Hostile sexism is related to worse mental health outcomes among fathers.

OBJECTIVE: Transition to parenthood is a life-changing yet stressful event for both men and women. The present study aims to: (1) establish the incidence of prenatal paternal depression and anxiety in a sample of expectant fathers and (2) assess the relationship between sexist beliefs and mental health outcomes. METHODS: We recruited expectant fathers (n = 100) who attended the Gynecology and Obstetrics Outpatient Clinic of Eskisehir Osmangazi University Hospital with their pregnant partners. Fathers completed the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and the Ambivalent Sexism Scale. RESULTS: 36% of expectant fathers reported depression, and 12% reported anxiety. Hostile sexism was correlated with depression (r = 0.303, p < 0.01), and anxiety (r = 0.228, p < 0.05). Benevolent sexism was not related to anxiety or depression (each, p > 0.05). Family social support (p = 0.004) and perceived financial satisfaction (p = 0.027) predicted anxiety, while family social support (p < 0.001) and perceived financial satisfaction (p = 0.036) predicted depression. Hostile sexism predicted both anxiety (B = 0.28, p = 0.004) and depression (B = 0.32, p < 0.001). LIMITATIONS: Results may not show a causal relationship due to the study's cross-sectional design. We recruited participants in only one center. Our measures of anxiety and depression were purely psychometric. CONCLUSIONS: Sexist beliefs may serve as environmental stressors among men in the perinatal period by increasing the masculine role stress. Future interventions to treat prenatal paternal depression may target sexism.

Left atrial structure and function: association with blood pressure variability in pregnant women.

BACKGROUND: The aim of this study was to investigate the relationship between left atrial (LA) abnormalities and ambulatory blood pressure variability (BPV) in pregnant women and their relationship with hypertension-related clinical outcomes in pregnancy. METHODS: This single-center, prospective study included 119 pregnant women. All participants underwent 24-h ambulatory blood pressure (BP) monitoring and echocardiographic examination before 20 weeks of gestation. BPV was evaluated using 24-h ambulatory BP monitoring. SD of the mean of SBP (SBP-SD) and DBP variability was calculated as 24-h, daytime and nighttime SBP and DBP. The patients were classified into two groups based on median 24-h SBP-SD (11.3 mmHg). LA features of the patients were compared according to the high and low BPV groups. RESULTS: One hundred and nineteen pregnant women (mean age, 28.6 ± 5.2 years) were included in the study. The mean office SBP and DBP were 108.7 ± 15.4 mmHg and 68.2 ± 10.2 mmHg, respectively. In pregnant women with high BPV, even though BP is normal, reservoir and conduit LA functions have decreased and LA stiffness has increased. Gestational hypertension and composite outcomes were more common in pregnant women with high BPV. Among the LA parameters, the most associated with composite outcome was conduit LA function. CONCLUSION: In pregnancy, higher BPV is associated with worse LA function. The LA conduit strain offers potential value in predicting hypertension-related clinical outcomes in pregnancy.

The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial.

The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants' fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without.  Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.  Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495,  https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist= . Retrospectively registered, date of registration: August 2022. What is Known: • It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation. What is New: • The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent). • In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.

Assessment of foetal ventriculomegaly from prenatal to early postnatal period: a single-centre retrospective cohort study.

The aim of this study was to evaluate the early neonatal outcomes of cases with foetal ventriculomegaly (VM) and to investigate the aetiological and prognostic factors according to the degree of VM in a single tertiary referring centre. The medical records of 87 foetuses diagnosed with VM (≥10 mm) within 6 years were evaluated. Postnatal evaluation and early neonatal prognosis were determined in 39 cases divided into two groups as mild (10-15 mm, 30 cases) and severe (>15 mm, 9 cases) according to the ventricular size. The mean gestational age at which foetal VM was detected was 22 + 3 weeks. In terms of severity, severe cases of VM were more frequent in terminated pregnancies. There was no difference in gestational age, birth weight, fifth minute Apgar scores, or cord blood gases between mild and severe cases at delivery. Isolated VM was detected in 63% of mild and 22% of severe cases. In severe cases, the need for intensive care and surgery was higher than in mild cases. Antenatal VM regressed in 50% of mild cases and 22% of severe cases. Increasing knowledge about neonatal prognosis, the factors involved in aetiology, and the degree of VM will guide the management of foetal VM.IMPACT STATEMENTWhat is already known in this subject? Some cases of foetal VM resolve spontaneously, and postnatal ultrasonography can detect normal ventricle sizes. While 74.6% of isolated VM cases show spontaneous regression, this rate is 52.1% in nonisolated cases. The gestational week at the time of diagnosis, the degree and cause of VM, intrauterine progression and the presence of any genetic, infectious, cerebral, or extracerebral disorders all influence the prognosis.What do the results of this study add? Antenatal VM regressed in 50% of mild cases and 22% of severe cases. In severe cases, the need for intensive care and surgery was higher than in mild cases. The higher frequency of accompanying cerebral findings in severe cases was striking.What are the implications of these findings for clinical practice and/or further research? The current study revealed that isolated VM with ventricular diameter less than 15 mm, after excluding out chromosomal abnormalities and prenatal infections, and no prior history of VM, has a favourable neonatal prognosis in terms of mortality and morbidity. In cases of foetal VM, increased knowledge of neonatal prognosis will guide pregnancy care and postnatal follow-up planning. Prospective multicentre studies on the neonatal period are required to bridge the gap between foetal VM and long-term consequences.

Management of caesarean scar pregnancy with ultrasound guided suction curettage followed by foley balloon catheter placement.

OBJECTIVE: Caesarean scar pregnancy (CSP), which is a direct consequence of caesarean delivery, can lead to serious complications such as placenta acreta spectrum (PAS). The aim of this study is to assess the effectiveness of ultrasound-guided suction curettage followed by foley balloon tamponade for the management of CSP in the first trimester of pregnancy. STUDY DESIGN: A retrospective evaluation of 32 women who were managed with ultrasound-guided suction curettage and foley balloon catheter insertion to the CSP region was performed. The primary outcome of the study was the rate of successful termination of CSP without need of additional surgical intervention. Secondary outcomes were the rate of haematocrit decrease, duration of hospitalization and need for transfusion. RESULTS: The described procedure was performed successfully without need for additional interventions for all patients. Median decrease in the haematocrit level post-operatively was 4% (2.25-5). Median hospitalization time was 1 day (1-2). CONCLUSIONS: Ultrasound-guided suction curettage followed by foley balloon tamponade is an effective and safe method for the management of CSP. Direct comparative studies with other methods are required for a more precise conclusion.

The relationship of foetal superior mesenteric artery blood flow and the time to first meconium passage in newborns with late-onset foetal growth restriction.

This study aimed to assess the relationship between the foetal superior mesenteric artery (SMA) Doppler and the time to first meconium passage (FMP) in foetuses with late-onset foetal growth restriction. This single-centre, prospective, observational, cohort study included 57 patients with late-onset FGR. The newborn infants were divided into two groups: preterm (36.8%) and term (63.2%). The time to FMP of the infants was compared to the foetal SMA parameters obtained within a week before delivery. The median time to FMP was similar between two groups (p = .31). The SMA pulsatility index (PI) was higher in the preterm group (p < .01). There was no correlation between foetal SMA PI or resistance index and time to FMP. In late-onset FGR infants, our study found no association between SMA Doppler measurements and time to FMP. However, a significant difference was detected in SMA PI between preterm and term infants. Impact StatementWhat is already known in this subject? Foetal growth restriction (FGR) can affect splanchnic circulation of the foetus and this alteration can be associated with some disorders including necrotising enterocolitis.What do the results of this study add? Superior mesenteric artery (SMA) Doppler indices are not associated with first meconium passage in neonates with late-onset foetal growth restriction. The pulsatility index of SMA is significantly higher in foetuses delivered before term.What are the implications of these findings for clinical practice and/or further research? Further research should be conducted to investigate the relationship between foetal SMA Doppler indices and neonatal gastrointestinal morbidities in foetuses with early onset FGR with Doppler anomalies. These studies can shed light from the prenatal to the postnatal period, allowing clinicians to predict potential problems and take precautions.

Peripartum Hysterectomy: Is There Any Difference Between Emergency and Planned Surgeries?

OBJECTIVE: To compare the outcomes of emergency and planned peripartum hysterectomies. METHODS: The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. RESULTS: A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p = 0.014), and higher postoperative hemoglobin levels (9.9 ± 1.3 versus 8.3 ± 1.3; p < 0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases. CONCLUSION: Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.

OBJETIVO: Comparar os resultados das histerectomias periparto de emergência e planejada. MéTODOS: Este estudo transversal retrospectivo foi realizado em dois hospitais. Os resultados maternos e neonatais foram comparados de acordo com as histerectomias periparto de emergência e planejada. RESULTADOS: Um total de 34.020 partos foram avaliados retrospectivamente, e 66 casos de histerectomia periparto foram analisados. Destes, 31 eram casos de cirurgias planejadas, e 35, cirurgias de emergência. As pacientes que foram submetidas à histerectomia periparto planejada tiveram uma taxa menor de transfusão de sangue (83,9% versus 100%; p = 0,014), e níveis mais elevados de hemoglobina pós-operatória (9,9 ± 1,3 versus 8,3 ± 1,3; p < 0,001) em comparação com o grupo de histerectomia de emergência. O peso ao nascer foi menor, embora as pontuações na escala de aparência, frequência cardíaca, irritabilidade reflexa, tônus muscular, e respiração (appearance, pulse, grimace, activity, and respiration, Apgar, em inglês) fossem maiores no grupo da cirurgia planejada em comparação com os casos de emergência. CONCLUSãO: A histerectomia periparto planejada com uma equipe experiente resulta em menos necessidade de transfusão e melhora os resultados neonatais em relação à histerectomia periparto de emergência.

Peripartum Hysterectomy: Is There Any Difference Between Emergency and Planned Surgeries? / Histerectomia periparto: Existe alguma diferença entre as cirurgias de emergência e planejada?

Abstract Objective To compare the outcomes of emergency and planned peripartum hysterectomies. Methods The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies. Results A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; p=0.014), and higher postoperative hemoglobin levels (9.9±1.3 versus 8.3±1.3; p<0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases. Conclusion Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.

Resumo Objetivo Comparar os resultados das histerectomias periparto de emergência e planejada. Métodos Este estudo transversal retrospectivo foi realizado em dois hospitais. Os resultados maternos e neonatais foram comparados de acordo com as histerectomias periparto de emergência e planejada. Resultados Um total de 34.020 partos foram avaliados retrospectivamente, e 66 casos de histerectomia periparto foram analisados. Destes, 31 eram casos de cirurgias planejadas, e 35, cirurgias de emergência. As pacientes que foram submetidas à histerectomia periparto planejada tiveram uma taxa menor de transfusão de sangue (83,9% versus 100%; p=0,014), e níveis mais elevados de hemoglobina pós-operatória (9,9±1,3 versus 8,3±1,3; p<0,001) em comparação com o grupo de histerectomia de emergência. O peso ao nascer foi menor, embora as pontuações na escala de aparência, frequência cardíaca, irritabilidade reflexa, tônus muscular, e respiração (appearance, pulse, grimace, activity, and respiration, Apgar, em inglês) fossem maiores no grupo da cirurgia planejada em comparação com os casos de emergência. Conclusão A histerectomia periparto planejada com uma equipe experiente resulta em menos necessidade de transfusão e melhora os resultados neonatais em relação à histerectomia periparto de emergência.

Stress caused by environmental effects on the birth process and some of the labor hormones at rats: ideal birth environment and hormones.

OBJECTIVE: The aim of this study was to compare the effect of environmental conditions on the birth hormones and the labor of rats. MATERIALS AND METHODS: This Study is animal experiment. A total of of 18 pregnant Sprague Dawley rats were divided into control, stress and enriched groups. Animals in the stress group were exposed to unexpected variable stress paradigm three times a day during the third trimester of their pregnancies. Whereas animals raised in the enriched environment were kept in larger cages equipped with various toys. They were subjected to open field test for 5 minutes in the last trimester. Blood samples were taken from the tail vein at the beginning of birth, and 10 parameters (including corticotropin-releasing hormone, oxytocin, endorphin, epinephrine, norepinephrine, prolactin, estrogen, progesterone, vasopressin, and brain-derived neurotrophic factor) involved in labor were assessed. Kruskal Wallis, Mann Whitney U, and Spearman's rho correlation analysis were used to compare data. RESULTS: Interactions of hormones were significantly different among the groups. While hormonal interactions in the control group were similar to the physiological parameters, other groups displayed various results. There were significant (p < .05) differences in the values of corticotropin-releasing hormone (CRH) and vasopressin hormone levels. In the open Field test, standing distribution scores of animals displayed differences among control, stress and enriched environment groups (p < .05). CONCLUSION: These results showed that labor environment diversely affects physiology aspects of birth. It is known that many factors such as procedures in a hospital environment, birth environment, noise, and birth position affect the hormones at birth. Therefore, the birth environment, either at home or at the hospital, needs to be well-organized accordingly.

Impact of the expanded examination of fetal heart to the prenatal diagnosis of congenital heart diseases.

OBJECTIVE: In the present study, for which reasons fetal cardiac evaluation was requested from our pediatric cardiology clinic, the effects of routine fetal cardiac evaluation in obstetric ultrasonography (USG) on the detection of congenital heart disease (CHD) and the distribution of intrauterine diagnosis of CHD according to pregnancy risk profiles were retrospectively analyzed. MATERIALS AND METHODS: Fetal echocardiography reports which containing the nineteen-month period were retrospectively examined. We performed a fetal echocardiography for all pregnant women who were referred to pediatric cardiology clinic after detail obstetric USG screening. The pregnancies were categorized into two groups based on the risk of CHD: Low-risk and high-risk groups. Detected congenital cardiac structural malformations were classified as complex, moderate, and mild according to perinatal mortality risk. RESULTS: Of the 736 pregnancies, 22 were twin, and fetal cardiac evaluation was performed in 758 fetuses. There were 341 (46.3%) pregnancies in the high-risk group and 395 (53.6%) pregnancies in the low-risk group. The most common reason for fetal cardiac evaluation request was inability to adequately visualize the fetal heart (36.1%), while suspected fetal cardiac abnormality was the second most common cause (21.3%). Number of fetuses detected with cardiac abnormalities was 80 (23.5%) among high-risk pregnancies, and 20 (5%) among low-risk pregnancies. The most common type of malformation was simple cardiac abnormalities (6%) followed by complex lesions (4.1%). The most common cardiac abnormality was ventricular septal defect comprised of 18 cases (2.4%) while the most common complex cardiac abnormality was pulmonary atresia (1.2%). The rate of consistency was 40.1% between obstetricians and pediatric cardiologist in terms of the diagnosis of the congenital cardiac malformations. CONCLUSION: Routine evaluation of the fetal heart by means of obstetric USG, including four chambers, outflow tracts' and three vessel views, would allow for diagnosing congenital cardiac malformations to a large extent during the intrauterine period.

Characteristics of prenatally detected right aortic arch cases in a single institution.

This study aimed to elucidate the diagnostic process, the associated anomalies and the perinatal outcomes of right aortic arch (RAA) in a group of low-risk patients. The obstetric imaging database and digital patient files were reviewed between January 2015 and June 2016. There were 12 RAA cases detected prenatally. Seven foetuses had an aberrant left subclavian artery and one foetus had mirror image branching. The prevalence of RAA was 1.8 in 1000. Invasive prenatal diagnosis was offered to patients and seven tests were performed. There was one associated cardiac anomaly (8.3%) and one extra-cardiac anomaly (8.3%) in the same foetus which cordocentesis revealed trisomy 21. There were also two 22q11.2 microdeletion cases with isolated RAA with aberrant left subclavian arteries. All patients have given live births except one patient has chosen a termination of pregnancy for 22q11.2 microdeletion. The median follow-up time of the newborns was 21 months. None of the babies required surgery for RAA during follow-up. All the babies are alive, except for the one with trisomy 21, who dead at 5 months due to the surgical complications of an oesophageal atresia operation. Patients with an RAA foetus should be offered for foetal karyotyping and analysis for 22q11.2 microdeletion. When isolated, RAA has usually a good prognosis and rarely requires cardiac surgery. Impact Statement What is already known on this subject? Prenatal diagnosis of RAA should prompt a detailed cardiac and extra-cardiac ultrasound examination. When isolated, RAA is associated with 22q11 deletion and aneuploidies in 4.6% and 5.1%, of cases respectively. What the results of this study add? Our study showed that 28.5% of isolated RAA cases are associated with 22q11.2 microdeletion. Cardiac surgery is rarely required when RAA is an isolated anomaly. What the implications are of these findings for clinical practice and/or further research? Invasive prenatal testing for karyotypes and 22q11.2 microdeletion should be offered to patients with RAA, even in the case of an isolated one. Further larger studies are needed to confirm this finding.

Sequential use of Foley catheter with misoprostol for second trimester pregnancy termination in women with and without caesarean scars: a prospective cohort study.

PURPOSE: The aim of this study is to evaluate the effectiveness and safety of misoprostol and Foley catheter in second trimester termination in women with and without caesarean section (CS) scars. MATERIALS AND METHODS: Women with an indication for pregnancy termination between 14 and 22 completed weeks of gestation were included to the study. Enrolled women were allocated into three groups: (1) women with no history of CS, (2) women with one CS and (3) women with ≥2 CS. Study consisted 337 patients (233 group 1, 88 group 2 and 16 group 3). Misoprostol and Foley catheter were used sequentially. The primary outcome was the induction to abortion interval. Secondary outcomes were the successful vaginal abortion rate, the percentage of abortions in 24 h and the rates of surgical removal of the placenta, Foley catheter use and major maternal complications (transfusions, thromboembolic events, uterine rupture and death). RESULTS: Demographic characteristics were comparable. All study outcomes were statistically similar among groups. There was no major maternal complication among all patients. CONCLUSIONS: Sequential use of misoprostol and Foley catheter is safe and effective in second trimester pregnancy termination for patients with and without CS scars.

Evaluation of interventricular septum movements in structurally normal foetuses during second and third trimester of pregnancy: A prospective observational study.

Foetal cardiac assessment is a standard part of antepartum obstetric ultrasound evaluation. Heart examination, including four-chamber view and outflow tract views, should be routinely performed for all women as recommended by The International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG). Although the anatomical survey of foetal heart is well-defined, current knowledge on myocardial contractility is scarce. The aim of our study was to investigate the interventricular septum (IVS) shortening in normal foetuses. Interventricular septum length and thickness were assessed by re-evaluation of 3-dimensional spatiotemporal image correlation (STIC) acquisition planes in second and third trimesters of pregnancy in otherwise structurally normal foetuses. Twenty-one foetuses were included to the study. Mean gestational age at second and third trimester investigations were 24.4 (±1.6) and 31.3 (±2), respectively. Systolic and diastolic IVS length and thickness were significantly correlated with the gestational age. Interventricular septum shortening and thickening indexes were not different between second and third trimesters. Foetal cardiac contractility is a subject that recently gained attention. The current study revealed that interventricular septum shortening and thickening was relatively stable during second and third trimesters of pregnancy.

Analgesic effects of acetaminophen, diclofenac and hyoscine N-butylbromide in second trimester pregnancy termination: a prospective randomized study.

OBJECTIVES: This prospective, randomized study aimed to compare the analgesic effects of acetaminophen, diclofenac and hyoscine-N-butylbromide (HnBB) in cases of second trimester pregnancy termination. METHODS: In 60 women with indications for second trimester pregnancy termination, three analgesic agents were randomized into three groups: group 1, acetaminophen; group 2, diclofenac; and group 3, HnBB. A visual analog scale (VAS) used for the evaluation of pain perception. The primary outcome of the study was mean VAS score during the procedure and last VAS score before the completion of termination. The secondary outcomes were the induction-to-abortion interval, the percentage of aborted cases within the first 24 h and finally the need for parenteral analgesia. RESULTS: Demographic characteristics were similar among the groups. The mean VAS and last VAS scores before termination did not differ among the groups (p = 0.3 and 0.2, respectively). The need for parenteral analgesia did not differ among the groups (p = 0.3). Although a shorter induction-to-abortion interval and greater number of cases with successful termination before 24 h were found in the HnBB group, the differences were not statistically significant (p = 0.6 and 0.5, respectively). CONCLUSIONS: Our study did not demonstrate a difference in pain perception among second trimester pregnancy termination cases using acetaminophen, diclofenac and HnBB.

Labia Majora Augmentation with De-epithelialized Labial Rim (Minora) Flaps as an Auxiliary Procedure for Labia Minora Reduction.

BACKGROUND: Esthetic surgery of external female genitalia remains an uncommon procedure. This article describes a novel, de-epithelialized, labial rim flap technique for labia majora augmentation using de-epithelialized labia minora tissue otherwise to be excised as an adjunct to labia minora reduction. METHODS: Ten patients were included in the study. The protruding segments of the labia minora were de-epithelialized with a fine scissors or scalpel instead of being excised, and a bulky section of subcutaneous tissue was obtained. Between the outer and inner surfaces of the labia minora, a flap with a subcutaneous pedicle was created in continuity with the de-epithelialized marginal tissue. A pocket was dissected in the labium majus, and the flap was transposed into the pocket to augment the labia majora. RESULTS: Mean patient age was 39.9 (±13.9) years, mean operation time was 60 min, and mean follow-up period was 14.5 (±3.4) months. There were no major complications (hematoma, wound dehiscence, infection) following surgery. No patient complained of postoperative difficulty with coitus or dyspareunia. All patients were satisfied with the final appearance. CONCLUSION: Several methods for labia minora reduction have been described. Auxiliary procedures are required with labia minora reduction for better results. Nevertheless, few authors have taken into account the final esthetic appearance of the whole female external genitalia. The described technique in this study is indicated primarily for mild atrophy of the labia majora with labia minora hypertrophy; the technique resulted in perfect patient satisfaction with no major complications or postoperative coital problems. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications.

Fetal arterial and venous Doppler is a useful tool for the monitoring of growth restricted fetuses. Our aim in this study was to compare outcomes when fetuses were grouped according to the combinations of the Doppler results and also according to each vessel Doppler. Deliveries during the period 2002-2008 were reviewed retrospectively and cases with a birth weight less than the 10th percentile were selected for the study. Cases with congenital malformations or chromosomal abnormalities were excluded. Cases were then grouped according to umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler results. Two hundred fifty-five cases were selected for the study. The perinatal mortality rate was 9.8% (11 prenatal and 14 neonatal). In the presence of absent or reverse flow in UA, fetal death and neonatal complication rates were higher. In the fetuses having reverse or absent "a" wave, there were findings of metabolic deterioration. Absent-reverse UA end-diastolic flow increased the odds ratios of perinatal and fetal death, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), and need for neonatal intensive care unit (NICU) (2.81, 5.94, 10.82, 5.79, 5.19, and 11.60, respectively). Absent/reverse "a" wave in DV increased the odds ratio of perinatal death, fetal death, neonatal death, RDS, and abnormal pH (19.89, 18.06, 12.50, 8.29, and 9.67, respectively). For prediction of fetal metabolic status, DV Doppler is a reliable tool. However, when perinatal complications are considered, this finding for intervention to delivery is a late point. Therefore, when reverse end-diastolic flow in the UA is observed, decision-to-delivery should be taken in order to avoid metabolic deterioration and increased postpartum death.

Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases.

OBJECTIVE: Ovarian granulosa cell tumors are rare malignancies with a relatively favorable prognosis. However, patients still suffer from disease-related mortality. Therefore, the prognostic factors should be clarified. The purpose of this study was to investigate the clinical and pathologic characteristics related with disease recurrence and mortality in adult type ovarian granulosa cell tumors. METHODS: Eighty surgically staged patients with granulosa cell ovarian tumor treated at the Hacettepe University Hospital between 1982 and 2006 were retrospectively reviewed. Clinical and pathological characteristics were analyzed. RESULTS: Granulosa cell ovarian tumors accounted for 4.3% of malignant ovarian neoplasms. Mean age was 47.6 years. The most common presenting symptom was abnormal uterine bleeding (53.7%). Endometrial pathology was detected in 51.2% of patients preoperatively. Seventy percent of patients were diagnosed at stage I, and 53.8% of patients received adjuvant treatment. Mean follow-up was 67.5 months. Overall 5-year and 10-year survival was 91% and 86%, respectively. Mean survival was 147.1 months. Recurrence rate was 11.2%. In univariate analysis, advanced stage, advanced age, residual disease after surgery, and need for adjuvant treatment were associated with disease-related mortality and advanced stage disease and absence of initial staging surgery were associated with disease recurrence. However, in multivariate analysis, only initial stage was found to be a significant prognostic factor. CONCLUSION: Initial stage seems to be the single most important prognostic factor in ovarian granulosa cell tumors. Therefore, a comprehensive staging surgery should be attempted to document the real extent of disease and to estimate the oncologic outcome more accurately.

Prognostic factors for recurrence and survival in primary vulvar squamous cell cancer.

OBJECTIVE: To evaluate survival estimates and clinico-pathological variables in women with primary vulvar squamous cancer. DESIGN: Retrospective observational study. Setting. University hospital in Turkey. POPULATION OR SAMPLE: Patients treated for primary vulvar squamous cancer. METHODS: Retrospective evaluation of demographic, pathologic and follow-up data of 91 patients obtained from hospital records and private gynecologic oncology files. MAIN OUTCOME MEASURES: Recurrence rate and survival estimates. RESULTS: The mean age at the time of diagnosis was 62 years. Of the women, 62% had early stage disease (stages I-II), while 39% had advanced stages (stages III-IV) at diagnosis. The overall recurrence rate was 13%. Recurrence rates were significantly higher in the presence of local wide-deep excision as an initial treatment, larger initial tumor size, positive lymph node involvement, advanced stage, presence of ulcerative lesions and adjuvant radiotherapy. The overall and 5-year survival estimates were 92 and 83%, respectively. CONCLUSION: Lymph node invasion, stage, having ulcerative lesion, receiving adjuvant therapy, tumor diameter larger than 10 mm and having local excision as primary surgery may increase the risk of recurrent disease.

A third evaluation of tertiary cytoreduction.

OBJECTIVE: To evaluate the impact of tertiary cytoreductive surgery (TCS) on patient survival and to determine predictors of optimal TCS. METHODS: Twenty patients with recurrent epithelial ovarian carcinoma who had TCS at Hacettepe University Hospital during 1992-2004 were retrospectively reviewed. RESULTS: Tertiary cytoreductive attempt was successful (optimal defined as <2 cm residual) in 12 patients and suboptimal in the remaining eight patients. Seven patients had no macroscopic residual, five patients had <2 cm gross residual and remaining 8 patients had >or=2 cm gross residual disease. Of these alive patients, 10 patients were alive with metastatic disease and only three patients were alive without any evidence of disease. Three patients had operative morbidity (15%), all of which were mild-moderate degree. Multivariate analysis could not differentiate a unique significant factor to have a possible predictor effect of optimal TCS. Multivariate survival analysis also could not differentiate any factor to have significant effect upon patient survival, neither the outcomes of primary, secondary or tertiary cytoreductive surgeries nor the usage of preoperative or postoperative chemotherapies. CONCLUSION: TCS may not be helpful for patient survival. Neither of the clinical factors predicted an optimal TCS. Further larger series are needed for a definite conclusion.

Metastatic lymph node number in epithelial ovarian carcinoma: does it have any clinical significance?

OBJECTIVE: To analyze the clinicopathological correlations of metastatic lymph node (LN) numbers in patients with epithelial ovarian carcinoma. METHOD: A total of 328 patients with epithelial ovarian carcinoma diagnosed and treated at Hacettepe University Hospital during 1982-2005 were retrospectively reviewed. Patients' age, number of resected lymph nodes, clinical disease stage, preoperative Ca-125 levels, peritoneal cytology, presence of ascites, tumor histology, tumor grade, maximal tumor diameter, cytoreductive success, overall and disease-free survivals were compared with respect to the number of metastatic lymph nodes (< 4 vs. > or = 4). RESULTS: The mean number of resected lymph nodes was 24.5 and mean number of metastatic lymph nodes was 6.2. About 47.3% (n=155) of the patients had < 4 metastatic lymph nodes and the remaining 52.7% of patients (n=173) had > or = 4 metastatic lymph nodes. Univariate comparison of the two groups relived preoperative Ca-125 values, peritoneal cytology and clinical disease stage to be significantly different among the two groups. However, multivariate analysis revealed a high Ca-125 level (> or = 500 IU/l) to be unique factor significantly different among the groups. Survival analysis also could not find a significant difference with respect to overall and disease-free survival among the groups. CONCLUSION: The number of metastatic lymph nodes increases as the preoperative Ca-125 values increase. Other patient characteristics do not have a significant effect on the number of metastatic lymph nodes. Metastatic LN number does not have a prognostic significance in terms of either the overall or the disease-free survival. Prospective series are needed for a definitive conclusion.