Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries?

Objective: To compare surgical complications and maternal and neonatal outcomes of low-risk, late preterm and term pregnant women who have had one or two previous cesarean sections [CSs] with those who have had three or more CSs

Methods: We conducted a retrospective study of 850 patients undergoing repeat CS at a tertiary level maternity hospital in Ankara, Turkey. Of those, 380 had previously undergone one or two CSs [Group-I: second or third CS] and 470 had previously undergone three or four CSs [Group-II: fourth or fifth CS]. Outcomes and complications were compared between the groups

Results: The two groups were statistically significantly different in terms of maternal age, parity, body mass index, maternal weight gain during pregnancy, and length of hospital stay [all p<0.001]. Although the prevalence of intraperitoneal adhesions and placenta previa was higher in Group-II than in Group-I [p<0.001], there was no statistically significant difference in terms of cesarean hysterectomy and adjacent organ injuries [p>0.05]. There were also no significant differences between the groups in terms of neonatal outcomes [p>0.05]

Conclusion: Although the increase in the number of CSs appears to be associated with intraperitoneal adhesions and placenta previa, adverse maternal and neonatal outcomes were not observed in those women with low-risk pregnancies who underwent CS for the fourth or fifth time. Therefore, fourth and fifth CSs may be considered relatively safe surgical procedures in this cohort

Is striae gravidarum related to cesarean scar and peritoneal adhesions?

Objective: To evaluate the relationship between striae gravidarum [SG] score and abdominal scar characteristics together with intraperitoneal adhesion [IPA] grades of patients who were hospitalized for second cesarean delivery

Methods: A total of 145 consecutive women undergoing scheduled cesarean section [CS] in a tertiary level maternity hospital between November 2013 and January 2014 were included in the study. All women had transverse suprapubic skin incision due to the previous CS and none of them had a history of vaginal delivery. Patients were classified according to the SG status, as women with no SG: Group-1[n=53], mild SG: Group-2[n=27] and severe SG: Group 3[n=65]. Groups were compared between themselves with regard to various sociodemographic properties, cesarean scar characteristics and IPA scores

Results: No significant difference in the length, width and color of the scar was detected among groups. While flat scar was the most prominent form of scar, the elevated scar was significantly more frequent in Group-1 compared to other groups [p=0.009]. IPA grades were 0 or 1 in 77.3% of Group-1, 81.3% of Group-2 and 76% of Group-3. There was no significant difference in IPA scores between groups [p=0.884]. After combining CS scar characteristics [flat, depressed and elevated] and SG status [SG [+] or SG [-]], we found no significant difference between the groups in terms of IPA severity

Conclusion: Striae gravidarum [SG] was found to be associated with scar characteristics, but not associated with the severity of intraperitoneal adhesion [IPA]

Do serum vitamin D levels have any effect on intrauterine insemination success?

Background: Recent studies have shown that vitamin D has an essential role in the reproductive system. In this study, we aimed to investigate the effect of vitamin D levels in patients undergoing ovulation induction [OI], and subsequent intrauterine insemination [IUI] procedure

Materials and Methods: One hundred and four infertile and one hundred and three fertile women were recruited in this cross-sectional study which was conducted in a tertiary level maternity hospital. Infertile patients were divided into pregnant and non-pregnant subgroups after treatment. Individual characteristics and 25-hydroxyvitamin D3[25 [OH] D3] levels were compared between the groups

Results: The vast majority of our study population consisted of women who had vitamin D deficiency [96.6%]. There was no statistically significant difference between infertile and fertile groups in terms of serum 25 [OH] D3 levels [P=0.512]. Similarly, no significant difference was observed between the pregnant and non-pregnant subgroups of infertile patients regarding 25 [OH] D3levels [P=0.267]

Conclusion: There is no association between female infertility and serum vitamin D levels. Vitamin D does not predict pregnancy in infertile women undergoing OI with IUI. Further research which will provide a comparison between much more women who have deficient and sufficient 25 [OH] D3levels is warranted

Are uterine and ovarian artery doppler velocimetry values good pregnancy predictors in clomiphene citrate cycles?

We conducted this prospective study to evaluate the prognostic significance of uterine and ovarian artery Doppler velocimetry in clomiphene citrate [CC] cycles. A total of 80 patients with unexplained infertility were given 100 mg/day of CC from day 3 to day 7 of their cycles in this current prospective study. On cycle day 3, before administration of CC, each patient underwent Doppler transvaginal ultrasonography. The Doppler velocimetries of the right and left uterine and ovarian arteries were recorded and analyzed in association with demographic and clinical parameters. There were 6 out of 80 patients who became pregnant, the overall pregnancy rate in this population was 7.5% for the current study. The cases were divided into two groups according to whether they became pregnant or not. Demographic characteristics showed no statistically significant differences between these groups [p>0.05]. However, the duration of infertility did show statistically significant differences between the groups. Doppler velocimetry was not statistically significantly different between the two groups. Doppler velocimetry of the uterine and ovarian arteries is not a factor in the prognosis for pregnancy in CC cycles