Glucose tolerance of premenopausal women after menopause due to surgical removal of ovaries.

OBJECTIVE: To evaluate the influence of the abrupt withdrawal of ovarian function on glucose tolerance by studying premenopausal women before and after oophorectomy. METHODS: Thirty premenopausal women who needed hysterectomy for benign reasons volunteered for the study in our hospital in Istanbul, Turkey. An oral glucose tolerance test (OGTT) was performed before surgery and 3, 6 and 12 months after surgery. Fasting glucose, fasting insulin levels and insulin/glucose indexes, HOMA indexes, insulin and glucose levels were measured during OGTT. RESULTS: The mean fasting and 2-h glucose levels of the women did not change significantly during the 12 months of follow-up. However, the glucose levels during the glucose tolerance tests changed significantly after surgery (p<0.05). Insulin responses to the glucose tolerance test also increased significantly (p<0.005). Insulin/glucose indexes were significantly higher after surgery (p<0.005). Type 2 diabetes mellitus was detected in five women and impaired glucose tolerance was detected in 12 of the 30 patients after surgery in the 12-month period. CONCLUSION: The impairment of carbohydrate metabolism due to an abrupt decrease in natural estrogen levels should be considered before removing the ovaries during hysterectomy in premenopausal patients.

Caesarean delivery or vaginal birth: preference of Turkish pregnant women and influencing factors.

The aim of this study was to assess the preference of pregnant women for mode of delivery in an uncomplicated pregnancy and reasons of their choice, also to determine if maternal characteristics were predictors of maternal preference. Pregnant women applying to the antenatal clinic for a routine control visit were recruited. After verbal consents, a questionnaire was administered to 1,588 pregnant women. Of the women questioned, 84.1% opted for vaginal delivery whereas only 15.9% opted for an elective caesarean delivery. The main reasons for vaginal delivery preference were; earlier healing and earlier hospital discharge, being a more physiological way of delivery and previous vaginal delivery history. The most common reasons for choosing caesarean delivery were; fear of vaginal delivery, tubal ligation demand and to avoid labour pain. Educational status, occupation and gestational age were not found to be influencing factors but age, parity and monthly income were found to be influencing factors for maternal preference.

Diagnostic power of the vaginal washing-fluid prolactin assay as an alternative method for the diagnosis of premature rupture of membranes.

OBJECTIVE: The purpose of this study was to determine the reliability of the vaginal washing-fluid prolactin assay for the diagnosis of premature rupture of membranes (PROM) and to determine a diagnostic cut-off value. STUDY DESIGN: Seventy pregnant women between 11 and 40 weeks of gestation who were admitted with vaginal fluid leakage were included in the study group, and were then further subdivided into two subgroups according to amniotic fluid pooling and nitrazine paper test results. Group 1 was the 'confirmed PROM group', positive for both pooling and nitrazine (38 patients). Group 2 was the 'suspected but unconfirmed PROM group' which had possible pooling and/or nitrazine (32 patients). Seventy pregnant women between 11 and 40 weeks of gestation without any complaint and complication were included in the control group (group 3). All patients underwent vaginal washing-fluid sampling and prolactin level determination. For the statistical analysis one-way analysis of variance, Tukey multiple comparison test, chi2 test and receiver operating characteristic (ROC) curve analysis were used. RESULTS: Geometric mean values of vaginal washing-fluid prolactin levels were 616.59 microIU/ml for group 1, 23.98 microIU/ml for group 2 and 10 microIU/ml for group 3 (p < 0.0001). The optimal diagnostic cut-off value was found to be 30 microIU/ml with 95% sensitivity, 78% specificity, 84% positive predictive value, 93% negative predictive value, 87% accuracy and 11.30 relative risk. CONCLUSIONS: We recommend vaginal washing-fluid prolactin level determination as an alternative diagnostic method for PROM.