Progesterone effects on preterm birth in high-risk pregnancies: a randomized placebo-controlled trial.

PURPOSE: The purpose of this study was to evaluate whether the prophylactic administration of vaginal progesterone would reduce the preterm birth rate in high-risk population including singleton and twin pregnancies. METHODS: This was a randomized, double blind, placebo-controlled study that included 150 high-risk pregnancies. Risk groups included prior spontaneous preterm birth, twin pregnancy, and uterine malformation. Micronized progesterone or placebo (100 mg) was administered daily by vaginal suppository between 24 and 34 weeks of gestation. We compared progesterone and placebo groups for incidence of preterm labor and preterm delivery. Data were compared by χ² analysis and Fisher exact test. RESULTS: There was a statistically significant difference in the rate of preterm labor between placebo and progesterone groups (45.7 vs. 25%, respectively; p < 0.05). More women delivered before 37 weeks in placebo group (57.2%) than in progesterone group (40%; p < 0.05). Administering progesterone also reduced the preterm birth before 34 weeks of gestation. The difference between placebo and progesterone group was statistically significant (24.3 vs. 8.8%; p < 0.05). However, there was no significant difference in neonatal death between placebo and progesterone groups. CONCLUSION: Prophylactic vaginal progesterone reduced the rate of preterm labor and preterm delivery in high-risk pregnancies.

Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study.

BACKGROUND: Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). AIMS: To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). METHODS: One-hundred and sixty-four patients were included in the study (n = 81 for TVT, n = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. RESULTS: The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). CONCLUSIONS: The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings.

Validation of the prolapse quality of life questionnaire (P-QOL) in a Turkish population.

OBJECTIVE: To validate the Turkish translated version of the prolapse quality of life questionnaire (P-QOL). STUDY DESIGN: After establishing the test-retest reliability and internal consistency in a pilot study, 310 patients were enrolled in the study and general and subscale scores of the questionnaires were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q). RESULTS: One hundred and forty-five (49.7%) women were symptomatic and 147 (50.3%) were asymptomatic. The level of missing data ranged from 0 to 2.2%. For the test-retest reliability, Spearman's rho was from 0.91 to 1.00 for all domains (p<0.001). The severity of P-QOL was strongly correlated with the vaginal examination findings among the symptomatic group (p<0.001). Items correlated with the objective vaginal examination findings. The total and domain scores for P-QOL of symptomatic and asymptomatic women were found to be statistically significant (p<0.001). CONCLUSION: The Turkish translated version of the P-QOL is reliable, consistent and valid instrument for assessing symptom severity, impact on quality of life in women with uterovaginal prolapse. It is easy to understand may be easily administered and self-completed by the women.

Validation of the short forms of the incontinence impact questionnaire (IIQ-7) and the urogenital distress inventory (UDI-6) in a Turkish population.

AIM: To validate the Turkish versions of the IIQ-7 and UDI-6 for use in Turkish-speaking populations. METHODS: After establishing the test-retest reliability and internal consistency in a pilot study, 302 patients were enrolled in the study and general and subscale scores of the questionnaires were calculated. All participants underwent an urodynamic assessment. RESULTS: Both instruments showed a high internal consistency (Cronbach's alpha for the IIQ-7 and UDI-6 was 0.87 and 0.74, respectively) and test-retest reliability (Spearman's rho was 0.99 for both of the scales (P < 0.001). 55.6% of the participants showed urodynamic abnormality and/or leakage. 39.7% had urodynamic stress incontinence (USI) and 15.9% had detrussor overactivity (DOA) +/- USI. The mean scores of each IIQ-7 and UDI-6 were significantly higher in the USI, and DOA +/- USI groups compared with normal women. Women with DOA +/- USI scored highest in the IIQ-7 and UDI-6. The irritative subscale scores of the 1st and 2nd items of the UDI-6 were significantly higher in the DOA +/- USI group. The stress subscale scores of 3rd and 4th items of UDI-6 were significantly higher in the USI group. Women with postvoid residual (PVR) urine values greater than 50 ml had significantly higher obstructive subscale scores compared to the ones who had less residual volumes. CONCLUSIONS: The Turkish translated versions of the IIQ-7 and UDI-6 are reliable, consistent and valid instruments for assessing symptom severity and the impact on QOL in Turkish speaking women with urinary incontinence.

A faster converging snake algorithm to locate object boundaries.

A different contour search algorithm is presented in this paper that provides a faster convergence to the object contours than both the greedy snake algorithm (GSA) and the fast greedy snake (FGSA) algorithm. This new algorithm performs the search in an alternate skipping way between the even and odd nodes (snaxels) of a snake with different step sizes such that the snake moves to a likely local minimum in a twisting way. The alternative step sizes are adjusted so that the snake is less likely to be trapped at a pseudo-local minimum. The iteration process is based on a coarse-to-fine approach to improve the convergence. The proposed algorithm is compared with the FGSA algorithm that employs two alternating search patterns without altering the search step size. The algorithm is also applied in conjunction with the subband decomposition to extract face profiles in a hierarchical way.