A comparison of maternal outcomes in complicated vaginal and cesarean deliveries.

OBJECTIVE: The purpose of this study was to compare general characteristics, laboratory data, and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section (C-section). This way, the authors intended to determine the results of complications in these patients. MATERIALS AND METHODS: Data of patients referred from the peripheral care centers to the present tertiary care center in the first 24 hours after a vaginal delivery or C-section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, laboratory parameters, indications for C-section, mortality rates, maternal morbidities, surgical and medical treatments administered in the clinic, as well as operations performed in other care centers were noted. RESULTS: A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in demographic characteristics, results of laboratory parameters, maternal morbidity, and mortality rates. Requirement of hysterectomy and relaparotomy was significantly higher in the postoperative group. CONCLUSIONS: In the early follow-up, it was found that complicated C-sections and vaginal deliveries had similar results. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for C-section.

Serum and follicular fluid irisin levels in poor and high responder women undergoing IVF/ICSI.

OBJECTIVE: We examined the follicular fluid (FF) and serum levels of irisin in high and poor responders undergoing IVF/ICSI to test whether irisin has a role in the metabolic regulation of energy homeostasis in growing follicle. PATIENTS AND METHODS: Twenty infertile women with PCOS and 20 poor responder participants undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol for IVF/ICSI treatment were allocated. Blood was obtained at the time of oocyte retrieval. The follicular fluid content of mature follicles was collected from both high and poor responder women. Irisin levels were measured by using EIA. RESULTS: There was no significant difference between serum and FF-irisin levels in women with PCOS. (11.18 ± 5.14 µg/mL vs. 11.06 ± 4.93 µg/mL, p < 0.96). In contrast, serum levels of irisin in poor responders were significantly higher than in the FF-irisin levels (13.13 ± 4.27 µg/mL vs. 10.09 ± 4.14 µg/mL, p < 0.01). FF-irisin levels of PCOS subjects were positively and significantly correlated with serum levels of irisin (r: 0.81, p < 0.00). Serum irisin was positively associated with serum levels of total testosterone but was negatively associated with HOMA-IR in the overall patient population. FF-irisin levels were also noted to be negatively correlated with HOMA-IR. Although there is no correlation between serum irisin and AMH levels, FF irisin levels were negatively correlated with serum AMH levels in PCOS subjects. Contrary to PCOS group there were no significant correlation between serum and FF-irisin levels in poor responder group (r: 0.21; p < 0.35). CONCLUSIONS: The present study is the first attempt to explore the role of irisin in oocyte development by measuring FF and serum levels of this molecules in patients with poor and high responders undergoing IVF/ICSI.

Clinical experience in pregnancies complicated by adnexal torsion.

OBJECTIVE: The purpose of this study was to present data on clinical and operational management and postoperative outcomes of pregnancies complicated by adnexal torsion (AT). MATERIALS AND METHODS: Twenty-four pregnant women who presented to the present clinic between January 2007 to December 2013 and were intraoperatively diagnosed with AT were included in this study. Demographic data such as age and data on obstetric history, gestational week, current trimester, previous gynecologic and non-gynecologic operations, type of surgery that was performed, average size, location and number of adnexal masses, surgical techniques that were employed, postoperative complications, and pathology results were investigated and noted. RESULTS: In this study, 132 patients were operated due to AT, and the rate of pregnant women with AT was 18.2% (24/132). The mean age of the patients was 29.25 ± 6.27 years, and the mean gestational week was 18.25 ± 7. Eight patients were in their first trimester (33.3%) whereas 13 were in their second trimester (54.2%), and three were in their third trimester (12.5%) when they presented to the hospital. The mean AT size was 95.3 ± 53.9 mm, as measured by ultrasonography. All the patients were operated by laparotomy. Regarding the types of abdominal incision, 13 patients (54.2%) had a Pfannenstiel incision, three patients (12.5%) had an infra-umbilical median incision, and eight patients (33.3%) had a pararectal incision. Duration of operation was significantly shorter in patients with pararectal incisions (p < 0.01) compared to those with Pfannenstiel and infra-umbilical median incisions. Regarding the types of treatment, ten patients (41.7%) underwent unilateral salpingo-oophorectomy (USO), eight patients (33.3%) underwent adnexal detorsion+cystectomy, and six patients (25%) underwent adnexal detorsion only. CONCLUSION: AT is a gynecologic emergency that requires early diagnosis and treatment, as it is capable of complicating the pregnancy. Determination of the current gestational week prior to the surgical intervention will assist and guide the surgeon in identifying the suitable type of surgery for a particular patient. Pararectal incision should be the incision of choice for a shorter duration of operation, which is crucial in pregnant women for reduced exposure to anesthesia.

Serum levels of androgens and prostate-specific antigen in endometriosis.

OBJECTIVE: The aim of the present study was to evaluate the levels of serum androgens and prostate-specific antigen (PSA) levels in patients with endometriosis. MATERIALS AND METHODS: Patients with Stage III/IV (advanced stage) endometriosis were compared to controls with respect to basal serum levels of total testosterone (T), free testosterone (fT), androstenedion (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S), and PSA in the early follicular phase of menstrual cycle for this prospective case control study. RESULTS: Level of T, fT, A, DHEA, and DHEA-S were higher in patients with endometriosis when compared to control subjects, but the difference was not statistically significant. The mean PSA level was 0.0074 +/- 0.0120 ng/ml in patients with endometriosis and 0.0059 +/- 0.0056 ng/ml in control group and there was no statistically significant difference between groups (p = 0.58). CONCLUSION: Serum basal androgens and PSA levels are higher in endometriosis group with respect to control but the differences are not statistically significant.

Autoimmunity and hepatitis A vaccine in children.

BACKGROUND: Universal vaccination remains the most effective way of preventing the spread of many infectious diseases. Although most adverse effects attributed to vaccines are mild, rare reactions such as autoimmunity do occur. OBJECTIVES: We aimed to evaluate the possible role played by hepatitis A vaccine (HAV) in inducing the synthesis of autoantibodies. The study included 40 healthy children vaccinated with 2 doses of HAV at a 6-month interval. The children were investigated for autoantibodies including anti-nuclear antibodies (ANAs), anti-smooth muscle antibodies, anti-nDNA, anti-microsomal antibodies, anti-cardiolipin (aCL) immunoglobulin (Ig) M/IgG, anti-ds DNA, ANA profile, and anti-neutrophil cytoplasmic antibody profile. RESULTS: One month after the first dose, ANAs at a titer of 1:100 and aCL IgG at 23.7 IgM phospholipid units were detected in 4 children and 1 child, respectively. Of the ANA-positive children, 1 also had ASMA positivity, and another had perinuclear and cytoplasmic ANCA positivity. After the second dose, 3 of the children had aCL IgM. In addition, 2 distinct children had positive anti-thyroid microsomal antibodies and ANA after the second dose. The presence of these autoantibodies following vaccination was statistically significant (P = .002). At month 12 of the study, only 2 children continued to be ANA-positive at the same titer as after the first vaccine dose. CONCLUSIONS: Although HAV can induce the production of autoantibodies, none of the children developed autoimmune disorders. Long-term follow up is necessary to check whether autoimmune disorders develop in children who still have ANA. Genetic, immunological, environmental, and hormonal factors are also important in the development of vaccine-induced autoimmunity.