The Impact of Underweight Status on the Prognosis of Ovarian Cancer Patients: A Meta-Analysis.

Malnutrition and underweight status pose an unfavorable prognosis for cancer patients. Several studies have addressed the impact of a low body mass index (BMI) (<18.5 kg/m(2)) on ovarian cancer progression. However, their results seem to be conflicting. The present meta-analysis investigates whether the underweight status negatively affects the progress of ovarian cancer. We conducted a systematic review searching the Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), and Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2014) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Statistical meta-analysis was performed using the RevMan 5.1 software. Current evidence suggests that the stage of the disease does not differ between underweight and normal-weight patients [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.46-1.39 for stage I; OR 1.27, 95% CI 0.71-2.27 for stage II; OR 1.03, 95% CI 0.71-1.51 for stage III; and OR 1.05, 95% CI 0.63-1.76 for stage IV disease]. Concurrently, the risk of residual disease after surgery (OR 1.03, 95% CI 0.69-1.52) and the risk of dying due to ovarian cancer (OR 1.08, 95% CI 0.64-1.85) seem to be similar. According to the findings of our systematic review, the underweight status does not seem to have a detrimental impact on ovarian cancer prognosis. However, the methodological limitations of published studies and the small number of enrolled underweight patients preclude firm results. Thus, future research in this field is necessary.

An evaluation of calprotectin as serum marker of preeclampsia: a systematic review of observational studies.

BACKGROUND: Calprotectin is calcium-binding protein which can be found in the cytosol of neutrophils. Several studies have studied its levels in preeclamptic women; however, to date there is no consensus regarding its effectiveness in the field. PURPOSE: To investigate whether serum calprotectin levels are elevated among preeclamptic women compared to healthy controls. MATERIALS AND METHODS: We used Medline (1966-2015), Scopus (2004-2015), ClinicalTrials.gov (2008-2015), Cochrane Central Register of Controlled Trials CENTRAL (1999-2015) and Google Scholar (2004-2015) search engines in our primary search, together with reference lists from included studies. RESULTS: Seven studies were finally included in our systematic review which recruited 439 women (245 with preeclampsia and 194 healthy controls). Their methodological quality was relatively high as they reached a score that ranged between 6 and 7 according to the Ottawa-Newcastle classification. All included studies reported that the serum calprotectin levels were significantly elevated among preeclamptic patients (p < 0.05). One study suggested that patients with severe preeclampsia have significantly higher levels of calprotectin than patients with mild preeclampsia (p = 0.01). However, to date there is no evidence regarding specific cut-off values which would help screen women for preeclampsia, or even follow the course of the disease. CONCLUSION: Current evidence suggests that serum calprotectin is significantly raised among women with preeclampsia during the third trimester. Future research is needed to reach firm conclusions regarding its use as a potential screening and surveillance marker during the pregnancy course of women at risk of developing preeclampsia.

Propranolol and oxytocin versus oxytocin alone for induction and augmentation of labor: a meta-analysis of randomized trials.

BACKGROUND: We sought to study the effect of propranolol co-administration with oxytocin during the latent and active phases of labor on labor outcomes. MATERIALS AND METHODS: We searched Medline, Scopus, ClinicalTrials.gov and Cochrane Central Register databases. The meta-analysis was performed with the RevMan 5.1 software. Six studies were included in the present meta-analysis which enrolled 609 parturient. RESULTS: According to the findings of our study, propranolol administration during the latent phase effectively reduces the cesarean section rates (OR 0.49, 95 % CI 0.27, 0.89). However, this beneficial effect is not observed during the active phase of labor. The 5 min neonatal Apgar scores are not influenced by its administration (MD -0.07, 95 % CI -0.017, 0.02). Respectively, the neonatal admissions to a NICU are similar to those of neonates exposed only to oxytocin (OR 0.96, 95 % CI 0.36, 2.53). CONCLUSION: Propranolol's effect on the duration of the various stages of labor was underreported, however, evidence seem to support that it shortens the latent phase and possibly the total duration of labor. Firm results are, however, precluded due to the low number enrolled parturient and due to the significant methodological heterogeneity of included studies.

Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials.

BACKGROUND: We investigated the impact of pulmonary recruitment maneuver in reducing shoulder pain after laparoscopic procedure. METHODS: We conducted a systematic review of the literature using Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), www.ClinicalTrials.gov (2008-2014), and Google Scholar (2004-2014) along with reference lists of electronically retrieved studies. Statistical meta-analysis was performed using the RevMan 5.1 software. RESULTS: Six studies were included in the present systematic review, involving 571 patients. Among them, 291 (51 %) were offered a pulmonary recruitment maneuver, and 280 patients (49 %) were treated with conventional evacuation of pneumoperitoneum that included either passive evacuation or gentle pressing of the abdominal walls with the trocar ports open. The introduction of a pulmonary recruitment maneuver significantly decreased postoperative shoulder pain 12 h (435 patients, REM, MD -1.55, 95 % CI -2.01, -1.10), 24 h (435 patients, REM, MD -1.59, 95 % CI -2.00, -1.18), and 48 h post-operatively (335 patients, REM, MD -0.93, 95 % CI -1.37, -0.50). We also identified evidence of a potential beneficial effect in the reduction of postoperative upper abdominal pain. However, discrepancies in the interpretation of abdominal pain among the included studies precluded meta-analysis of this index. CONCLUSIONS: According to the results of our meta-analysis, pulmonary recruitment maneuver seems to be an easily performed, potentially preventive measure of post-laparoscopic shoulder pain. Further research is mandated, however, in the field, because firm results are precluded by the small number of included studies.

Vaginal Misoprostol for Overcoming Inadequate Colposcopies: A Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: Inadequate colposcopic results due to inadequate visualization of the cervical transformation zone is a diagnostic problem that is encountered in approximately 10% to 15% of these procedures. The objective of the present systematic review and meta-analysis was to investigate whether misoprostol effectively converts inadequate colposcopic examinations to adequate. MATERIALS AND METHODS: We searched MEDLINE (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), CENTRAL (1999-2014), and Google Scholar (2004-2014) search engines along with reference lists of all electronically retrieved articles. For the meta-analysis of selected indices, we used the RevMan 5.2 program. RESULTS: Treatment with misoprostol significantly increases the rates of adequate colposcopic examinations (odds ratio [OR] = 6.78, 95% confidence interval [CI] = 2.94-15.61). Its principal adverse effect is abdominal pain (OR = 10.19, 95% CI = 2.19-47.45). Neither nausea (105 women, random effects model [REM], OR = 4.99, 95% CI = 0.54-45.71) nor fever (111 women, REM, OR = 3.90, 95% CI = 0.59-25.56) or diarrhea (111 women, REM, OR = 2.21, 95% CI = 0.49-10.00) was found increased among women receiving misoprostol. The conversion rates toward an adequate examination ranged between 55.5% and 78.9% in the misoprostol group. CONCLUSIONS: According to our meta-analysis, misoprostol seems to improve the conversion rates from inadequate colposcopic examinations to adequate diagnoses. However, firm results to generalize our findings among specific populations, such as those already having a previous conization, are precluded by the small number of enrolled studies. Thus, future research in the field becomes necessary.

The effect of vaginal lubrication on unsatisfactory results of cervical smears.

OBJECTIVE: Speculum lubrication with water-based gels before cervical smear sampling has been investigated and commented on thoroughly during the last decade. The present meta-analysis was based on randomized and quasi-randomized control trials and evaluated its impact on unsatisfactory cytologic results. We also assessed its efficacy in producing lower pain scores during speculum insertion. MATERIALS AND METHODS: We searched MEDLINE (1966- 2013), Scopus (2004-2013), Clinicaltrials.org (1997-2013), Popline (1973-2013), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2013), and Google Scholar (2004-2013) engines for published randomized control trials, as well as the reference lists from all the included studies. RESULTS: Five randomized trials and 2 quasi-randomized trials were included in the present review involving 8,717 women. Unsatisfactory results based on conventional cytology did not statistically differ among procedures performed with lubricated speculums and those without (odds ratio = 0.94, 95% CI = 0.64-1.37). Consequently, pain scores also did not differ significantly among the 2 groups (odds ratio = -0.37, 95% CI = -1.10 to 0.36). Only 2 studies evaluated unsatisfactory results on liquid-based cytology, precluding firm results. CONCLUSIONS: It seems that speculum lubrication does not interfere with the rates of unsatisfactory results when examination is based on conventional cytology. Conversely, however, the limited number of studies evaluating speculum lubrication on liquid-based cytology precludes firm conclusions.

Mammary gland epithelial changes in thyroidectomized female rats.

PURPOSE: Numerous clinical studies have addressed the relationship of hypothyroidism and breast cancer with conflicting results. In the present experimental study we sought to determine whether absolute hypothyroidism established for a long period of time leads to epithelial alterations of the mammary gland. METHODS: Thirty five female Wistar rats were allocated to be subjected to either thyroidectomy (N=20) or not (N=15). The rats were kept alive for a period of 3 months in a weather controlled environment. Serum T3, T4, follicular stimulating hormone (FSH) and estradiol levels were measured at baseline and 10 days after thyroidectomy. Mammary glands were obtained at the end of the experiment and reviewed by an expert pathologist. RESULTS: Both serum FSH and estradiol levels were lower 10 days after thyroidectomy; however, only FSH values were significantly lower in the thyroidectomized animals. Pathological analysis revealed significantly increased atrophy and periductal fibrosis of the mammary gland among thyroidectomized animals. CONCLUSION: This is the first in vivo experimental study that reveals an association between the thyroid and mammary glands. Future studies should address the proteomic relationship that connects them.

Fetal alcohol spectrum disorders and cognitive functions of young children.

Fetal alcohol spectrum disorder (FASD) is one of the main causes of mental retardation worldwide. Nearly 1% of children in North America are affected from antenatal exposure to ethanol. Its economic burden in industrialized countries is increasing. It is estimated that, in the United States, 4.0 billion dollars are annually expended in the treatment and rehabilitation of these patients. As a pathologic entity, they present with a broad symptomatology. Fetal alcohol syndrome (FAS) is the most readily recognized clinical manifestation of these disorders. Various factors seem to contribute in the pathogenesis of FASD-related cognitive disorders. During the last 20 years, several potential pretranslational and posttranslational factors have been extensively studied in various experimental animal models. Research has specifically focused on several neurotransmitters, insulin resistance, alterations of the hypothalamic-pituitary-adrenal (HPA) axis, abnormal glycosylation of several proteins, oxidative stress, nutritional antioxidants, and various epigenetic factors. The purpose of the present review is to summarize the clinical manifestations of this disorder during childhood and adolescence and to summarize the possible pathophysiologic and epigenetic pathways that have been implicated in the pathophysiology of FASD.

Analgesic options for placement of an intrauterine contraceptive: a meta-analysis.

OBJECTIVE: Several randomised controlled trials have been published in the last few years which evaluated the efficacy of various analgesics in reducing visual analogue (VAS) pain scores during intrauterine device (IUD) placement. Their results seem to be conflicting and inconclusive. METHODS: We searched Medline (1966-2013), Scopus (2004-2013), Clinicaltrials.org (1997-2013), Popline (1973-2013), Cochrane CENTRAL (1999-2013) and Google Scholar (2004-2013) engines for published randomised controlled trials, as well as the reference lists from all electronically retrieved studies. RESULTS: Thirteen studies, involving 1353 women, were finally included in the present meta-analysis. Among the products used, and with respect to their mode of delivery, only paracervical lidocaine was effective in producing lower VAS pain scores related to tenaculum placement (mean difference [MD]: - 20.54; 95% confidence interval [CI]: - 39.92, - 1.15) and IUD insertion (MD: - 28.99; 95% CI: - 53.14, - 4.84). Misoprostol produced higher VAS pain scores for the immediate post-insertion period (MD: 2.83; 95% CI: - 0.79, 6.45) and it caused various side effects. CONCLUSION: Paracervical administration of lidocaine prior to IUD insertion reduces VAS pain scores. In view of the small number of studies assessing its efficacy further studies should confirm our findings.

Hormone therapy for ovarian cancer survivors: systematic review and meta-analysis.

OBJECTIVE: Hormone therapy (HT) alleviates menopausal symptoms, but there is a lack of consensus regarding its use among premenopausal ovarian cancer survivors. METHODS: We systematically reviewed the literature and searched the Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), ClinicalTrials.gov (2008-2014), and Cochrane Central Register of Controlled Trials CENTRAL (1999-2014) databases and the reference lists of electronically retrieved studies. Statistical meta-analysis was performed using RevMan 5.1 software. RESULTS: Six studies were included in our systematic review, which involved 1,521 women. Among them, 451 women (29.6%) received HT, whereas the remaining 1,070 women (70.4%) did not receive any treatment. We noticed a statistically significant reduction of ovarian cancer-related deaths among women who received HT (odds ratio, 0.47; 95% CI, 0.28-0.80); however, disease recurrence rates did not differ between the two groups (odds ratio, 0.71; 95% CI, 0.45-1.14). Studies included in the present systematic review did not report a significant difference in overall survival and disease-free survival rates among women receiving HT and controls. CONCLUSIONS: Based on the results of meta-analysis, HT does not influence the odds of ovarian cancer recurrence; however, this conclusion must be confirmed separately because of significant limitations in the methodological quality of the studies included.

Systemic hypertension and diabetes mellitus as predictors of malignancy among women with endometrial polyps: a meta-analysis of observational studies.

OBJECTIVE: Diabetes mellitus (DM) and systemic hypertension (SH) are frequent benign diseases which might coexist with endometrial polyps. We sought to evaluate whether women who suffer from these diseases have an increased incidence of premalignant and malignant lesions. METHODS: We systematically searched the literature using the Medline (by using Pubmed) (1966-2015), Scopus (2004-2015), ClinicalTrials.gov (2008-2015), Cochrane Central Register (CENTRAL), and Google Scholar (2004-2015) databases along with the references of all articles which were retrieved in full text. We performed the meta-analysis with the RevMan 5.1 software. RESULTS: Both DM and SH seem to be correlated with increased odds of developing premalignant and malignant endometrial polyps (odds ratio 2.43, 95% confidence interval 1.51, 3.91) and (odds ratio 2.36, 95% confidence interval 1.16, 4.81). However, it remains unclear whether type I or type II DM exert a more pronounced effect and whether the severity of SH has an impact on these odds. Also, the potential relation of antidiabetic and antihypertensive treatment with these lesions cannot be excluded. CONCLUSIONS: Physicians should increase their awareness among women with endometrial polyps who suffer from DM and/or SH. Further studies are needed to corroborate our findings and elucidate the underlying mechanisms of this relation.

Diabetes mellitus and functional sperm characteristics: A meta-analysis of observational studies.

OBJECTIVE: Insulin resistance and diabetes mellitus (DM) are well defined causes of female infertility. Animal studies present evidence for decreased sperm quality, but conflicting results have been presented in clinically-orientated studies. We sought to evaluate whether DM affects functional sperm characteristics. STUDY DESIGN: We searched the Medline, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials databases. RESULTS: DM seems to decrease the seminal volume (MD -0.66ml, 95% CI -1.10, -0.22) and the percentage of motile cells (MD -14.29%, 95% CI -22.76, -5.82) and increase the FSH values (MD 0.47mIU/ml, 95% CI 0.01, 0.93) of men who were screened for infertility. It does not, however, influence the total sperm count (MD 13.16 106 cells, 95% CI -22.75, 49.07), the percentage of normal sperm morphology (-3.06%, 95% CI -6.25, 0.14), or LH (MD 0.65mIU/ml, 95% CI -0.84, 2.13 Supp. Fig. 2) and testosterone values (MD -0.18ng/ml, 95% CI -0.60, 0.24). CONCLUSION: Current evidence suggests that the presence of DM seems to influence functional sperm characteristics. Firm results are, however, precluded due to the significant heterogeneity of the included studies. Future prospective studies will clarify whether the DM affects semen quality and IVF outcome.

Oxytocin discontinuation after the active phase of labor is established.

Despite the widespread usage of oxytocin, there is still no consensus on its mode of administration. The scope of the present meta-analysis was to assess the effect of oxytocin discontinuation after the active phase of labor is established on maternal fetal and neonatal outcomes. We searched Medline, Scopus, Popline, ClinicalTrials.gov and Google Scholar databases. Eight studies were finally retrieved, which involved 1232 parturient. We observed significantly decreased rates of cesarean sections among parturient that discontinued oxytocin (OR 0.51, 95% CI 0.35, 0.74) as well as decreased rates of uterine hyperstimulation (OR 0.33, 95% CI 0.19, 0.58). Similarly, cases of non-reassuring fetal heart rates were fewer among women that did not receive oxytocin after the establishment of the active phase of labor (OR 0.63, 95% CI 0.41, 0.97). Keeping in mind the aforementioned maternal and neonatal adverse effects that seem to result from infusion of oxytocin until delivery, future practice should aim towards its discontinuation after the establishment of the active phase of labor, as it does not seem to influence the total duration of labor. Future studies should aim towards specific populations of parturient in order to clarify whether different approaches are needed.

Double versus single cervical cerclage for the prevention of preterm births.

OBJECTIVE: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes. METHODS: We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines. RESULTS: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34 weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28 weeks (645 cases, OR 0.43, 95% CI 0.26-0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37 weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82). CONCLUSIONS: It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies.

Electrosurgical bipolar vessel sealing during axillary lymphadenectomy: a systematic review and meta-analysis.

BACKGROUND: Various methods are currently used during axillary lymphadenectomy. Our systematic review aims to investigate the potential benefits of bipolar vessel sealing systems (EBVS) over conventional suture ligation during the axillary dissection of breast cancer patients. METHODS: We searched Medline (1966-2014), Scopus (2004-2014), Popline (1973-2014) Cochrane CENTRAL (1999-2014) and ClinicalTrials.gov (2000-2014) together with reference lists from included studies Statistical meta-analysis was performed using the RevMan 5.1 software. RESULTS: Four studies were finally included, involving 352 patients. Usage of EBVS significantly increased the number of retrieved axillary lymph nodes (MD 1.67 nodes, 95% CI 0.21, 3.13). Intraoperative times were not affected by these new technique, when compared to traditional suture ligation (MD -10.82 minutes, 95% CI -23.27, 2.70). Neither the volume of postoperative axillary drainage (MD -38.47 ml, 95% CI -110.26, 32.59) nor the duration of drainage (MD -0.49 days, 95% CI -1.23, 0.25) were significantly affected by EBVS application. We observed, however, that bipolar systems may be associated with an increased risk of postoperative seroma formation (OR 2.04, 95% CI 1.13, 3.70). CONCLUSION: Electrosurgical bipolar vessel sealing systems seem to increase the accuracy of axillary dissection and are equally safe compared to conventional suture ligation regarding intraoperative and postoperative blood loss. They are associated, however, with and increased incidence of seroma formation. Further randomized trials are needed in the field in order to obtain firm conclusions.

Botulinum toxin for the prevention and healing of wound scars: A systematic review of the literature.

BACKGROUND: Botulinum toxin injections have been investigated for the treatment or prevention of hypertrophic scars in several clinical studies. However, its clinical effectiveness has not yet been established. OBJECTIVE: To examine all available evidence that support the use of botulinum toxin injections for the treatment or prevention of hypertrophic scars in current clinical practice. METHODS: A systematic review searching the MEDLINE (1966 to 2014), Scopus (2004 to 2014), Popline (1974 to 2014), ClinicalTrials.gov (2008 to 2014) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999 to 2014) databases together with reference lists from included studies was conducted. RESULTS: Ten studies (255 patients) were included. Of these, 123 patients were injected with botulinum toxin type A, nine patients were offered botulinum toxin type B and the remaining 123 patients represented the control groups. Significantly improved cosmetic outcomes were observed among certain studies using the visual analogue scale (experimental group: median score 8.25 [range 6 to 10]) versus control group: median score 6.38 [range 2 to 9]; P<0.001) and the Stony Brook Scar Evaluation Scale (experimental group score: 6.7 versus control group score: 4.17; P<0.001) assessments. However, the methodological heterogeneity of the included studies, the lack of control group in the majority of them, the use of subjective scales of measurement and the frequent use of patient self-assessment precluded unbiased results. CONCLUSIONS: Current evidence does not support the usage of botulinum toxin. Future randomized controlled trials are needed in the field to reach firm conclusions regarding its place in current clinical practice.

HISTORIQUE: Plusieurs études cliniques ont porté sur la prévention et le traitement des cicatrices hypertrophiques grâce aux injections de toxine botulique, mais leur efficacité clinique n'a pas encore été démontrée. OBJECTIF: Examiner toutes les données probantes qui appuient l'utilisation d'injections de toxine botulique pour traiter ou prévenir les cicatrices hypertrophiques en pratique clinique. MÉTHODOLOGIE: Les chercheurs ont réalisé une analyse systématique des bases de données MEDLINE (1966 à 2014), Scopus (2004 à 2014), Popline (1974 à 2014), ClinicalTrials.gov (2008 à 2014) et Cochrane Central Register of Controlled Trials (CENTRAL) (1999 de 2014) ainsi que des listes de références des études retenues. RÉSULTATS: Les chercheurs ont retenu dix études, comptant un total de 255 patients. De ce nombre, 123 ont reçu une injection de toxine botulique de type A, neuf se sont fait offrir de la toxine botulique de type B et les 123 autres faisaient partie des groupes témoins. D'après l'échelle visuelle analogique, certaines études donnaient des résultats beaucoup plus esthétiques (groupe expérimental : score médian de 8,25 [plage de six à dix]) que ceux du groupe témoin : score médian de 6,38 [plage de deux à neuf]; P<0,001) et l'échelle Stony Brook d'évaluation des cicatrices (score du groupe expérimental : 6,7 par rapport à celui du groupe témoin : 4,17; P<0,001). Cependant, à cause de l'hétérogénéité méthodologique des études retenues, de l'absence de groupe témoin dans la majorité d'entre elles, de l'utilisation d'échelles de mesure subjectives et du recours fréquent à l'autoévaluation des patients, il était impossible d'éviter les résultats non biaisés. CONCLUSIONS: Les données probantes actuelles n'appuient pas l'utilisation de toxine botulique. D'autres essais aléatoires et contrôlés s'imposent pour établir hors de tout doute si elle a sa place en pratique clinique.

Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise?

OBJECTIVE: To investigate the incidence of gynecological malignancy in menopausal women who develop tubo-ovarian abscesses (TOAs), and to address the differences in presentation and underlying pathology between premenopausal and postmenopausal women with TOAs. STUDY DESIGN: In a retrospective study we included 93 patients with a diagnosis of a TOA and compared a premenopausal group (group 1) with a postmenopausal group (group 2). RESULTS: Group 1 included 76 (82%), and group 2 17 (18%) patients. Abdominal pain and pyrexia >38 degrees C were present in 93 and 74% cases of group 1, and in 71 and 41% cases of group 2 (P=0.016 and 0.019, respectively). Irregular vaginal bleeding and gross ascites were significantly more frequent in group 2. With respect to benign additional pathology we found no differences between the two groups. On the contrary a significant association between TOAs in menopause and malignancy was established. In 8 (47%) postmenopausal cases a concomitant gynecological malignancy was found including a variety of cancers. CONCLUSION: Postmenopausal women presenting with TOAs, should be thoroughly investigated to exclude a concomitant pelvic malignancy. Conservative treatment of TOAs has no place during the menopause.

First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis.

The rates of cesarean section at full cervical dilatation (second stage cesarean sections) are currently increasing. The purpose of the present study is to compare maternal and neonatal morbidity and mortality among cases offered cesarean section at full dilatation to those offered cesarean section prior to full dilatation. We searched Medline, Scopus, Clinicaltrials.org, Popline, Cochrane CENTRAL, and Google Scholar search engines, along with reference lists from all included studies. The RevMan 5.0 software was used for all analyses. Primary maternal outcomes were defined as death, ICU admission and need for transfusion, while primary neonatal outcomes were defined as death, neonatal unit admission and 5min Apgar score less than 7. Ten studies were finally retrieved involving 23,104 singleton childbearing women (18,160 operated in the first stage and 4944 in the second stage of labor). Second stage cesarean section seems to lead to higher maternal admissions to ICU (OR 7.41, 95% CI 2.47-22.5) and higher transfusion rates (OR 2.60, 95% CI 1.49-2.54). Neonatal death rates were also increased (OR 5.20, 95% CI 2.49-10.85) along with admissions to neonatal unit (OR 1.63, 95% CI 0.91-2.91) and rates of Apgar score less than 7 in 5min (OR 2.77, 95% CI 1.02-7.50). Second stage cesarean section seems to result significantly increased morbidity for both mothers and neonates. It seems that a direct evaluation with forceps and vacuum extractors is imperative in order to establish its place in modern evidence-based practice.