Metabolomic signatures of low- and high-adiposity neonates differ based on maternal BMI.

Maternal obesity [body mass index (BMI) > 30 kg/m2] is associated with greater neonatal adiposity, cord blood (CB) insulin levels, and a proinflammatory phenotype at birth, contributing to risk of future cardiometabolic disease in the offspring. Variation in neonatal adiposity within maternal BMI groups is underappreciated, and it remains unclear whether the metabolic impairments at birth are an outcome of maternal obesity or excess fetal fat accrual. We examined the hypothesis that CB metabolites associated with fetal fat accrual differ between offspring of normal-weight and obese women. Umbilical venous blood was collected at the time of scheduled cesarean delivery from 50 normal-weight women (LE; pregravid BMI = 22.3 ± 1.7 kg/m2) and 50 obese women (OB; BMI = 34.5 ± 3.0 kg/m2). Neonatal adiposity was estimated from flank skinfold thickness. The first (low adiposity, LA) and third (high adiposity, HA) tertiles of neonatal %body fat were used to create four groups: OBLA, OBHA, LELA, and LEHA. CB metabolites were measured via untargeted metabolomics. Broadly, the LA offspring of OB women (OBLA) metabolite signature differed from other groups. Lauric acid (C12:0) was 82-118% higher in OBLA vs. all other groups [false discovery rate (FDR) < 0.01]. Several other fatty acids, including palmitate, stearate, and linoleate, were higher in OBLA vs. OBHA groups. CB metabolites, such as lauric acid, a medium-chain fatty acid that may improve insulin sensitivity, were associated with neonatal adiposity differently between offspring of women with and without obesity. Changes in metabolically active lipids at birth may have long-term consequences for offspring metabolism.NEW & NOTEWORTHY Using untargeted metabolomics in 100 newborns, we found that cord blood metabolite signatures associated with neonatal adiposity differed between offspring of women with and without obesity.

Extraterrestrial Gynecology: Could Spaceflight Increase the Risk of Developing Cancer in Female Astronauts? An Updated Review.

Outer space is an extremely hostile environment for human life, with ionizing radiation from galactic cosmic rays and microgravity posing the most significant hazards to the health of astronauts. Spaceflight has also been shown to have an impact on established cancer hallmarks, possibly increasing carcinogenic risk. Terrestrially, women have a higher incidence of radiation-induced cancers, largely driven by lung, thyroid, breast, and ovarian cancers, and therefore, historically, they have been permitted to spend significantly less time in space than men. In the present review, we focus on the effects of microgravity and radiation on the female reproductive system, particularly gynecological cancer. The aim is to provide a summary of the research that has been carried out related to the risk of gynecological cancer, highlighting what further studies are needed to pave the way for safer exploration class missions, as well as postflight screening and management of women astronauts following long-duration spaceflight.

Obesity and IVF: weighing in on the evidence.

Obesity is associated with serious health risks, and its rising prevalence represents a growing public health emergency. Ongoing research into the association of obesity and assisted reproductive technology (ART) outcomes aims to disentangle selective detrimental effects of obesity on the oocyte and the endometrium. More translational studies involving women with severe obesity and in the third-party reproduction setting will help improve the standard of care in the provision of ART services for obese patients.

Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar.

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statementWhat is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction.What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar.What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.

Evaluation of ovarian reserve in women with psoriasis.

The aim of this study is to evaluate ovarian reserve in women with psoriasis. Thirty-six women with psoriasis and 36 healthy women were enrolled in this prospective study. On day 3 of the menstrual cycle, blood samples for AMH and other hormones were collected. On the same day, antral follicle count (AFC), and ovarian volumes were measured. A multiple regression analysis was carried out to examine the contribution of factors to the serum AMH levels in patients with psoriasis. The serum AMH levels and ovarian volumes were lower in the psoriasis group than in the control group (1.85 ± 1.13 ng/ml vs 2.46 ± 1.21 ng/ml, p = .029 and 10.43 ± 3.08 cm3 vs 11.93 ± 3.01 cm3, p = .038). However, the mean AFC between the two groups was not significantly different. The psoriasis area severity index (PASI) score did not correlate with AMH. On the other hand, the duration of the disease negatively correlated with AMH, total AFC and ovarian volume. In the multiple regression analysis, duration of disease and total AFC were the most significant contributors to the serum AMH levels in patients with psoriasis. Autoimmune diseases may affect ovarian reserve regardless of immunosuppresive treatment. Longitudinal follow-ups regarding reproductive function might be required in women with psoriasis.

Inflammatory marker YKL-40 levels in intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy is a diagnosis of exclusion and presents with unexplained pruritus, abnormal liver function tests, and increased serum bile acid levels, particularly in the third trimester of pregnancy. Serum YKL-40 levels are increased in liver diseases and our aim was to investigate YKL-40 levels in pregnant women with ICP. 40 women with intrahepatic cholestasis of pregnancy and 40 healthy pregnant women were included in this cross-sectional study. Serum YKL-40 levels were measured in both groups and correlation analysis were performed between the YKL-40 and other liver function tests. Serum YKL-40 concentrations were higher in the intrahepatic cholestasis of pregnancy group than in the control group (103.46 ± 53.03 vs. 57.60 ± 30.30 ng/ml, p = .002). The cutoff YKL-40 serum concentration was 84.80 ng/ml for the diagnosis of intrahepatic cholestasis of pregnancy. There was no correlation between fasting bile acids and YKL-40 levels. However, there was a significant positive correlation between the YKL-40 levels and aspartate aminotransferase (r = 0.22, p = .04) and alanine aminotransferase (r = 0.24, p = .02). Raised YKL-40 levels might support the evidence on inflammatory processes in intrahepatic cholestasis of pregnancy.

Gremlin-1 and gremlin-2 levels in polycystic ovary syndrome and their clinical correlations.

Objective: Gremlin 1 and 2 regulate oocyte primordial follicle transition in animal models. The main objective of this study is to measure the blood levels of Gremlin 1 and 2 in the women with Polycystic Ovary Syndrome (PCOS). We also aimed to evaluate the association of these markers with hormonal and biochemical parameters of PCOS as interrupted folliculogenesis in those women is related to metabolic dysfunction. Material and methods: Fifty women with PCOS were diagnosed according to Rotterdam criteria, and thirty age-matched female controls were included in this prospective study. Gremlin 1 and 2 levels along with hormonal and metabolic parameters were compared between PCOS and control groups. Results: Serum Gremlin 1 levels were significantly higher in the PCOS group than in the control group (p = .001). Gremlin 2 levels were similar between the groups. Besides, there was a significant positive correlation between Gremlin 1 and insulin levels, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) and waist to hip ratio (WHR) (r = 0.305; r = 0.297; r = 0.303, respectively). Conclusion: Our data suggest that Gremlin 1 may be the key regulator in the pathogenesis of PCOS. In future, Gremlin 1 may be a novel therapeutic target for the treatment of PCOS.

Oxytocin infusion reduces bleeding during abdominal myomectomies: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of oxytocin infusion to reduce intraoperative bleeding during abdominal myomectomies. METHODS: This randomized, parallel group, blinded study was conducted between October 2017 and May 2018. Patients undergoing abdominal myomectomies were randomized 1:1 either to the oxytocin group or to the control group (saline). In the oxytocin group, 10 IU oxytocin in 500 ml of saline at a rate of 120 ml/h was given during the course of the operation. The primary outcome of this study was to measure intraoperative blood loss between the study groups. Correlation and multiple regression analysis were performed to illustrate factors associated with intraoperative blood loss during the myomectomy. RESULTS: The mean intraoperative blood loss during the surgery was 489.20 ± 239.72 ml in the oxytocin group and was 641.40 ± 288.21 ml in the control group. The hemoglobin decline was more evident in the control group than in the oxytocin group. Positive correlations were also observed between the intraoperative blood loss and number of fibroids removed during the surgery, largest fibroid removed and weight of fibroids removed. The use of oxytocin infusion during the myomectomy resulted in a reduction of bleeding in the regression model. CONCLUSION: Intravenous oxytocin infusion is a safe and practical method to reduce intraoperative blood loss during the abdominal myomectomy.

Omission of a Bladder Flap during Cesarean Birth in Primiparous Women.

AIMS: Creation of a bladder flap has traditionally been an integral surgical step of Cesarean birth, and the practicality of such a procedure to create a bladder flap is still highly debated. METHODS: A total of 208 patients undergoing a primary cesarean birth were randomized. Group 1 (bladder flap) had 101 patients and group 2 (omission of a bladder flap) had 100 patients. The primary outcome was the total operating time and secondary outcomes were postoperative urinary symptoms, bladder injury, postoperative urinary retention, and postoperative residual urine volume. RESULTS: No significant differences were found among groups in terms of mean total operating time and mean skin incision-to-delivery time. No bladder injury occurred in either group. Postoperative urine retention observed in the bladder flap group was 2%. The postoperative residual urine volume was significantly more in the bladder flap group compared to the non-bladder flap group (24.5 ± 2.8 vs. 16.2 ± 1.4 mL). The number of patients with dysuria was significantly higher in the bladder flap group (42 vs. 13%). CONCLUSIONS: The creation of a bladder flap during cesarean birth does not have an effect on intraoperative results and operation time, but it is associated with short-term urinary complaints, such as postoperative urinary retention and dysuria.

Efficiency of the Foley catheter versus the double balloon catheter during the induction of second trimester pregnancy terminations: a randomized controlled trial.

PURPOSE: To compare induction-to-delivery intervals of Foley catheters and double balloon catheters in second trimester pregnancy terminations. METHODS: This randomized parallel study was conducted on women who underwent second trimester terminations between December 2016 and December 2017. Pregnant women in the second trimester with a Bishop score < 6 were included in the study. Participants were randomized into two groups, the first being the Foley catheter group and the second being the double balloon catheter group. The time frames from insertion of catheters to the delivery were recorded in each group. A multiple regression analysis was carried out to examine the contribution of factors to the induction-to-delivery interval. A survival analysis was conducted to compare the Foley method and the double balloon method. RESULTS: A total of 91 pregnant women were included in the final analysis. The induction-to-delivery interval was shorter in the Foley catheter group than in the double balloon catheter group (38 h 54 min ± 21 h 6 min versus 58 h 17 min ± 25 h 56 min). We also found that women with intrauterine fetal death (IUFD) had a shorter time to delivery compared to women with live fetuses (39 h 12 min ± 18 h 46 min vs 51 h 30 min ± 26 h 42 min, p = 0.04). Women with a history of vaginal delivery also had a shorter induction-to-delivery time compared to women who never delivered vaginally before (38 h 12 min ± 17 h 42 min vs 53 h 54 min ± 27 h 18 min, p = 0.004). In the multiple regression analysis, the most significant contributor to the induction-to-delivery time was the method used for induction of labor and followed by other factors including the viability of the fetus (live/IUFD), history of vaginal delivery and PPROM. The survival analysis showed that the induction-to-delivery interval was significantly shorter in the Foley catheter group than in the double balloon catheter group (HR 2.51, 95% CI 1.57-4.00, p = 0.001). CONCLUSION: During the termination of second trimester pregnancies time from induction of labor to delivery is shorter with the Foley catheter compared to double balloon catheter.

Postoperative pain and neuropathy after caesarean operation featuring blunt or sharp opening of the fascia: a randomised, parallel group, double-blind study.

The purpose of this study was to compare postoperative pain and neuropathy after primary caesarean sections with either blunt or sharp fascial expansions. A total of 123 women undergoing primary caesarean sections were included in the study. The sharp group had 61 patients, and the blunt group had 62. In the sharp group, the fascia was incised sharply and extended using scissors. In blunt group, the fascia was bluntly opened by lateral finger-pulling. The primary outcome was postoperative pain. The long-term chronic pain scores were significantly lower in the blunt group during mobilisation (p = .012 and p = .022). Neuropathy was significantly more prevalent in the sharp group at both 1 and 3 months postoperatively (p = .043 and p = .016, respectively). The odds ratio (OR) and 95%CI for postoperative neuropathy at 1 and 3 months were as follows; OR 3.71, 95%CI 0.97-14.24 and OR 5.67, 95%CI 1.18-27.08, respectively. The OR for postoperative pain after 3 months was 3.26 (95%CI 1.09-9.73). The prevelance of postsurgical neuropathy and chronic pain at 3 months were significantly lower in the blunt group. Blunt fascial opening reduces the complication rate of postoperative pain and neuropathy after caesarean sections. Impact statement What is already known on this subject? The anatomic relationship of the abdominal fascia and the anterior abdominal wall nerves is a known fact. The fascia during caesarean sections can be opened by either a sharp or blunt extension. Data on the isolated impact of different fascial incisions on postoperative pain is limited. What do the results of this study add? The postoperative pain scores on the incision area are lower in the bluntly opened group compared to the sharp fascial incision group. By extending the fascia bluntly, a decrease in trauma and damage to nerves was observed. What are the implications of these findings for clinical practice and/or future research? The lateral extension of the fascia during caesarean sections must be done cautiously to prevent temporary damage to nerves and vessels. The blunt opening of the fascia by lateral finger pulling might be a preferred method over the sharp approach that uses scissors. We included only primary caesarean cases, however, comparisons of blunt and sharp fascial incisions in patients with more than one abdominal surgery should be explored in future studies.

Clinical characteristics and pregnancy outcomes of Syrian refugees: a case-control study in a tertiary care hospital in Istanbul, Turkey.

PURPOSE: We aimed to compare the clinical characteristics and pregnancy outcomes in women who are Syrian refugees and Turkish women who are non-refugees at a maternity center in Istanbul, Turkey. METHODS: A total of 600 singleton pregnancies who delivered at Sisli Hamidiye Etfal Training and Research Hospital were included in the study. Demographic data, obstetrical history, clinical findings, obstetrical and neonatal outcomes were compared between 300 Syrian refugees and 300 control patients. RESULTS: The Syrian refugee patients were significantly younger than Turkish patients. The percentage of adolescents aged 12-19 years were significantly higher in the Syrian patients (14.3 vs. 5.3 %, p < 0,001). 41.3 % of the refugee patients had no antenatal care. However, this ratio was only 7.7 % for the control group (p < 0.001). Preterm birth rates showed no difference between the groups, however, postterm birth rates were significantly higher in the control group. Low Birthweight (<2500 gr), oligohydramnios, stillbirth and fetal anomaly rates were not different between the two groups. CONCLUSIONS: In comparison to non-refugee control patients, refugee women in our study had poor antenatal care but no adverse perinatal outcomes were observed. Further larger multicenter studies may provide more convincing data about obstetric outcomes in the Syrian refugee population as well as adolescent pregnancies in this population.

Iodine status of pregnant women in a metropolitan city which proved to be an iodine-sufficient area. Is mandatory salt iodisation enough for pregnant women?

The objective of this study was to assess the iodine status of pregnant women in a metropolitan city which was stated as iodine sufficient area after salt iodination program. This multicenter, cross-sectional study was carried out on 3543 pregnant women. Age, gestational weeks, smoking, consumption of iodized salt, dietary salt restriction, history of stillbirth, abortus and congenital malformations were questioned. Spot urine samples were analyzed for urine iodine concentration (UIC). The outcomes were: (a) median UIC in three trimesters of pregnancy and (b) frequency of ID among pregnant women. The median UIC was 73 µg/L. The median UIC was 77 µg/L (1-324), 73 µg/L (1-600) and 70 µg/L (1-1650) in three trimesters of pregnancy, respectively (p: 0.14). UIC <50 µg/L was observed in 36.6% (n: 1295) and UIC<150 µg/L was observed in 90.7% (n: 3214) of pregnant women. Only 1% (n: 34) of the pregnant women had UIC levels higher than 500 µg/L. This study showed that more than 90% of the pregnant women in this iodine-sufficient city are facing some degree of iodine deficiency during their pregnancy. A salt iodization program might be satisfactory for the non-pregnant population, but it seems to be insufficient for the pregnant population.

Use of anti-Müllerian hormone for understanding ovulatory dysfunction in polycystic ovarian syndrome.

PURPOSE OF REVIEW: The aim of this review is to understand how anti-Müllerian hormone (AMH) contributes to ovulatory dysfunction in polycystic ovarian syndrome (PCOS). RECENT FINDINGS: In the last few years, new findings have emerged on AMH and its role on the central nervous system causing ovulatory dysfunction. SUMMARY: Anovulation is a prominent feature of PCOS. Women with anovulatory PCOS have higher AMH levels than in ovulatory PCOS. Higher levels of AMH may contribute to the pathophysiology of PCOS through central and peripheral actions. Once universal standardization is achieved to measure serum AMH, the benefits would be significant in diagnosing women with PCOS.

Efficacy of chewing gum for improving bowel function after cesarean sections: a randomized controlled trial.

Objective: To investigate the effects of chewing xylitol-free gum at different intervals after cesarean sections.Study design: One hundred fifty patients undergoing cesarean sections were randomized into a gum chewing group (n = 75) and a control group (n = 75). Patients in the gum group chewed one sugarless gum for 30 min at 3, 5, and 7 h postoperatively. The two groups were compared in terms of time to first bowel movement, first feeling of hunger, first passage of flatus, and defecation time. Postoperative satisfaction with bowel movements was rated on a scale of 1-5.Results: First bowel movement time (4.93 ± 1.05 versus 7.97 ± 2.33 h postoperatively, p = .0001), first feeling of hunger (5.51 ± 1.68 versus 6.30 ± 1.58 h postoperatively, p = .004), first passage of flatus (11.73 ± 4.61 versus 14.10 ± 2.71 h postoperatively, p = .001), and mean length of hospital stay (2.30 ± 0.49 versus 2.50 ± 0.50 d, p = .015) were significantly reduced in the gum group compared with the control group. Postoperative satisfaction scores for overall bowel function were better in the patients who chewed gum.Conclusion: Gum chewing at frequent intervals in the early postoperative period promotes the early return of bowel movements, shortens hospitalization, and increases patient satisfaction regarding bowel function.

A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies.

Introduction: Adolescent pregnancies are associated with adverse maternal and fetal outcomes including preeclampsia, preterm birth, and fetal growth restriction compared to adult pregnancies. The purpose of our study is to compare the incidents of obstetric outcomes between the adolescent pregnancies and adult pregnancies.Materials and methods: This retrospective case-control study was conducted between January 2013 and January 2018 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The institutions' medical records were screened for women with pregnancies after 24 weeks of gestation. Women under 19 years of age were included as the adolescent group and women between the ages of 20 and 29 were included as the control group. Obstetric outcomes were compared between the groups.Results: There were 3875 adolescent pregnancies in the case group and 3875 adult pregnancies in the control group. Even after adjusting for confounders in our adolescent pregnant cohort, the odds of intrauterine growth restriction, preterm birth and premature rupture of membranes were higher than in our adult pregnant cohort. On the other hand, we found low incidents of preeclampsia and gestational diabetes mellitus in pregnant women younger than 19 years of age.Conclusions: Adolescent pregnancies should be closely followed up as they have higher preterm birth rates as well as the risk of intrauterine growth restriction.

Maternal serum mitofusin-2 levels in patients with preeclampsia: the possible role of mitochondrial dysfunction in preeclampsia.

Purpose: Hypoxia alters mitochondria function and our aim was to measure mitochondrial fusion protein mitofusin-2 (Mfn2) in patients with preeclampsia.Materials and methods: This cross-sectional study was conducted including 82 pregnant women, 27 with normal pregnancy and 55 with preeclampsia (27 with early-onset preeclampsia and 28 with late-onset preeclampsia). Maternal serum levels of Mfn2 were measured by using enzyme-linked immunosorbent assay kits.Results: The mean serum mitofusin-2 levels were higher in women with preeclampsia than in the control group (68.02 ± 8.7 pg/mL vs. 99.72 ± 37.27 pg/mL, p < .0001). The mean serum mitofusin-2 level was found to be the highest in the early-onset preeclampsia (EOPE) group (EOPE: 101.6 ± 38.5 pg/mL). Maternal serum mitofusin-2 levels correlated with both systolic and diastolic blood pressures as well as uterine artery pulsatility index. The optimal cutoff value of Mfn2 for determining preeclampsia was 75.3 pg/mL.Conclusion: Mfn2 has regulatory roles in stress response. Maternal serum Mfn2 is higher in patients with preeclampsia suggesting that Mfn2 increases in the maternal system as a stress response against hypoxia and endothelial dysfunction.What do the results of this study add? Hypoxia causes mitochondrial dysfunction that has been linked to the etiology of many diseases including preeclampsia. Mitofusin-2 is a mitochondrial fusion protein, and the levels can be altered in preeclampsia. For the first time, we showed that maternal levels of mitofusin-2 are higher in patients with preeclampsia. Further, we reported the correlation of mitofusin-2 with blood pressures and uterine artery pulsatility index. These findings will open up other avenues for researchers to investigate other mitochondrial molecules while under stress.

The predictive nature of uterocervical angles in the termination of second trimester pregnancy.

AIM: To establish how useful and the predictive capacity of uterocervical angles (UCA) in the termination of second trimester pregnancies. MATERIAL AND METHODS: This prospective cohort study was conducted at a tertiary center with a total of 120 singleton pregnancies delivered between 14 and 24 gestational weeks. Before the beginning of misoprostol induction, patients were screened for both cervical length (CL) and uterocervical angles (UCA). The UCA is defined as an angle constructed by the measurement of the cervical canal and lower uterine segment. The study population was subdivided into four groups; successful and failed terminations at the end of 24 hours of induction and successful and failed terminations at the end of 48 hours of induction. We decided to further evaluate our study population based on their UCAs, and placed them into four categories; UCA ≥95°, UCA <95°, UCA ≥105°, and UCA <105°. RESULTS: In the 24-hour time frame group, the mean UCA was 105.50 ± 15.38 degrees in the successful termination group and was 100.22 ± 11.12 degrees in the failed group (p = .001). In the 48-hour time frame group, the mean UCA was 104.19 ± 13.51° in the successful termination group and was 93.52 ± 7.84° in the failed group (p = .007). The mean hour of induction was shortest in the UCA ≥105° group. CONCLUSIONS: Regardless of the time frames, patients who had successful terminations had a broader angle, less amount of misoprostol use and shorter duration of induction as compared to the failed termination groups. What do the results of this study add? The uterocervical angle has never been measured in second trimester pregnancies to predict the timing of termination. Our study demonstrated the useful application of this ultrasonographic finding in the prediction of successful second trimester terminations.

Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections.

Purpose: Surgical site infections (SSIs) after cesarean section cause maternal morbidity and economic and emotional burdens on society. Our aim is to measure procalcitonin (PCT) levels in patients who developed incisional SSIs after cesarean section while also comparing PCT concentrations between patients who underwent a secondary suture and who did not require a secondary suture.Methods: Ninety-four patients who developed incisional SSI after cesarean section were enrolled in our study. At the time of admission, serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured. The study population was grouped into two, based on the need of a secondary suture and the patients baseline blood tests were compared.Results: The mean serum CRP level was not significant among the groups; however, the median serum PCT level was significantly higher in patients who required a secondary suture (0.21 vs. 0.05 ng/ml, p ≤ .0001). Serum PCT levels were positively correlated with the length of hospital stay (r = 0.72, p = .0001). Area under the curve (AUC) for PCT in predicting the need of a secondary suture was 0.85 (95% CI: 0.772-0.922) and the cutoff point was 0.142 ng/ml with a sensitivity of 75% and specificity of 97.8% (p = .0001).Conclusion: Serum PCT is a promising marker for both diagnosing and predicting the severity of SSIs after cesarean sections.Trial registration: ClinicalTrials.gov identifier: NCT03223233.

The efficiency of the uterocervical angle in the prediction of second-trimester pregnancy terminations in multiparous women.

Aim: To show how uterocervical angles are used for the prediction of second-trimester pregnancy terminations in multiparous women. Material and methods: A total of 148 multiparous singleton women in their second trimesters were enrolled in this prospective study. The intracervical Foley catheter was used for the induction of delivery. The cervical length (CL) and the uterocervical angle (UCA) were measured before the beginning of induction. The study population was subdivided into four groups; successful and failed terminations at the end of 24 and 48 h time frames. A stepwise multiple regression analysis was carried out to examine the contribution of UCA and other parameters to the induction-to-delivery time. A survival analysis was conducted to compare two groups defined by the cut-off value. Results: The UCA was broader in the successful termination group compared to the failed termination group in 24 h of induction (112.50° ± 29.00° versus 100.68° ± 27.13°, p = .02). A negative correlation was found between the UCA and the induction-to-delivery time (r = -0.27, p = .0007). A cut-off value of 97.5° was found for the UCA in predicting induction outcomes. During the 24-h period, 63.1% of women with the UCA ≥97.5° terminated successfully while 36.8% of women with the UCA <97.5° terminated successfully (p = .001). The mean induction-to-delivery time was significantly shorter in the UCA ≥97.5° group compared to the UCA <97.5° group (38.2 ± 19.5 h versus 47.8 ± 27.5 h, p = .02). The binary logistic regression analysis showed that the UCA was the only contributor to a successful termination (OR = 1.01, 95% CI: 1-1.02, p = .02). Conclusion: The UCA is broader in multiparous women who successfully terminated and is linked to a shorter duration of induction. The UCA by itself is the only significant contributor to the outcome of second trimester pregnancy terminations.