.9%, chlamydial 4.0%, and trichomanas 1.7% were found. Two pregnancy cases were found., Conclusion: Most of CSA had no physical injury. None of the injury cases required any suture or hospital admission. Majority of sexual injury was new hymenal tear.

Objective: To compare the effectiveness of misoprostol sublingual and oral routes before manual vacuum aspiration (MVA) in first trimester termination of pregnancy., Material and Method: A double-blinded randomized controlled trial was conducted infirst trimester termination ofpregnancy cases. Eighty cases were recruited and divided into sublingual and oral groups. Both groups were randomized to receive 400 microg misoprostol two hours prior to MVA. Main outcomes were cervical dilatation, operative time, complications, side effects, pain scores, and patient satisfactions., Results: Sublingual group had significantly more cervical dilatation and shorter operative time than oral group (7.3 +/- 1.5 vs. 5.9 +/- 1.4 mm, p<0.001 and 5.2 +/- 3.3 vs. 7.3 +/- 4.6 min, p = 0.02, respectively). However there were similar side effects, pain scores, and patient satisfactions in two groups. The present study had no uterine perforation, cervical tear hemorrhage, or re-evacuation., Conclusion: Sublingual misoprostol route was more effective for cervical priming prior to MVA in first trimester therapeutic abortion than oral route.

Background: Uterine rupture was a common occurrence at previously cesarean-sectioned scar Early sign ofuterine rupture was a severe fetal bradycardia., Case Report: A 30-year-old, 3 gravida, 1 para woman was presented with an acute abdominal pain and hypovolemic shock. Her gestational age was estimated at 18 weeks by emergency pelvic ultrasound. She had a lower segment scar from a previous caesarean section. Initially, alive intrauterinepregnancy with massive hemoperitoneum was a provisional diagnosis. During exploratory laparotomy, a ruptured of the right uterine fundus was found with placenta percreta. Hysterectomy was performed. Fetal weight was 450 grams, APGAR score 0, 0 and the fetus could not survive. The patient was discharged on the 4th day after surgery in healthy condition., Conclusion: Uterine rupture is a catastrophic kituation. Severefetal bradycardia might be an early sign. This case demonstrates the importance ofclinical judgment based on clinical acumen.

Objective: To determine the accuracy of colour Doppler ultrasonography to diagnose placenta accreta., Material and Method: The authors reviewed cases of placenta accreta between January, 2008 and December, 2012. Ultrasonographic images consistent with signs ofplacenta accreta (numerous vascular lacunae, loss ofsubplacentalsonolucent space, absent lower uterine segment between bladder-placenta, turbulent or complicated blood flow at the uteroplacental interface) were correlated with findings at the time of surgery and pathologic examination., Results: Over 60 months, 12 cases (0.48/1,000 deliveries) with suspected placenta accreta by ultrasonography were studied. The median gestational age atfirst diagnosis was 24 weeks. All cases had at least one previous cesarean delivery. At surgery, all cases had an adherent placenta requiring hysterectomy (five accreta, three increta, andfourpercreta). Four cases (33%) had accidental tear of urinary bladder Nine cases (75%) required blood transfusions., Conclusion: Colour Doppler ultrasonography appears useful in antenatal diagnosis ofplacenta accreta.

Objective: To present the results of Maylard incisionfor gynecologic surgery in Thammasat University Hospital during the past four years., Material and Method: A retrospective study of gynecologic surgery performed via the Maylard muscle cutting incision compare to Pfannenstiel muscle splitting and midline incision. Data came from subjects who underwent gynecologic surgey at Thammasat University Hospital, Pathumthani, Thailand friom January 2010 to December 2013., Results: In the period of 4 years, there were 283 cases of elective surgery that performed via Maylard, Pfannenstiel and midline incision by the single experience gynecologic surgeon team. One hundred and six cases were performed via Maylard incision technique. The remaining 59 and 118 cases were performed via Pfannenstiel and midline incision technique, respectively. Two-thirds and one-thirds of cases underwent hysterectomy and conservative surgery, respectively. Benign conditions were the major indicationfor surgery at the percentage of 83.4. Operative results were not significantly different from well-known midline and Pfannenstiel incision in terms of blood loss, time to first meal and postoperative pain. Operative time in Maylard incision was longer than in Pfannenstiel incision. Length of stay in Maylard incision was longer than Pfannenstiel but shorter than midline incision. Overall complications (eoperation, bowel injuries, urinary bladder injuries and blood transfusion rate) were not significantly different., Conclusion: Maylard incision provides similar operative results with midline and Pfannenstiel technique. Even though it takes more time for abdominal entry but it gives more operative exposure than Pfannenstiel incision. In the woman with previous low transverse scar and gynaecologic surgery is needed, Maylard incision could be an optional technique that provides cosmetic and successfud results. Hand on training for Maylard incision from their mentors should be encouraged to more practice.

Objective: To determine the prevalence, indications, types and complications of peripartum hysterectomy at Thammasat University Hospital, Thailand., Material and Method: A retrospective peripartum hysterectomy (PH) study. Data came from parturient who delivered at Thammasat University Hospital, Pathumthani, Thailand between January 2007 and December 2012., Results: In the period of 6 years, there were 37 cases of PH among 28,023 parturient. The overall prevalence of PH was 1.32 per 1,000 deliveries with average parturientage of 30. Nineteen hysterectomies were performed after vaginal delivery (1.1/1,000) and the remaining 18 hysterectomies were performed after cesarean section (1.67/1,000). Seven cases (18.9%) were performed as subtotal and the remaining 30 cases (81.1%) as total hysterectomy Major indication of PH was uterine atony (75.7%, 28/37) followed by abnormal placentation (10.8%, 4/37) and uterine rupture (5.4%, 2/37). From hysterectomy specimens, placenta accreta, placenta increta and placenta percreta were found in 5, 3, and 3 cases, respectively. Two cases of cervical intraepithelial neoplasia were later discovered from hysterectomy specimens. Three cases of placentapercreta were associated with pre-operative diagnosis of placenta adherent, uterine rupture and placenta previa. The average estimated blood loss was 2,416 ml. The overall surgical complication rate was 35.1% (13/37). The rate of reoperation, maternal death, wound infection, gut obstruction and lung complications were 16.2, 8.1, 2.7, 2.7 and 2.7 percent, respectively., Conclusion: Peripartum hysterectomy is a major hazardous procedure carrying a high mortality and morbidity rate. In this study, maternal mortality was 8.1%. Silent abnormal placentation was found in 21.2 percent (7/33) of hysterectomy specimen.

Background: To determine the frequency of dysplastic lesions in the endocervical curettage (ECC) specimens of women with ASC-US and LSIL Pap and to evaluate the possible factors associated with high grade dysplasia in those ECC specimens., Materials and Methods: Two hundred and sixty patients with ASC-US and LSIL cytologic smears who underwent an ECC at the time of colposcopic examination during January 2010 and December 2012 were reviewed. Demographic and clinicopathologic data were collected. Multivariate analysis using binary logistic regression was used to identify factors that might be associated with high grade endocervical dysplasia., Results: The frequency of endocervical dysplasia was 7.7% (20 out of 260 patients). Cervical intraepithelial neoplasia (CIN) 1 and CIN 2-3 lesions in the endocervical canal were observed in 12 and 8 patients, respectively. No microinvasive or invasive cervical cancers were identified. There was no difference in the frequency of high grade endocervical dysplasia between the patients with satisfactory and unsatisfactory colposcopic examinations (1.4% vs 5.1%, respectively, p=0.087). A multivariate logistic regression analysis demonstrated a significant association between high grade CIN on ectocervical biopsy as well as LSIL cytologic smears and high grade dysplasia in endocervical canal (OR=0.046, 95%CI=0.007-0.288; p=0.001 and OR=0.154, 95%CI=0.025-0.942; p=0.043, respectively)., Conclusions: The frequency of high grade endocervical dysplasia in women with ASC-US and LSIL cytologic smears was low. Therefore, routine performance of ECC in those women is debatable. High grade ectocervical dysplasia and LSIL cytologic smears may be used as predictors for high grade dysplasia in endocervical canal and ECC in these patients is reasonable.

Background: To evaluate the overtreatment rate with the see and treat approach in the management of women with abnormal cervical cytology., Materials and Methods: A retrospective review of patients with abnormal cervical cytology who underwent S and T at MSMC between January 2008 and December 2012 was conducted. Loop electrosurgical excision procedure (LEEP), histological results, cytology and colposcopic impression were analyzed to evaluate overtreatment rate, cyto-histologic correlation and related factors., Results: Average age of S and T cases was 42 years. Ninety seven percents were referred from affiliated health care providers. The study revealed 83.2% patients had HSIL or higher from cervical cytology. Correlation between HSIL and final histology was relatively low at 75% compared to other studies. Overtreatment rate was 28%., Conclusions: S and T was done in 197 patients in a tertiary care health facility with patient satisfaction. Overtreatment occurred, but the rate can be reduced with appropriate recommendations. HSIL Pap smears should be reexamined before S and T while low grade and lesser colposcopic impression groups should obtain conventional colposcopic approach for patient future reproductive benefit.

Background: To investigate abnormal cervical histopathology (ACH) from hysterectomy specimens with normal preoperative Papanicolaou (Pap) smears., Materials and Methods: Medical records from May 2009 to April 2012 were retrospectively reviewed of subjects from whom hysterectomy specimens were taken in Thammasat University Hospital. All had normal preoperative Pap smears. ACH was the primary outcome. A p-value less than 0.05 was considered significant. A total of 483 subjects with an average age of 50.5 years were recruited. Benign cases of enlarged uterus and pelvic mass were present in 94% (430/483). Endometrial and ovarian cancer were found at 6.2 and 4.7%, respectively. In hysterectomy specimens there were 19 (4%) cases of ACH. Silent ACH with benign disease, endometrial and ovarian cancers were 1.2% (5/430), 33.3% (10/30) and 17.4% (4/23), respectively. The negative predictive value (NPV) and false negative rate of Pap smears were 96 and 4%, respectively. ACH in malignant cases were 27.9% (12/43) and 20% (2/10) in adequate (APS) and inadequate (IPS) Pap collection groups, respectively. ACH in benign condition were 0.68% (2/292) and 2.2% (3/138) in APS and IPS, respectively. ACH was more often found in hysterectomy specimens with indication of malignancy than benign conditions with statistical significance. One third of preoperative stage I endometrial cancer cases had cervical involvement., Conclusions: Silent ACH in normal preoperative Pap smear was 4 %. Inadequate Pap smear collection is still the major problem in this study. Reducing inadequate Pap smear collection could reduce the false negative rate.

Background: To study the prevalence of abnormal anal cytology by Papanicolaou (Pap) technique in HIV- infected women who attended a HIV clinic at Prapokklao Hospital, Chanthaburi, Thailand., Materials and Methods: HIV-infected women who attended a HIV clinic at Prapokklao Hospital from March 2013 to February 2014 were recruited for anal Pap smears. Participants who had abnormal results of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal anal cytology., Results: A total of 590 anal Pap smears were performed at HIV clinic of Prapokklao Hospital during the study period. There were only 13 patients who had abnormal Pap tests, which were: 11 ASC-US and 2 HSIL (high grade squamous intraepithelial lesion). The prevalence of abnormal anal Pap smears in HIV-infected women who attended HIV clinic at Prapokklao Hospital was 2.2 percent. Percentage of high risk HPV in patients who had abnormal Pap test was 88.9 (8/9)., Conclusions: The prevalence of abnormal anal Papanicolaou smears in HIV-infected women who attended the HIV clinic at Prapokklao hospital was quite low in comparison to the earlier literature.

Background: Time to colposcopy (TC) after abnormal Pap smears was evaluated for influence on cytohistologic correlation (CHC)., Materials and Methods: This retrospective study assessed the correlation between TC and CHC of women who had abnormal Pap smears. Colposcopic chart review included participants from 2010- 2013 who attended a colposcopic clinic, Thammasat University Hospital, Thailand., Results: Four hundred and sixty cases who had abnormal Pap smears were recruited. Pap reports were atypical smears with low grade squamous intraepithelial lesion (SIL), high grade SIL and cancer at 339, 114 and 7 cases, respectively. One hundred and twenty four patients underwent loop electrosurgical excision procedure (LEEP). A half of the cases were colposcopically examined within 1-2 months after abnormal Pap collection. CHC was 88 percent and not affected at all by TC. Subjects who attended cervical cancer screening from affiliated health providers had shorter TC than those screened in our tertiary hospital., Conclusions: Time to colposcopy with abnormal Pap smears conducted at Thammasat University Hospital had a highest frequency of 42 days, in line with the literature. Length of TC does not affect the correlation between Pap and histopathologic reports. A longer waiting period for colposcopy did not alter progression or regression of the disease.

Objective: To study the effectiveness of sublingual misoprostol for cervical ripening before MVA in women aged between 35 and 55 years old., Material and Method: Women aged between 35 and 55 years old who had indications for endometrial sampling were recruited. Exclusion criteria were gross pathology of cervix, pregnancy, allergy to misoprostol, and abnormal coagulopathy. Eighty women who had indication for MVA were then assigned by randomization (block of four). Participants were treated with either sublingual 200 microg of misoprostol (study group) or placebo (controlled group) for cervical priming at two hours before procedure. The largest diameter of the Hegar's dilator through internal so without any resistance before MVA was the primary collected data. Secondary data were operating time, immediate pain score, satisfactory score, complications, and side effects., Results: Mean age of misoprostol and controlled group were 44.8 +/- 5.2 and 45.5 +/- 5.0 years old, respectively. One third of both groups had previously experienced uterine curettage. The initial cervical diameter before MVA of individuals receiving misoprostol and controlled group were 6.9 +/- 2.0 and 5.5 +/- 2.4 mm, respectively. The MVA time in misoprostol group was significantly shorter than controlled group (5.1 +/- 1.7 vs. 8.0 +/- 3.9 min, p < 0.001). The additional analgesia was not different in both groups. Side effect before MVA were more significantly found in misoprostol group (p = 0.001). Lower post MVA pain and satisfactory score were better reported in misoprostol group than placebo's (p < 0.001)., Conclusion: Two hundred micrograms of sublingual misoprostol administration prior to MVA gave significantly effective result of cervical priming. Satisfactory and pain scores were more favorable in misoprostol group with manageable side effects.

Objectives: To evaluate the frequency of cytohistologic discrepancy of high-grade squamous intraepithelial lesions (HSILs) in Pap smears and associated factors., Methods: Medical records of 223 women with HSIL Pap smears who were treated at Thammasat University Hospital were reviewed. Data on age, parity, menopausal status, contraceptive use and colposcopic directed biopsy and loop electrosurgical excision procedure (LEEP) pathology results were recorded., Results: Mean (SD) age of patients was 38.0 (9.4) years. The majority were premenopausal (86.5%) and multiparous (83.9%). Cytohistologic discrepancy between the Pap test and colposcopic-directed biopsy histology was 45.7% and that between the Pap test and LEEP histology was 29.5%. Fifty-four (24.2%) women had no high-grade CIN on both colposcopic directed biopsy and LEEP. Nulliparity, postmenopausal status and having no oral contraceptive pills use were factors associated with cytohistologic discrepancy., Conclusion: The exact cytohistologic discrepancy rate was relatively high (24.2%). Factors associated with cytohistologic discrepancy were nulliparity and postmenopausal status and having no oral contraceptive pill use.

Objective: To determine the major-complication rate of gynecological laparoscopy in Police General Hospital., Material and Method: A retrospective and descriptive analysis of medical records from 423 women who underwent gynecological laparoscopy in Police General Hospital was conducted., Results: Four hundred twenty three women were recruited between January 2007 and December 2010. One-third of subjects had history of previous gynecological surgery. Major complication rate was 2.84% (12/423). Urinary bladder, ureter, bowel, and vesico-vaginal fistula injury were 0.95% (4), 0.71% (3), 0.95% (4), and 0.23% (1), respectively. The conversion rate to exploratory laparotomy was 4.7% (20). There was no death in subject who had serious complication in this study. The operative time trended to decline in minor operation but not changed in major and advanced operation. Two-third of major complication was intraoperative diagnosed and repaired., Conclusion: The major complication rate was 2.84%. The urologic and bowel injury are the common complications.

Objective: To compare the basic knowledge scores, attitudes and acceptability to HPV immunization before and after acknowledge about HPV, cervical cancer and vaccine to study group., Material and Method: An anonymous survey was applied to women attending the outpatient clinic, Thammasat University Hospital from April 2010 to October 2010. Basic knowledge about cervical cancer, HPV, HPV vaccine, attitudes and acceptability to HPV immunization were collected via a self administered questionnaire., Results: A total of 173 mothers completed the survey responses rate of 86.5% (173/200). There is no difference in characteristic and lifestyles of the responders. The basic knowledge scores was higher in the subjects who had higher education level and regular cervical screening history. Most of subjects (> 85%) recognized that HPV is associated with cervical cancer but more than half of them confused about route of transmission. Basic knowledge scores is increased in all acceptability group (strongly agree to strongly disagree) after be informed about HPV and vaccine was observed. Most subjects (78.6%) agree to their daughters' vaccination indicating the high vaccine acceptances. The leading factors to maternal acceptances were free vaccination, negative attitudes such as sexual behavior of daughters and positive attitudes such as vaccine efficacy., Discussion: HPV vaccine acceptance seems to be depended on cost and efficacy than maternal knowledge. The vaccine is not widely used. The cost-effectiveness analysis should be provided by government. Education and communication in public media are aimed for increasing coverage of vaccination in the future., Conclusion: Maternal acceptances of vaccine depend on high efficacy and low cost.

A case of well differentiated endometriod adenocarcinoma of the endometrium with a synchronous endometriod and clear cell adenocarcinoma of both ovaries was reported. Recently, a 28-year-old woman presented with vaginal bleeding was diagnosed to have only FIGO stage IaG1 (FIGO 2000) cancer of the endometrium. After 3 months of high dose progestin treatment, 15 cm bilateral ovarian tumors later diagnosed as FIGO stage IIIa ovarian cancer (mixed endometriod and clear cell adenocarcinoma) were detected, and later surgically removed. The patient then was started on Placitaxel/Carboplatin combination chemotherapy for 6 cycles after surgery. The synchronous cancers of endometrium and ovary are usually presented in woman with median age of 50 with obesity, diabetes, and hypertension. These low grade tumors and better prognosis are the norm in contrast to the authors' case with clear cell component and higher stage of ovarian cancer in young lean Thai woman.

Background: Several adjuvant analgesic agents proposed to treat the postoperative pain while reducing the doses of opioid and its derivatives. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in several operative procedures. The present study aimed to demonstrate the morphine-sparing effects of single-dose intramuscular diclofenac sodium in explore laparotomy gynecologic surgery., Material and Method: Forty-six patients were randomly assigned to receive 75-mg of diclofenac sodium or normal saline with intramuscular morphine during immediate postoperative period. Additional morphine for pain control was given by patient-controlled analgesia. 24-hour morphine consumption, pain score, adverse effects and satisfaction of the patients were recorded., Results: Median morphine consumption among groups was significant difference between placebo and diclofenac group (32 and 19 mg) (p = 0.041). Greater difference was shown in patients who underwent total abdominal hysterectomy (p = 0.009). Catagorical pain score at 6-hour postoperatively was significant lower in diclofenac group (p = 0.006). No significant difference was found between groups in visual analogue pain score, patients' satisfaction, presence of bleeding or nausea and vomiting., Conclusion: The present study demonstrated that single dose of diclofenac sodium has morphine-sparing effects and can be safely used in explore laparotomy gynecologic surgery without significant adverse effects.

Objective: The aim of the present study was to evaluate the prevalence of abnormal Pap smears as detected by liquid-based (LBP) and conventional (CPP) techniques in women who were patients in the gynecologic clinic, Thammasat University Hospital., Material and Method: Retrospective analysis of cervical cancer screening, histopathological findings and operative procedures was done between January 2009 and December 2009. Of the 6,332 participants who underwent gynecological examination and cervical screening and had a Pap smear result as atypical squamous cells of undetermined significance or worse would be performed a further colposcopic examination., Results: A total of 6,332 women were screened for cervical cancer in the one year period. A total of 169 abnormal Pap smears were found. Of 497 (8%) and 5,835 (92%) women were screened by LBP and CPP, respectively. The mean age of patients was 39.45 years old (14-90) and 1,550 (24.5%) women were post menopausal. The Prevalence of abnormal Pap smears was 4.0 and 2.6% in the LBP and CPP groups, respectively. Among LBP group, patients with atypical smear and LSIL (low grade squamous intraepithelial lesion) were 11 (2.29%) and 9 (1.8%), respectively. While CPP group, patient with atypical smear, LSIL, HSIL (high grade squamous intraepithelial lesion) and cancer were 73 (1.25%), 49 (0.84%), 25 (0.43%) and 2 (0.03%), respectively., Conclusion: The prevalence of abnormal Pap smear in women who attended gynecologic clinic of Thammasat University Hospital was 4.0% and 2.6 % per LBP and CPP group, respectively. There was no significant difference in the incidence of atypical smear and false positive result between LBP and CPP.

Objective: To determine the prevalence of cervical intraepithelial neoplasia (CIN) 2-3 (high-grade CIN) among women with Atypical Squamous Cells of Undetermined Significance (ASC-US) Pap smear., Material and Method: A retrospective medical record review of220 women with ASC-US cervical Pap smear, including age, menstruation status, parity, placed of residence, occupation, main complaint, and definite histopathological result between July 2007 and January 2010 was done., Results: The prevalence of high-grade CIN2 and CIN 3 in Thammasat University Hospital were 8.6% and 3.2% respectively No cancer was found in the present study. There was no statistically significant difference in the prevalence of high-grade CIN between the patients who were 50 years old or more and those who were younger., Conclusion: Prevalence of high-grade CIN in women with ASC-US was 11.8%. Immediate colposcopy is recommended in women with ASC-US

Objective: To determine the prevalence of abnormal cervical cytology by liquid based cytology (LBC) in pregnant women who attended the antenatal care clinic at Thammasat University Hospital., Material and Method: LBC was performed on specimens from the collecting vial containing preserved cell solution (Cytyc, Boxborough, MA) in pregnant women who attended antenatal care at the antenatal care clinic, Thammasat University Hospital between March and July 2010. One hundred forty three pregnant women were recruited in the present study. All cytological reports were reviewed by senior cytopathologists for accurate diagnosis using the Bethesda System 2001 criteria. Patients with abnormal results as "abnormal squamous/glandular cells of undetermined significant" or more over were referred for colposcopic examination., Results: One hundred forty three pregnant women participated in the present study. The average age was 27.09 years. There were 10 abnormal Pap smear results with four, five, and one cases of ASC-US, LSIL and HSIL respectively The prevalence of abnormal cervical cytology in this investigation was 7% with 0.7% high-grade cervical intraepithelial neoplacia. Only 6% of participants had the correct understanding of the necessity of Pap smear testing. Thirty-one percent of multiparous pregnant women in the present study had no previous Pap smear screening. The majority of participants had coitarche before the age of 20., Conclusion: The prevalence of abnormal cervical cytology in pregnant patients attending the antenatal care clinic at Thammasat University Hospital was 7%. The cervical cytology and related education were highly recommended in antenatal care clinic to increase cervical cancer screening coverage among reproductive age women.

Objective: To determine risk factors of high-grade cervical intraepithelial neoplasia (CIN 2-3) among women with atypical squamous cells of undetermined significance (ASC-US) Papanicolaou (Pap) smears., Methods: Two-hundred and sixty-six women with ASC-US Pap tests who underwent a colposcopy with histologic study were enrolled between August 2008 and June 2010. Patient data including age, education, income, parity, current pills used, number of vaginal deliveries, number of sexual partners, age at first sexual intercourse, history of sexually transmitted diseases, history of pelvic inflammatory disease and smoking habits were obtained. Logistic regression analysis was used to evaluate factors associated with CIN 2-3., Results: CIN was diagnosed in 134 of 266 women (50.4%). Ninty-seven of these (72.4%) had CIN 1 and 37 (27.6%) had CIN 2-3. Frequency of the latter was lower in women who had at least bachelor's degree graduation as compared to those having less than primary school graduation (odds ratio (OR) 0.085, 95% confidence interval (CI) 0.013-0.557). In addition, those with a higher income (5,000-20,000 baht per month) had less frequent CIN 2-3 (OR 0.378, 95% CI 0.147-0.970), whereas women who had 3 or more sexual partners were more likely to develop CIN 2-3 (OR 3.181, 95% CI 1.316-7.687)., Conclusions: Women with ASC-US Pap smears who had 3 or more sexual partners, low education and low income were at an increased risk of CIN 2-3. Therefore, this group of patients deserve a high priority for immediate colposcopy in order for early detection of high-grade CIN.

Aim: To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP)., Material & Methods: A total of 50 female patients were recruited. The study group consisted of 25 women with CPP of possible gynecological origin. Twenty-five women without CPP made a control group. All women were examined using transvaginal color Doppler ultrasonogram after negative finding of pelvic examination. The mean pulsality index (PI) and resistant index (RI) of the uterine arteries were recorded and compared., Results: The mean ages were 36.6 ± 10.6 and 32.0 ± 6.7 years in the study group and control group, respectively. The duration of pain ranges from 6-48 months (mean, 14.8). The mean PI and RI values of the uterine arteries in patients with CPP were significantly lower than in the control group; PI = 2.12 ± 0.78, 2.76 ± 0.84 and RI = 0.79 ± 0.19, 0.89 ± 0.05, respectively (P < 0.05)., Conclusions: Doppler flow indices demonstrated significant increase of uterine arteries vascularization in CPP women related to pelvic causes. Transvaginal ultrasound with noninvasive Doppler study could be a useful primary investigation for CPP women, especially when financial resource is an issue., (© 2010 The Authors. Journal of Obstetrics and Gynaecology Research © 2010 Japan Society of Obstetrics and Gynecology.)

Background: Most Thai people believe that health care providers have a lower risk of any disease than their patients. This belief may lull Thai health care providers into accepting the false belief that they are at a lower risk of having the precancerous conditions that lead to cervical cancer., Objective: This study compares the prevalence of abnormal Pap smears from health care providers (HC) and non health care providers (NHC) by using the standard liquid-based Pap smear processing at Thammasat University Hospital's pathology department, Thailand., Material and Method: Both health care providers (HC) and non health care providers (NHC) were patients at the outpatient clinic, Thammasat University Hospital. They were screened for cervical cancer by using liquid-based Pap smear (LBP). Cytological diagnoses and specimen adequacy were classified using the Bethesda system 2001. All subjects who had abnormal cytology more than atypical squamous cells or atypical glandular cells were counseled to have performed a colposcopic directed biopsy for confirmation of pathology., Study Design: A total of 250 liquid-base Pap smears were processed and evaluated at the Gynecology clinic, Thammasat University Hospital from April 2008 to May 2008., Results: The groups of HC and NHC consisted of 122 and 128 women, respectively. In general, both the HC and NHC groups were similar in their age, religion, income and education level distributions. The range of ages was between 16 and 75 years, with the mean age equal to 40.2 +/- 10.5 years. Prevalence of abnormal Pap smears was 9.8% in HC and 9.4% in NHC (p-value = 0.90). HC showed atypical change (ASC, AGC), low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) at 0.8%, 1.6% and 7.4%, respectively. NHC had an incidence of atypical change, LSIL and HSIL at 0.8%, 0.8% and 7.8%. HC had an equal incidence of abnormal Pap smears prevalence to NHC. Further, the percentage of HC and NHC groups with histological confirmed cervical intraepithelial neoplasia (CIN) 1 were not significantly different (4.92% vs. 6.25%, p-value = 0.70), likewise CIN 2/3 (1.64% vs. 1.56%, p-value = 1.00). According to our study the rate of abnormal Pap smears observed in both health care providers and clients was essentially the same., Conclusions: The prevalence of abnormal Pap smears in health care providers was statistically equivalent to that in their clients.

Objective: To study the accuracy of self vaginal douching and collection for HPV types 16, 18, 31 and 33 in women visiting Thammasat Hospital for the explicit purpose of cervical screening., Methods: A pelvic examination and Pap smear were performed for all women who came for cervical screening. Specimens were also collected by self vaginal douching before cervical screening and sent to the cell and molecular biology laboratory for analysis of human papillomavirus (HPV) types 16, 18, 31 and 33 using the polymerase chain reaction (PCR)., Results: HPV prevalence was 3.6% overall from 250 women in this study. Twenty-four (9.6%) women had an abnormal cytology screening result. No cancer was found. Four women had a high grade squamous intraepithelial lesion (HSIL) and 14 had a low grade squamous intraepithelial lesion (LSIL) from colposcopic biopsy. Self vaginal douching for HPV 16, 18, 31 and 33 was used to predict abnormal Pap smear. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 12.5%, 97.5%, 33.3% and 91.3%, respectively., Conclusion: From our analysis of self-vaginal douching for HPV detection using cases from Thammasat university hospital, it cannot replace the Pap smear.

Aim: To determine the frequency of cervical cytologic abnormalities in patients who were diagnosed as having CIN 1 and had undergone either cryotherapy or expectant management., Methods: A retrospective medical record review of 87 patients with colposcopic cervical biopsy-proven CIN 1, was undertaken including age, parity, menstruation status, cervical cytology reports, colposcopic findings, and cervical cytologic follow-up reports. There were 38 patients (43.7%) treated with cryotherapy and the remainder underwent expectant management., Results: Mean (SD) age of patients treated with cryotherapy was less than that of the patients who had expectant management (36.2 (9.4) vs 41.1 (9.4) years, respectively, p= 0.02). There were no differences in the frequencies of cervical cytologic abnormalities between the groups at 6- and 12-month-follow-up visits (cryotherapy group vs expectant group: 18.4% vs 18.4% at 6-months and 19.2% vs 16.1% at 12 months)., Conclusion: Cryotherapy and expectant management with cytologic surveillance had comparable frequencies of cytologic abnormalities during a 12-month follow-up period. Expectant management requires adherence to follow up and high quality cytology and colposcopy testing. Therefore, it should be reserved for these settings. Cryotherapy may be more reasonable in women who are likely to be lost to follow up and high quality cytology cannot be guaranteed.

Background: To study the prevalence of high-risk human papillomavirus (HPV) types 16, 18, 31 and 33 in healthy Thai women using polymerase chain reaction (PCR) technique., Material and Method: Two hundred and sixty three healthy urban women in Pathumthani, Thailand were recruited. Cervical cancer screening was performed and residual specimen from Pap smears was subjected to PCR to identify the presence of HPV types 16, 18, 31 and 33. Individuals' demographic, health-specific and sexual behavior data were also collected., Results: Colposcopic biopsy revealed cases with high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL). HPV 16 and 18 positive results were associated with abnormal Pap smears. Genotyping gave a 6.1%, 11.8%, 12.1%, and 14.1%, prevalence for HPV types 16, 18, 31 and 33, while 25% were infected with multiple HPV types., Discussion: High-risk HPV screening, used with abnormal pathology of HSIL gives 100% sensitivity and negative predictive value. Data from patient showed not significant correlation with neither different religion level of education, marital status, age of first sexual experience nor the number of sexual partners. Thus high-risk HPV screening is a recommended procedure with excellent sensitivity for detecting HSIL.

Objective: The colposcopic vision guided loop electrosurgical excisional procedure (LEEP) was studied for the effective diagnosis of cervical cancer and cervical intraepithelial neoplasia (CIN)., Methods: A total of 199 patients participated in this study. Individual cases were from gynecologic outpatients at Thammasat University Hospital, Thailand. These had diagnoses for CIN and were selected for treatment with colposcopic guided LEEP. The average age of patients in this study was 45. Menopausal women represented 31%, (61/199) of the patients. The most frequently found Pap smear result among these women (44%, 88/199), was that of high-grade squamous intraepithelial lesion. The next most frequent Pap smear result (32%, 64/199) was low-grade squamous intraepithelial lesion. Patients' medical records and outcomes were evaluated for consistency of pathological examination between colposcopic directed biopsy and LEEP. Discrepancies between initial diagnosis and the final diagnosis were also analyzed., Results: The colposcopic guided LEEP accurately determined 100% of the cervical cancer cases and 84.8 % of the high-grade squamous intraepithelial lesion cases. Involvement of the ectocervical or endocervical margin regions was found to be 5% and 10% respectively, in this study. Excessive bleeding complication, either during the excision and/or postoperative recovery was found in 3% and 6% of cases, respectively., Conclusion: LEEP under colposcopic vision is a recommended technique for ambulatory management of precancerous lesion and early diagnosis of cervical cancer. This technique significantly reduces rate of positive ectocervical cone margin involvement.

Objective: To present the indications associated with the increase in cesarean section rate at Thammasat University Hospital during the past three years., Material and Method: This was a cross-sectional study. Pregnant women who underwent cesarean section between January 2003 and December 2005 at Thammasat University Hospital were recruited for the present study. Cases of fetal anomaly or intrauterine fetal death were excluded. Demographic and obstetric data including indications of cesarean section and pregnancy outcomes were collected and analyzed, Results: Among the 1328, 1402, and 1522 cases of cesarean section (27.31, 27.94, and 29.26%) in 2003, 2004 and 2005 respectively, the major indication was previous cesarean section (29%). Cephalopelvic disproportion (CPD), and elective cesarean section were second, and third most common indication (24.64%, 11.23%) respectively., Conclusion: The increasing cesarean section rate was due to rising of elective cesarean section or patient's request. Cesarean section without obstetric indication should be reconsidered to lower the cesarean section rate.

Objective: To investigate the prevalence of abnormal Papanicolaou smear in pregnant patients who attend the Antenatal Care Clinic at Thammasat University Hospital., Material and Method: Pregnant patients who attended the antenatal care clinic at Thammasat University Hospital from August 2003 to December 2003 were recruited for Papanicolaou test. Patients who had abnormal results of equally or over "abnormal squamous/glandular cells of undetermined significance" were assigned for colposcopy and colposcopic biopsy to confirm the result., Results: From 500 Papanicolaou smear performed, there were only four patients who had abnormal Pap tests, which were: 2 ASC-US and 2 LSIL. The prevalence of abnormal Pap smear in pregnant patients who attended the antenatal clinic at Thammasat University Hospital was 0.8 percent., Conclusion: The prevalence of abnormal Papanicolaou smear in pregnant patients attending antenatal care clinic at Thammasat University Hospital was quite low in compares with other literature.