Prediction of Mid-Urethral Sling Failure with Clinical Findings and Urodynamics.

OBJECTIVE: Mid-urethral slings (MUS) become a standard, minimally invasive surgery to treat urinary stress incontinence. Our aim is to investigate the contribution of preoperative urodynamics to mid-urethral slings success and determine predictors for choosing mid-urethral sling route. METHODS: Women with stress urinary incontinence and who desired surgical correction of their incontinence were included in the study. The selection of the procedure was according to an algorithm used in an institution. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. RESULTS: A total of 159 patients in the tension free transvaginal tape (TVT) group and 83 patients in the transobturator tape (TOT) group were included in the present study. Urodynamic findings of subjects who were considered MUS failure were not significantly different from those women who were continent after 1 year of surgery. Detrusor overactivity was present on urodynamics in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). A vaginal hysterectomy had been performed on 13 of 37 (35.1%) subjects with MUS failure 1 year after operation, and 20 of 205 subjects (9.8%) in the stress urinary incontinence (SUI) continent group (P < 0.001). CONCLUSIONS: Preoperative detrusor overactivity (DO) was the only urodynamic finding that negatively affected the success of surgery in both TOT and TVT groups. Our study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse.

Partial HELLP syndrome: maternal, perinatal, subsequent pregnancy and long-term maternal outcomes.

AIMS: Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, in its complete form, is associated with increased risk of maternal mortality and increased rate of serious obstetric complications, such as acute renal failure, hepatic failure, abruptio placentae, pulmonary edema, sepsis, hemorrhage and disseminated intravascular coagulopathy. To compare maternal and perinatal outcomes, we investigated the subsequent pregnancy outcomes and long-term complications of women with partial HELLP (pHELLP) and complete HELLP (cHELLP) syndromes. MATERIAL AND METHODS: In this retrospective study, patients complicated with HELLP between the years 2002 and 2007 were analyzed. cHELLP syndrome was defined by the presence of all of the three laboratory criteria according to the Tennessee Classification System. pHELLP syndrome was defined by the presence of one or two features of HELLP, but not the complete form. RESULTS: Sixty-four patients had cHELLP syndrome and 67 had pHELLP syndrome. Maternal complications and neonatal outcomes of the indexed pregnancies were similar. The rate of blood product transfusion was significantly higher in the cHELLP group (P<0.0001). Twenty-eight patients within the cHELLP group and 26 within the pHELLP group had subsequent pregnancies with a mean interpregnancy interval of 2.9 ± 1.5 years and 2.4 ± 1.1 years, respectively. Elective termination of pregnancy (dilatation and curettage) was more frequent in the cHELLP group. Pre-eclampsia recurrence was higher in the pHELLP group than in the cHELLP group (7.1% vs 34.6%). CONCLUSIONS: Partial and complete HELLP syndrome are not distinct groups based on neonatal, long-term and subsequent pregnancy outcomes. They probably represent a continuum in the natural evolution of the same disease.

Effect of Nigella sativa oil on postoperative peritoneal adhesion formation.

AIM: We aim to evaluate the effect of Nigella sativa oil (NSO) on postoperative peritoneal adhesion formation in female rats. This experimental study is the first on the prevention of postoperative adhesion formation by NSO. METHODS: Twenty-four Wistar albino female rats were randomly assigned to three groups of eight rats each. Rats in group 1 were each injected i.p. with 1 mL of NSO. In group 2, an adhesion model was created with no injection of NSO. In group 3, an adhesion model was created and the area was covered with 1 mL of NSO. The rats were killed on postoperative day 8, and the severity of adhesions was evaluated macroscopically and histopathologically. RESULTS: There was a statistically significant difference in adhesion scores between group 2 (control) and group 3 (NSO-treated) (P = 0.003). Statistically significant differences in angiogenesis, fibrosis and inflammation were observed between the control and Nigella sativa groups (P = 0.002, P = 0.001 and P = 0.004, respectively). CONCLUSION: Covering peritoneal surfaces with NSO after peritoneal trauma is effective in decreasing peritoneal adhesion formation.

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre.

OBJECTIVE: We reviewed the data of the termination of pregnancy (TOP) cases between 2002 and 2010 to evaluate the changes in fetal indications for both early and late TOPs in this period. MATERIAL AND METHODS: The data of 962 TOP cases were analysed in two groups according to the periods as in 2002-2006 and 2007-2010. The women were also subdivided into two categories according to their gestational age; <23 weeks' gestation (early termination) and ≥23 weeks' gestation (late termination). RESULTS: Four hundred and fifty-eight (47.6%) of TOPs were performed between 2002 and 2006 (Group 1) and 504 (52.3%) were performed between 2007 and 2010 (Group 2). The number of early (<23 weeks) and late (≥23 weeks) terminations were 583 (60.6%) and 379 (39.3%), respectively. The vast majority of anomalies were central nervous sytem malformations (51.8%). They were followed by multiple anomalies (10.2%) and chromosomal anomalies (9.4%). Chromosomal and cardiovascular system anomalies were significantly higher in 2007-2010 in comparison to 2002-2006 (p<0.0001 and p=0.002, respectively). There was no statistically significant difference between the fetal indications that led to early termination compared to those that led to late termination. CONCLUSION: The distribution of indications for TOP was influenced by the development in prenatal screening policy, resulting in a significant increase in terminations due to chromosomal and cardiovascular system anomalies. Cultural, educational, religious and legal factors cause differences in the indications for TOP as well as the gestational age that TOPS are performed.

Prediction of metabolic syndrome in women with polycystic ovary syndrome.

OBJECTIVE: To identify biochemical factors that serve as predictors for the metabolic syndrome (MetS) in patients with polycystic ovary syndrome (PCOS) and to investigate the value of adipocytokines in the prediction of metabolic syndrome. MATERIAL AND METHODS: A total of 91 pre-menopausal women with PCOS diagnosed according to the Rotterdam consensus criteria were recruited as study subjects. Waist circumference, blood pressure, body mass index (BMI), fasting glucose, serum lipids, insulin, FSH, LH, E2, total testosteron, homeostatic model assessment-insulin resistance (HOMA-IR), serum leptin and adiponectin levels were evaluated for all patients. RESULTS: Of the 91 women with PCOS, 15 patients met the criteria for MetS. Body weight, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, triglyceride, and VLDL concentrations were significantly higher and HDL was significantly lower in women with PCOS+MetS compared with those with PCOS only. However, the level of LDL, FSH, LH, E2 and total testesterone was not significantly different between these two groups. Women with PCOS+MetS had significantly higher levels of leptin and HOMA-IR, and significantly lower levels of adiponectin compared to the women with PCOS only. In the multiple logistic regression model, the association between HOMA-IR and leptin, and MetS remained statistically significant (p=0.001 and 0.018), while the association between adiponectin and MetS was no longer statistically significant. CONCLUSION: Aside from the biochemical markers such as glucose, cholesterol and triglyceride, adipose tissue factors and insulin resistance are valuable parameters in the prediction of MetS in patients with PCOS.

Iniencephaly: Prenatal diagnosis with postmortem findings.

Iniencephaly is a rare but almost always lethal neural tube defect with the following cardinal features: occipital bone defect, partial or total absence of cervicothoracal vertebrae and fetal retroflexion. Iniencephaly is associated with malformations of the central nervous system, gastrointestinal and cardiovascular system. Prenatally diagnosed cases of iniencephaly are rare because careful and early ultrasonographic evaluation is necessary. The present cases of iniencephaly were found to carry associated malformations such as atrioventricular septal defect and club foot. We present an iniencephaly prenatally diagnosed by sonography, in which therapeutic abortion was induced, with a review of the published literature.