The evaluation of maternal systemic thiol/disulphide homeostasis for the short-term prediction of preterm birth in women with threatened preterm labour: a pilot study.

The aim of this study was to investigate maternal systemic thiol/disulphide homeostasis (TDH) for the short-term prediction of preterm birth in women with threatened preterm labour (TPL). This prospective study included 75 pregnant women whose pregnancies were complicated by TPL. Thirty-seven of them delivered within 7 days and 38 of them delivered beyond 7 days. Maternal serum samples were collected at the day of diagnosis and the TDH was measured. The maternal disulphide level was significantly higher in pregnant women who delivered within 7 days (25.0 ± 9.8 µmol/L vs 19.4 ± 9.8 µmol/L, p: .015). The threshold value of 22.1 µmol/L for maternal disulphide level predicted delivery within 7 days with 62.2% sensitivity and 60.5% specificity (area under curve 0.651, confidence interval 0.53-0.78). The likelihood ratios for short cervix (≤25 mm) and maternal disulphide level (≥22 µmol/L) to predict delivery within 7 days was found to be 8.7 and 7.3, respectively. The likelihood ratio of combining two tests to predict delivery within 7 days was found to be 11.4. The maternal TDH, which is an indicator of oxidative stress status in maternal compartment, is disturbed in TPL cases who delivered within 7 days. Elevated maternal disulphide level along with cervical length screening predicts a short latency period in pregnancies with TPL. IMPACT STATEMENTWhat is already known on this subject? Spontaneous preterm delivery is one of the major complication of pregnancy and the common cause of neonatal morbidity and mortality. Threatened preterm labour (TPL) is also a frequent complaint in obstetric emergency care units in all around the world. Triaging women with TPL is mandatory for planning further management therapies, since the most of them will eventually deliver at term. Only the measurement of cervical length in symptomatic women has moderate accuracy in predicting preterm delivery. Short cervix is described as an independent predictor of preterm delivery in women with TPL, its predictive accuracy as a single measurement is relatively limited. On this account, several potential markers like foetal fibronectin in the cervicovaginal fluid, salivary oestriol, prolactin in vaginal discharge, maternal serum calponin and interleukin-6 in the amniotic fluid were examined to predict preterm delivery in previous studies. However, none of them represented an excessive predictive accuracy like high sensitivity, PPV or NPV.What do the results of this study add? We report a method which has higher diagnostic and predictive performance to identifying TPL women with high risk of preterm delivery. According to the current literature, there are accumulated data about the correlation between oxidative stress (OS) and preterm delivery regardless of the amniotic membrane status. However, it is still debated whether OS is a trigger or a consequence of preterm delivery. Our study provides evidence for the first time that maternal serum thiol/disulphide homeostasis, which is an indicator of OS in maternal compartment, is disturbed in TPL cases who delivered within 7 days. The high disulphide level in maternal serum, along with cervical length measurement (short cervix) accurately predicts a short latency period in TPL cases.What are the implications of these findings for clinical practice and/or further research? This novel test combination (maternal serum disulphide level and cervical length measurement) could be used clinically to triage pregnant women presenting with TPL, avoiding overtreatment, unnecessary hospitalisations and increased medical costs. The future research would be addressed on reducing maternal OS by using new antioxidant treatment strategies to improve perinatal and long-term childhood outcomes.

Comparison of topical lidocaine spray with forced coughing in pain relief during colposcopic biopsy procedure: a randomised trial.

Our objective was to compare the effectiveness of local lidocaine spray (LS) compared to forced coughing (FC) for relieving the pain during colposcopically guided cervical biopsies (CGBs). The study was a randomised study, which included patients with abnormal cervical cytologic results requiring a colposcopic biopsy procedure. The patients were randomly assigned to either the 10% LS or the FC groups before the biopsy procedure. As a primary outcome, the pain was assessed by using a 10 cm visual analogue scale at the different steps during the procedure. Forty-four and 42 patients had CGBs using LS and FC, respectively. The age, parity, body mass index, history of previous curettage and vaginal delivery, smoking status and the number of biopsies were similar in both groups. The mean ± SD pain scores after the cervical biopsy were 3.25 ± 1.4 and 4.4 ± 1.3 in the LS and FC groups, respectively (p< .05). The operative time was longer in the LS than in the FC group (7.6 ± 1.4 vs. 5.2 ± 0.8, p: .004). No complication or adverse effect was observed in both groups. The present study showed that LS use can be recommended for pain relief during colposcopically directed cervical biopsy procedure with a superiority to the FC in the terms of pain and absence of any adverse reactions. Impact Statement What is already known on this subject? A colposcopic-guided cervical biopsy is a painful procedure and different techniques have been proposed to relieve this pain with conflicting results. Studies have demonstrated that a forced coughing is a good and easy method for relieving pain with some disadvantages. Local lidocaine spray (LS) is another option for pain relief during the biopsy procedure. However, no randomised study has compared these two methods yet. What the results of this study add? The results from this randomised study suggest that LS has superiority in terms of pain relief during the colposcopic biopsy procedure and has no adverse reactions. What the implications are of these findings for clinical practice and/or further research? The evidence from different studies showed some conflicting results regarding the pain relief methods during the colposcopic biopsy procedure. The local LS can be used in this procedure in routine clinical practice. However, further studies with larger samples and comparison of different methods are needed.

What should the optimal intrauterine pressure be during outpatient diagnostic hysteroscopy? A randomized comparative study.

AIM: The aim of this study was to evaluate and compare lower and higher uterine filling pressures during outpatient diagnostic hysteroscopy. METHODS: One hundred and seventy-five women eligible for outpatient diagnostic hysteroscopy were included in this randomized double blind comparative study. The subjects were randomized into two groups. Group 1 (n = 80) underwent surgery with lower intrauterine filling pressures (30, 40, and 50 mmHg) and group 2 (n = 81) underwent surgery with higher filling pressures (70, 80, and 100 mmHg). The primary outcome measure was adequate visibility during the procedure. The secondary outcome measure was pain perceived by the patient during and 30 min after the procedure. RESULTS: In total, 161 patients completed the trial. Group 2 had significantly higher adequate visibility than group 1 (71/80, 88.75% in group 1 and 79/81, 97.5% in group 2, P = 0.008). There was a trend toward increase in pain scores with higher pressures during the procedure. However, there were no significant differences between the two groups in terms of visual analog scale pain scores measured 30 min after the procedure. CONCLUSION: Lower uterine filling pressure was associated with lower pain scores with a higher trend towards inadequate visibility. It appears that higher filling pressure can be used for performing office hysteroscopy, but it is associated with higher pain scores.

Relationship between maternal blood ceruloplasmin level, catalase and myeloperoxidase activity and neural tube defects.

OBJECTIVES: The exact pathogenesis of neural tube defects (NTDs) is poorly understood. We aimed at evaluating maternal anti-oxidant capacity (ceruloplasmin level, myeloperoxidase and catalase activity) in pregnancies complicated by NTDs. MATERIAL AND METHODS: Fifty-four mothers with NTD-affected pregnancies and 61 healthy mothers, matched for gestational age, were recruited. Maternal venous blood samples were obtained after detailed fetal ultrasound examination to measure myeloperoxidase, catalase activity and ceruloplasmin levels. The clinical characteristics of all participants were collected. RESULTS: Maternal blood catalase activity was significantly lower in the study group (117.1 ± 64.8 kU/L) as compared to controls (152.2 ± 110.6 kU/L) (p = 0.044). Maternal blood ceruloplasmin levels were also significantly lower in the study group (180.5 ± 37.7 U/L) as compared to controls (197.9 ± 35.9 U/L) (p = 0.012). Myeloperoxidase activity was similar in both groups (112.6 ± 22.2 U/L vs. 113.6 ± 38.1 U/L) (p = 0.869). CONCLUSIONS: In the present study, maternal blood ceruloplasmin level and catalase activity were found to be lower in NTD-affected pregnancies as compared to healthy controls. Thus, it seems safe to conclude that impaired antioxidant capacity may play a role in the development of NTDs during pregnancy, in addition to the genetic, environmental and metabolic factors.

Maternal and fetal outcomes after laparoscopic vs. Open appendectomy in pregnant women: data from two tertiary referral centers.

Objectives: Appendectomy is the most common cause of non-obstetric surgery in pregnant women. Our aim was to compare the clinical characteristics, peri-and post-operative data of pregnant women undergoing either laparoscopic appendectomy (LA) or open appendectomy (OA). Materials and methods: This was a retrospective study of medical records of all pregnant women diagnosed and treated surgically for acute appendicitis at two referral centers of Yuzuncu Yil University Medical Faculty and Kafkas University Medical Faculty, from January 2010 to January 2015. Results: The study included 48 patients, divided to two groups (12 - LA and 36 - OA). There were no significant differences in demographic characteristics of the studied population, including age, BMI, gestational age at operation, gravidity, parity, and history of cesarean sections. A far as obstetric and fetal outcomes are concerned, no significant differences were found in terms of preterm delivery, fetal loss, delivery mode, birth weight, APGAR score, and maternal death between the two investigated groups. One perioperative complication of intra-abdominal abscess was noted in the OA group. However, the LA group had shorter hospital stay (3.25±2.45 vs. 4.28±3.31, p=0.004), earlier mobilization time (8.1±2.2 vs. 10.1±1.6, p=0.025), and shorter time to first flatus (2.3±0.3 vs. 4.0±1.6, p=0.032) as compared to the OA group. The OA group had statistically shorter operation time than the LA group (38.61±11.5 vs. 49.42±11.38, p=0.007). Conclusion: LA is related to shorter hospital stay, faster return to daily activities, and shorter time to first flatus. LA appears to be as safe and effective as OA in pregnant patients without increasing adverse perinatal outcomes.

Clinical and perinatal outcomes in eclamptic women with posterior reversible encephalopathy syndrome.

PURPOSE: To compare the clinical and perinatal outcomes in eclamptic women with and without posterior reversible encephalopathy syndrome (PRES). METHODS: This single-center, retrospective, cohort study was conducted between 2008 and 2013. The clinical and perinatal outcomes of eclamptic patients were obtained from hospital records. Magnetic resonance imaging was used for the diagnosis of PRES. Eighty-one eclamptic women were divided into two groups: 45 and 36 patients were included in the PRES and non-PRES groups, respectively. RESULTS: In the PRES group, headache and visual impairment together (60.0 %) were the most common presenting symptoms. In the non-PRES group, only headache was the most common (50 %) presenting symptom. Occipital and parietal lobes were the most frequently affected areas in the PRES group. Women in the PRES group had a higher body mass index value (p = 0.005), longer hospitalization time (p = 0.001), and higher level of proteinuria (p = 0.012) than those in the non-PRES group. Women in the non-PRES group had higher Apgar scores (p = 0.002) than those in the PRES group. CONCLUSIONS: This study indicates that PRES manifests predominantly with headache and visual impairment together. Adverse neonatal outcomes are also common in these patients.

Differences in geographical distribution and risk factors for urinary incontinence in Turkey: analysis of 6,473 women.

OBJECTIVE: To assess the prevalence, types and risk factors for urinary incontinence (UI) and to evaluate the impact of incontinence on quality of life by using validated and objective questionnaires in the western and eastern parts of Turkey. METHODS: In this multicenter observational study, 6,473 women from 38 cities in the western and eastern parts of Turkey were included. UI was assessed by ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) and IIQ-7 (Incontinence Impact Questionnaire). RESULTS: The UI rate was 20.9% (10% for stress, 8.3% overactive bladder and 2.6% for mixed type). In all, stress incontinence was the most common type. The rate of UI in women residing in the west was higher than in women living in the east (p < 0.001). ICIQ scores were comparable in the two groups but women in the west scored higher in each item of the IIQ. Age >40 years (p < 0.001), number of siblings >5 (p < 0.001) and low educational status (p < 0.001) increased the rate of incontinence. In binary logistic regression analysis menopausal status, age >40 years, number of siblings >5, being overweight, region of residence, and educational status were associated with UI. CONCLUSION: The rate of UI in women residing in the western part of Turkey was higher than women living in the east. Residing in a different geographical region (in our case living either in the western or eastern part of Turkey) seemed to be an independent risk factor for UI. Moreover, UI deteriorates quality of life and more attention should be paid to this vulnerable population.

Effect of surgical staging on 539 patients with borderline ovarian tumors: a Turkish Gynecologic Oncology Group study.

OBJECTIVE: The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. METHODS: In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. RESULTS: The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. CONCLUSION: Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.

Paraoxonase lactonase activity (PON-HTLase), asymmetric dimethylarginine (ADMA) and platelet activating factor-acetylhydrolase (PAF-AH) activity in non-obese women with PCOS.

OBJECTIVE: Paraoxonase1 (PON1), exhibits both esterase activity (PON1-AREase) and homocysteine thiolactonase activity (PON1-HTLase) which respectively prevent LDL oxidation and detoxify homocysteine thiolactone (HTL). Platelet-activating factor-acetylhydrolase (PAF-AH) is an antioxidant enzyme preventing LDL oxidation by hydrolysis of oxidized phospholipids. Both of these enzymes exhibit a proatherogenic role. ADMA is an endogenous inhibitor of nitric oxide (NO) synthesis causing endothelial dysfunction. The aim was to compare non-obese PCOS patients with a BMI matched control group using the following characteristics: serum PON1-HTLase, ADMA, PAF-AH, and lipid and hormonal parameters. RESULTS: 77 women with PCOS and 25 healthy subject were recruited for this study, The controls were non-obese BMI and age matched with the patients. There were no significant differences with respect to age, BMI, FSH, free testosterone, DHEA, androstenadion, total cholesterol, triglycerides, HDL, LDL, VLDL, fasting glucose/insulin ratio and HOMA-IR among the groups (p > 0.05). However, total testosterone and fasting glucose levels were significantly higher in the PCOS group (p < 0.05). On the other hand, PON1-HTLase levels (39.6 ± 5.77 vs. 33.8 ± 8.2, p = 0.02) were significantly lower in the PCOS group while ADMA levels (1.14 ± 0.6 vs. 3.37 ± 6.4, p = 0.004) were significantly higher in the PCOS group. However, there was no significant difference in PAF-AH activity among the groups. CONCLUSIONS: Decreased PON1-HTLase and increased ADMA levels might be a relevant marker for the development of future atherosclerotic heart disease (AHD) in non-obese PCOS patients. Further studies are needed to confirm our results.

A practical FIST maneuver to minimize the bleeding during cesarean hysterectomy for placenta percreta: a retrospective comparative study.

BACKGROUND: Placenta percreta (PP) is a life-threatening condition and its surgery poses a very high potential for bleeding. The recommended treatment is a cesarean hysterectomy. There are several techniques reported in the literature to reduce the bleeding during percreta operations. OBJECTIVE: To show and describe a practical and novel intraoperative maneuver to minimize the hemorrhage during cesarean hysterectomy for PP. METHODS: The patients who were diagnosed with PP and underwent cesarean hysterectomy (CH) in our unit between 2016 and 2020 were retrospectively evaluated. These patients were divided into two groups. Group A included patients who underwent hysterectomy with intraoperative FIST maneuver. Group B included patients with ordinary cesarean hysterectomy. The groups were compared with regards to the intraoperative bleeding, surgical complications, and perioperative outcomes. RESULTS: Seventy-two patients who had a cesarean hysterectomy and diagnosed with PP during the study period were included in this retrospective cohort. 22 patients underwent intraoperative FIST maneuver with CH as Group A and 50 patients underwent ordinary CH as Group B. The demographic variables including maternal age, gravida, number of previous cesarean sections, and body-mass index were not statistically different between the two groups. Intraoperative FIST maneuver was significantly associated with reduced operative hemorrhage, the need for transfusion of erythrocyte suspension, admission to intensive care unit, and hospitalization days (p < .005). The operative time was statistically significantly shorter in Group A than Group B, respectively (90 ± 18.6 vs 120 ± 20.5 min) (p < .05). CONCLUSION: FIST maneuver is a very practical, easy to apply, and effective method that reduces the obstetrical bleeding during cesarean hysterectomy in placenta percreta cases.

Maternal serum ischemia-modified albumin as an oxidative stress biomarker in preterm pre-labor rupture of membranes.

OBJECTIVES: To evaluate the maternal serum ischemia-modified albumin (IMA) concentration as an oxidative stress biomarker in pregnancies complicated by preterm pre-labor rupture of membranes (PPROM) without maternal clinical infection and compare these results with healthy pregnancies. MATERIAL AND METHODS: The present cohort study included 40 pregnancies complicated by PPROM and 49 similar gestational age healthy pregnancies in the third trimester of gestation. Maternal venous blood specimens were obtained at the day of first diagnosis. Maternal serum IMA level was assayed with an Albumin Cobalt Binding test. The subjects were followed up until delivery and perinatal outcomes were recorded. RESULTS: The maternal serum IMA concentrations were significantly higher in the study group (0.56 ± 0.05 absorbance units) as compared to controls (0.54 ± 0.03 absorbance units) (p = 0.020). The maternal serum IMA concentrations were not significantly correlated with the initial maternal white blood cell count (r: 0.118, p = 0.269) and C-reactive protein levels (r: 0.066, p = 0.541). The maternal serum IMA concentrations were negatively correlated with gestational age at delivery (r: -0.248, p = 0.019), birthweight (r: -0.247, p = 0.020) and Apgar scores (r: -0.200, p = 0.049; r: -0.245, p = 0.020). The threshold value of maternal serum IMA concentration above 0.55 absorbance units indicated the pregnancy complicated by PPROM by 57.5% sensitivity and 57.1% specificity (Area under curve 0.613, confidence interval 0.50-0.73). CONCLUSIONS: The current study supported for the first time that there is an association between increased maternal serum IMA levels and the development of PPROM in the third trimester of gestation without maternal clinical infection. Elevated maternal serum IMA levels may alert the obstetrician about poor ongoing perinatal outcomes in the early phase of PPROM before increased maternal C-reactive protein and white blood cell count.

The relationship between brachial artery flow-mediated dilatation, high sensitivity C-reactive protein, and uterine artery doppler velocimetry in women with pre-eclampsia.

PURPOSE: To investigate serum high sensitivity C-reactive protein (hs-CRP) levels and endothelial function in pregnancies complicated by pre-eclampsia and to clarify their relationship with uterine artery Doppler velocimetry. METHODS: A cross-sectional study was carried out in 70 pregnant women (35 patients with pre-eclampsia and 35 age-matched normotensive healthy pregnant women) during the third trimester of pregnancy. The maternal levels of serum hs-CRP were determined in all cases by immunonephelometry. Uterine artery Doppler velocimetry was performed. Flow-mediated dilatation was measured by sonography of the brachial artery for the assessment of endothelial function. RESULTS: Serum hs-CRP levels were higher in the pre-eclamptic group than in the normotensive group. hs-CRP levels were positively correlated with mean arterial pressure. Eleven patients with pre-eclampsia had abnormal uterine artery Doppler velocimetry. hs-CRP levels were significantly higher in pre-eclamptic patients with than without abnormal uterine artery Doppler velocimetry. Endothelial function was inversely correlated with hs-CRP levels and mean arterial pressure. CONCLUSIONS: These findings suggest that maternal serum hs-CRP levels increase with the severity of pre-eclampsia, reflecting endothelial dysfunction and constituting a potential marker of pathological utero-placental perfusion, with a high risk for fetal growth restriction.

Association of cord blood ischemia-modified albumin level with abnormal foetal Doppler parameters in intrauterine growth-restricted foetuses.

Objective: To investigate cord blood ischemia-modified albumin (IMA) levels in pregnancies with intrauterine growth restriction (IUGR) and to determine its association with abnormal fetal Doppler findings.Methods: Umbilical cord IMA levels were assessed in 34 pregnant women with IUGR and 32 pregnancies with normal fetal development. Associations of IMA with abnormal umbilical artery Doppler findings, preeclampsia, and oligohydramnios were investigated. IMA was measured using a colorimetric test based on a decrease in cobalt binding.Results: No significant between group differences in maternal age, body mass index, gravida, and parity were identified. The mean gestational age at delivery was earlier in the IUGR group than in the control group (35.7 ± 3.2 versus 38.4 ± 1.2, respectively). The mean cord blood IMA values for the IUGR group were significantly increased compared to those in the control group (0.565 ± 0.22 versus 0.250 ± 0.12, respectively, p = .001). There was a significant positive correlation between umbilical artery pulsatility index and IMA levels in the IUGR group. Patients with preeclampsia, oligohydramnios, and abnormal nonstress test results in the IUGR group had significantly higher IMA levels. Patients with systolic to diastolic ratios >3 and pulsatility index (PI) above the 95th percentile in the IUGR group had significantly higher cord blood IMA levels (p = .001 and p = .007, respectively).Conclusions: Cord blood IMA values may be a useful marker for perinatal asphyxia. Abnormal Doppler findings are associated with increased IMA levels in complicated pregnancies with IUGR.

Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: a descriptive study.

BACKGROUND: Infertility patients are a vulnerable group that often seeks a non-medical solution for their failure to conceive. World-wide, women use CAM for productive health, but only a limited number of studies report on CAM use to enhance fertility. Little is known about traditional and religious forms of therapies that are used in relation to conventional medicine in Turkey. We investigated the prevalence and types of complementary and alternative medicine (CAM) used by infertile Turkish women for fertility enhancement. METHODS: A face-to-face questionnaire inquiring demographic information and types of CAM used for fertility enhancement were completed by hundred infertility patients admitted to a primary care family planning centre in Van, Turkey between January and July 2009. RESULTS: The vast majority of infertile women had used CAM at least once for infertility. CAM use included religious interventions, herbal products and recommendations of traditional "hodja's" (faith healers). Of these women, 87.8% were abused in the last 12 months, 36.6% felt not being supported by her partner and 80.5% had never spoken with a physician about CAM. CONCLUSIONS: Infertile Turkish women use complementary medicine frequently for fertility enhancement and are in need of information about CAM. Religious and traditional therapies are used as an adjunct to, rather than a substitute for, conventional medical therapy. Physicians need to approach fertility patients with sensitivity and should be able to council their patients about CAM accordingly.

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels.

PURPOSE: To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction. METHODS: A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion and the second group consisted of 50 healthy babies of women who had received 25 µg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period. RESULTS: The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 ± 0.27 mg/dl versus 3.55 ± 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but was not significantly so [7.47 ± 0.63 mg/dl versus 6.86 ± 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 ± 1.23 and 58.04 ± 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 ± 1.27 and 58.96 ± 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance. CONCLUSIONS: Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.

Does residual amniotic fluid after preterm premature rupture of membranes have an effect on perinatal outcomes? 12 years experience of a tertiary care center.

OBJECTIVE: To review our experience with preterm premature rupture of membranes at a tertiary-care hospital in Turkey to determine whether the amount of residual amniotic fluid after rupture has prognostic value for adverse maternal and fetal outcomes. METHODS: We reviewed the medical records of 191 pregnant women with gestational ages between 24 and 34 weeks at the time of rupture of the amniotic membrane and of their babies delivered in our hospital between January 1996 and September 2008. On the basis of amniotic fluid index (AFI) values recorded at the time of admission, patients were categorized into two groups: those with an AFI < 50 mm (n = 119) and those with an AFI > 50 mm (n = 72). RESULTS: The patients with high gravidity (4-8) were more prevalent in the group with an AFI < 50 mm (37 vs. 23.6%), while nulliparous women were more common in the group with an AFI > 50 mm (44.4 vs. 30.2%) (P < 0.05). Seventy-two percent of the cesarean sections performed due to nonreassuring fetal status were in the group with an AFI < 50 mm (P < 0.01). In 71.4% of the cases with a 5 min Apgar score < or = 7, AFI was less than 50 mm (P < 0.01). AFI < 50 mm was present in 65, 70.8, 76.7, and 73.1% of the pregnancies complicated by chorioamnionitis, respiratory distress syndrome, composite neonatal morbidity, and neonatal death, respectively (P < 0.05). CONCLUSIONS: A residual AFI < 50 mm after preterm PROM between 24 and 34 weeks of gestation, which is mostly seen in grand multiparous women in Eastern Turkey, may be a valuable prognostic variable for anticipating adverse maternal and neonatal outcomes.

Short-term results of posterior intravaginal slingplasty in grade 4 uterine prolapse.

PURPOSE: The purpose of this study was to evaluate the short-term efficacy and complication rates of posterior intravaginal slingplasty (IVS) procedures. METHODS: Thirty-four patients who had advanced (grade 4) uterine prolapse were recruited. All patients underwent vaginal hysterectomy and the cuff was suspended with a posterior IVS operation. The mean follow-up duration was 12 months (range 3-20 months). RESULTS: Thirty-three patients (97.1%) had satisfactory level I support defined objectively as stage 0 or I for point C as described in the pelvic organ prolapse quantification system. There were no rectal, vesical, ureteric, or vascular injuries in this series. During the postoperative period no complications, including tape erosion, were seen. CONCLUSIONS: Posterior IVS is a minimally invasive procedure for grade 4 genital prolapse with a high success rate.

Brucellosis in pregnancy: a 6-year clinical analysis.

AIM: To review our experience with brucellosis in pregnancy and to characterize the risk factors, clinical presentations, the rates of possible perinatal complications, and the effect of hospitalization on pregnancy outcomes. METHODS: We reviewed the medical records of 21 pregnant women at a tertiary care hospital and 12 at a maternity hospital, who presented with acute, subacute, chronic, or relapsing brucellosis. Their risk factors and clinical presentations were defined. The reproductive outcomes of 29 cases were compared within themselves according to the hospitals they were managed and with the outcomes for all women followed in the maternity hospital for the period from January 2008 through December 2008. RESULTS: Consumption of unpasteurized dairy products had occurred in 92.3% of the cases. Spontaneous abortion, intrauterine fetal death, and preterm delivery rates were 24.14, 3.45, and 6.9%, respectively. Only spontaneous abortion rate substantially exceeded that among the general population of pregnant women in our maternity hospital (P<0.05). Hospitalization did not affect pregnancy outcomes significantly (P>0.05). CONCLUSIONS: Brucellosis in pregnancy is associated with increased incidence of spontaneous abortion without an association with the magnitude of serum agglutination titer, the clinical type of brucellosis and hospitalization. In endemic areas with inhabitants of low socioeconomic class and low educational level, educating women of childbearing age about brucellosis may help to prevent the disease and its complications in pregnancy.

Expression of laminin receptor 1 in gestational trophoblastic diseases and normal placenta and its relationship with the development of postmolar tumors.

OBJECTIVES: To investigate the expression of laminin receptor 1 (LR1), a non-integrin-type laminin receptor, in gestational trophoblastic diseases and normal first-trimester placenta, since it may play a role in controlling trophoblast invasion in normal and molar pregnancies. METHODS: Paraffin sections from 24 gestational age controlled normal first-trimester placentas, 47 partial moles, 56 complete moles, 3 invasive moles, 4 gestational choriocarcinomas, and 1 placental-site trophoblastic tumor were studied immunohistochemically for expression of LR1. RESULTS: In complete and partial moles, decidual cells showed significantly stronger LR1 protein staining compared to the normal placenta (p<0.01). When compared to the partial moles, weak staining in less than 33% of decidual cells was also more prominent in the normal placenta (p<0.05). Complete and partial moles, invasive moles, choriocarcinomas, and placental-site tumors did not differ from each other with respect to staining intensity. Strong immunostaining for LR1 in decidual cells, cytotrophoblasts, syncytiotrophoblasts, and extracellular matrix cells of partial and complete moles was not significantly correlated with the development of persistent postmolar gestational trophoblastic tumors. CONCLUSIONS: LR1 may be important in the pathogenesis of gestational trophoblastic diseases. The increased expression of LR1 in decidual cells of partial and complete moles may not influence the development of persistent gestational trophoblastic tumor. Since they are seen rarely, multicentric studies should be planned to study LR1 expression in invasive moles and gestational trophoblastic neoplasms.

Debulking surgery for incompletely operated advanced epithelial ovarian carcinoma.

BACKGROUND AND OBJECTIVES: There is still no any data about the role of re-operation and re-debulking in previously incompletely operated advanced staged patients with epithelial ovarian carcinoma (EOC). In this study, the authors aimed to analyze the effect of an incomplete primary surgery on patient prognosis. METHODS: Clinicopathological variables of 317 advanced staged EOC patients were retrospectively collected. RESULTS: Twenty-nine patients had an initial incomplete surgery and referred to our center for debulking while remaining 288 had undergone primary debulking surgery at our institution. Comparison of the two groups with respect to clinicopathological variables could not reveal significant difference. Median survival was 3.24 years for re-operated patients while it was 2.07 years for patients who had undergone primary debulking surgery. Upon multivariate analysis, final optimal debulking, tumor grade and a history of an incomplete surgery before the final debulking were the significant prognosticators. A subgroup analysis of re-staged patients could not reveal a significant role for either the type or the time interval between the operations. CONCLUSION: A history of an incomplete primary surgery does not seem to adversely affect patient prognosis and the optimal cytoreductive success achieved in final debulking surgery is still the most important prognostic factor.