Cesarean section: requested mode of delivery?.

AIM: To constitute accurate policies for reducing the cesarean section (C/S) the authors evaluated the attitudes and knowledge of health workers and public population towards the mode of delivery, C/S on demand, and delivery complications in a large population. MATERIALS AND METHODS: 1,892 female volunteers in reproductive age were enrolled in the study and 589 of them were health workers. Patients were evaluated with questionnaire about their delivery mode and their answers were analyzed. RESULTS: The overall cesarean rate of the study population was 45.4%. This rate were 51.4% and 28.2%, respectively, for the health workers and public group (p < 0.001). Medical indication ratio ivere 57.7% and 40.1% for the healthcare group and the public population respectively and 20.2% of health workers and 13.9% of the public group had C/S by their preference without any medical indications (p < 0.001). CONCLUSION: C/S rate is high in Turkey and an action plan is needed to decrease the rate. When a patient's preference towards the mode of the delivery is C/S on demand, obstetricians, in their capacity as patient advocate, should help guide their patient through the sophisticated detailed medical information toward a decision that respects both the patient's attitude and the physician's obligation to optimize the health of both the mother and the newborn.

In contrast to leptin, serum concentrations of ghrelin are not related to premenstrual syndrome.

OBJECTIVE: Premenstrual syndrome (PMS) is a disorder related to mood and appetite changes during the premenstrual phase. Unfortunately, the understanding of the pathophysiology of PMS is quite poor. Though, ghrelin and leptin play important roles in the control of food intake. The aim of this study was to evaluate leptin and ghrelin serum concentrations in PMS patients. PATIENTS AND METHODS: Forty-five PMS patients diagnosed according to ICD-10 diagnostic criteria and 45 healthy women as a control group, were included in the study. These groups were matched for age, body mass index and duration of menstrual cycle. Symptoms of the patients were evaluated using "Menstrual Distress Questionnaires". Serum leptin and ghrelin serum concentrations were measured using ELISA in the postmenstrual phase (5-9 days) and 2-3 days before menstruation. Mann-Whitney U test, independent sample t-test and Wilcoxon test were used for statistical analyses. RESULTS: In the PMS group, there was no difference in the serum concentrations of ghrelin; however, leptin serum concentrations were 31.05 (± 14.16) and 16.42 (± 15.81) ng/ml during the premenstrual and postmenstrual periods, respectively (p < 0.05). Ghrelin serum concentrations in the premenstrual period were 6.9 (± 9.3) ng/ml in the PMS group and 8.8 (± 9.3) ng/ml in the control group, but this difference was not statistically significant (p = 0.79). CONCLUSIONS: Ghrelin serum concentrations were not associated with PMS, while leptin serum concentrations were found to be higher in the premenstrual period in PMS patients. Though, these two hormones work antagonistically to control the food intake and body weight, we suggest that this function is not relevant to PMS.

Perinatal outcomes of borderline diabetic pregnant women.

We examined the perinatal outcomes of borderline diabetic pregnant women who had impaired 50 g oral glucose challenge test (OGCT) results, but normal 100 g oral glucose tolerance test (OGTT) results. Our study group included 70 pregnant women who had increased 50 g OGCT results, but normal 100 g OGTT results, and a control group of 122 pregnant women with normal 50 g OGCT results. Polyhydramnios, macrosomia and neonatal birth weight were significantly higher in the study group. After adjusting the results for possibly affecting variables, the risk of polyhydramnios remained significant, while the risk of macrosomia and neonatal birth weight was not significant between the groups. The results from the study group were similar to the control group, when adjusted for other risk factors. Increased 50 g OGCT results in pregnant women can be accepted as a benign state if the 100 g OGTT results are normal.

Evaluation of the effects of maternal anxiety on the duration of vaginal labour delivery.

OBJECTIVE: In the present study, the authors aim to investigate the effect of anxiety during late pregnancy periods and during labour on the duration of delivery in patients giving birth vaginally. MATERIALS AND METHODS: In the study we included 50 nulliparous and 35 multiparous patients who were at or above the 28th gestational age and followed-up and admitted for birth at the present hospital. During the admission at the outpatient clinic at third trimester and at the beginning of labour, anxiety levels of patients were detected by performing the Spielberger State-Trait Anxiety Inventory. The duration of the labour stages of pregnant women were recorded and these durations and maternal state-trait anxiety levels were compared. RESULTS: The trait anxiety of patients both during the third trimester and labour was similar, while during labour state anxiety was seen to be increased. Statistically, the levels of the trait anxiety of multiparous patients were significantly higher. There was a statistically significant correlation between state anxiety for both periods in nulliparous patients and latent and active phases, the first and the second stages, and total duration of the labour. In addition, there was a significant relationship between trait anxiety levels for both period and total duration of the labour. For multiparous patients, only positive significant correlation was detected with the level of state anxiety during labour. CONCLUSION: It has been seen that the anxiety occurring at the last trimester of pregnancy and labour, and especially acute state anxiety have negative effects on the duration of the phases of labour. It has been considered that the physical care provided for patients at the last trimester and during labour and also evaluation in terms of anxiety and provision of emotional support may cause positive outcomes for the duration of labour.

Attitudes towards mode of delivery and cesarean on demand in Turkey.

OBJECTIVE: To assess the attitudes of healthcare providers and the public in Turkey towards mode of delivery and cesarean delivery on demand. METHODS: A written questionnaire was given to female healthcare providers and women from the general public, and their answers were analyzed. RESULTS: A total of 329 female healthcare providers and 347 women from the public group completed the survey. In response, 48.1% of healthcare providers and 69.6% of the public group chose vaginal delivery as the preferred mode of delivery (P<0.001). Some 45.3% of healthcare providers and 20.6% of the public group had undergone a cesarean delivery without any medical indications (P<0.001). In addition, 37.8% of healthcare providers and 36.2% of the public group believed that women should have the right to a cesarean delivery on demand. CONCLUSIONS: In the two groups studied the preference for cesarean delivery is higher in Turkish healthcare providers than in the public population. In both groups the attitude towards cesarean delivery on demand is high.