The impact of preoperative anxiety on pain and analgesia consumption in women undergoing vaginal hysterectomy with general anesthesia and spinal anesthesia.

OBJECTIVES: To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia. MATERIAL AND METHODS: A total of 200 participants, including 100 undergoing vaginal hysterectomy with general anesthesia (group 1) and 100 with spinal anesthesia (group 2), were enrolled. A visual analog scale (VAS) was used for the postoperative pain intensity. RESULTS: The 1st hour, 6th hour, 12th hour, and 18th hour VAS scores were higher in vaginal hysterectomy with general anesthesia than in vaginal hysterectomy with spinal anesthesia. CONCLUSIONS: Although participants undergoing VH with spinal anesthesia (preoperative state anxiety inventory score > 45) had lower pain intensity scores in the first 18 hours compared to those undergoing VH with general anesthesia, their postoperative analgesic requirements were similar.

Evaluation of concordance between loop electrosurgical excisional procedure and cervical colposcopic biopsy results

Objective: To evaluate the results of loop electrosurgical excisional procedures (LEEP) with colposcopic biopsy results of patients who presented to our hospital for vaginal smears. Material and Methods: The LEEP reports of patients who presented to our gynecology clinic between January 2015 and December 2020 were retrospectively evaluated. The data were obtained from electronic patient records and the department of medical pathology archives. Results: A total of 579 patients were evaluated with a mean age of 38.05±6.17 years. Colposcopy-guided biopsy was not taken from 102 patients. The results of the remaining 477 (82.4%) patients were: no dysplasia (n=12; 2.1%), Cervical intraepithelial neoplasia-I (CIN-I) (n=99; 17.1%), CIN-II (n=111; 19.2%), CIN-III (n=248; 42.8%), and cancer (n=7; 1.2%). Completed excision was performed in 87.0% of the patients using LEEP, the lesion was positive at the surgical margins in 10.9%, and the lesion could not be completely excised in 2.1%. The complication rate after LEEP was 3.1% including pelvic pain (n=5; 0.9%) and bleeding (n=13; 2%). The histopathologic results of LEEP were: benign (n=50; 8.6%), CIN-I (n=110; 19.0%), CIN-II (n=89; 15.4%), CIN-III (n=280; 48.4%), cancer (n=7; 1.2%), and metaplasia (n=37; 6.4%). The concordance between colposcopic biopsy and LEEP results was 85.9% for CIN-I, 71.2% for CIN-II, 98.4% for CIN-III, and 85.7% for cancer diagnoses. Conclusion: LEEP is a simple minimally invasive method used in the treatment of CIN, with low persistence, recurrence, and complication rates and increased human papillomavirus clearance in most patients. Our results support the consistency of cervical colposcopic biopsy and LEEP results.

The effect of embryo transfer technique on pregnancy rates in in vitro fertilization-intracytoplasmic sperm injection cycles: A prospective cohort study.

OBJECTIVE: To investigate whether embryo transfer affects pregnancy rates in in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) treatment. MATERIALS AND METHODS: A total of 2,257 patients who underwent IVF-ICSI treatment between 2012 and 2017 were included in this study. Subjects were categorized according to the embryo transfer technique that was required: group 1 (n=1,657) underwent easy transfer with a soft catheter; group 2 (n=548) received external guidance transfers; and group 3 (n=52) experienced difficult transfers with a stylet. Basal parameters, clinical and laboratory IVF-ICSI outcomes, and clinical pregnancy rates (CPR) were compared between the groups. RESULTS: There were no differences between the groups in terms of age, body mass index, smoking status, duration and etiology of infertility, baseline follicle-stimulating hormone, luteinizing hormone, estradiol (E2), thyroid-stimulating hormone, prolactin levels, antral follicle count, duration of stimulation, stimulation protocol, total gonadotropin dose required, peak E2 levels, progesterone levels, and endometrial thickness on human chorionic gonadotropin administration and transfer days (p>0.05). The numbers of oocytes retrieved, MII and 2PN, fertilization rate, day of embryo transfer, and CPRs were also comparable between the groups (p>0.05). CONCLUSION: Our data suggest that embryo transfer has no impact on pregnancy rates in patients who undergo IVF-ICSI treatment. Further studies with more participants are required to elucidate this situation.

Early-cleavage versus blastocyst stage embryo transfer: a prospective comparative study

Objective: To evaluate whether or not embryo transfer (ET) day has an effect on the rates of clinical pregnancy (CPR) and live birth (LBR) in in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) treatment. Material and Methods: A total of 757 patients who underwent IVF-ICSI treatment between 2012 and 2017 were included. The participants were stratified into three groups according to ET day: group 1 (day 2 transfer, n=43); group 2 (day 3 transfer, n=633); and group 3 [day 5 (blastocyst) transfer, n=81]. Basal parameters and IVF-ICSI outcomes were compared between the groups. Results: Group 1 and 2 patients were older, had a higher body mass index, worse response rate, lower antral follicle count, lower peak estradiol levels, and less endometrial thickness, and required higher total gonadotropin dose than group 3. In addition, the number of oocytes and metaphase II oocytes, fertilization rate, and 2 pronucleus number were statistically different between the groups. The CPR (19.5% vs 36.9% vs 39.0%, respectively) and LBR (14.6% vs 30.4% vs 35.1%, respectively) were significantly lower in group 1 than in groups 2 and 3 (p<0.05). Grade 1 embryos were significantly more prevalent in groups 1 and 2 with clinical pregnancy positive [odds ratio (OR): 4.444; 95% confidence interval (CI): 0.876-22.536; p=0.001 and OR: 1.756; 95% CI: 1.234-2.500; p<0.001) and live birth (OR: 5.021; 95% CI: 0.787-31.768; p=0.001 and OR: 1.676; 95% CI: 1.154-2.433; p=0.007). Conclusions: These data suggest that an earlier ET day has a negative effect on the CPR. Older primary infertile women should not postpone their desire to have a baby because they appear to be poorer responders.

Investigation of serum vitamin D and ischaemia-modified albumin levels in infertile Turkish men.

Our aim was to explore the existence of a possible relationship of sperm motility with serum 25-hydroxyvitamin D3 (25-OH VD) levels and with ischaemia-modified albumin (IMA) levels in infertile Turkish men. A total of 30 men with nonobstructive azoospermia (no spermatozoa in ejaculate), 30 men with oligospermia (total progressive motile sperm count (TPMSC) <15 × 106 /ml) and 33 fertile men with normospermia (with at least one child, as the control group) were enrolled in the study. The mean 25-OH VD levels for groups 1, 2 and 3 were 9.31 ± 6.46, 19.71 ± 12.80 and 30.52 ± 12.49 respectively (p < .05). There was a statistically significant difference in serum IMA levels among the groups (479.32 ± 307.56 vs. 296.37 ± 127.27 vs. 150.04 ± 81.05, respectively; p < .05). A positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels were determined. Infertile men had lower serum 25-OH VD and higher IMA levels than fertile men, with a positive correlation between serum 25-OH VD levels and TPMSC, and a negative correlation between TPMSC and serum IMA levels. Vitamin D supplementation may increase the sperm motility.

Effects of preoperative anxiety on postcesarean delivery pain and analgesic consumption: general versus spinal anesthesia.

Objective: The aim of this study was to determine the effects of preoperative anxiety on the postoperative pain and analgesic consumption in patients undergoing cesarean deliveries (CDs).Materials and methods: This observational cohort study included 160 women, with ages ranging from 18 to 40 years old and a 37-week minimum gestation, received general (Group 1, n = 80) or spinal (Group 2, n = 80) anesthesia during an elective CD. The State Anxiety Inventory (SAI), Trait Anxiety Inventory (TAI), and Somatosensory Amplification Scale (SSAS) were used to measure the prenatal anxiety. The postoperative pain intensity was evaluated using the Visual Analogue Scale (VAS), and the pain and analgesic requirements were recorded at the 1st, 6th, 12th, 18th, and 24th postoperative hours.Results: No statistically significant differences were found between the groups in the demographics, clinical characteristics, or laboratory parameters. In addition, there were no differences with regard to the mean SAI, TAI, and SSAS scores and the diclofenac and pethidine consumptions (p > .05). The 1st hour [4.15 ± 1.84 versus 3.28 ± 2.41, odds ratio (OR) = 0.832, 95% confidence interval (CI) = 0.725-0.956, p = .009], 6th hour (3.85 ± 2.02 versus 3.13 ± 1.51, OR = 0.793, 95% CI = 0.668-0.942, p = .008), and 12th hour (3.64 ± 2.11 versus 2.94 ± 2.03, OR = 0.851, 95% CI = 0.737-0.983, p = .028) VAS scores were lower in Group 2 than in Group 1. No correlations were noted between the SAI, TAI, and SSAS scores and the VAS.Conclusions: While the patients with preoperative SAI scores >45 and who underwent cesarean deliveries (CDs) with general anesthesia had higher pain intensity scores in the first 12 hours than those underwent CDs with the spinal anesthesia, no difference was observed between the groups in terms of the postoperative analgesic requirements. Evaluating the patient's anxiety state and psychiatric evaluation may be useful for decreasing the postoperative pain intensity. Further studies are needed to corroborate our findings.

Assessment of circulating betatrophin levels in intrahepatic cholestasis of pregnancy.

Objective: To investigate maternal serum levels of betatrophin and their relationship with total bile acid (TBA) levels in patients with intrahepatic cholestasis of pregnancy (ICP).Materials and methods: Fifty-nine pregnant women with ICP (31 patients with severe and 28 patients with mild disease classifications) and 23 healthy women with uncomplicated pregnancies as the control group included the study. The maternal betatrophin, fasting blood glucose, fasting insulin (FI), and homeostatic model assessment of insulin resistance (HOMA-IR) levels of the groups were compared.Results: Serum betatrophin levels were significantly higher in the ICP groups than in the control group (p = .04 and p < .001, respectively). The FI levels and HOMA-IR values were significantly higher in the severe ICP group than in the control group (p = .006 and p = .001, respectively). While a significant positive correlation was found between betatrophin levels and fasting and postprandial TBA levels, there was no significant correlation among betatrophin and HOMA-IR or FI levels.Conclusions: Betatrophin levels were shown to correlate with TBA levels, it provides a model for future studies to understand the physiopathology of ICP, a complex metabolic disease. Changes in betatrophin levels may shed light on the pathogenesis of ICP.

Are there any differences between antagonist administration on days <6 and ≥6 of Controlled Ovarian Hyperstimulation on assisted reproductive technique outcomes?

BACKGROUND: The aim of this study was to investigate the cost-effectiveness of antagonist administration on stimulation on days <6 and ≥6 of COH on assisted reproductive technique (ART) outcomes. METHODS: In this retrospective cohort study, 412 patients who were admitted to the ART Department were evaluated. In group 1 (203 patients), antagonist administration was provided on days <6 of COH. For group 2 (209 patients), antagonist administration was provided on days ≥6 of COH. We preferred a flexible antagonist protocol in clinical practice and added an antagonist treatment regimen when dominant follicles were enlarged to 13 mm or the serum blood E2 was >300 pg/mL. RESULTS: There were no differences between antagonist administration on days <6 and days ≥6 of COH in terms of age, BMI, duration and etiology of infertility, AFC, serum FSH, LH, peak E2 levels, the number of MII oocytes, 2PN, FR, the number of transferred embryos, and CPR per woman. However, there were statistically significant differences between the duration of stimulation, the total gonadotropin dose required, and progesterone levels on day hCG [8.26 ± 1.83 vs 9.56 ± 1.51 (p = 0.001); 2173.71 ± 860.00 vs 2749.17 ± 1079.51 (p = 0.001); 0.75 ± 0.44 vs 0.92 ± 0.59 (p = 0.002), respectively]. CONCLUSION: Our results have demonstrated that there was no effect of antagonist administration on days <6 and ≥6 of COH on ART outcomes. However, taking cost-effectiveness into consideration, we suggest an antagonist administration on days <6 of COH since the necessary gonadotropin dose is lower.

The level of using family planning methods and factors that influence the preference of methods in the Konya-Meram area.

OBJECTIVE: To determine the level of contraceptive method use and factors that influence the preference of method among women of reproductive age that live in Meram, the central district of Konya. MATERIAL AND METHODS: Parameters such as age, duration of marriage, number of pregnancies and births, socioeconomic status, education level, and preferred contraceptive method of women who presented to the family planning outpatient clinic of our hospital over a five-year period between January 1st, 2010, and December 31st, 2015, were recorded and evaluated. RESULTS: The mean age of the women was identified as 31.57±8.14 years, the mean duration of marriage was 10.3±8.14 years, the mean number of births was 1.92±1.01, and the mean number of children was 1.83±0.90. Among the women in the study group, 65% were high school graduates, 88.92% had social security, and 82.84% were in the middle-income group according to their financial status. Only 31 patients were not married officially. It was observed that the most preferred method was intrauterine device (IUD), and the least preferred method was subcutaneous implant (SI). The use of IUD, oral contraceptives, and SI increased as the socioeconomic status and educational level improved (p<0.05). CONCLUSION: To ensure that women of reproductive age use effective family planning methods, the education levels and socioeconomic status of women must be improved.

Placental levels of total oxidative and anti-oxidative status, ADAMTS-12 and decorin in early- and late-onset severe preeclampsia.

OBJECTIVE: Preeclampsia (PE), can be classified according to the timing of disease onset: early-onset PE occurs before the 34th gestational week and late-onset PE occurs in the 34th gestational week or later. The aim of this study was to determine whether total antioxidant status (TAS), and total oxidant status (TOS), ADAMTS-12 and decorin levels differ among early-onset severe PE (EOS-PE), late-onset severe PE (LOS-PE) and uncomplicated pregnancies. METHODS: In this case-control study, placental samples obtained from 25 pregnant patients with EOS-PE, 26 pregnant patients with LOS-PE and 28 healthy patients with uncomplicated pregnancies (control group). RESULTS: Placenta levels of decorin and TOS were significantly higher and TAS was significantly lower in the EOS-PE and LOS-PE groups than in the control group. These alterations were more prominent in patients with EOS-PE than in patients with LOS-PE. There were no significant differences in the ADAMTS-12 levels of the groups. CONCLUSION: The distinctly higher rate of negative perinatal outcomes in both EOS-PE and LOS-PE patients is well evidenced. However, the main questions that need to be answered are whether the only difference between these two diseases is the time of their onset and whether the only difference between them with respect to fetal morbidity and mortality is prematurity.

Successful Conservative Management of a Dislocated IUD.

Background. Intrauterine contraceptive devices (IUDs) are widely utilized all over the world owing to their low cost and high efficacy. Uterine perforation is a rare complication that may occur at IUD insertion resulting in extrauterine location of the IUD. Traditionally, surgical removal of dislocated IUDs has been recommended. Case. A 68-year-old patient who had an IUD (Lippes loop) inserted 32 years ago and whose routine examination incidentally revealed a dislocated IUD in the abdominal cavity. The patient remained asymptomatic during three years of follow-up and the IUD was left in place. Conclusion. Asymptomatic patients, whose vaginal examinations and ultrasonography or X-ray results reveal a dislocated IUD, may benefit from conservative management.

Comparison of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women.

OBJECTIVE: To compare the effectiveness of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women. DESIGN: Placebo-controlled, double blind, randomized trial. SETTING: Teaching and research hospital. PATIENT(S): Ninety women of reproductive age eligible for diagnostic hysteroscopy. INTERVENTION(S): Randomly assignment to receive 400 µg of misoprostol (n = 30) or 10 mg of dinoprostone (n = 30) vaginally before diagnostic hysteroscopy, with a control group (n = 30) not receiving any cervical priming agent. PRIMARY OUTCOME: the number of women requiring cervical dilatation; secondary outcomes: cervical width before surgery, duration of dilatation time, ease of dilatation, complications during surgical procedure, and side effects of the drugs. RESULT(S): In the placebo group, 23 patients required cervical dilatation compared with 17 in the misoprostol group and 9 in the dinoprostone group. The mean (± standard deviation) cervical widths for the placebo, misoprostol, and dinoprostone groups were 4.23 ± 0.43 mm, 5.43 ± 0.5 mm, and 5.83 ± 0.64 mm, respectively. These widths were statistically significantly different. The duration of dilatation was also statistically significantly longer in the control group. CONCLUSION(S): Vaginally administered dinoprostone before diagnostic hysteroscopy is more effective than misoprostol for inducing cervical priming. Further studies are required to elucidate the most efficient option with the least side effects for cervical ripening. CLINICAL TRIAL REGISTRATION NUMBER: NCT01620814.