Serial progesterone levels more accurately predict the time of ovulation in subfertile women: a prospective cohort study.

PURPOSE: To predict ovulation in subfertile women using serial follicular growth (FG) and serum hormone measures (estradiol (E2), luteinizing hormone (LH), and progesterone (P) levels) in mathematical models. METHODS: This was a prospective observational study of 116 subfertile women aged between 18 and 40 years. FG was assessed by serial transvaginal ultrasonography starting from cycle days 8-12, depending on cycle length. Once the dominant follicle reached 15-16 mm, hormone levels were assessed daily. The primary outcome measure was ovulation (Ov), with a serum LH level ≥15 IU/l defining the start of the LH surge (the day prior to ovulation) and a serum P level >1 µg/ml concurrent with a drop in serum E2 levels indicating Ov. To determine Ov, mathematical models were generated using FG, LH, E2, and P measurements. RESULTS: A mathematical model was constructed using exponential regression to relate days until and after ovulation with P levels. The Ov(P) model was found to be superior to the Ov(LH) model in the prediction of Ov, with high R2 and low RMSE values of 0.9983 and 0.2454, respectively. In the range of [-2, 2] days, the net accuracy of the Ov(P) model was 63.0%, while with an allowed one-day error, the accuracy was 99.6%. CONCLUSION: Serum P levels display a highly predictable linear curve in natural cycles, which enables the prediction of ovulation. The Ov(P) model can be independently used to schedule embryo transfer in natural frozen-thaw cycles and could therefore replace the Ov(LH) model in clinical practice.

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.

Increased pancreatic-derived factor (PANDER) levels in gestational diabetes mellitus.

The aim of the study was to investigate the pancreatic-derived factor (PANDER) levels in healthy pregnant women and in pregnant women with gestational diabetes mellitus (GDM). A total of 50 women consecutively diagnosed with GDM and 30 randomly selected age-matched and gestational-age-matched healthy pregnant women were included in this cross-sectional study. Serum PANDER levels and other variables were analyzed. The age, the gestational age at the time, the blood sample was obtained and the hemoglobin A1c (HbA1c) levels of the GDM and control groups were similar. The body mass index (BMI), fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and serum PANDER levels were significantly higher in the GDM group than the control group. The optimal PANDER cutoff value was 227.2 ng/ml, and the ratios above this value were 100 and 86.6% for sensitivity and specificity, respectively (p=.0001). Serum PANDER levels were higher in women with GDM compared to the control group and were positively correlated with insulin, HOMA-IR, and HbA1c levels. These results suggest that PANDER might be considered a new biomarker for GDM.

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.

Ovarian reserve after internal iliac artery ligation.

AIM: Ligation of major vessels supplying ovaries may alter hormones and ovarian reserve due to disturbances of vascular circulation. Our purpose is to measure serum anti-Müllerian hormone (AMH) levels and ovarian volume in patients who had internal iliac artery ligation (IIAL) and/or IIAL plus hysterectomy due to uterine atony. METHODS: Patients who underwent IIAL and IIAL+ hysterectomy were evaluated 6 months after their operations and were compared with the control group. The hormones, ovarian volume and antral follicle count (AFC) were measured in each group. RESULTS: Serum AMH levels in the post-partum 6th month interval were lower in the IIAL group than in the control group and were the lowest in the IIAL+ hysterectomy group. Similar to AMH results, AFC and ovarian volumes were also lowest in the IIAL+ hysterectomy group. CONCLUSION: IIAL and hysterectomy are lifesaving interventions during peripartum hemorrhage; however, they might alter ovarian reserve in the short term.

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.

The role of serum ADAMTS-1 and aggrecan on polycystic ovary syndrome in adolescents and younger-aged females.

PURPOSE: The aim of this study was to analyze serum a disintegrin-like and metalloproteinase with thrombospondin-type motifs-1 (ADAMTS-1) and aggrecan levels in adolescents and younger-aged females with polycystic ovary syndrome (PCOS) compared with ovulatory controls to determine whether these are potential markers for the prediction of PCOS diagnosis. We also aimed to determine whether they could predict the development of clinical implications associated with PCOS. METHOD: PCOS (n = 49) and ovulatory age-matched controls (n = 41) (mean age, 18.6 ± 2.5) were recruited. Anthropometric measurements were recorded and biochemical parameters were analyzed. Serum ADAMTS-1 and aggrecan levels were determined with enzyme-linked immunosorbent assay. The predictive effects of ADAMTS-1 and aggrecan on the diagnosis of PCOS and for the development of cardiovascular disease (CVD) risk and insulin resistance (IR) were evaluated. The correlation between investigated markers and anthropometric, biochemical, and hormonal parameters were also investigated. RESULTS: Mean serum ADAMTS-1 level was increased in adolescents and younger-aged females with PCOS compared to ovulatory controls. An elevated ADAMTS-1 level was positive predictive of the diagnosis of PCOS with the best cut-off value of 2.5 ng/ml (sensitivity 69% and specificity 78%). A positive predictive role of ADAMTS-1 on the development of CVD risk and IR was found among all patients. Serum ADAMTS-1 and aggrecan levels were significantly and positively correlated with each other. CONCLUSION: Increased levels of ADAMTS-1 could be a potential marker for the etiopathogenesis of PCOS in adolescents and younger-aged females and predict the development of CVD risk and IR among all patients with the same age.

A comparison of pelvic organ prolapse and sexual function after abdominal and laparoscopic hysterectomy.

OBJECTIVES: Hysterectomy is one of the risk factors of pelvic organ prolapse (POP). There is no consensus on whether the route of hysterectomy affects the subsequent development of POP. The aim of the study was to assess POP and sexual function 1 year after a hysterectomy when comparing total abdominal hysterectomy (TAH) with total laparoscopic hysterectomy (TLH). The study applied the pelvic organ prolapse quantification (POP-Q) as the measure of POP and a short-form of the POP/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). MATERIAL AND METHODS: All patients that underwent either TAH or TLH due to benign causes between March 2016 and March 2017 at the tertiary hospital used for the study were included in our prospective cohort study. POP-Q measurements and PISQ-12 scores were assessed 1 year postoperatively. RESULTS: We included 182 patients in the clinical examinations. There were no statistically significant differences in demographic characteristics between the TAH and TLH groups. Also, there we no differences observed in the objective POP measurements between the two study groups. Results of the two groups' PISQ-12 scores were also similar. However, postoperative vaginal lengths were found to be significantly shorter in the patients who had undergone TAH compared with those who had undergone TLH. CONCLUSIONS: TAH and TLH are comparable regarding short-term objective pelvic organ prolapse. Although we found statistically a significant difference in vaginal lengths between the two groups, no clinical significance was found in terms of sexual function.

Single-layer versus double-layer closure of the vaginal cuff with barbed sutures in laparoscopic hysterectomy.

OBJECTIVES: The utilization of barbed sutures in laparoscopic hysterectomy has become popular among gynecologic sur-geons. Our aim was to compare the outcomes of two different techniques for closing the vaginal cuff with barbed sutures in laparoscopic hysterectomies. MATERIAL AND METHODS: A retrospective study was completed on 202 patients who underwent laparoscopic hysterectomy for benign diseases at Istanbul Kanuni Sultan Suleyman Training and Research Hospital from April 2014 through June 2016. In group 1 (n = 139), a single-layer continuous suturing method was used; each bite contained the pubocervical fascia and vaginal mucosa anteriorly, and vaginal mucosa and rectovaginal fascia posteriorly. In group 2 (n = 63), a double-layer continuous suturing method was used; only vaginal mucosa was included in the first layer, and a second layer incorporated the pubocervical and rectovaginal fascias. RESULTS: Patient characteristics (age, body mass index, parity, previous abdominal surgery, smoking, comorbidity) were similar between the two groups. There were also no differences in total operation time, length of hospitalization, intraop-erative complications, and perioperative change in hemoglobin levels. There was no difference between the two groups in terms of vaginal cuff dehiscence, which was the primary outcome measure of the study. Secondary outcome measures (presence of granulation tissue, spotting, cuff cellulitis) were also similar between the two groups. CONCLUSIONS: We observed no differences in outcomes between single- or double-layer vaginal closure techniques with barbed sutures.

Follicular ADAMTS-1 and aggrecan levels in polycystic ovary syndrome.

PURPOSE: Polycystic ovary syndrome (PCOS) is the most common cause of ovulatory dysfunction and female infertility. The etiopathogenetic mechanisms of PCOS have been studied for many years, although exact causes remain unclear. It has been demonstrated that proteoglycan degradation by a disintegrin-like metalloproteinase with thrombospondin type motifs-1 (ADAMTS-1) is essential for ovulation and fertilization. The objective of our study is to analyze the levels of ADAMTS-1 and aggrecan in the follicular fluid (FF) of PCOS patients compared with normal ovulatory women and to determine whether these markers could be a predictor of in vitro fertilization (IVF) success in PCOS patients. METHODS: Women with PCOS (n = 21) and normal ovulatory controls (n = 22) undergoing IVF treatment were recruited. ADAMTS-1 and aggrecan levels were analyzed with enzyme-linked immunosorbent assay (ELISA) and compared between PCOS and normal ovulatory controls. The predictor effect of ADAMTS-1 and aggrecan on fertilization rate and implantation was evaluated. RESULTS: FF ADAMTS-1 and aggrecan levels increased in women with PCOS compared to controls. Elevated ADAMTS-1 levels but not aggrecan were related to increased implantation in PCOS. CONCLUSION: Our study demonstrated that altered levels of ADAMTS-1 and aggrecan may have a partial role in the etiopathogenesis of PCOS, and ADAMTS-1 could be a predictive marker for implantation success in PCOS patients.

Predictive factors for pregnancy outcome following controlled ovarian stimulation and intrauterine insemination.

OBJECTIVE: To establish predictive factors for positive pregnancy outcome in cases of controlled ovarian stimulation and intrauterine insemination. METHODS: The retrospective study was conducted at Kanuni Sultan Suleyman Training and Research Hospital and comprised subjects having undergone ovulation induction cycles and intrauterine insemination between June 2010 and June 2015. Data was analysed in terms of various parameters affecting clinical pregnancy rates. SPSS 23 was used for statistical analysis. RESULTS: There were 475 patients having undergone a total of 923 cycles. Pregnancy was established in 133(28%) patients. Univariate analysis of biological/clinical variables revealed the presence of secondary infertility, high endometrial thickness, antral follicle number, post wash total motile sperm count and midluteal progesterone levels following intrauterine insemination to be associated with positive pregnancy outcomes (p<0.05 each). Multiple logistic regression analysis was performed to establish factors that affected the pregnancy rate. The aetiology and type of infertility and high midluteal progesterone levels following intrauterine insemination were found to be statistically significant predictors of pregnancy (p<0.05 each). CONCLUSIONS: The best chance of pregnancy was found in cases with anovulatory infertility, a history of prior pregnancy, and high midluteal progesterone levels following treatment with gonadotrophins and intrauterine insemination.

Assessing the efficacy of a novel sperm-washing medium enriched with serotonin, L-carnitine, and coenzyme Q10: an observational cohort study.

ABSTRACT: This observational cohort study investigated the potential of a novel sperm-washing medium (SWM) enriched with serotonin (5-HT), L-carnitine (L-C), and coenzyme Q10 (CoQ10) to enhance sperm motility and reduce DNA damage. It compared this innovative medium (5-HT/L-C/CoQ10 SWM) with two widely used commercial media (SWM 1 and SWM 2). Ninety-eight volunteers from an infertility clinic provided semen samples, which were divided into three aliquots for analysis in different SWMs: group 1, SWM was composed of hydroxyethyl piperazineethanesulfonic acid (HEPES), sodium bicarbonate, human serum albumin (HSA), taurine, and gentamicin sulfate (SWM 1); group 2, SWM was composed of HEPES, sodium bicarbonate, and HSA (SWM 2); and group 3, SWM was composed of HEPES-buffered human tubal fluid supplemented with 5-HT, L-C, and CoQ10 (5-HT/L-C/CoQ10 SWM). Sperm motility was categorized as progressive, nonprogressive, or immotile. Apoptosis, reactive oxygen species (ROS) production, and DNA fragmentation were also assessed. There were no significant differences in total or progressive sperm motility among the groups. Spermatozoa in group 3 exhibited reduced apoptosis, necrosis, and ROS levels and increased viability. No significant differences were observed in the DNA fragmentation index among groups. The 5-HT/L-C/CoQ10 SWM reduced sperm oxidative stress and apoptosis compared with those of the two commercially available SWMs, suggesting that 5-HT/L-C/CoQ10 SWM could be useful for enhancing in vitro fertilization success rates.

Oocyte vitrification for oncological and social reasons.

The aim of this review is to present information related to oocyte cryopreservation, and particularly oocyte vitrification, performed to preserve fertility in oncologic and social indications. The success rates of oocyte cryopreservation have increased with the widespread use of the vitrification technique and are currently similar to those of in vitro fertilization performed with fresh oocytes. Vitrification is the most successful technique for oocyte cryopreservation. The most important factors that influence the success rate are the patient's age at the time of vitrification and the number of mature oocytes frozen. Thus, live birth rates differ for each age depending on the number of oocytes thawed and the freezing method. The American Society of Reproductive Medicine and the American Society of Clinical Oncology recommend presenting the option of oocyte cryopreservation for fertility preservation in cancer patients. Besides cancer patients, use of oocyte vitrification is increasing in women who wish to postpone pregnancy age and to have reproductive freedom with the development of the cryopreservation technique and the achievement of pregnancy rates similar to the use of fresh oocytes. Patients are provided consultancy service in terms of indication, the success rates by age, and the total number of oocytes frozen. It should be emphasized that this procedure is not a type of insurance policy for fertility, especially in elective oocyte cryopreservation.

Pre-delivery fibrinogen level is a predictor for severity of placental abruption.

Objective: To determine pre-delivery fibrinogen levels in predicting adverse maternal or neonatal outcomes in patients with placental abruption. Materials and method: We conducted a retrospective study of all women admitted for placental abruption between January 2012 and May 2018. Postpartum hemorrhage (PPH), disseminated intravascular coagulation (DIC), massive blood transfusion and hospitalization in intensive care unit parameters were evaluated for maternal outcomes. For the neonatal outcomes, the 5th minute APGAR score, umbilical artery pH and stillbirth were evaluated. Results: The mean predelivery fibrinogen levels were 221.3 ± 111.6 mg/dL. In multivariate logistic regression analysis, fibrinogen level was determined as an independent indicator for PPH, red cell concentrate (RCC) and fresh frozen plasma (FFP) transfusion. When fibrinogen levels decreased below 130 mg/dL, the risk of PPH increased and when fibrinogen levels decreased below 100 mg/dL, the risk of overt DIC and also the risk of red cell concentrate and fresh frozen plasma transfusion increased. In terms of the fetal results, there may be adverse neonatal outcomes when fibrinogen levels are below 250 mg/dL. Conclusion: Predelivery fibrinogen levels are good indicators for predicting adverse maternal outcomes in placental abruption cases. In addition, fibrinogen levels might be a guide for management of placental abruption cases.

Skin closure at cesarean section, polypropylene versus polyglactin 910: a randomized controlled study.

AIM: To compare the rates of surgical wound infection in women who have undergone cesarean delivery with subcuticular skin closure with polyglactin 910 or polypropylene. METHODS: Between April 2018 and October 2018, patients who had undergone a cesarean delivery for any reason were randomized with polyglactin 910 or polypropylene for subcuticular skin closure. Participants were evaluated for wound complications on day 7 and 30 postoperatively. The primary outcome was surgical site infection within the first 30 days following delivery. In addition, factors affecting surgical site infections were analyzed by binary regression. RESULTS: A total of 220 women who had undergone cesarean delivery were randomized and 213 were included in the final analysis. The groups were similar in terms of demographic characteristics and perioperative features. No statistically significant difference was observed between the groups in terms of wound complications or superficial site infections (8.3% in the polypropylene group versus 10.6% in the polyglactin 910 group, p = .642). Similarly, no difference was observed between the groups in terms of other wound complications. A binary logistic regression analysis indicated that superficial wound site infection was not affected by gravidity, BMI, duration of operation, repeated or unplanned cesarean delivery. CONCLUSION: It was observed that surgical site infections and other wound complications in skin closures with polyglactin 910 were similar to those with polypropylene.

Benign cystic mesothelioma: a case series with one case complicated by pregnancy.

Benign cystic mesothelioma (BCM) is a rare tumor of unknown origin, most frequently encountered in women of reproductive age and with unknown etiology. Most patients have a history of previous pelvic operation, endometriosis, or pelvic inflammatory disease. Preoperative diagnosis is difficult. We report the cases of three patients, with one case complicated by pregnancy, and discuss the diagnostic evaluation and treatment of this rare disease. Complete surgical resection is recommended if feasible. However, recurrent disease is not uncommon. Clinical positive effects of different adjuvant medical treatments are also discussed.

The role of video-based multimedia information in reduction of anxiety before dilatation and curettage.

OBJECTIVE: Considerable amount of women undergoing dilatation and curettage (D&C) are subject to preoperative anxiety. We hypothesized that the implementation of video-based multimedia information (MMI) before the D&C might facilitate patients' education and provide clear information regarding the procedure. This study aimed to compare the impact of video-based MMI and conventional written information on anxiety, pain severity, and satisfaction in patients undergoing D&C. METHODS: Seventy four women scheduled for D&C for abnormal uterine bleeding were enrolled in this prospective randomized study. Subjects were assigned to receive a video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after the application of the MMI or written information. All patients underwent D&C by the same gynecologist. Following D&C, patient satisfaction and procedural pain were ranked using a Likert scale and Visual Analogue Scale. RESULTS: Post-informational STAI-S score was significantly lower than the pre-informational STAI-S score in the video group (p<0.001), whereas no significant change occurred in STAI-S score in the control group (p=0.210). The satisfaction rate of the patients receiving MMI before the D&C was significantly higher than the satisfaction rate of the controls (75% vs. 50%, p=0.027). CONCLUSION: Implementation of MMI before the D&C procedure is associated with less anxiety, less severe postoperative pain and improved patients satisfaction, compared to the conventional written information.

What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital.

OBJECTIVE: To identify changing trends in peripartum hysterectomy (PH), both elective. cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey. MATERIALS AND METHODS: A retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan Süleyman Training and Research Hospital were analyzed. RESULTS: There were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001-2008 and 2009-2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001-2008, whereas that percentage increased to 95.4% during 2009-2017. CONCLUSION: Placenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality.

Assessment of fetal right ventricular myocardial performance index changes following intrauterine transfusion.

INTRODUCTION: Severe fetal anemia may cause cardiac ischemia, reduced contractility, and dysfunction. The purpose of our study is to evaluate right ventricular myocardial performance index (MPI) before and after intrauterine transfusion (IUT) in patients who underwent this procedure because of fetal anemia due to Rh-D alloimmunization. MATERIALS AND METHODS: This prospective cohort study was conducted between January 2018 and June 2019 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The pregnant women who were applied IUT because of fetal anemia due to Rh-D alloimmunization in our perinatology clinic were included in the study. Fetal right ventricular MPI before and 24 h after IUT were evaluated. RESULTS: A total of 28 IUTs were performed in 17 pregnant women during the study period. The isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) values measured before IUT, were found to be significantly longer compared to the ICT and IRT values measured after IUT. The MPI values measured after transfusion was found to be higher than before transfusion. CONCLUSIONS: The fetal right ventricular MPI increases 24 h after IUT. This increase in the right ventricular MPI might be used as a marker for predicting adverse fetal outcomes following IUT.