Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience

Objective: To compare the obstetric outcomes of cesarean section in women who had a history of four or more previous cesarean sections with those who had a history of two or three previous cesarean sections

Methods: Total 1318 women who underwent repeat cesarean section between January 2013 and January 2016 were retrospectively reviewed. Of these, 244 [18.5%] had previously had four or more cesarean sections [multiple repeat cesarean section group] and 1074 [81.5%] had previously had two or three cesarean sections [control group]. Demographic characteristics and obstetric outcomes were compared using the Independent t and chi-square tests

Results: The adhesion rate [p < 0.001], number of blood transfusion [p = 0.044], operation time [p = 0.012], length of hospital stay [p < 0.001] and tubal ligation surgery [p < 0.001] were significantly higher in multiple repeat cesarean section group compared to control group

Conclusion: Although multiple repeat cesarean section are asscociated with adhesion occurrence, higher number of blood transfusion, increased operation time and length of hospital stay, there is no remarkable difference in serious morbidity associated with multiple repeat cesarean section

Does menopausal status impact urinary continence outcomes following abdominal sacrocolpopexy without anti-incontinence procedures in continent women?

Objective: We investigated the impact of menopausal status on urinary continence following abdominal sacrocolpopexy [ASC] without an anti-incontinence procedure in continent women

Methods: We conducted a clinical follow-up study of 137 patients diagnosed with stage 3 or higher pelvic organ prolapse [POP] without urinary incontinence between January 2012 and December 2014. Patients were provided with detailed a priori information pertaining to the abdominal sacrocolpopexy procedure and were invited to attend follow-up visits at 1, 3, 12, and 24 months. Follow-up visits included a gynecological examination, cough test, and validated Urinary Distress Inventory6 [UDI-6] and Incontinence Impact Questionnaire?[[110.-7] questionnaires

Results: The mean follow-up time for the cohort was 16.5 +/- 3.45 months. The study group was divided according to menopausal status: premenopausal [Group-1] and postmenopausal women [Group-ll]

Anatomical recurrence was not detected during the follow-up period in either group, but de novo stress urinary incontinence was seen in 15 of 53 [28.3%] Group-l patients and in 6 of 84 [7.1%; p < 0.01] Group-ll patients

Conclusions: The risk of de novo stress urinary incontinence in postmenopausal women after ASC is low. However, premenopausal patients have a higher incidence of de novo stress incontinence which affect quality of life

Can anemia predict perinatal outcomes in different stages of pregnancy?

Objective: To investigate the effect of anemia on perinatal outcomes as preterm delivery [PTD] and low birth weight [LBW] in the different stages of pregnancy

Methods: Medical records of 39,587 Turkish pregnant women who delivered between January 2011 and September 2014 were reviewed. Anemia during pregnancy was defined as hemoglobin [Hb]< 11 g/dl, low birth weight was defined as birth weight <2500 gr and PTD was defined as <37 weeks. The pregnant women were divided into three groups [Hb<10 gr/dl, Hb 10-11 gr/dl, Hb>11 gr/dl]. Perinatal outcomes were compared between these anemic and non-anemic groups

Results: The anemia prevalence in our study was 25.1%. In the first and second trimester of Hb<10g/dl group LBW ratio was significantly higher [respectively 13.5%, 9.8%, p=0.03; 22.7%, 14.7%, p=0.01]. In the second and third trimesters of Hb<10 g/dl group PTD ratio was significantly higher [respectively 29.1%, 19%, p=0.00; 17.7%, 15.4% p=0.02]. In the first trimester Hb<10 g/dl group cesarean section rate was significantly higher [respectively 65.2%, 57.6%, p = 0.01]

Conclusions: LBW infants and preterm birth rate was higher in Hb <10 gr/dl group than non-anemic in the first, second and third trimester. Hb <10 gr/dl group had higher cesarean rate in first trimester. The mean birth weight was significantly lower in anemic pregnant women in the second trimester. Preterm birth and cesarean section rate, in the group of anemic throughout pregnancy was higher than those of non-anemic in the whole pregnancy period

Comparison of frequency of asymptomatic microhematuria in patients with stage 2-4 versus stage 0-1 pelvic organ prolapse

Objective: To compare the frequency of asymptomatic microhematuria [AMH] in patients with stage 2-4 and stage 0-1 pelvic organ prolapse [POP]. Methods: The hospital database was searched for women diagnosed with pelvic floor disorders and all medical records were reviewed retrospectively for the presence of AMH. An additional search was conducted for women with other benign gynecological conditions such as myoma uteri, endometrial hyperplasia or adnexal masses without evidence of pelvic organ prolapse [control group]. The control group was created using 1:1 matching for age and menopausal status. The frequency of AMH in these patients were compared. The degree of hematuria was categorized as reported by the laboratory as 3 to 25 [low grade hematuria], 26 to 50 [intermediate grade hematuria] and 51 or more [high grade hematuria] red blood cell/high powered field. Results: AMH is statistically significant more often seen in study group than in control group [p:0.016]. In the prolapse group 20 women [13.7%] had AMH compared with 9 [6.2%] in the control group. All of 29 patients with AMH had low grade hematuria defined as < 25 red blood cell/high powered field. Patients were followed up for 22 +/- 7 [12 to 33] months. No bladder cancer and no cancer of the upper urinary tract has been detected in these 29 patients with AMH during follow-up. Conclusions: Women with stage 2-4 POP are more likely to be diagnosed with AMH than those with stage 0-1 prolapse