Prospective randomized trial of oxytocin administration for active management of the third stage of labor.

OBJECTIVE: To determine the most efficient route and timing of oxytocin administration for active management of the third stage of labor. METHODS: A prospective randomized study was done at one center in Ankara, Turkey, between January and October 2010. Women with a singleton pregnancy (>37 weeks) who had a live vaginal birth were randomly allocated to four groups: iv-A (intravenous oxytocin after delivery of the fetus), iv-B (when anterior shoulder seen), im-A (intramuscular oxytocin after delivery), and im-B (when anterior shoulder seen). Postpartum blood loss within the first hour, hemoglobin, hematocrit, and duration of the third stage were compared. RESULTS: A total of 600 eligible women were recruited; 150 were assigned to each group. Postpartum blood loss, prepartum and postpartum hemoglobin and hematocrit, and need for additional uterotonics were similar among groups (P>0.05). The duration of the third stage of labor and changes in hemoglobin and hematocrit were significantly reduced in group iv-B (P<0.05). Among women not exposed to oxytocin before delivery, postpartum blood loss was significantly lower in group iv-B (P=0.019). Labor augmentation was related to significantly increased postpartum blood loss in all groups except iv-A. CONCLUSION: Although postpartum blood loss was similar in all groups, early intravenous administration seemed to have beneficial effects. ClinicalTrials.gov: NCT01954186.

Insulin resistance and its relationship with high molecular weight adiponectin in adolescents with polycystic ovary syndrome and a maternal history of polycystic ovary syndrome.

OBJECTIVE: To assess the rate of insulin resistance (IR) and the relationship between IR and high molecular weight (HMW) adiponectin in normal weight adolescents with polycystic ovary syndrome (PCOS) and a maternal history of PCOS. DESIGN: Case-controlled study. SETTING: Adolescent clinic of a teaching and research hospital. PATIENT(S): Forty normal weight adolescents with PCOS and a maternal history of PCOS and 40 normo-ovulatory age- and body mass index (BMI)-matched controls. INTERVENTION(S): A 75-g oral glucose tolerance test (OGTT) was performed for each participant. MAIN OUTCOME MEASURE(S): Homeostasis model assessment of IR and HMW adiponectin. RESULT(S): There were no statistically significant differences between the PCOS and control groups in terms of fasting glucose, fasting insulin, and lipid parameters. Although total and free T were significantly higher, HMW adiponectin levels were significantly lower in the PCOS group compared with the control group. When the PCOS group was compared according to the IR, the HMW adiponectin level was significantly lower in the adolescents with PCOS and IR. The adolescents with PCOS and biochemical hyperandrogenemia had significantly lower HMW adiponectin levels and significantly higher homeostasis model assessment of IR score compared with the adolescents with PCOS and normoandrogenemia. CONCLUSION(S): The adolescents with PCOS had a significantly increased rate of IR without clinical findings of metabolic disorders or obesity. The HMW adiponectin levels were negatively correlated with IR.

Fetal tyhmus size as a predictor of histological chorioamnionitis in preterm premature rupture of membranes.

OBJECTIVE: To predict histological chorioamnionitis (CA) in the cases of preterm premature rupture of membranes by using fetal thymus transverse and anteroposterior diameters and areal measurements. METHODS: Fifty healthy and 50 patients diagnosed with preterm premature rupture of membranes (PPROM) between 24 and 37 weeks of gestation were included in the study. Fetal thymus measurements were done and repeated on a weekly basis until delivery, Furthermore white blood cell, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured every other day until delivery, too. Following delivery, all patients' placentas were sent to pathology. RESULTS: Histological CA was detected in 48% of the PPROM patients. There were no patients in either group with clinical CA. Thymus transverse diameter had 91% sensitivity, 81% specificity, 82% PPV, and 91% NPV in predicting histological CA in PPROM patients. No linear relationship was found between thymus anteroposterior diameter measurements and gestational age. Thymus area measurements have sensitivity of 75%, specificity of 81%, PPV of 78%, NPV of78% in determining CA in patients with PPROM. CONCLUSION: Both thymus transverse diameter and area measurement are more significant than sedimentation and CRP values in predicting histological CA. Fetal thymus measurements can be used in early diagnosis of infections among high risk patients.