How does the ERAS protocol work in patients who underwent cesarean section? (HERMES study).

OBJECTIVE: To assess the effect of the enhanced recovery after surgery (ERAS) protocol for cesarean deliveries (CD) on postoperative outcomes. METHODS: This multicenter prospective cohort study was conducted in six different centers between September 2020 and March 2021 and involved women who underwent either planned or unplanned CD. The primary outcome was time to the first passage of flatus following CD. Secondary outcomes included postoperative pain score, postoperative complications, and patient satisfaction. The protocol included early postoperative oral intake of ice cream and coffee, multimodal analgesia, antiemetic medications, and early ambulation. RESULTS: A total of 448 patients were included. The median time to the first passage of flatus was 10 h in the Hermes group and 18 hours in the control group (P < 0.001). Postoperative visual analog scale scores were significantly higher in the control group. Patient satisfaction scores and the frequency of postoperative complications did not differ between the groups (P = 0.08, P = 0.604, respectively). CONCLUSIONS: The ERAS protocol, including early serving of ice cream and coffee in the early postoperative period, enabled early discharge and a faster return of bowel function. Implementation of the ERAS protocol for patients who underwent planned and unplanned CD appeared to be safe and effective.

EROSS study: effect of ovarian reserve on sexual satisfaction.

TRIAL REGISTRATION NUMBER: NCT04776902 Clinical Trials.

Does the presence of endometriosis cause a challenge for transvaginal oocyte retrieval? A comparison between patients with and without endometriosis

Objective: The aim of the study was to compare patients with and without endometriosis regarding performance rates, difficulties, and complications associated with transvaginal oocyte retrieval (TVOR) procedures. Material and Methods: A prospective cohort study was conducted at the In Vitro Fertilization Unit of the Division of Reproductive Endocrinology and Infertility Department of a university hospital. Fifty-eight patients with endometriosis and 61 patients without endometriosis underwent TVOR procedures consecutively. Primary outcome measures were; number of needle entries per patient and performance rating defined as the total number of oocytes retrieved per vaginal needle entry. The requirement for manual compression of the abdominal wall (assistance) to reach the ovaries, procedure-related pain, and procedural complications were also evaluated. Results: The median number of needle entries through the vaginal wall per patient was comparable between the two groups (p=0.45). Performance rates were higher in the control group (p=0.001). Performance rates and total number of the needle entries through the vaginal wall were not significantly correlated with ovarian endometrioma (OMA) diameter (r=0.28; p=0.68; r=0.275, p=0.068, respectively) in the endometriosis group. Body mass index (BMI) scores were found to be correlated with the number of the needle entries and higher BMI scores were associated with higher numbers of vaginal wall punctures (p<0.001). The requirement for manual compression of the abdominal wall was significantly higher in the control group (57.4% vs 27.6%, p=0.001). A similar proportion of women needed analgesic medications after the TVOR procedure in both groups (10.3% vs 16.4%, p=0.33). Hospital readmissions for any symptoms were also comparable between the two groups (p=0.22). Three women were treated for pelvic infection, all of whom were in the endometriosis group. Conclusion: Endometriosis seems to cause a challenge for TVOR that may have reflection on individual surgeon's performance rates for the procedure, independently from the diameter of a pre-existing OMA or ovarian adhesions. Obesity is another factor that may present a challenge for the procedure.

Detrimental effects of endometriosis on oocyte morphology in intracytoplasmic sperm injection cycles: a retrospective cohort study.

While an association can be addressed among endometriosis and subfertility, the causal relationship has not been elucidated yet. Impaired oocyte quality in endometriosis patients has been accused for the unsuccessful outcomes of assisted reproductive techniques. There are limited studies in literature evaluated association between endometriosis and oocyte morphology. We conducted this retrospective study to evaluate whether morphological abnormalities of oocytes are more common in women with endometriosis than women with diagnosis of male factor infertility as a source of healthy oocytes. Totally 1568 oocytes, 775 (49.4%) in endometriosis groups and 793 (50.6%) in control group were evaluated for morphological parameters before ICSI cycles. Abnormal oocyte morphology was detected in 352 (22.4%) of 1568 oocytes. Of the abnormal oocytes, 208 (59.1%) were in endometriosis group and 144 (40.9%) in control group (p < .001). The following dysmorphisms were significantly higher in oocytes retrieved from endometriosis group: dark cytoplasm; dark, large or thin zona pellucida; and flat or fragmented polar body (p < .05 for all). When morphological parameters for oocytes of endometriosis patients evaluated, the oocyte defects has increased significantly in endometriosis patients. These findings are thought to be useful to clarify the subfertility in endometriosis patient, which needs to be confirmed with further studies.

In vitro comparison of the retentive properties of ball and locator attachments for implant overdentures.

PURPOSE: To compare the retentive properties of ball and locator attachments during 5,000 insertion-separation cycles, corresponding to approximately 4.5 years of clinical use. MATERIALS AND METHODS: Four dental implants (diameter, 3.8 mm; length, 12 mm) were inserted into the prepared beds of two polyethylene blocks. Twenty acrylic prosthetic components were fabricated and connected to the ball and locator abutments. Tensile force was applied to the prosthetic components until the attachments were separated from the abutments. All samples were subjected to 5,000 insertion-separation cycles. Retention forces were measured after 10, 100, 200, 300, 400, 500, 1,000, 1,500, 2,000, 3,000, 4,000, and 5,000 insertion-separation cycles. Additionally, the wear of the attachments was measured using scanning electron microscopy. Data were analyzed to determine statistical equivalence among the two different attachments using the Student t test procedure and the Mann-Whitney U test procedure (α = .05). RESULTS: Ball attachments showed significant retention loss after 100, 200, 400, 500, 1,500, and 4,000 cycles, and the locator attachments showed significant retention loss after 100, 200, 300, 500, and 3,000 cycles as compared with the previous cycle (P < .05). Retention loss after 5,000 cycles was detected significantly more often for ball attachments than for locator attachments (P = .049). No significant difference was detected between the retention losses of the two attachment systems during the other cycles as compared with the initial retention values (P > .05). No significant difference was detected between the wear on the two attachment systems after 5,000 cycles (P > .05). CONCLUSION: Both attachment systems showed decreased retentive forces after 5,000 insertion-separation cycles. However, after 5,000 insertion-separation cycles, locator attachments showed better retentive properties than ball attachments.