Abnormal uterine bleeding in women aged 35 years or over is an important clinical sign of many gynecological conditions. The diagnoses of these conditions require the pathological report of the endometrial tissue. Outpatient-based endometrial biopsy is an excellent option compared to standard fractional uterine curettage or hysteroscopy with endometrial biopsy in providing a definite diagnosis for abnormal uterine bleeding as it is less painful and does not require high potency anesthesia. This study evaluates the effect of intrauterine lidocaine on the patient's pain score during endometrial biopsy by the Novak curette. We included patients aged 35 years or more who had abnormal uterine bleeding between December 2016 and March 2018. The study was conducted at Thammasat University Hospital, Pathum Thani, Thailand. 250 patients were randomly allocated to either receive intrauterine lidocaine (study group) or normal saline (control group). Assessment of pain severity was evaluated using a visual analogue scale (VAS) score at 6 time-points, namely, before performing the procedure, when grasping the cervix by the tenaculum, during the intrauterine instillation of lidocaine or normal saline, during the uterine curettage, and then 15 minutes and 2 hours after the procedure. This study showed that there was significant pain reduction in patients who received intrauterine instillation of lidocaine compared to placebo, during uterine curettage, as well as 15 minutes and 2 hours after procedure (p<0.0001). Patient satisfaction was not significantly different between the two groups, while physician satisfaction significantly improved in the lidocaine group. Serious complications were not found during this study. (This research project had been approved for registration at Thai Clinical Trials Registry. TCTR identification number is TCTR20161031003.)

Aim To compare effects of cold therapy on patient pain score during and after amniocentesis procedure. Methods We performed a prospective randomized‐controlled study comparing the anticipated pain, perceived pain during the procedure, and pain after 15 and 30 min of amniocentesis between pregnant women receiving cold therapy before (group 1), after (group 2), and both before and after amniocentesis (group 3) with a control group (group 4). Pain was measured using a visual analog scale (VAS) score. Results A total of 480 participants were recruited and randomly assigned into four groups of 120 each. Anticipated pain scores in all groups were not statistically different. When compared with group 4, groups 1 and 3 experienced significant pain reduction during amniocentesis, while VAS scores at 15 and 30 min after amniocentesis in groups 1–3 were significantly lower as compared to group 4. Conclusion Cold therapy both before and after amniocentesis procedure is most effective in pain reduction. It encourages the pregnant woman's cooperation during the procedure and provides a good amniocentesis experience. Application of cold compression is also beneficial in other aspects as it is simple, safe, convenient, and yet reusable and economically efficient for routine use in all pregnant women undergoing amniocentesis.

Background: Body mass index (BMI) has commonly been used to evaluate the risk of gestational diabetes mellitus (GDM), but BMI does not always represent body fat mass distribution. Body fat index (BFI), which includes the measurement of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), has been suggested to be a better predictor for GDM than BMI. Objective: The objective of this study is to compare the risk of GDM among pregnant females with BFI of >0.5 and ≤0.5. Methods: Maternal abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) thickness were measured by ultrasonography before 14 weeks of gestation, and BFI was calculated (VAT×SAT/height). The study group was 160 females with BFI of >0.5, and the comparison group was 80 females with BFI of ≤0.5. All females received GDM screening during the first antenatal visit and at 24-28 weeks of gestation. The rate of GDM was compared between the two groups. The correlation between BFI and BMI and their diagnostic ability for GDM were evaluated. Logistic regression analysis was performed to determine the independent associated factors for GDM. Results: Females with BFI of >0.5 were significantly older (p=0.033) and had higher body mass index (BMI) (p<0.001) and were more likely to be overweight or obese (p<0.001). BFI correlated well with BMI (correlation coefficient of 0.736, p<0.001). GDM was significantly more common in females with BFI of >0.5 (24.4% versus 11.3%, p=0.017). The diagnostic ability for GDM between BFI and BMI was similar (areas under receiver operating characteristic {ROC} curves of 0.641 and 0.646, respectively). Significant independent risk factors for GDM were a BFI of >0.5 and a BMI of ≥25 kg/m 2 (adjusted odds ratio {OR}, 3.8; 95% confidence interval {CI}, 1.5-9.2), age of ≥30 years (adjusted OR, 2.8; 95% CI, 1.2-6.4), and family history of diabetes mellitus (DM) (adjusted OR, 4.0; 95% CI, 1.9-8.3). Conclusion: Females with BFI of >0.5 were significantly more likely to have GDM. The diagnostic ability of BFI and BMI for GDM was comparable. Females with BFI of >0.5 and BMI of ≥25 kg/m 2 have an increased risk for GDM.