How does the ERAS protocol work in patients who underwent cesarean section? (HERMES study).

OBJECTIVE: To assess the effect of the enhanced recovery after surgery (ERAS) protocol for cesarean deliveries (CD) on postoperative outcomes. METHODS: This multicenter prospective cohort study was conducted in six different centers between September 2020 and March 2021 and involved women who underwent either planned or unplanned CD. The primary outcome was time to the first passage of flatus following CD. Secondary outcomes included postoperative pain score, postoperative complications, and patient satisfaction. The protocol included early postoperative oral intake of ice cream and coffee, multimodal analgesia, antiemetic medications, and early ambulation. RESULTS: A total of 448 patients were included. The median time to the first passage of flatus was 10 h in the Hermes group and 18 hours in the control group (P < 0.001). Postoperative visual analog scale scores were significantly higher in the control group. Patient satisfaction scores and the frequency of postoperative complications did not differ between the groups (P = 0.08, P = 0.604, respectively). CONCLUSIONS: The ERAS protocol, including early serving of ice cream and coffee in the early postoperative period, enabled early discharge and a faster return of bowel function. Implementation of the ERAS protocol for patients who underwent planned and unplanned CD appeared to be safe and effective.

EROSS study: effect of ovarian reserve on sexual satisfaction.

TRIAL REGISTRATION NUMBER: NCT04776902 Clinical Trials.

Symptom-related Ki-67 expression in endometrial polyps.

OBJECTIVE: The aim of this study was to compare Ki-67 expression in endometrial polyps that present with different abnormal uterine bleeding patterns. STUDY DESIGN: A total of 120 women diagnosed with endometrial polyps were included in the study. In this prospective study, tissue samples taken by hysteroscopic polypectomy method between September 2019 and September 2020 at Bursa City Hospital were examined. The main study groups were determined as premenopausal and postmenopausal patients. The patients' complaints at first admission to the hospital, demographic, histopathological and immunohistochemical features were recorded. RESULTS: Ki-67 glandular and stromal expressions were higher in the premenopausal patient group (p = 0.016 and p = 0.005 respectively). Median Ki-67 gland and stroma measurements; was higher in patients with heavy menstrual bleeding (HMB) than in patients with intermenstrual bleeding (IMB), patients with postmenopausal bleeding (PMB), and patients who were asymptomatic [(p = 0.012, p = 0.011 and p = 0.009 respectively); (p < 0.001, p < 0.001 and p = 0.004 respectively)]. The median Ki-67 stroma measurement was found to be higher in the patient group whose complaint persisted after polypectomy (p = 0.034). In the estimation of response to treatment, the cut-off value for Ki-67 stromal expression was determined as ≤ 6%. CONCLUSION: High Ki-67 expression in endometrial polyps is associated with HMB and may predict the continuation of abnormal uterine bleeding after polypectomy.

Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019.

BACKGROUND: It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.

Endometrioma-related reduction in ovarian reserve (ERROR): a prospective longitudinal study.

OBJECTIVE: To evaluate whether endometrioma is associated with a progressive decline in ovarian reserve, and to compare the rate of decline with natural decline in ovarian reserve. DESIGN: Prospective, observational study. SETTING: Tertiary university hospital, endometriosis clinic. PATIENT(S): Forty women with endometrioma and 40 age-matched healthy controls. INTERVENTION(S): Women with endometriomas who did not need hormonal/surgical treatment at the time of recruitment and were expectantly managed. Controls were age-matched, healthy women. All participants underwent serum antimüllerian hormone (AMH) testing twice, 6 months apart. Sexually active patients with endometrioma also underwent antral follicle count. MAIN OUTCOME MEASURE(S): Change in serum AMH levels. RESULT(S): Median (25th-75th percentile) serum AMH level at recruitment was 2.83 (0.70-4.96) ng/mL in the endometrioma group and 4.42 (2.26-5.57) ng/mL in the control group. The median percent decline in serum AMH level was 26.4% (11.36%-55.41%) in the endometrioma group and 7.4% (-11.98%, 29.33%) in the control groups. Twenty-two women with endometrioma who had antral follicle count (AFC) had median AFC of 10 (8-12) at recruitment and 8 (6.3-10) at 6 months. CONCLUSION(S): Women with endometrioma experience a progressive decline in serum AMH levels, which is faster than that in healthy women. CLINICAL TRIAL REGISTRATION NUMBER: NCT02438735.

The effects of pregnancy on nasal physiology.

BACKGROUND: Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy. METHODS: The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls. RESULTS: The NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm(2), third trimester 0.31 cm(2). There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = -0.10, p = 0.318; r = -0.04, p = 0.654, respectively). CONCLUSION: Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters.