Low back pain and kinesiophobia in pregnant women.

BACKGROUND: During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations. OBJECTIVE: To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy. METHODS: The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia. RESULTS: The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n= 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2, and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p= 0.49), gestational week (p= 0.75), and gravida (p= 0.81) were similar. BMI (p= 0.038) and ODI scores (p< 0.001) were higher in the group with LBP. CONCLUSION: LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend.

Serum amphiregulin and cerebellin-1 levels in severe preeclampsia.

PURPOSE: Preeclampsia is a form of hypertensive disorders of pregnancy and defined as the presence of new-onset hypertension and proteinuria or other end organ damage occurring after 20-week gestation. Preeclampsia can be a destructive process that can cause maternal and infant mortality. The exact etiopathogenesis of preeclampsia is still undefined. We aimed to compare serum amphiregulin and cerebellin-1 levels of severe preeclampsia patients with healthy pregnant women and healthy control subjects. MATERIALS AND METHODS: A total of 88 women were enrolled in this study. Patients diagnosed with severe preeclampsia were group 1 (n = 28), healthy non-pregnant normotensive women group 2 (n = 30), and healthy pregnant women group 3 (n = 30). The participants in each group were matched for age. Pregnant women in groups 1 and 3 were also matched for gestational age. Serum amphiregulin and cerebellin-1 levels were measured using ELISA. RESULTS: Serum amphiregulin levels were 3413 ± 1.38 ng/ml (1748-7739), 8510 ± 7213 ng/ml (2019-24,000), and 6580 ± 5360 ng/ml (2484-24,000) in preeclampsia patients, controls and healthy pregnant women, respectively. Amphiregulin levels were significantly lower in preeclampsia patients than healthy pregnant women (p=.008) and controls (p = .015). Amphiregulin levels were similar between healthy controls and healthy pregnant women (p = 1.00). Cerebellin-1 levels were 222.039 ± 92.681 pg/ml (138,580-557,757) in preeclamptic patients, 537.043 ± 525.117 pg/ml (150,432-1,600,000) in controls and 415.091 ± 436.580 pg/ml (137,284-1,600,000) in healthy pregnant women. Cerebellin-1 levels were similar among groups (p = .272). Serum amphiregulin and cerebellin-1 levels were significantly and positively correlated with each other in preeclampsia patients (r = 0.693, p < .001), controls (r = 0.882, p < .001), and healthy pregnant women (r = 0.591, p = .001). Serum level of amphiregulin ≤3590 pg/ml had a sensitivity of 67.9% and specificity of 63.3% in the diagnosis of preeclampsia (AUC: 0.751; p = .001). CONCLUSIONS: Serum amphiregulin decreases in severe preeclampsia patients.

The role of G protein-associated estrogen receptor (GPER) 1, corin, raftlin, and estrogen in etiopathogenesis of intrauterine growth retardation.

Objective: The aim of the present study was to detect the role of G protein-associated estrogen receptor (GPER) 1, corin, raftlin and estrogen in etiopathogenesis of intrauterine growth retardation (IUGR).Materials and methods: The present study was designed prospectively between January 2017 and May 2018. The study group included 32 patients with unexplained IUGR and 32 healthy pregnant women who gave birth at term among the patients who referred to obstetrics clinic of a tertiary reference hospital. Intrauterine growth retardation (IUGR) was accepted as birth weight below 10th percentile according to the estimated fetal weight. Exclusion criteria were as follows: the patients with renal or hepatic dysfunction, presence of any chronic disease, smoker patients, preeclampsia, acute or chronic inflammatory diseases, body mass index as <18 kg/m2 and >25 kg/m2, structural or chromosomal abnormality in fetus Estradiol (E2), estriol (E3), GPER, corin, and raftlin levels were analyzed in maternal serum and placental tissue homogenate through ELISA method.Results: Serum levels of GPER-1, raftlin, and E3 were significantly lower in IUGR group when compared with the control group (p < .05 for all). Serum corin and E2 levels were similar between two groups. GPER-1, E2, E3, raftlin, and corin levels in placental homogenate were found significantly higher in the control group (p < .05 for all).Conclusion: Although maternal, fetal, and placental causes take place in etiopathogenesis of IUGR, exact etiological factor is not revealed in majority of the IUGR cases. The present study serves as the first study revealing the role of the decrease in GPER-1 and raftlin in maternal serum and placental levels on the etiopathogenesis of IUGR. Furthermore, the decrease in placental corin expression of the cases with IUGR was detected first in the literature. The present study reveals a potential therapeutic use of GPER-1, corin, and raftlin for IUGR.

The serum level of soluble CXCL16 is increased in preeclampsia and associated with hepatic/renal damage.

OBJECTIVE: To compare the serum level of the chemokine, CXCL 16, in preeclamptic and healthy pregnant patients. METHODS: This prospective case control study was conducted between January and December 2018 in a tertiary level hospital. The study group was formed of 70 pregnant women diagnosed with preeclampsia, and the control group was formed of 70 healthy pregnant women matched to the study group in respect of age, gestational week and body mass index (BMI). The study group was separated into two subgroups of mild preeclampsia (n = 35) and severe preeclampsia (n = 35). The groups were compared in terms of demographic and clinical parameters and the levels of serum CXCL 16. RESULTS: No statistically significant difference was determined between the study and control groups in respect of maternal age, gravida, parity, BMI, and gestational age at sampling. Neonatal birth weight was significantly lower in the study group than in the control group. Mean serum alanine aminotransferase (ALT), aspartate amino transferase (AST) and creatinine levels of the study group were significantly higher than those of the control group (p < .05 for all). There was a statistically significant difference between the study and control groups regarding the mean platelet count. Compared to the control group, the severe and mild preeclampsia groups had a significantly higher serum level of CXCL 16. The serum level of CXCL 16 was significantly higher in patients with severe preeclampsia than in patients with mild preeclampsia (2.94 ± 3.89 pg mL-1 vs. 1.08 ± 1.87 pg mL-1, p = .14). Correlation analysis revealed a significant positive correlation of serum CXCL 16 level with serum ALT level (r = 0.320, p ≤ .001) and serum AST level (r = 0.373, p ≤ .001) and serum creatinine level (r = 0.279, p = .01) in both groups. High values indicated presence of preeclampsia, with a diagnostic cut-off point of 0.225, sensitivity of 75.7% and specificity of 72.9% for CXCL 16 (area under curve: 0.820, p < .001 CI: 0.753-0.888). CONCLUSIONS: This is the first study in literature to show a significantly higher level of CXCL 16 in patients with severe preeclampsia compared to those with mild preeclampsia. The study can also be considered of value in respect of showing that CXCL 16 could play a role in the etiopathogenesis of preeclampsia and the emergence of renal-hepatic damage. Blocking the CXCL 16/CXCR six axis in preeclampsia treatment could lay the ground for the development of new drugs which could be used in the treatment of preeclampsia.

Copper/Zinc Ratio Can Be a Marker to Diagnose Ectopic Pregnancy and Is Associated with the Oxidative Stress Status of Ectopic Pregnancy Cases.

It was aimed to evaluate serum zinc and copper levels and oxidative stress parameters in ectopic pregnancy cases, healthy pregnant women, and healthy non-pregnant women. In this cross-sectional case-control study, 30 patients diagnosed with tubal ectopic pregnancy in the gynecology clinic of a tertiary hospital constituted the study group. A healthy pregnant control group (n = 30) was formed of age, body mass index (BMI), and gestational week-matched subjects, and a healthy non-pregnant control group (n = 30) was formed of age and BMI-matched women. The groups were compared in terms of demographic characteristics and laboratory parameters including serum zinc (Zn) level, serum copper (Cu) level, serum malondialdehyde (MDA) level, serum catalase (CAT) activity, serum glutathione peroxidase (GPX) activity, and serum superoxide dismutase (SOD) activity. The groups were similar in respect of demographic characteristics. In the ectopic pregnancy group, serum GPX activity and Cu level were significantly lower, and serum SOD and CAT activity and Zn and MDA levels were higher compared with those of the healthy pregnant and healthy non-pregnant groups. The Cu/Zn ratio showed a significant, positive correlation with the serum GPX activity and serum progesterone level and a negative correlation with serum SOD and CAT activity. When 1.14 was taken as the cutoff value, sensitivity and specificity of the Cu/Zn ratio to determine ectopic pregnancy were 73.3% and 80.0%, respectively. Comparing the area under curve (AUC) in the ROC (receiver operating characteristic) curve analysis, the Cu/Zn ratio was determined to be more valuable than the Cu or Zn values alone in predicting ectopic pregnancy. In correlation analysis, serum beta hCG level showed a negative correlation with SOD and CAT activities and Zn levels. Serum progesterone level showed a negative correlation with serum CAT and SOD activities and MDA and zinc levels and a positive correlation with serum GPX activity and serum copper level (p < 0.05 for all). The current study can be considered of value as the first study in literature to show a significantly lower serum Zn level and higher serum Cu level in ectopic pregnancy cases compared with healthy pregnant control cases. This is also the first study to have revealed an association between the serum Cu/Zn ratio, oxidative status, and ectopic pregnancy. Furthermore, the serum Cu/Zn ratio was found to be useful in the diagnosis of ectopic pregnancy cases.

The role of omentin in early pregnancy losses.

This prospective case-control study aimed to investigate the role of omentin, an anti-inflammatory adipokine in early pregnancy losses. The study comprised 47 women with spontaneous miscarriage at a gestational age of 8-12 weeks and 36 healthy pregnant women, matched for age, body mass index and gestational age, gravdity and parity. A significant negative correlation was determined between plasma omentin concentrations and body weight (r= -0.242, p = .027) and gestational age (r= -0.249, p = .023). Although not statistically, the women with spontaneous miscarriage had higher plasma concentrations of omentin compared to those with healthy pregnancies (7.798 ± 3.453 ng/ml vs. 7.200 ± 3.442 ng/ml, p = .435). This finding might support the hypothesis that increased inflammation plays a role in the etiopathogenesis of early pregnancy losses. These results revealed the potential use of omentin to predict unhealthy pregnancies.Impact statementWhat is already known on the subject of the paper? The exact mechanism of early pregnancy loss with euploid foetal karyotype has not been elucidated yet. An alteration in the physiological inflammatory response of pregnancy might be one of the mechanisms responsible for miscarriage.What does this study add? To the best of our knowledge, this is the first study to investigate the role of omentin in early pregnancy loss. The results obtained from this current study could be used to clarify the relationship between inflammatory processes and miscarriage.What are the implications for clinical practice and/or further research? Identification of the role of omentin in the process of early pregnancy losses would be helpful in order to design further studies to determine the feasibility of using omentin as a serum marker to predict the risk of miscarriage in early pregnancies. Additionally, understanding of the etiopathogenesis of early pregnancy losses with euploid karyotype will give a lead to further researches which could focus on exploring new interventions to detect and treat altered inflammation in early pregnancies.

The role of osteopontin in the pathogenesis of placenta percreta.

OBJECTIVE: This study aims to determine how the expression of osteopontin is altered in the placenta percreta by compar-ing osteopontin expression in normal placentas and placenta percreta tissues. MATERIAL AND METHODS: Placental tissues from hysterectomy materials which were histopathologically diagnosed with placenta percreta (study group, n = 20) and placental tissues obtained from normal term pregnancies (control group, n = 20) were immunohistochemically stained with osteopontin antibody. The groups were compared with respect to the intensity of cytoplasmic staining for osteopontin. RESULTS: The study and control groups were similar with respect to age, gravidity, parity, gestational age at birth, number of previous cesarean deliveries and curettages and (p > 0.05 for all). Immediate postoperative hemoglobin was significantly lower and the need for blood transfusion was significantly higher in the study group (p = 0.001 for both). Placental osteo-pontin expression was significantly altered in the study group (p = 0.020). Negative staining for placental osteopontin was significantly more frequent in the placenta percreta group than the control group (9/20 vs 0/20, 45.0% vs 0%, p = 0.037). CONCLUSION: As reduced placental osteopontin expression was determined in the placenta percreta cases compared to the normal term placenta tissues, osteopontin can be considered to have a role in morbidly adherent placentation. This study is of value as the first study to investigate the changes in osteopontin expression in placenta percreta cases.

Analysis of the factors determining the type of surgical procedure in mature cystic teratomas.

OBJECTIVES: It was aimed to evaluate which factors determine the surgical procedure selected by surgeons for cases with mature cystic teratoma (MCT). MATERIAL AND METHODS: This study included 50 cases with histopathologically proven MCT between January 2011 and August 2016 at a tertiary reference hospital. Data related to demographic and clinical characteristics were retrieved from medical records. Multivariate logistic regression analysis was conducted to evaluate the independent factors determining the type of surgical procedure to be applied. RESULTS: A higher rate of patients with large cyst size and elevated CA 19-9 was determined in the postmenopausal patients compared to the premenopausal patients (p = 0.033, p = 0.035). Cystectomy and oopherectomy were applied to 72.55% and 27.5% of the cases respectively. No recurrence in the operated ovary was observed in the 1-year follow-up period in any of the cystectomy cases. The major and only independent variable for the preference of cystectomy over oopherectomy was found to be a younger age (≤ 40 years). There was no independent variable which predicted the selection of laparoscopy or laparotomy by surgeons. CONCLUSIONS: Cystectomy was seen to be preferred by surgeons in the majority of MCT patients aged ≤ 40 years regardless of the size of the cyst. This is plausible since these patients have greater concerns about future fertility compared to patients > 40 years old. No recurrence was detected in any of the cystectomy cases, which strengthens the feasibility of this procedure. No serious complications developed in laparoscopy which could render it a safe option for undertaking cystectomy/oopherectomy in MCT cases.

Pre-implantation genetic screening among women experiencing recurrent failure of in vitro fertilization.

OBJECTIVE: To determine the efficiency of pre-implantation genetic screening (PGS) among women scheduled to undergo intracytoplasmic sperm injection who had experienced recurrent in vitro fertilization (IVF) failure. METHODS: The present retrospective cohort study reviewed the medical records of consecutive women who had experienced recurrent IVF failure and had presented at a private IVF facility in Trabzon Province, Turkey, to undergo intracytoplasmic sperm injection between May 1, 2012, and December 31, 2014. Patient data and perinatal outcomes were compared between patients who underwent PGS and those who did not. RESULTS: There were 88 patients included in the study; 43 patients had undergone PGS and 45 had declined to do so. No differences were detected in the clinical pregnancy rate (P=0.846), spontaneous abortion rate (P=0.416), number of perinatal deaths (P=0.162), or the number of live deliveries (P=0.188) between the groups of patients. The pregnancies included in the study resulted in 25 neonates being delivered; 24 had normal karyotypes, and one neonate from the control group had a karyotype of 46, XX, 9ph. Among the 19 embryos that were not transferred, the most frequently encountered chromosomal anomalies were diploidy, monosomy X, and 2N/N/4N mosaicism, detected in 7 (37%), 2 (11%), and 2 (11%) embryos, respectively. CONCLUSION: PGS had no effect on perinatal outcomes among women experiencing recurrent IVF failure.

Use of Gelatin Sponge Affects Postoperative Morbidity In Cesarean Section Patients.

BACKGROUND This study aimed to determine the effects of use of a local hemostatic gelatin sponge (GS) on postoperative morbidity in patients undergoing cesarean section (CS). MATERIAL AND METHODS The records of 318 patients who underwent CS surgery were retrospectively evaluated. Group 1 consisted of 59 patients with gelatin sponge (GS) applied, and Group 2 consisted of 259 patients with no GS applied. The groups were compared for time to the first flatus, nausea and vomiting, requirement for anti-emetic drugs, development of postoperative ileus, and the length of hospitalization. RESULTS The patients in Group 1 and Group 2 were statistically similar in mean age, gravida, parity, and body mass index (BMI) (p=0.352, p=0.275, p=0.458, and p=0.814, respectively). No significant difference was determined in the number of patients with nausea, vomiting, anti-emetic drug use, febrile morbidity, and postoperative ileus (p=0.063, p=0.436, p=328, p=0.632, and p=0.179, respectively). Time to the first flatus and length of hospitalization were significantly longer in Group 2 (p<0.001 and p<0.001, respectively). CONCLUSIONS Delay in recovery of bowel motility may be due to the local hypersensitivity reaction caused by GS and/or dislocation of this local hemostat. Women who receive gelatin sponge treatment during CS should be monitored closely for the recovery of postoperative intestinal motility.

Increased oxidative stress is associated with insulin resistance and infertility in polycystic ovary syndrome.

OBJECTIVES: The present study aims to investigate the role of oxidant-antioxidant status in young women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Seventy-one women with PCOS and 53 healthy controls are compared in aspect of demographic characteristics, biochemical data, hormones, and oxidant-antioxidant status. RESULTS: The PCOS group had significantly lower zinc, higher malondialdehyde and gluthathione peroxidase and lower serum catalase levels than the control group (p = 0.016, p < 0.001, p = 0.043 and p = 0.025 respectively). The PCOS patients with IR had significantly higher malondialdehyde, lower catalase and serum zinc levels than the PCOS patients without IR (p = 0.015, p = 0.010, p = 0.001 respectively). The infertile PCOS patients had significantly higher malondialdehyde, lower catalase and serum zinc levels than the fertile PCOS patients (p = 0.022, p = 0.045,p = 0.001 respectively). There was a statistically significant and positive correlation between HOMA-IR and malondialdehyde values (r = 0.523, p = 0.001), between HOMA-IR and glutathione peroxidase values (r = 0.468, p = 0.001) and between HOMA-IR and zinc values (r = 0.601, p = 0.001). There was a statistically significant and negative correlation between HOMA-IR and catalase values (r = -0.493, p = 0.001). CONCLUSIONS: The patients with PCOS are under oxidative stress and this oxidative stress seems to be the highest in patients with IR and with infertility. Despite the prominent increase in the oxidative stress, there was a variation in the antioxidant response.

Is elective single-embryo transfer a viable treatment policy in in vitro maturation cycles?

OBJECTIVE: To compare the clinical outcome of single-embryo transfer (SET) with double-embryo transfer (DET) in in vitro maturation (IVM) cycles performed in patients with polycystic ovary syndrome (PCOS), and to determine which factors predict those outcomes. DESIGN: A retrospective analysis. SETTING: Private assisted reproduction center. PATIENT(S): One hundred and fifty-nine women with PCOS. INTERVENTION(S): In vitro maturation with elective SET or DET conducted between September 2007 and May 2014. MAIN OUTCOME MEASURE(S): Live-birth rates. RESULT(S): Single-embryo transfer was performed in 83 patients (52.2%), and DET was performed in 76 patients (47.7%). When compared with the patients who had DET, the patients who had SET were statistically significantly younger (32.4 ± 3.5 vs. 24.1 ± 4.2 years) and had a shorter infertility duration (9.2 ± 4.5 vs. 4.4 ± 2.1 years), fewer previous ART cycles (<2 prior attempts, 39.5% vs. 6%; ≥2 prior attempts, 60.5% vs. 0), fewer collected oocytes (15.1 ± 4.6 vs. 12.6 ± 3.8), fewer metaphase II oocytes (9.0 ± 4.1 vs. 5.7 ± 2.9), fewer fertilized oocytes (8.2 ± 3.7 vs. 3.6 ± 2.3), and a higher implantation rate (27% vs. 47%). The SET and DET groups had similar embryo quality and similar clinical pregnancy (44.6% vs. 44.7%) and live-birth rates (34.9% vs. 34.2%). Twin pregnancy rates were statistically significantly higher in the DET compared with the SET groups (9.2% vs. 2.4%). CONCLUSION(S): In vitro maturation is a successful assisted reproduction technique that can be an alternative to conventional in vitro fertilization in women presenting with PCOS-related infertility. Our observations suggest that SET is a feasible option to prevent multiple pregnancies while maintaining the live-birth rate.

Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding.

AIM: The present study aims to determine how transvaginal ultrasonography and histopathological examination findings are correlated in a cohort of premenopausal and postmenopausal Turkish women with abnormal uterine bleeding. METHODS: This is a retrospective review of 350 Turkish women who underwent transvaginal ultrasonography and suction curettage as a result of abnormal uterine bleeding. RESULTS: Sonographic appearance of the endometrium was normal in 244 patients (69.7%), while homogeneous thickening was detected in 47 patients (13.4%) and cystic thickening in 21 patients (6.0%). A sonographic diagnosis of endometrial polyp was made in 38 patients (10.9%). Histopathological analysis of endometrial samplings revealed proliferative endometrium (36%), secretory endometrium (24.6%), decidualization (10.9%), endometrial polyp (8.3%), endometritis (6.8%), endometrial hyperplasia (4.6%), irregular shedding (3.7%), atrophic endometrium (3.1%), endometrial cancer (1.1%) and placental retention (0.9%). The sonographic and histopathological findings correlated significantly (χ(2) = 122 768, P = 0.001; r = 0.215, P = 0.001). Approximately 51% of the women with homogeneous endometrial thickening had proliferative endometrium. Only 44.7% of the women with ultrasonographically visualized endometrial polyps had histopathologically diagnosed endometrial polyps. Nearly 57% of the women with cystic endometrial thickening had proliferative endometrium. CONCLUSION: If there is no facility for hysteroscopy or hysteroscopy-guided endometrial biopsy for women with abnormal uterine bleeding, transvaginal ultrasonography findings can be efficiently used to make a preliminary diagnosis and, thus, notify the pathologists.

Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy.

OBJECTIVE: To compare vaginal length and sexual function after total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH), and vaginal hysterectomy (VH). METHODS: The present cross-sectional study at a single center in Turkey compared vaginal length and sexual function among women who received TLH, TAH, VH, or no surgery (groups 1, 2, 3, and 0, respectively) between January 2011 and April 2014. All women underwent hysterectomy for benign reasons at least 3months before the study and were sexually active. Vaginal length was measured between the hymenal ring and vaginal apex. Sexual function was assessed via the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, short form (PISQ-12). RESULTS: Vaginal length in groups 0, 1, 2, and 3 was 10.9±1.5, 8.9±1.4, 8.5±1.2, and 8.1±0.7cm, respectively; it was significantly longer in the control group (P<0.001), and significantly shorter in group 3 than in group 1 (P=0.03). The mean PISQ-12 score in groups 0, 1, 2, and 3 was 18.6±5.2, 12.9±3.0, 13.8±4.4, and 11.5±4.4, respectively, and was significantly higher in group 0 (P<0.001). CONCLUSION: Total hysterectomy shortened vaginal length and compromised sexual function regardless of the technique used.

Misoprostol versus misoprostol and foley catheter combination in 2nd trimester pregnancy terminations.

OBJECTIVE: The efficacy and safety were assessed of a misoprostol regimen used alone or in combination with foley catheter for second trimester pregnancy termination. METHODS: A retrospective examination was made of the records of patients who underwent pregnancy termination at 14-24 weeks of gestation in our university hospital between January 2011 and June 2014. Records were available for patients 378 who underwent terminations. Group 1 comprised patients with no history of cesarean section. An initial dose of 200 µg misoprostol was administered intravaginally and then until the termination was completed an additional 200 µgr dose was administered sublingually every 4 hours (Group 1: 234 patients). Group 2 comprised patients with a history of cesarean section. An initial dose of 200 µg misoprostol was administered intravaginally and 2 hours later an intracervical foley catheter was inserted (Group 2: 144 patients). RESULTS: The total misoprostol dosage used was 1160 µg and 560 µg (p< 0.001), intervals from the administration of the first misoprostol tablet until termination were 854.8 and 704.2 minutes (p= 0.03) in Groups 1 and 2, respectively. CONCLUSIONS: The misoprostol + foley catheter combination reduces the total dosage of misoprostol required for termination and shortens the termination interval, thereby increasing patient's comfort. Based on these results, the usage of the misoprostol + foley catheter combination can be recommended especially for patients with a history of caesarian section.

A comparison of two techniques of uterine closure in caesarean section.

OBJECTIVE: To compare the results of two different techniques of uterine closure in caesarean section operations in which assistant surgeons participated. METHODS: A total of 765 patients were separated into two groups.In Group1(n = 380), the assistant surgeon, while pulling the suture in a caudal direction with the left hand, held the uterine wall from the joined site with the right hand to prevent upward tension of tissue. In Group 2 (n = 385), the suture was placed by the assistant surgeon by pulling it in the cephalic direction with the right hand. These two techniques were evaluated in respect of the postoperative decrease in haemoglobin level ,the need for additional sutures and operative outcomes. RESULTS: The need for additional sutures was determined as statistically high in Group 2 at mean 0.5 ± 0.6 compared to mean 0.2 ± 0.5 in Group1 (p < 0.001). The mean operating time was determined as statistically significantly longer in Group 2 (Group1, 38.0 ± 5.6 mins and Group2, 41.3 ± 4.3 mins) (p < 0.001). The postoperative decrease in hb was statistically significantly greater in Group 2 (Group1, 1.1 ± 0.4, Group2, 1.2 ± 0.4) (p = 0.002). CONCLUSION: The cephalic direction placement of the suture with the right hand of the assistant surgeon in uterine closure leads to bleeding due to tissue cuts in the lower wound lip and thereby creating a need for additional sutures. Therefore, the suture should be placed in a caudal direction with the left hand.

First trimester examination of fetal nasal bone in the Turkish population.

AIM: The present study aims to assign the reference values for nasal bone length (NBL) screened at 11-14 weeks of pregnancy in the Turkish population, determining whether the NBLs specified for Caucasians can be validated for Turkish people. MATERIALS & METHODS: The values of NBL were investigated in a total of 415 singleton fetuses that had Turkish parents and normal neonatal outcome. Sonographic measurements of NBL were done on a transabdominal midsagittal plane at 11-14 weeks' gestation. Regression analysis was used to assess the relationship between NBL and crown-rump length (CRL). Reference values, including the 5(th), 50(th) and 95(th)percentiles, were calculated for each gestational age. RESULTS: The mean NBL was estimated to be 2.5 mm for 11-11 + 6/7 weeks, 2.9 mm for 12-12 + 6/7 and 3.4 mm for 13-13 + 6/7 weeks' gestation. The measurements of NBL showed a significant increase with CRL so that a linear and direct correlation was found between NBL and CRL (NBL = 0.267 + 0.043 x CRL, P < 0.001). Moreover, a significant and linear relationship was detected between NBL and gestational age (NBL = -3.858 + 0.537 x gestational age, P < 0.001). CONCLUSION: The measurement of NBL is found to be achievable in the majority of first trimester pregnancies. The reference range of NBL in normal Turkish fetuses is established so that basic data can be recorded for further studies related to NBL measurements in screening for various chromosomal abnormalities including Down syndrome within Turkish population.

Complete mole coexistent with a twin fetus.

INTRODUCTION: Complete hydatiforme mole with coexisting live fetus (CMCF) is a rare entity. Management for this rare twin pregnancy still remains undetermined. We report the delivery of a healthy baby coexisting with complete mole as twins. There was no other complication during or after the pregnancy. CASE REPORT: A 30-year-old multiparous woman was first time assessed in the antenatal outpatient department of our hospital at 17 weeks gestation for normal pregnancy control. Ultrasound examination showed a 17 week and 5 days viable fetus with normal anatomy and placenta. There was a second multicystic placenta located at the posterior wall of the uterus next to the normal placenta. Hydatiforme mole was suspected. The couple was informed about the possible complications but they were not willing to consider pregnancy termination or to have any invasive procedure for diagnosis. A cesarean section was performed at 33 weeks gestation due to premature rupture of membranes and initiation of labor with the fetus presenting as breech. After the delivery of a live healthy female 1,950 g baby, as well as the normal placenta, a second vesicular placenta was delivered. Histopathologic examination confirmed the diagnosis of complete mole. CONCLUSION: Today most of the twin pregnancies with complete mole are identified in the first or second trimester. In this case, the parents who choose continuation of pregnancy, are counseled about the increased risk of complications like preeclampsia, fetal loss, persistent gestational trophoblastic disease. Close surveillance of the woman with CMCF is mandatory during and after the pregnancy.

The effects of betamethasone treatment on clinical and laboratory features of pregnant women with HELLP syndrome.

AIM: The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. METHODS: A prospective, randomized and placebo-controlled clinical trial was undertaken in a total of 60 pregnant women with HELLP syndrome who were treated at the perinatology department of the study center between January 2005 and February 2008. Betamethasone treatment (intramuscular injection of 12 mg in every 24 h) was given to 30 subjects while remaining 30 subjects received placebo. The treatment and control groups were compared in the aspects of clinical outcome and laboratory data. RESULTS: The alterations in platelet counts, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase levels of women treated with betamethasone were statistically similar to those of the placebo group. Although there was a significant decrease in diastolic blood pressure values of control group (P = 0.04), alterations in systolic blood pressure values were statistically indifferent in both study groups. Hematological and metabolic complications occurred significantly less in women treated with betamethasone (P < 0.05). Interestingly, the percentage of women who received platelet transfusion was significantly higher in the control group (P < 0.005). No case of maternal mortality occurred. CONCLUSIONS: The betamethasone treatment has ended up with insignificant alterations in clinical outcomes and laboratory data of women with HELLP syndrome except beneficial effects on metabolic complications and need for platelet transfusion. Further investigation is required to assess the efficiency of betamethasone in management of HELLP syndrome.