Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure.

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure. Objective: To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure. Materials and Methods: Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained. Main outcome measures: Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results. Results: A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36). Conclusion: Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome. What is new?: The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.

Evaluation of cognitive deficits in patients infected with COVID-19.

OBJECTIVE: COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected with COVID-19. PATIENTS AND METHODS: The demographic and infection-related characteristics of patients who had been infected with COVID-19 were determined. Their cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) findings were recorded. The Mini-Mental State Evaluation (MMSE), clock drawing test, forward and backward digit span tests, visual memory test, and Frontal Assessment Battery were applied to the patients. Finger agnosia and ideomotor apraxia were also determined. RESULTS: The study included 176 patients [100 female (56.8%), 76 male (43.2%), mean age 66.09±13.96 years]. About half of the patients were hospitalized for symptoms of COVID-19 infection (n=82, 46.6%). One third of these patients required intensive care (n=26, 14.8%). While 50 (45.9%) of the 109 patients diagnosed with dementia before infection were hospitalized, 32 (47.8%) of the 67 patients without a diagnosis of dementia required hospitalization (p=0.46). The most common neurological finding during COVID-19 infection was insomnia (n=36, 20.5%). The MMSE and visual memory test scores of the patients who were hospitalized for severe respiratory distress were lower than those whose treatment at home was completed (respectively 17.92±7.69/20.59±7.01, p=0.02; 2.53 ±1.73/3.69±2.80, p=0.01). The patients with moderate to severe cognitive impairment had significantly higher CRP levels at admission than the others (37.52±43.09/20.93±31.74, p=0.01, respectively). CONCLUSIONS: Cognitive damage in COVID-19 infection may be caused by ACE receptor density in the pial, hippocampal, and amygdala areas. In addition, the reason why people with severe dementia have a milder infection might be explained by the atrophy in these areas.

Prophylactic misoprostol for the prevention of postpartum hemorrhage: a randomized controlled trial.

OBJECTIVE: Postpartum hemorrhage (PPH) is one of the major preventable causes of maternal death in developing countries. Although the non-parenteral use of misoprostol is a big advantage especially in home births, its benefits in prevention of PPH is still debating. We aimed to assess the effect and side-effects of prophylactic oral, rectal or vaginal misoprostol on preventing postpartum hemorrhage comparing with no-treatment option. PATIENTS AND METHODS: In a randomized clinical trial, during uncomplicated vaginal delivery, 248 women were assigned to receive one of the five treatment protocols in the third stage of labor which was managed routinely by early cord clamping and controlled cord traction. Maternal hemoglobin and hematocrit values, the duration of the third stage, and the incidence of blood transfusion was recorded. RESULTS: There was no statistically significant differences between the antepartum and postpartum values of hemoglobin or hematocrit between the groups. The mean duration (11.8 ± 4.5 min) of the third stage of labor in oral+vaginal group was significantly shorter. Shivering was observed totally in 11 women and the differences were not significant between groups. CONCLUSIONS: Despite misoprostol has benefit in treatment of postpartum hemorrhage, it has no remarkable effect in prophylaxis of atony-induced postpartum hemorrhage.

Vascular endothelial growth factor gene 1154 G/A, 2578 C/A, 460 C/T, 936 C/T polymorphisms and association with recurrent pregnancy losses.

Vascular endothelial growth factor (VEGF) regulates endothelial cell proliferation, migration and differentiation. VEGF plays a critical role in angiogenesis during placenta formation. We investigated whether VEGF gene polymorphisms are associated with recurrent pregnancy loss. Thirty-eight women with recurrent pregnancy loss and 30 control women with live-born children were recruited from 2010 to 2011 in the region of Bursa, Turkey. VEGF gene polymorphisms were assessed with PCR-RFLP analysis of DNA samples obtained from leukocytes. DNA fragments were investigated by using appropriate primers. SNP scanning was performed using MnII, BgIII, BshI2361, Hsp92II restriction enzymes for 1154 G/A, 2578 C/A, 460 C/T, and 936 C/T polymorphisms, respectively. The frequencies of 2578 C/A, 460 C/T, 936 C/T polymorphisms were not significantly different between the controls and women with recurrent pregnancy loss. However, the prevalence of the 1154 G/A polymorphism A/A genotype was significantly higher in the recurrent pregnancy loss group (23.7 vs 3.4%). One of the four common polymorphisms of the VEGF gene was found to be more frequent in women with recurrent pregnancy loss. It is possible that disruption of VEGF function and placental angiogenesis can contribute to pregnancy loss in women with recurrent pregnancy loss.

A comparison of low-dose and high-dose protocols of vaginal misoprostol for second trimester termination of pregnancy.

Sixty patients were randomized to low-dose and high-dose groups, receiving a maximum total dose 1400 g of misoprostol by the vaginal route to compare the efficacy of the protocols for second trimester termination of pregnancy. Outcome measures to be compared between the groups were success rates, time to termination, blood loss, complications and side-effects. Yet time to termination was significantly shorter in the high-dose than in the low-dose group (923 +/- 571 vs 1307 +/- 828 min; p < 0.05). The distance between the internal cervical os and the placenta was positively correlated with the duration of the termination process (r = 0.508, p < 0.001). Induction to the fetal expulsion period is shorter with the higher dose without any significant increase in morbidity. A shorter distance between the internal cervical os and the placenta may forecast a shorter termination process.

Successful spontaneous pregnancy in a patient with rectal carcinoma treated with pelvic radiotherapy and concurrent chemotherapy: the unique role of laparoscopic lateral ovary transposition.

Concurrent administration of external beam pelvic radiotherapy (RT) and chemotherapy (CT) is an effective treatment modality for rectal cancer. In adults in reproductive age, one of the most important side-effects resulting from this treatment is gonadal toxicity. Fortunately, it is possible to protect the ovaries by transporting them out of the RT area through lateral ovary transposition (LOT), as a minimally invasive method, which is performed before the application of RT. A 24-year-old female was diagnosed as having rectal adenocarcinoma in May 2003, and she was scheduled to receive adjuvant 5-fluorouracil-based CT followed by concurrent chemoradiotherapy (CRT). Before the onset of the adjuvant treatments, laparoscopic LOT was performed, and the patient was followed-up appropriately. Although amenorrhea developed during the CRT, the menstrual cycle of the patient resumed without performing any medical treatment eight weeks after the completion of the CRT. In July 2005, the patient became pregnant spontaneously with no local or systemic recurrences of rectal cancer. The present case shows that ovarian functions can be successfully protected in rectal cancer patients receiving RT by laparoscopic LOT, and by modifying the RT fields.

The perception of menopause and hormone therapy among women in Turkey.

OBJECTIVES: To investigate the influence of sociodemographic characteristics and menopause perception on self-reported menopause-related symptoms among Turkish women and analyze their knowledge and attitudes towards menopause and hormone therapy. METHODS: This was a population-based, cross-sectional, descriptive study. A total of 1007 women were recruited while attending primary-care health clinics. Women who agreed to participate in the study gave written informed consent. Each woman completed a questionnaire and had an interview to investigate her current health problems. RESULTS: Various different problems were reported by 86% of the women, mainly hot flushes. The women who perceived menopause as a pathological period had more complaints. The level of education influenced a more positive perception of the menopause. Only 12% of women were taking a hormonal treatment. CONCLUSION: Different perceptions of menopause among Turkish women are influenced by many factors, including cultural differences, level of education, regular exercise, social factors, and impact of the media. These need to be considered when studying the frequency and characteristics of menopausal problems.

The role of plasma renin activity in distinguishing patients with polycystic ovary syndrome (PCOS) from oligomenorrheic patients without PCOS.

All the components of the renin-angiotensin system have been identified in the human ovary. Renin plays a major role in folliculogenesis, and possibly in follicular atresia. Polycystic ovary syndrome (PCOS) is characterized by early follicular atresia. We studied whether assessment of plasma renin activity would be useful for diagnosing PCOS and distinguishing PCOS and non-PCOS in oligomenorrheic patients. Patients were divided into three groups: PCOS group (group 1, n = 40), non-PCOS oligomenorrheic group (group 2, n = 30) and ovulatory control group (group 3, n = 30). Plasma renin activity was determined in the early follicular phase of the menstrual cycle. Baseline serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, insulin, aldosterone and androgens (total testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate and 17alpha hydroxyprogesterone) were determined in all groups. The mean LH level was lower (4.94 +/- 4.65 mIU/ml) in control patients than in PCOS patients (12.9 +/- 1.75 mIU/ml) and non-PCOS oligomenorrheic patients (10.8 +/- 1.65 mIU/ml). There was no statistically significant difference between the groups regarding FSH levels. The mean plasma renin activity was 3.47 +/- 0.29 ng/ml in the PCOS group. The mean plasma renin activity was 1.59 +/- 0.21 ng/ml the non-PCOS oligomenorrheic group (statistically significiant differrence). There was no statistically significant difference between the non-PCOS oligomenorrheic (1.59 +/- 0.21 ng/ml) and control groups (1.2 +/- 0.16 ng/ml). Use of plasma renin activity alone as a diagnostic marker in PCOS is not useful, because the clinical findings of PCOS are heterogeneous and the pathogenesis is unclear. However, it can be used together with other variables to diagnose women with PCOS and to distinguish non-PCOS oligomenorrheic women from those with PCOS.

Should asymptomatic bacteriuria be screened in pregnancy?

The incidence of asymptomatic bacteriuria is reported as 2-14% during pregnancy. Fetal and maternal complications like acute pyelonephritis, hypertension, anemia, preterm labor, low-birth-weight infants and intrauterine growth retardation can be expected. The purpose of this study was to determine the incidence of asymptomatic bacteriuria during pregnancy and its relation to pregnancy complications. The study involved 270 pregnant women up to 32 gestational weeks during a 9-month period. At the initial visit, they were screened with urine culture in order to detect asymptomatic bacteriuria. A control group was formed in a retrospective manner from the first day of the study with 186 pregnant women who delivered in our clinic and who were not screened for asymptomatic bacteriuria. The incidence of asymptomatic bacteriuria was 9.31%. Escherichia coli accounted for 79%, which was the most frequent of the isolates. We observed recurrence and had to apply treatment again to 21.7% of the women. The sensitivity, specificity, positive predictive and negative predictive values of leucocyturia as a screening test for asymptomatic bacteriuria were 91.3%, 83.6%, 45.6% and 98.5%, respectively. We diagnosed preterm labor in six of 23 (26%) with asymptomatic bacteriuria and 16 in 163 (9.3%) women in the urine culture negative group. The ratio acute pyelonephritis in the group which was routinely screened and treated for asymtomatic bacteriuria was 0.5% while the prevalence was 2.1% in the nonscreened group. Considering the relatively high incidence of asymptomatic bacteriuria during pregnancy and the relevant complications, we propose to screen and treat asymptomatic bacteriuria routinely in all pregnant women.

Free and phospholipid-bound choline concentrations in serum during pregnancy, after delivery and in newborns.

The aims of this study were to determine whether serum free choline and phospholipid-bound choline concentrations change during the pregnancy or after childbirth and to determine if the serum choline concentrations of the mother and newborn are correlated. Serum free and bound choline concentrations were 10.7 +/- 0.5 microM and 2780 +/- 95 microM in control, non-pregnant women, and rose significantly (p < 0.001) to 14.5 +/- 0.6 microM and 3370 +/- 50 microM or to 16.5 +/- 0.7 microM and 3520 +/- 150 microM after 16-20 weeks or 36-40 weeks of pregnancy, respectively. Serum free and phospholipid-bound choline fell by 14-22% (p < 0.05-01) after either vaginal delivery or caesarian section, and remained low (by 15-42%; p < 0.05-0.001) for 12 h and then rose toward the baseline within 24 h. In amniotic fluid, free choline and phospholipid-bound choline concentrations were 22.8 +/- 1.0 and 19.6 +/- 0.8 microM or 24.0 +/- 1.5 and 516 +/- 43 microM at 16-20 weeks of gestational age or at term, respectively. In newborns, serum free choline concentrations were higher (p < 0.001) and phospholipid-bound choline concentrations were lower (p < 0.001) than in their mothers. These results show that serum free choline and phospholipid-bound choline concentrations are elevated during the pregnancy, which may be required for an adequate maternal supply of choline to the fetus. These observations are clinically important to determine the ideal dietary intake of choline during the pregnancy.

Misoprostol in labor induction.

The efficacy of a new dosing regimen of misoprostol, a recently introduced labor-inducing agent, was studied. Fifty-eight patients received 50 microg of misoprostol intravaginally and the dose was repeated every 3 hours until uterine contractions begin. Those who had an adequate contraction pattern, defined as three contractions in 10 minutes, were not given the repeat dose. Oxytocin augmentation, but not further misoprostol doses, was used in patients with an inadequate contraction pattern. The maximum total daily dose was 200 microg. The patients had the mean age of 28.9 +/- 5.4, the mean gestational age of 211.8 +/- 46.6 days, the mean gravidity of 2.5 +/- 1.2, the mean parity of 0.9 +/- 0.9 and the mean initial Bishop score of 1.6 +/- 1.8. The mean required dose of misoprostol was 120.5 +/- 54.7 microg and 10 of 58 patients required oxytocin augmentation. The mean induction of labor to delivery time was 701.5 +/- 404.0 minutes. When 3 cases who gave birth with caesarean section were excluded, the interval was 708.4 +/- 407.2 minutes. The mean 5th minute Apgar score of the newborns was 8.2 +/- 2.5. Two patients developed tachysystole after the second dose of misoprostol and were managed with vaginal irrigation and O2 supplementation successfully. Slight nausea and vomiting in 2 patients were the other adverse reactions. Our findings revealed that, 50 microg intravaginal misoprostol, combined with oxytocin augmentation when necessary, appears to be an effective and safe method of labor induction.

Plasma interleukin-1alpha, interleukin-1beta and interleukin-1 receptor antagonist levels in pre-eclampsia.

The values of plasma interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta) and interleukin-1 receptor antagonist (IL-1ra) levels were evaluated as the markers of pre-eclampsia in 35 serial plasma samples from ten pregnant women who subsequently developed pre-eclampsia and in 74 plasma samples from 20 uncomplicated pregnancies, retrospectively. No correlation was found between plasma IL-1alpha, IL-1beta and IL-1ra levels, liver and renal function tests, thrombocyte and white blood cell counts, proteinuria, systolic and diastolic blood pressures and gestational weeks. Almost equal levels of IL-1alpha and IL-1beta were measured in all corresponding groups, but these were too few in number to statistically analyze. IL-1ra values were higher in the pre-eclampsia group than in the uncomplicated pregnancy group, at 20-25 and 31-35 gestational weeks significantly and 26-30 gestational weeks insignificantly and showed an increase during labor in both groups. It was found to have 58% positive predictivity, 100% negative predictivity, 50% specificity and 100% sensitivity at gestational weeks 20-25. According to these results, IL-1ra seems to be considered for its high negative predictivity in the exclusion of the probability of pre-eclampsia development during antenatal visits, but its plasma level is not correlated with the severity of the disease.

Laparoscopic treatment of benign adnexial cysts.

The results of laparoscopic adnexial cyst excision operations performed within the last 2.5 years in our clinic are reported. Thirty-three adnexial masses thought to be benign after gynaecological examination and ultrasonographic findings were treated. Laparoscopy was done in 32 cases but laparotomy had to be performed in one case of stage IV endometriosis. The mean duration of the operations was 72.78 +/- 34.09 minutes and no major complication occurred. Pathologic examinations of the specimens were reported as benign in all cases. According to these results, laparoscopy should be the preferred method in the treatment of benign adnexial cysts.

Anticardiolipin antibodies in pregnancy induced hypertension.

It was suggested that anticardiolipin antibodies (ACA) were found positive in some obstetrical problems such as recurrent foetal losses, intrauterine growth retardation, etc. The aim of this study was to determine ACA levels in pregnancy induced hypertension (PIH) cases. ACA IgG and IgM levels were measured by the ELISA method in 65 PIH cases and 23 control pregnancies. We could not find any difference between the PIH and the control groups. There was not any statistically significant difference between the subtypes of PIH. According to these results, we say that ACA IgG and IgM levels have no diagnostic and prognostic value in PIH.

Hemodynamic profiles in severe preeclamptic and superimposed preeclamptic pregnancies.

In this study, we investigated the hemodynamic profiles of pregnancy-induced hypertension cases. Hemodynamic measurements were performed in five severe preeclamptic and three superimposed preeclamptic cases. We applied Swan-Ganz catheters and measured hemodynamic parameters. According to the results, we suggest that pulmonary edema occurs more easily in severe preeclampsia than in superimposed preeclampsia.

Gestational herpes: 3 cases.

Three histologically proven gestational herpes cases were presented. All were complaining of itching and vesiculobullous skin lesions. The diagnosis was confirmed by skin biopsies and they all gave a complete response to 1 mg/kg-day oral prednisolone therapy. No neonatal morbidity was observed.

Antenatal ambroxol usage in the prevention of infant respiratory distress syndrome. Beneficial and adverse effects.

A bromhexine metabolite ambroxol, is a relatively new promoter of fetal lung maturation. The data on its efficacy and side effects in humans are not yet as many as those of corticosteroids. We found that in 24 premature labor patients ambroxol reduced the incidence of respiratory distress syndrome when compared with the control group, consisting of 58 patients. There was no concomitant disorder in any patient that would have contributed to the fetal lung maturation. We also observed septic morbidity to be less frequent in the ambroxol group. Thyroid hormone levels were within normal range both in maternal and fetal circulation. There were no side effects attributable to the drug. Maternal liver and renal function test results did not differ significantly throughout the treatment.

PIP: At the clinics of Uludag University Medical Faculty's Department of Obstetrics and Gynecology in Bursa, Turkey, clinicians compared data on 24 premature infants whose mothers had received oral ambroxol (1300 mg/day until delivery) with data on 58 premature infants whose mothers did not receive ambroxol to determine whether or not ambroxol reduced infant respiratory distress syndrome (RDS) by promoting fetal lung maturation. RDS occurred in 8% of the infants in the ambroxol group compared to 10% in the control group. The only RDS case to survive had received ambroxol. Sepsis was more common in the control group than the ambroxol group (13% vs. 4%). None of the infants had any concomitant disorder that would have contributed to fetal lung maturation. Ambroxol did not significantly change maternal liver and renal function results. In infant and maternal cases, the blood thyroid hormone levels were within the normal range. None of the mothers in either group developed a puerperal infection. Ambroxol did not cause any significant maternal or infant side effects. These findings suggest that ambroxol may prevent RDS and sepsis. Larger study groups and studies of groups with hypertension, diabetes, and multiple gestations are needed to determine whether ambroxol is a valuable alternative to steroids for prevention of RDS.

The comparison of 50 grams glucose challenge test, HbA1c and fructosamine levels in diagnosis of gestational diabetes mellitus.

We evaluated the sensitivity, specificity, positive and negative predictive values of 50 grams glucose challenge test, serum fructosamine and HbA1c levels as screening tests for gestational diabetes mellitus. Forty-two pregnant patients between the 24th and 28th week of their pregnancies were included in the study. Blood fructosamine and HbA1c levels did not differ significantly from the 50 grams glucose challenge test and were concluded to be alternatives to this test. Any combination of these 3 tests gives better results than a single test, but no one of the combinations is superior to the others.