Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata.

OBJECTIVE: The present study aimed to investigate the perinatal morbidity associated with multiple repeat cesarean deliveries (CD) and, thus, to achieve a body of evidence for the current practice of discouraging pregnancy after undergoing three CDs. PATIENTS AND METHODS: This study prospectively reviewed a total of 500 women who consecutively underwent CD between January 1, 2009 and April 1, 2009. The patients were allocated into four groups based on the number of CDs they had undergone (Group 1: first CD, Group 2: second CD, Group 3: third CD, Group 4: fourth CD). Data related with their demographic and clinical characteristics were recorded as well as their perioperative characteristics and clinical characteristics of the neonates born to them. Cochran-Armitage test for trends and Spearman rank correlation analysis test was used to evaluate the trend of perioperative complications and neonatal outcome with the increasing number of CDs. RESULTS: The mean age, gravidity and parity were significantly higher in groups 2-4 than those of the women who had their first CD (Group 1). The average operation time and mean delivery time as well as severe adhesions, bowel injury increased significantly with the number of CD. Neonatal characteristics were similar among groups except for a trend towards a decrease in the rate of meconium stained and a trend towards increase in the rate of neonatal sepsis with the increasing number of CD. CONCLUSIONS: We have found positive correlation between the maternal morbidity and the number of CDs. The occurrence of adhesions emerges as the most significant indicator of maternal morbidity, eventually leading to the neighboring organ injury and prolonged operation time.

Treatment approaches in tubo-ovarian abscesses according to scoring system.

BACKGROUND: The aim of this study was to define treatment modalities in tubo-ovarian abscesses (TOA) using a scoring system. As there is no scoring system for TAO there is still a controversy on the management. In our opinion, as there is no evidence based TAO management strategy, a scoring system is needed in the management of these patients. For this purpose we prospectively tried to define that may be useful for favoring a treatment modality and the effects of the parameters on the outcome. METHODS: The study group comprised of hundred and eighty-four patients hospitalized between May 2001 and June 2008. Patients were divided in three groups according to the treatment modality--laparotomy (group 1, n: 122), medical treatment, (group 2, n: 34), and laparoscopic surgery (group 3, n: 28). Antibiotic regimens or other means of treatment strategies were directed according to our scoring system. RESULTS: Of the patients, 122 underwent laparatomy, 34 received medical treatment and 28 had operative laparoscopy. Intraoperative complications in the group of 122 patients who underwent laparatomy were bowel injury in 8 patients (6.5%) and ureteral injury in six (4.9 %). Fourteen patients (11.4 %) in the laparatomy group suffered from morbidity related to abdominal incision. In the laparoscopy group two patients (7.1 %) had bowel injury. CONCLUSION: With this study, we propose a scoring system in TOA cases and define treatment strategies accordingly. According to the results of our study, laparoscopy serves the best treatment option. Medical treatment, despite longer follow up, may be suitable in well-selected cases (Tab. 3, Ref. 39). Full Text in free PDF www.bmj.sk.

Gynecologic symptoms and sexual function in female kidney allograft recipients.

BACKGROUND: There is little information in the literature about changing menstrual patterns, sexuality, and fertility after kidney transplantation. The purpose of this study was to describe gynecologic symptoms, menstrual characteristics, sexual functions, details of pregnancies and gynecologic care before and after women underwent renal transplantation. METHODS: A detailed Turkish questionnaire was prepared for gynecologic evaluation. Fifty women of reproductive age who underwent renal transplantation took part in this study. The questionnaires were filled out at the time of the postoperative follow-up. RESULTS: The mean age and body mass index of all study participants at the time of interview was 33.9 years (range, 18-52) and 23.5 kg/m(2) (range, 16.5-33.3), respectively. There were no differences between bleeding between periods, heavy period, painful period, and period duration before and after transplantation. Eight women left active working life after grafting on their own accord. Thirteen women ceased sexual activity after transplantation. None of the women reported pregnancy after grafting. A total of 98% of women reported that they were never instructed about regular gynecologic care. CONCLUSION: We found that restrictions in the lives of women with transplanted kidneys included ceasing sexual activity and leaving active working life and that these were due to fear of possible organ damage. Women with transplanted kidneys must be informed about posttransplant sex life and the requirement for regular examinations by a gynecologist. Hence, close collaborations should be formed between patients, primary care physicians, and gynecologists.

Ritodrine tocolysis and neonatal intraventricular-periventricular hemorrhage.

Betamimetic drugs are commonly used for tocolytic therapy. To determine their potential role in periventricular-intraventricular neonatal hemorrhage (IVH), 103 preterm births with cranial ultrasonography results were evaluated for the history of betamimetic therapy. The study group was divided into three subgroups according to the cause of the preterm delivery: 44 patients were accepted as tocolysis failure (group A); 53 patients were too late for tocolysis (group B), and these latter cases were taken as controls for group A; for the remaining 6 patients, tocolysis was contraindicated due to fetomaternal reasons (group C), and these cases were not included in the analysis. In group A, 32 patients got ritodrine, 6 patients got combined therapy including ritodrine plus magnesium sulfate or nifedipine. When cases in group A who got ritodrine only or combined therapy are compared with the no-treatment group, no significant difference in neonatal IVH incidences could be found (p > 0.005). Ritodrine does not appear to affect the incidence of neonatal IVH.