The effect of Kinesio Taping on acute pain, breastfeeding behavior and comfort level in women with cesarean section: A randomized controlled trial.

Background: Kinesio taping is used to provide rehabilitation after surgical operations. Aim: The aim of this study is to determine the effect of kinesio taping (KT) on acute pain, breastfeeding behavior, and comfort level in women with cesarean section. Subjects and Methods: This was a randomized, single-blinded study. Women (n = 48) were randomly assigned to KT (n = 24) and control (n = 24) groups. KT was applied to both breasts and rectus abdominis muscles of those in the intervention group at the 8-hour postpartum. VAS (Visual Analogue Scale), LATCH (Breastfeeding Charting System and Documentation Tool), PBSES (Postpartum Breastfeeding Self-Efficacy Scale), and PCS (Postpartum Comfort Scale) were performed on the women in both the intervention and control groups on the 0th, 1st and 2nd postoperative days. Data were analyzed using descriptive statistics, the independent samples t-test, the Chi-square test, and the Friedman test. Results: Compared to the control group, the pain level was significantly reduced in the KT group (χ2 = 67,225; P = 0.001), breastfeeding self-efficacy increased (F = 221.940; P = 0.001) and the postpartum comfort level (χ2 = 36.432; P = 0.001) improved. Conclusion: In the study, it has been shown that KT has important effects on pain management, breastfeeding success, and increasing comfort level in women with cesarean section compared to the control group and the initial period, and can be used safely.

Comparison of immune modulatory properties of human multipotent mesenchymal stromal cells derived from bone marrow and placenta.

Multipotent mesenchymal stromal cells (MSC) can be isolated from many tissues, including bone marrow (BM) and placenta (PL). Human placenta can be obtained readily without invasive procedures. There may be differences, however, in differentiation capacity and immunomodulation by MSC isolated from BM or PL. The early pregnancy factor (heat shock protein 10; EPF/Hsp10) is a small protein that exhibits immunomodulatory properties. We compared BM- and PL-MSC, and assessed their efficacy for suppressing T-cell proliferation in vitro and the role of EPF/Hsp10 in this process. PL-MSC were collected from whole placenta after removal of the amniotic and chorionic membranes followed by serial enzymatic digestions. The PL-MSC were compared to BM-MSC, obtained from healthy donors. Differentiation capacity, cytokine secretion, expression and secretion of immunomodulatory molecules, immunophenotype and real time proliferation were assessed using cytokine arrays, ELISA assays, flow cytometry, immunohistochemical staining and western blotting. Whereas BM-MSC consisted of a homogeneous cell population with strong expression of mesenchymal markers, PL-MSC consisted of a mixed population of cells with variable CD73, CD90 and CD105 expression. PL-MSC exhibited a significantly greater proliferation rate than BM-MSC. The presence of both stem cells and more mature cells in the PL-MSC cultures resulted in decreased differentiation capacity and reduced efficacy of immune suppression in co-cultures with T-cells. Although robust intracellular expression of EPF/Hsp10 in both BM- and PL-MSC was observed, secretion of the protein in response to immune activating stimuli remained below detectable levels. Secretion of pro-inflammatory cytokines was significantly greater in BM-MSC than PL-MSC, whereas no difference was observed in the secretion of hematopoiesis supporting growth factors. Development of culture methods for isolation of pure populations of PL-MSC may improve the quality of the product and reproducibility of results.

Gestational outcomes of patients with multiple sclerosis: A tertiary centre experience

Background. Multiple sclerosis (MS) is a disease that predominantly affects the young female population. It is important for an obstetrician to know the effects of pregnancy on MS, and vice versa. Objective. To demonstrate the impact of MS on pregnancy outcomes. Methods. We retrospectively evaluated demographic features, clinical characteristics, and obstetric outcomes of 47 pregnancies in 24 patients with MS, between January 2007 and December 2016. Results. Patients were divided into three groups: (i) 35 pregnancies in patients with MS who were in remission at the beginning of pregnancy; (ii) 10 pregnancies in patients with MS whose disease was exacerbated at the beginning of pregnancy; and (iii) 2 pregnancies in patients with active MS whose symptoms were relieved after becoming pregnant. The overall early pregnancy loss rate was 36.2%, whereas it was 60% and 31.4% in the exacerbation and remission groups, respectively; and the overall preterm delivery rate was 30%, while it was 29.1% and 50% in the remission and exacerbation groups, respectively. Conclusion. Miscarriage and preterm delivery seem to be significant obstetric complications in pregnant women with MS

Neural injury markers to predict neonatal complications in intrauterine growth restriction.

We assessed the neural injury markers (NIMs) in maternal and umbilical blood in preterm deliveries with and without intrauterine growth restriction (IUGR), and relationship between NIMs and neonatal complications. Deliveries between 24 and 34 weeks' gestation with (study group) and without (control group) IUGR were included to the study. Three NIMs (s100B, neurone-specific enolase [NSE] and alpha-foetoprotein [AFP]) were investigated in umbilical arterial, umbilical venous and maternal venous serum. Thirty-two IUGR and twenty-nine non-IUGR pregnancies with preterm delivery were included. Maternal and umbilical arterial s100B levels were significantly higher in the study group, whereas there was no relationship among IUGR, AFP and NSE levels. In the study group, umbilical venous s100B and NSE levels were associated with perinatal mortality (p = 0.012, 0.005, respectively), necrotising enterocolitis (NEC) (p = 0.001, 0.04, respectively) and need for intubation (p = 0.001, 0.007, respectively). Negative predictive values for perinatal mortality and NEC were 100% and for need for intubation it was 92.8% when both s100B and NSE were below the cutoff line determined by the receiver-operating characteristic curves. Perinatal mortality, NEC and need for intubation can be predicted by assessment of umbilical venous s100B and NSE measurement during birth in IUGR newborns.

Preterm premature rupture of membranes in singleton vs twin pregnancies: The latency periods and the clinical outcomes revisited.

Our objective was to compare the latency periods after preterm premature rupture of membranes (PPROM) and determine its subsequent impact on maternal and fetal outcomes for singleton and twin gestations > 24 weeks' and ≤ 34 weeks' gestation. Delivery in the first 72 h after the rupture of membranes was observed to be more frequent in the twin group (RR 1.98, 95% CI 1.06-3.73, p = 0.03); whereas the overall median latency periods were comparable (p = 0.06). Singleton pregnancies had shorter latency periods after 28 gestational weeks by comparison to the latency periods before 28 weeks. Gestational age of rupture of membranes and delivery and latency periods were comparable between spontaneous twin pregnancies and twin pregnancies after assisted reproductive technologies (ART). As a conclusion, singleton and twin pregnancies had similar outcomes after PPROM. The first 72 h is especially important for the outcome of twin pregnancies at when the delivery risk is high.

Perinatal outcome in cases of isolated single umbilical artery and its effects on neonatal cord blood gas indices.

Abstract We aimed to evaluate perinatal outcomes and blood gas indices of isolated single umbilical artery (SUA). In this retrospective study, 134 fetuses with SUA were evaluated. A total of 77 (57.4%) fetuses with isolated SUA (iSUA) were compared with maternal age-matched 95 fetuses with double umbilical arteries (DUA), with respect to pregnancy outcome and umbilical cord blood gas indices. The incidence of SUA in our cohort was 1.04%. Patients with iSUA had lower neonatal birth weight compared with the control group (2,635 ± 972 g vs 2,991 ± 669 g; p = 0.009). Small for gestational age (SGA) frequency was higher in the group of iSUA when compared with fetuses with DUA (17.4% vs 5.4%; p = 0.03). Regarding the umbilical cord blood gas, the parameters were comparable between the two groups. SUA has a favourable obstetric outcome as long as the accompanying malformations are ruled out. Furthermore, neonatal cord blood gas parameters in fetuses with iSUA do not differ from fetuses with DUA.

Surgical outcome of transobturator tape procedure in obese and non-obese women.

The objective of this study was to assess the impact of body mass index (BMI) on transobturator tape (TOT) success rates, patient acceptability and complications 1 year following surgery. The medical records of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) patients who underwent the TOT operation were retrospectively reviewed. The patients were divided into non-obese (BMI < 25) and obese (BMI ≥ 30) groups. Baseline and 1 year post-surgical outcomes were assessed by including multichannel urodynamics, Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores and cure, failure and success rates. There were no significant differences between groups in terms of urodynamic parameters, objective cure rate and subjective success, quality of life scores, or postoperative complications. Both obese and non-obese patients had cure and/or improvement of their symptoms and had better quality-of-life in the postoperative period. As a conclusion, BMI does not affect the clinical effectiveness of TOT operation in the treatment of female SUI or MUI.

The Manchester operation for uterine prolapse.

OBJECTIVE: To evaluate the clinical characteristics, complications, and satisfaction scores of patients who underwent the Manchester operation. METHODS: This retrospective observational study evaluated data from 204 women who underwent the Manchester operation at the Department of Obstetrics and Gynecology of Hacettepe University School of Medicine, Ankara, Turkey, from January 1985 to April 2004. RESULTS: Mean age was 34.68+/-4.24 years and parity 2.47+/-0.96; 85.8% of the patients were premenopausal; 176 patients (86.28%) had grade 3 and 28 (13.72%) had grade 2 uterine prolapse; 95.1% of the patients had associated cystoceles and 51.3% had associated rectoceles; and 81.4% had urinary incontinence. Regarding early postoperative complications, 27 patients (13.23%) had febrile morbidity; retroperitoneal hematoma occurred in 1 patient (0.49%); urinary retention occurred in 45 patients (22.05%), and cervical stenosis occurred in 23 patients (11.27%). At 1 year, 1 patient had undergone abdominal hysterectomy because of unsuccessful cervical dilatation; and a mean of 3.6 years following the operation, 8 patients (3.9%) had undergone the tension-free vaginal tape procedure plus a vaginal hysterectomy for recurrent stress urinary incontinence and uterine prolapse. The mean satisfaction/acceptance score for the operation was 8.52+/-2.13 (range, 2-10). CONCLUSION: A high degree of acceptance/satisfaction and a low morbidity rate show the Manchester operation to be a good option for the treatment of uterine prolapse in women who wish to keep their uterus.

Primary ovarian fibrosarcoma: a case report and review of the literature.

Primary ovarian fibrosarcomas are very rare tumors with great heterogeneity among reported cases. There are only a few reports of the subject in the literature, and along with the nature of the disease, diagnosis and treatment still remain to be established. In this report, we reviewed the cases published in the English literature within the past 30 years and tried to highlight certain aspects of the disease. A 52-year-old parous woman was admitted to our hospital with the complaints of abdominopelvic pain. Initial diagnostic work-up revealed a solid mass on the right ovary. After explorative laparotomy, the pathologic examination reported a primary ovarian fibrosarcoma. The patient has been free of disease for 1 year without any adjuvant therapy. Although ovarian fibrosarcomas are unusual causes of solid masses in postmenopausal women, it should be kept in mind when evaluating adnexal masses in this age group.

The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries.

OBJECTIVE: To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries. PATIENTS AND METHODS: One hundred and fifty-four patients with nongenital cancers metastatic to the ovaries treated in Hacettepe University Hospital, Gynecologic Oncology Unit between 1982 and 2004 years were retrospectively evaluated. Data were obtained from patients' records and pathology reports. Demographic characteristics, prognostic factors, 5-year and median survivals were analyzed in all patients. RESULTS: During study period, nongenital cancers metastatic to the ovaries constituted 9% of all malignant ovarian neoplasms. Primary cancers were breast (35), stomach (35) and colorectal (33) cancers, lymphoma (17), undetermined origin (16), appendix (7), ileum (4), pancreas (3), gallbladder cancer (2) and mesothelioma (2). Of patients, 67% were premenopausal and 33% were postmenopausal. Although most common presenting symptoms were abdominal distension with dyspeptic complaints in 46%, abdominal mass in 22%, and pressure symptoms in 8.4%, 15 patients (10%) were asymptomatic and were diagnosed in routine control examinations. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), omentectomy, and bilateral pelvic and para-aortic lymphadenectomy (BP-PALND) with cytoreduction were performed in 102 patients (66%), TAH + BSO + omentectomy in 21 patients (14%), TAH + BSO in 23 patients (15%), minimal surgical effort including BSO or biopsy in 8 patients (5%). Eighty-four percent of patients received adjuvant treatment according to the primary origins. Mean follow-up was 47.3 +/- 5.9 months. Overall, 5-year survival was 36% and median survival was 42 months. Comparison of median survival times for the primary sites showed a significant overall differences (P = 0.0001) and were as follows: breast 54 months, stomach 18 months, colorectal 48 months, lymphoma 181 months, unknown primary 16 months, appendix 18 months, ileum 40 months, pancreas 3 months, gallbladder 8 months and mesothelioma 20 months. Median survival time of patients who underwent cytoreductive surgery was 48 months, compared with 26 months for patients with suboptimal cytoreductive surgery (P = 0.0039). The 5-year survival rate was 47% and 23%, respectively. Multivariate analysis identified age, menopausal status, primary site, diffuse peritoneal involvement and type of operation as prognostic factors. CONCLUSION: Presence of ovarian metastasis is associated with a poor prognosis in nongenital cancers. Surgery is essential for diagnosis of primary tumor and necessary for relief of symptoms. Cytoreductive surgery seems to have a beneficial effect on survival of selected patients, especially for patients with colorectal cancer metastatic to the ovary.

Nuchal cord type B associated with an excessively long umbilical cord as a cause of stillbirth: a case report.

Nuchal cord (NC) is defined as the umbilical cord being wrapped 360 degrees around the fetal neck. It is one of the most common complications of the umbilical cord and any pregnancy might be complicated with a nuchal cord. If a nuchal cord occurs in a pregnant woman with decreased fetal movements, it should be considered to be at high risk, particularly for fetuses with multiple nuchal cords. We report a case in breech presentation with an excessively long umbilical cord (190 cm) which was complicated with five nuchal loops around the fetal neck and resulted in intrauterine death at the 37th week of pregnancy.