Human epididymis protein 4 and fetal lung maturity.

OBJECTIVES: To document the maternal and fetal cord blood levels of human epididymis protein 4 (HE-4) in term and preterm newborns in order to investigate the possible physiological role of HE-4 in fetal lung development. METHODS: This cross-sectional study was conducted in a university-affiliated hospital between April 2018 and September 2018. The study population consisted of cesarean section (C-section) deliveries after 24 weeks of pregnancy. Both maternal and umbilical cord HE-4 levels (mHE-4 and uHE-4, respectively) were measured using chemiluminescent microparticle immunoassay. Amniotic fluid was sampled from each case to determine the lamellar body count (LBC) as the gold standard test for lung maturation. All the parameters, including the uHE-4 levels, were compared between the term delivery (≥37 weeks) (n=52) and preterm delivery (24-37th weeks) (n=30) groups. The best cut-off value of uHE-4 was calculated for fetal lung maturity. RESULTS: There were no statistically significant differences between the groups regarding the demographic data. The mHE-4 levels did not statistically significantly differ between the groups (p>0.05) whereas the uHE-4 level of the preterm newborns was significantly higher than that of the term newborns (p<0.05). There was a significant negative association between the uHE-4 level and LBC (r=-0.389; p<0.001). The uHE-4 level was the only statistically significant fetal parameter indicating fetal lung maturity confirmed by LBC. At a cut-off value of 281 pmol/L, uHE-4 had 96.8% sensitivity, 45% specificity, 84.5% positive predictive value, and 81.8% negative predictive value for fetal lung maturity. CONCLUSIONS: Although the exact physiological role of HE-4 has not yet been elucidated, this preliminary study supports the idea that HE-4 plays a role in fetal lung maturation to some extent.

Can Variable Plasma Volume Alterations Affect the Efficiency of the First Trimester Screening Test?

BACKGROUND: The aim of this study was to assess the effect of plasma volume alteration determined by hematocrit on biochemical parameters of the first trimester screening test. METHODS: Enrolled in this study were 1,424 pregnant women in their first trimester who underwent a first trimester screening test. Fetal Nuchal Trancluciency measurement was obtained by ultrasonographic evaluation. Blood samples were taken for complete blood count, serum free ß-HCG, and PAPP-A between 11 and 14 weeks of gestation. The effect of plasma volume alteration on the screening test was evaluated. Mean corpuscular volume was used to rule out possible iron deficiency anemia. RESULTS: There were 59 women with combined risk > 1/270. Of these 59 women, there were 21 false positive results (1.5%). Serum Htc significantly predicted the false positive cases (AUC: 0.839, p < 0.001). The optimal cutoff value was obtained at a value of 30.2% with 85% sensitivity and 75% specificity. CONCLUSIONS: Our study suggests that the degree of plasma alterations may affect the serum levels of the biochemical components of the first trimester screening test for aneuploidy, thereby leading to false positive test results.

Comparison of Amniotic Fluid Cytokine Levels in Postterm and Term Pregnancy: a Prospective Study.

BACKGROUND: To evaluate amniotic fluid pro- and anti-inflammatory cytokine levels in women with postterm and term pregnancies in labor and not in labor. METHODS: The study involved three groups: postterm (Group 1, n = 29), term in labor (Group 2, n = 28), and control (Group 3, n = 30). All groups were compared with respect to age, gravidity, parity, obstetric history, gestation week, cervical dilatation and effacement, maternal serum C-reactive protein and white cell count, amniotic interleukin 4, 6, and 10 levels, birthweight, and cord blood pH. RESULTS: The amniotic fluid interleukin 10 level was 24.4 ± 8.8 pg/mL in the postterm group, 13.5 ± 5.1 pg/mL in the term in labor group, and 19.8 ± 5.4 pg/mL in the control group (p < 0.001). The amniotic fluid interleukin 4 level was 86.5 ± 57.7 pg/mL in the postterm group, 38.2 ± 29.2 pg/mL in the term in labor group, and 81.9 ± 68.4 pg/mL in the control group (p = 0.002). The amniotic fluid interleukin 6 level was 329 ± 135.1 pg/mL in the postterm group, 252.8 ± 138.7 pg/mL in the term in labor group, and 227.9 ± 114.4 pg/mL in the control group (p = 0.02). There was a positive correlation between gestational age and IL-10 levels (p < 0.05). CONCLUSIONS: Amniotic fluid IL-10 and IL-4 cytokine levels were increased in postterm pregnancy and they decreased with active labor.

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

Background/aim: This study aimed to evaluate the impact of body fat distribution measured by body mass index (BMI), waist circumference (WC) and Pfannenstiel incision site tissue thickness, and elastosonography on bleeding and operation time during cesarean delivery.Materials and methods: A prospective study was made of 52 healthy, term pregnant women with prior cesarean deliveries. The impact of BMI, WC, incision site thickness, and elastosonography on preoperative and postoperative differences in hemoglobin (Hb) and hematocrit (Htc) levels and operation times was evaluated.Results: A moderate negative relationship was found between Htc levels and WC. Htc levels were found to decrease by 0.148 units for each 1-cm increase in WC. Skin-to-fascia time was found to increase by 0.697 s with each 1-unit increase in BMI, whereas fascia-to-uterus time was found to increase by 1.117 s with each 1-cm increase in Pfannenstiel site tissue thickness. None of the elastosonographies or differences in Hb levels were found to be significant for any parameter.Conclusion: Each of the evaluated parameters was found to have an impact on different factors: WC on Htc levels, BMI on skin-to-fascia time, and Pfannenstiel tissue thickness on fascia-to-uterus time.

Waist Circumference as a Predictor of Failure of Sonographic Estimation of Fetal Birth Weight.

OBJECTIVE: Several factors may interfere with the success of fetal birth weight (BW) prediction. In this study we tried to determine the most probable factors that may lead to unsuccessful BW estimation. METHODS: 200 consecutive pregnancies between 34 and 41 weeks of gestation were enrolled for the study. All subjects underwent sonographic fetal BW estimation before membrane rupture or engagement of presented part. Sonography was performed by the same sonographer blinded to the study design. Failure of estimation was determined when deviation was found to be >15%. RESULTS: Both amniotic fluid index (AUC = 0.768, p < 0.001) and maternal waist circumference (AUC = 0.698, p = 0.004) were significant predictors for failure of estimation. Optimal cut-off values were 80 mm for amniotic fluid index (77% sensitivity, 65% specificity) and 105 cm for maternal waist circumference (70% sensitivity, 61% specificity). The number of pregnancies with anteriorly located placenta was significantly higher in the group with failed estimation (12/20 vs. 39/180, p = 0.001). CONCLUSION: Amniotic fluid volume, body mass index, maternal waist circumference and placental location may all cause failure of fetal weight estimation and may need to be adjusted. Moreover, our results indicate that waist circumference may be a more reliable predictor of failure of fetal weight estimation compared to body mass index.

To what extent do the presentation of fetus, amniotic fluid index and fetal weight at term affect the cardiac axis?

OBJECTIVE: To analyse the change in cardiac axis with advancing gestational age and the factors that may affect it. METHODS: 45 healthy pregnant women in 20th weeks of gestation were enrolled to the study. The cardiac axis was noted for each participant. The same group was once more assessed at term and the change in cardiac axis was calculated with the difference of cardiac axis at term and the 20th gestational weeks. Change in cardiac axis with advancing gestational weeks and factors that may affect it such as amniotic fluid index (AFI), estimated fetal weight (EFW) at term, actual birth weight and presentation of the fetus at term were evaluated. RESULTS: The median of ages was 28.0 (IQR=12.0)years within a range of 18-39years. The median of change in cardiac axis was 11.0 (IQR=9.0) degrees within a range of 3.0-47.0 degrees. The change in cardiac axis in regard to the fetal presenting part was 11.0 (IQR=8.0) degrees in vertex presentation and 23.50 (IQR=21.0) degrees in breech presentation. 81.1% of the variation in change in cardiac axis was found to be due to the actual birth weight and fetal presentation, with each 100g increase in actual birth weight leads to an increase of 0.375 degrees in cardiac axis. CONCLUSION: EFW at term, presentation of the fetus and the actual birth weight were all found to be significant in predicting the change in cardiac axis, but not AFI. These findings may have future potential value in evaluating electrocardiogram (ECG), especially of pregnants with extremes of left axis deviation (polyhydramnios, large fetus or breech presentation). Clinicians should be cautious during the interpretation of the ECG in pregnants, especially in those with extremes of left axis deviation because of either polyhydramnios, large fetus or breech presentation.

The Diagnostic Role of Vitamin D and Cathelicidin Levels in Pelvic Inflammatory Disease.

BACKGROUND: The aim of this study was to evaluate the effect of 25-hydroxyvitamin D [25(OH)D] and cathelicidin levels on pelvic inflammatory disease [PID] in reproductive aged women. METHODS: A total of 81 reproductive aged women, 43 with PID and 38 without PID, were included in the study. Five millilitres of venous blood were collected from subjects and controls for complete hemogram and serum for CRP, IL-6, 25(OH)D and cathelicidin. RESULTS: There were significant differences between the study group and the control group for 25(OH)D (study group, 47.3 ± 2.01 ng/mL, control group, 28.38 ± 1.35 ng/mL, p = 0.001), for cathelicidin (study group, 165.56 ± 65.92 ng/mL, control group, 10.34 ± 6.48 ng/mL, p = 0.001). There was a positive correlation between 25(OH)D, cathelicidin, and other markers (WBC, CRP, and IL-6). Receiver operator curve analysis showed that the best cutoff value for 25(OH)D was 34.25 ng/mL, sensitivity 88%, and specificity 89%, and for cathelicidin 15 ng/mL, sensitivity 91%, specificity 90%. CONCLUSIONS: 25(OH)D and cathelicidin can be used as acute phase reactants like conventional markers in PID. Future studies are needed to understand the roles of these molecules in both diagnosis and follow-up of infectious situations.

Relationship between the body iodine status and menopausal symptoms during postmenopausal period.

AIM: The aim of this study was to assess the effect of body iodine status on hot flashes and cardiovascular disease risk in postmenopausal women. METHODS: Two hundred and ten consecutive postmenopausal women without known any risk factor for cardiovascular disease risk or systemic disorder were recruited for the study. All participants underwent serum screening consisted of lipid profile including lipoprotein-a (Lp(a)) and urinary iodine excretion. Participants were also asked for the frequency and the duration of hot flashes. All parameters were assessed for the association between urine iodine excretion and other parameters. RESULTS: Urine spot iodine level was significantly correlated with Lp(a) (r = -0.287, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = -0.187, p = 0.006), cholesterol level (r = -0.573, p < 0.001), TG level (r = -0.211, p = 0.02), frequency of hot flashes per a day (r = -0.467, p < 0.001), durations of hot flashes (r = -0.424, p < 0.001), fasting glucose level (r = 0.331, p < 0.001), and fT3 level (r = 0.475, p < 0.001). In multivariate analysis, Lp(a) levels were significantly associated with the urine iodine level (beta coefficient = -0.342, p < 0.001) after adjustment for LDL-C (beta coefficient = 0.225, p < 0.001), glucose (beta coefficient = 0.303, p < 0.001), and age (beta coefficient = 0.146, p < 0.017). CONCLUSION: Body iodine status during postmenopausal period is associated with the menopausal symptoms and lipid profile including Lp(a).

Do we need readjustment of the biochemical parameters in first trimester combined aneuploidy screening test in women with polycystic ovary syndrome?

OBJECTIVE: The aim of this study was to determine whether polycystic ovary syndrome (PCOS) affects the biochemical components of first trimester combined aneuploidy screening test. METHOD: A case-control study was performed at a tertiary referral hospital between years 2007-2013. Singleton pregnancies in the first trimester (11(+0) -13(+6) week) who had a history of PCOS and underwent first trimester combined aneuploidy screening test were included in the study. Three hundred and seventeen women met the criteria for inclusion. Control group was formed by 942 healthy pregnant women with similar gestational and maternal ages using a 1 : 3 ratio. Pregnancy-associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (fß-hCG) and fetal nuchal translucency were compared between the study group and the controls. RESULTS: The biochemical components PAPP-A and fß-hCG were significantly lower in the PCOS group compared with the control group (p = 0.001). There was no difference among groups with regard to the nuchal translucency measurements (p = 0.128). CONCLUSION: Our study shows that the levels of biochemical components of first trimester combined aneuploidy screening test (PAPP-A and fß-hCG) are altered in pregnant women with PCOS. Future trials of larger scale are needed to asses any need for readjustment of the risk in the patient population with PCOS.

Comparison of sublingual misoprostol with lidocaine spray for pain relief in office hysteroscopy: a randomized, double-blind, placebo-controlled trial.

STUDY OBJECTIVE: To compare the effectiveness of sublingual misoprostol with lidocaine pump spray for office hysteroscopy. DESIGN: Premenopausal women who had an indication for office hysteroscopy were included in this randomized, double-blind, placebo-controlled study. Eighty-two patients were evaluable for the final analysis. SETTING: A tertiary referral center. PATIENTS: Premenopausal women who had an indication for office hysteroscopy were included. Eighty-two patients were evaluable for the final analysis. INTERVENTIONS: Patients were randomized to receive either sublingual misoprostol and placebo of lidocaine or lidocaine pump spray applied to the cervix and placebo of misoprostol. MEASUREMENTS AND MAIN RESULTS: When compared with the lidocaine group, patients in the misoprostol group reported less pain by the immediate visual analog scale scores (2.2 ± 0.98 vs. 2.6 ± 0.99, p = .030), whereas visual analog scale scores at 10 minutes were similar between groups (2.1 ± 0.98 vs. 2.36 ± 1.06, p = .156). CONCLUSION: Sublingual misoprostol is more effective than lidocaine spray in pain reduction during office hysteroscopy. Misoprostol may cause vaginal spotting, which may impair the vision during hysteroscopy especially just after the menstrual period. Preventive measures should be taken to make the procedure pain free because the physician may underestimate pain perception during the procedure.

Is hyperandrogenemia protective for fibrocystic breast disease in PCOS?

The aim of this study is to evaluate the fibrocystic breast disease rates and its association with different clinical, endocrine and metabolic parameters between main polycystic ovary syndrome (PCOS) phenotypes. One hundred thirty two consecutive women were included in the study. Body mass index, serum follicle-stimulating hormone, luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulphate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein, insulin, insulin sensitivity and fibrocystic breast disease rates were compared among different phenotypes of PCOS. Group 1: Polycystic ovaries (PCO)-anovulation (n = 32), Group 2: Hyperandrogenemia (HA)-anovulation (n = 28), Group 3: HA-PCO (n = 29), Group 4: HA-PCO-anovulation (n = 43). There were statistically significant differences between the different phenotype groups in terms of waist-hip ratio (p = 0.006), serum LDL-C (p = 0.008), LH (p = 0.002), estradiol (p = 0.022), fasting glucose (p = 0.001), progesterone (p = 0.007), free testosterone levels (p < 0.001) and Ferriman-Gallwey (FG) scores (p < 0.001). Different phenotype groups had significantly different fibrocystic breast disease rates. (p = 0.016). Higher free testosterone >3 pg/dl was protective for fibrocystic disease (RR = 0.316, 95:% CI 0.109-0.912, p = 0.033). Higher FG scores were more protective for fibrocystic disease (RR = 0.005, 95:% CI 0.001-0.042, p < 0.001). Group 3 ovulatory PCOS patients with PCO and hyperandrogenemia phenotype had lower risk to develop fibrocystic disease, while higher rates were observed in group 1 anovulatory-normoandrogenemic PCOS patients. Hyperandrogenemia is protective for fibrocystic diseases in PCOS.

Ovarian gonadoblastoma with dysgerminoma in a 15-year-old girl with 46, XX karyotype: case report and review of the literature.

OBJECTIVE: To present a challenging case of hCG positivity in a young patient and to review similar cases reported in the literature. METHODS: Literature search of gonadoblastoma cases with pure 46, XX karyotype using PubMed database. RESULTS: A 15-year-old girl with hCG positivity was investigated for the source and the initial diagnosis was an ectopic pregnancy. An ovarian tumor was identified after failed methotrexate therapy and the pathological diagnosis was gonadoblastoma with dysgerminoma. To the best of our knowledge, the case was unique in the literature for having the smallest diameter of a gonadoblastoma tumor with 46, XX karyotype. CONCLUSION: Differential diagnosis of perimenarcheal vaginal bleeding may be challenging for the clinician. Rare causes such as pregnancy both intrauterine and extrauterine and hormone producing tumors should be kept in mind.

Clamping compared to cauterization for subcutaneous hemostasis in Pfannenstiel incision.

We compared subcutaneous clamping and cauterization for hemostasis at laparotomy with Pfannenstiel incision with reference to surgical site infection, postoperative fever and time taken for incision. A total of 214 patients with consecutive hysterectomies were alternately assigned to incisional hemostasis by clamping (n= 107) or cauterization (n= 107). The groups were similar in terms of age, gravidity, parity, body mass index, uterine size and mean hemoglobin drop. Rates of surgical site infection, postoperative fever and time from skin incision to peritoneal cavity entry were significantly higher in the group with cauterization (p < 0.05).

Mediterranean climate is associated with early age at menopause and low high-density lipoprotein in postmenopausal women.

OBJECTIVE: The aim of this study was to investigate the effect of three different climates on age at menopause and metabolic factors in postmenopausal women. METHODS: Study population consisted of 232 postmenopausal women with natural menopause who admitted to Dr. Sami Ulus Maternity and Women's Health Teaching and Research Hospital Menopause outpatient clinic for routine check up. Participants were divided into three groups according to climate where they had lived during reproductive span. Black Sea, Mediterranean, and continental climate effects on age at menopause and metabolic factors were investigated. RESULTS: Postmenopausal women living in three different climates were significantly different according to body mass index, gravidity, age at menopause, menarche, and high-density lipoprotein (HDL) (p < 0.05). The lowest mean age at menopause and HDL levels were observed in women living in Mediterranean climate. Adjusted mean age at menopause remained significant (p < 0.05). CONCLUSION: Mediterranean climate is associated with early menopause and low HDL levels.

Hysterectomy for large symptomatic myomas: minilaparotomy versus midline vertical incision.

OBJECTIVE: The aim of this study was to analyze the perioperative outcomes of laparotomy with conventional midline incision and minilaparotomy in patients with large myomas, in a prospective and randomized manner. STUDY DESIGN: From January 2005 to January 2009, 205 consecutive hysterectomies for large symptomatic myomas had been performed by abdominal approach. Patients were randomly assigned to minilaparotomy or midline incision. RESULTS: Groups were compared and found to be similar in terms of age, gravida, parity, body mass index, uterine size, operative time and intraoperative hemorrhage volume. Length of hospital stay, rate of surgical site infection and postoperative fever were significantly higher in the conventional laparotomy group with midline incision. CONCLUSION: Minilaparotomy is an applicable procedure in hysterectomy for large myomas in the majority of women, resulting in decreased length of hospital stay and complication rates.

Vitamin D deficiency in adolescent pregnancy and obstetric outcomes.

OBJECTIVE: The aim of this study was to evaluate the rates of vitamin D deficiency in adolescent pregnants and its influence on the obstetric outcomes. MATERIALS AND METHODS: A total of 300 singleton pregnant women aged between 14 and 20 years, were divided into three groups according to their gestational weeks (100 pregnant adolescents from each trimester). Randomly selected 300 singleton pregnant women older than 20 years of age with the similar gestational ages were designed as the control group at the same time period. We divided serum 25(OH)D levels into three categories deficiency, inadequacy and adequate levels according to the Endocrine Society guidelines. Serum 25(OH)D levels were also evaluated according to age, seasons and gestational periods. Adverse obstetric outcomes were recorded. RESULTS: Overall, 86% of the subjects were found to have deficient 25(OH)D levels (<20 ng/ml). The levels indicated an inadequate state in 72 subjects (12%) and only 12 (2%) women had adequate 25 (OH) D levels. Among adult pregnant women the rates of deficient, inadequate and adequate levels were 88.3%, 11%, and 0.7% respectively. Among adolescent pregnant women these rates were 83.7%, 13%, and 3.3% respectively. The lowest 25(OH)D levels occurred during the winter while the highest levels were detected during the summer in both groups. Calcidiol, 25(OH)D, was a significant predictor for preterm delivery (AUC = 0,909; p < 0,001) and also for SGA (AUC = 0,915; p < 0,001). Maternal age was another significant predictor for SGA (AUC = 0,787; p < 0,001) and preterm delivery (AUC = 0,785; p < 0,001). CONCLUSION: We found a high incidence of 25(OH)D deficiency in Turkish pregnant women. Adolescent age and low 25(OH)D levels are significant risk factors for PTD and SGA. Effective prophylaxis programs for vitamin D deficieny and/or fortification of foods with vitamin D are essential in pregnant women especially in the winter season.

MaFOS-GDM trial: Maternal fish oil supplementation in women with gestational diabetes and cord blood DNA methylation at insulin like growth factor-1 (IGF-1) gene.

BACKGROUND: To evaluate the effects of maternal fish oil supplementation in women with gestational diabetes mellitus (GDM) on birthweight and DNA methylation at insulin like growth factor-1 (IGF-1) gene in their offspring. METHODS: Randomized controlled trial. A total of 120 women with GDM were randomized to one of the two groups between 24 and 28 weeks of the pregnancy: Group 1 (n = 52) received fish oil liquid softgel (Ocean plus®) and Group 2 (Placebo) (n = 68) sunflower oil liquid softgel. The birthweight and DNA methylation at IGF-1 gene of the offsprings were assessed. RESULTS: We observed a significant inverse association between fish oil use during pregnancy and birthweight (ß = -0.18, s.e.:125, P = .04), corresponding to a 250 g lower birthweight among infants born to fish oil users. This association didn't persist in multivariate analysis. Cord blood IGF-1 was lower in fish oil group (P = .001). Cord blood DNA methylation percentages at CpG-1044 and CpG-611 sites of IGF-1 gene promoter 1 (P1) region were higher in fish oil group compared to placebo group (P = .02 and P = .001, respectively). However, CpG-1044 and CpG-611 methylations were not associated to birthweight (ß = 0.04, s.e: 25.1, P = .66 and ß = 0.04, s.e: 22.7, P = 0.66, respectively). CONCLUSIONS: Maternal fish oil use has small effects on birthweight and DNA methylation when given to mothers with GDM at late pregnancy. Future studies are needed to show associations between maternal fish oil use and neonatal DNA methylations. CLINICAL TRIAL REGISTRATION: "Fish Oil Supplementation in Women with Gestational Diabetes". IDENTIFIER: NCT02371343.

Relationship between anemia and depressive mood in the last trimester of pregnancy.

OBJECTIVE: To compare the relationship between the severity of anemia and depressive mood in the last trimester of pregnancy. METHODS: A cross-sectional study, enrolled a total of 450 pregnant women who attended the antenatal clinics in their third trimester for their routine antenatal follow-up. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. The study group was divided into two groups according to presence of anemia; anemic group (Hb < 11 gr/L; n = 150) and non-anemic group (Hb ≥ 11 gr/L; n = 300) and depression scores were compared. RESULTS: One hundred and fourteen (25.3%) women scored ≥13 points which were considered the cutoff value for depression on the EPDS. Anemia frequency was found as 33.3%. The total EPDS score was significantly higher in the anemic group (EPDS score 11 [min-max 0-29]) compared with the non-anemic group (EPDS score 7 [min-max 0-21]) (p = 0.000). Multiple regression analysis also revealed that serum Hb level was an independent factor for antenatal depressive mood. CONCLUSIONS: As anemia is associated with higher depressive symptom levels, it should be carefully considered during pregnancy. Prospective studies are needed to confirm our results.

Comparison of elastosonography and digital examination of cervix for consistency to predict successful vaginal delivery after induction of labor with oxytocin.

OBJECTIVE: To compare elastosonography and digital examination of cervix for consistency in the prediction of successful vaginal delivery. METHODS: A total of 64 pregnant women with the indication of induction of labor (IOL) were enrolled to the study. The uterine cervix is evaluated before and after the IOL with elastosonography and digital examination for consistency and sonography for length. Methods were compared in regard to the prediction of successful vaginal delivery. RESULTS: The median of gestational age was 41.00 (IQR = 2.32). Out of 64 participants, 40 (62.5%) had vaginal delivery and 24 (37.5%) had cesarean delivery. The preinduction and postinduction elastosonographic indices were insignificant in delivery groups. The preinduction and postinduction evaluations of cervical consistency with digital examination were significant within vaginal delivery group (p = 0.046), whereas it was insignificant within cesarean delivery group and between the delivery groups. The preinduction and postinduction Bishop scores were significant within vaginal delivery group (p = 0.005), whereas it was insignificant within cesarean delivery group and between the delivery groups. Postinduction Bishop score was significant between the delivery groups. CONCLUSION: Evaluation of cervix for consistency with either elastosonography or digital examination was found to be insignificant in prediction of successful vaginal delivery after IOL with oxytocin.

Early initiation and exclusive breastfeeding: Factors influencing the attitudes of mothers who gave birth in a baby-friendly hospital.

OBJECTIVE: To investigate the initation time of breastfeeding, exclusive breastfeeding rates, and complementary feeding practices during the first six months of life among mothers who gave birth in a baby-friendly hospital. MATERIALS AND METHODS: A cross-sectional study was conducted with 350 mothers. Demographic characteristics, obstetric history and information about breastfeeding initiation were collected at the hospital. Information about factors affecting breastfeeding duration and feeding practices of the infants were obtained at the end of six months. RESULTS: Some 97.4% of the mothers initiated breastfeeding, 60.1% within the first hour. Exclusive breastfeeding was maintained for six months in 38.9%. Low education levels of mother/father, random breastfeeding, rare breastfeeding at night, nipple problems, bottle/pacifier use, and lack of social support were found associated with early cessation. Planned pregnancy [odds ratio (OR=2.02)] and vaginal delivery (OR=0.3) were found as the most important factors in early initiation, whereas antepartum breastfeeding education (OR=7.17) was the most important factor for exclusive breastfeeding duration in the logistic analysis. More than half (61.1%) of the infants were partially/bottle fed for six months; the most common reason was the belief that breast milk was insufficient. CONCLUSION: Efforts to encourage mothers and society to breastfeed exclusively should be made as part of a primary public health strategy to prevent early cessation of breastfeeding.