Role of first trimester total testosterone in prediction of subsequent gestational diabetes mellitus.

AIM: To assess the role of first trimester maternal testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels in prediction of development of gestational diabetes mellitus (GDM). METHODS: Four hundred and fifty pregnant women were included in this prospective cohort study. All pregnant women with a singleton pregnancy who were not diabetic, had no family history of diabetes, had no history of previous GDM, were of white race and non-smokers were enrolled. Total testosterone and DHEA-S were measured at 11-14 weeks of gestation. The patients were called for routine pregnancy visits and followed accordingly. Forty-two patients did not come to their visits and were excluded. During gestational weeks 24-28, the remaining 408 patients were screened for GDM. The total testosterone and DHEA-S levels were compared between patients with and without GDM. Regression and receiver-operator curve analysis were performed. RESULTS: GDM developed in 22 women (5.7%). Compared with women without GDM, first trimester total testosterone levels were higher among women in whom GDM subsequently developed. The DHEA-S level did not differ. Age, total testosterone and body mass index were found to be independent predictors of GDM development. A total testosterone value of 0.45 ng/mL was found to predict development of GDM with a sensitivity of 63.6% and a specificity of 62.7%. CONCLUSION: First trimester total testosterone has a low testing power for GDM screening with low sensitivity and specificity values and cannot be used as a marker alone. It may have a role in combination with other markers.

The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy.

INTRODUCTION AND HYPOTHESIS: It has been suggested that weight reduction decreases the frequency of urinary incontinence (UI) episodes. However, it is not known if this improvement is associated with anatomical changes in the pelvis. The aim of this study was to investigate the effects of weight loss on UI episodes and pelvic floor anatomy. METHODS: Three hundred seventy-eight overweight/obese women were randomly allocated either to behavioral weight loss or to structured education programs. The patients were evaluated by voiding diary, Pelvic Floor Distress Inventory (PFDI), and Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and after 6 months. RESULTS: The women in the intervention group had a mean weight loss of 9.4 %, whereas the weight in the control group remained almost the same (P < 0.001). While there were no change in stress and urge incontinence episodes in the control group, the mean number of stress incontinence episodes per 3-day diary dropped from 7.96 episodes to 3.11, and the mean number of urge incontinence episodes per 3-day diary dropped from 2.85 episodes to 1.08 in the study group (P < 0.05). Regarding the POP-Q system, only genital hiatus, perineal body, and Ap measurements were significantly lower in the weight loss group than in the control group after 6 months. CONCLUSIONS: Weight reduction provides improvement in episodes of UI, decreases the incidence of drops of urine leakage, and increases quality of life related to pelvic floor symptoms. However, there are little to no changes in the parameters of the POP-Q system with weight reduction.

Comparison of the use of LigaSure, HALO PKS cutting forceps, and ENSEAL tissue sealer in total laparoscopic hysterectomy: a randomized trial.

STUDY OBJECTIVE: There are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy. The aim of the study was to compare the use of LigaSure (Valleylab, Boulder, CO), HALO PKS cutting forceps (Gyrus-ACMI, Maple Grove, MA), and ENSEAL tissue sealer (SurgRx, Inc. Redwood City, CA) in total laparoscopic hysterectomy with respect to operation time and blood loss as main outcomes. Perioperative complications, return of gastrointestinal activity, and hospitalization time were assessed as secondary outcomes. DESIGN: Randomized prospective study (Canadian Task Force classification I). SETTING: Adana Numune Training and Research Hospital. PATIENTS: Forty-five patients with the indication of hysterectomy were randomized into 3 groups for total laparoscopic hysterectomy. Patients with malignancies, having 3 or more previous abdominal surgeries, a uterus larger than 12 weeks of gestation, and who had to undergo additional surgical procedures during the same operation were excluded. INTERVENTIONS: Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: Operations were completed in all 15 patients in the LigaSure and HALO PKS Cutting Forceps groups with the planned instruments. In 2 patients in the ENSEAL group, bleeding could not be controlled with ENSEAL, and additional instruments were used. One patient in the ENSEAL group had bladder injury. The mean operation time and blood loss were 52.4 ± 12.8, 51.86 ± 14.11, and 55.7 ± 15.7 minutes (p > .05) and 138 ± 54.3, 118 ± 63.3, and 218 ± 115.9 mL (p < .05) in the LigaSure, HALO PKS, and ENSEAL groups, respectively. Changes in hemoglobin/hematocrit levels, return of gastrointestinal activity, and hospitalization time did not differ between groups. CONCLUSION: These 3 novel bipolar platforms had similar results in total laparoscopic hysterectomy. These instruments were not determined to be independent predictors of operating time and amount of blood loss.

The effect of episiotomy on pelvic organ prolapse assessed by pelvic organ prolapse quantification system.

OBJECTIVE: This study aimed to assess the association between episiotomy and measures of pelvic organ prolapse quantification system (POP-Q) in a cohort of women with vaginal parturition. STUDY DESIGN: A prospective study was conducted with 549 eligible patients with vaginal delivery history. Women who were pregnant, gave birth within the preceding 6 months period, had a known history of pre-pregnant prolapse, had a history of hysterectomy or any operation performed for pelvic organ prolapsus and stress urinary incontinence, refused to participate and to whom POP-Q examination could not be performed (due to anatomic or orthopedic problems) were excluded. Patients were categorized as women with episiotomy and without episiotomy. The degree of genital prolapse was assessed by using POP-Q system. The effect of episiotomy on overall POP-Q stage and individual POP-Q points was calculated with logistic regression. RESULTS: 439 patients had a history of episiotomy whereas 110 patients had no episiotomy. 38.2% of women without an episiotomy, and 32.0% of women with episiotomy had genital prolapse determined by POP-Q system. There was no statistically significant association between episiotomy and POP-Q stage (AOR, -0.24; 95% CI, -0.65-0.18, P=0.26). Episiotomy was found among the independent predictors for certain POP-Q points such as Bp, perineal body (pb) and total vaginal length (tvl). Episiotomy was negatively correlated with prolapse of Bp and with pb and tvl. CONCLUSION: Episiotomy had an effect on certain POP-Q indices, but had no influence on overall POP-Q stage.

Prevalence of pelvic organ prolapse and related factors in a general female population.

OBJECTIVE: The aim of this study was to assess the prevalence and the related factors of pelvic organ prolapse (POP) in a female population to whom health care services are offered. MATERIALS AND METHODS: 1354 of the 3000 women admitted to the outpatient clinic between June 2008 and December 2008 were enrolled as they accepted to participate to the study. 34 of these patients with a history of previous hysterectomy and/or any kind of pelvic reconstructive surgery were excluded. Baseline characteristics, as well as medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. POP-Q stages ≥2 were defined as prolapse. Women with and without prolapse were compared. Regression analysis was used in order to determine the independent predictors. RESULTS: Prolapse (stage ≥2) was detected in 358 patients (27.1%). Patients with prolapse were found to be significantly older and heavier. They had a higher waist to hip ratio and had a higher parity. Compared to women without prolapse, cesarean rate was significantly lower in women with prolapse (10.6% vs. 20.8%; p<0.001), and the mean birth weight of the babies of the women with prolapse was significantly higher (3584±574 vs. 3490±389 g, p=0.004). Prevalence of prolapse was found to be decreased as the level of education increased. Waist to hip ratio (OR:46.2, CI: 3.3-655, p=0.005), parity (OR:1.5, CI:1.3-1.7, p<0.001), vaginal delivery (OR:1.5, CI: 0.3-0.8, p=0.005), and menopausal status (OR:1.2, CI: 1.1-1.4, p=0.005) were found to be independent predictors of development of POP. CONCLUSION: In the present study, POP was found to be associated with waist to hip ratio, parity, vaginal delivery, and menopausal status.

The effect of pelvic organ prolapse on sexual function in a general cohort of women.

INTRODUCTION: This is a report about the effects of pelvic organ prolapse on sexual function in women. AIM: To determine the effect of pelvic organ prolapse on sexual function in women. METHODS: The study group consisted of 1,267 sexually active women. Baseline characteristics, medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. Of 1,267 women, 342 (27.0%) had prolapse stage ≥2. MAIN OUTCOME MEASURE(S): The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores of the women were recorded. RESULT(S): Women with genital prolapse had lower PISQ-12 scores than women without it. The difference resulted mainly from urinary incontinence during sexual activity, fear of incontinence and avoidance of intercourse due to prolapse. Multivariate analyses showed that genital prolapse was one of the confounding factors for sexual function. CONCLUSION(S): Pelvic floor dysfunction is a multi-faceted problem because it has both anatomical and functional aspects. Although pelvic organ prolapse had an effect on some aspects of sexuality, it has no effect on certain aspects of sexual function such as orgasm and sexual satisfaction.

The effect of myomectomy on health-related quality of life of women with myoma uteri.

AIM: An equal consideration should be paid to improving health-related quality of life (HRQoL) in addition to successful medical outcome. Many studies have evaluated the effect of other methods rather than myomectomy on HRQoL, and have focused solely on the presence of myoma without regarding any concurrent pelvic pathology. METHODS: This study involved 80 patients with myomas and 75 controls. Domains of the Short Form - 36 (SF-36) questionnaire were evaluated pre- and postoperatively in 72 women with myomas. Furthermore, any correlations between myoma characteristics and SF-36 physical components (PC) and mental components (MC) were investigated. RESULTS: All SF-36 domains were lower in women with myoma uteri than in the control group, except for physical and social function. There was no correlation between PC and MC scores and the number, location and total volume of the myomas. However, fundal and posteriorly positioned myomas were related with the PC score, and posterior myomas with the MC score. Women with uteri over 200 cm(3) had significantly lower mean PC and MC scores. After myomectomy, all SF-36 domains were improved except for physical function and mental health. CONCLUSION: The findings from this study suggest that myomectomy improves HRQoL, and that myoma characteristics may modulate quality of life domains.

Gonadotropin-releasing hormone antagonist use in controlled ovarian stimulation and intrauterine insemination cycles in women with polycystic ovary syndrome.

OBJECTIVE: To observe the effects of ganirelix on controlled ovarian stimulation and intrauterine insemination (COS/IUI) cycles in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized, controlled clinical study. SETTING: An academic clinical research center. PATIENT(S): Women with PCOS and anovulatory infertility undergoing COS/IUI. INTERVENTION(S): Recombinant FSH therapy was started on day 3. In women assigned to the control group (n = 47), treatment was continued up to the day of hCG administration. In patients assigned to receive GnRH antagonist (n = 42), ganirelix was added when the leading follicle was > or =14 mm. MAIN OUTCOME MEASURE(S): Pregnancy rates, serum E(2), P, and LH levels, and follicle numbers at hCG day, prevalence of premature luteinization, and cost of stimulation. RESULT(S): Serum E(2), P, and LH levels were significantly lower in the ganirelix group. Although premature luteinization and cycle cancellation was encountered less in the ganirelix group, the pregnancy rates per cycle were similar (15.4% vs. 10.7%). Patients would pay 6,153 dollars more for each pregnancy when using ganirelix. CONCLUSION(S): Gonadotropin-releasing hormone antagonist resulted in more monofollicular development, less premature luteinization, and less cycle cancellation in IUI cycles of patients with PCOS; however, the cost of stimulation increased without an improvement in pregnancy rates.

The effect of myoma uteri and myomectomy on sexual function.

INTRODUCTION: This is a report about the effects of myoma uteri and myomectomy on sexual function in women. AIM: The aim of this article was to determine the effects of myoma uteri and myomectomy on sexual function in women. METHOD: The study was designed as a controlled clinical study in an academic clinical research center. The study patients consisted of 80 women with myoma uteri and 75 control women. Baseline characteristics and properties of the myomas were recorded. A validated questionnaire was used to determine pre- and postoperative sexual function in the patients. MAIN OUTCOME MEASURE: Female sexual function index (FSFI) scores of the women were recorded before and after surgery. RESULTS: Women with myoma uteri had lower FSFI pain and satisfaction scores than women without it, even after correction for possible confounders. Fundal and posterior myomas were associated with pain, whereas only posterior myomas were related to the overall FSFI scores. However, although there was no relation between the volume of the myomas and the FSFI scores, women with a uterine volume over 200 cm(3) had significantly lower mean FSFI satisfaction, pain, and total scores. The mean FSFI pain and total scores of the patients improved significantly after undergoing a myomectomy. CONCLUSIONS: The findings of this study suggest that a potential impairment of sexual function exists in women with myomas. This is mainly because of pain during sexual intercourse, although it does not seem to have an effect on either the arousal or orgasmic phases. Furthermore, the performance of a myomectomy may alleviate pain during intercourse, and thereby improve sexual function in the patients.

Modulating interaction of glutathione-S-transferase polymorphisms with smoking in endometriosis.

OBJECTIVE: To evaluate the interaction of glutathione-S-transferase (GST) gene polymorphisms and smoking as a risk factor for endometriosis. STUDY DESIGN: The study group consisted of 150 women who were diagnosed by means of surgery and histopathology as having endometriosis. The control group consisted of 150 women who displayed no evidence of endometriosis during exploratory laparotomy or laparoscopy. We assessed the interaction of smoking and GSTM1 and GSTT1 polymorphisms in these patients. RESULTS: Logistic regression analyses showed that the GSTM1-null allele was associated with a significantly increased risk of endometriosis and smoking with a decreased risk of endometriosis separately. There was no association between endometriosis and the GSTT1-null allele. The interaction of smoking and GST polymorphisms showed a joint effect. We found that the GSTM1-null allele was more prevalent in active smoking endometriosis patients (63.4%) than in the controls (35.0%), and the difference was statistically significant. A similar tendency was also observed in the GSTT1 allele distribution. CONCLUSION: Genetic factors could modify the response to environmental pollutants in endometriosis.

PPAR-gamma2 Pro12Ala polymorphism is associated with weight gain in women with gestational diabetes mellitus.

OBJECTIVE: The polymorphisms of peroxisome proliferator-activator receptor-gamma2 (PPAR-gamma2) have been suggested to affect glucose metabolism and weight gain. Both conditions show great variations during pregnancy that makes pregnancy a suitable condition to detect any metabolic abnormalities related to PPAR-gamma2 polymorphisms. The objective of this study is to investigate the prevalence and metabolic impacts of PPAR-gamma2 polymorphism in control pregnant women and in patients with gestational diabetes mellitus (GDM). METHODS: In this case-control study, anthropometric and metabolic variables of 100 non-diabetic pregnant women and of 62 women who were diagnosed as having GDM according to 100 g oral glucose tolerance test (OGTT) were compared on the basis of PPAR-gamma2 polymorphism by univariate analysis of covariance. RESULTS: There were no statistically significant differences in baseline characteristics and the mean 50 g glucose challenge test values of pregnant women in both groups on the basis of PPAR-gamma2 genotype, although patients with Pro12Ala polymorphism were significantly taller in GDM group. The Pro12Ala polymorphism had no effect on 100 g OGTT results of patients with GDM. However, patients with GDM who had Pro12Ala polymorphism gained significantly more weight during their pregnancy. CONCLUSION: The PPAR-gamma2 Pro12Ala polymorphism was observed to have no effect on glucose metabolism in normal pregnant women and women with GDM. However, only the patients with GDM who had this polymorphism gained significantly more weight during their pregnancy. It seems that Pro12Ala polymorphism plays a dynamic and interactive role in the regulation of BMI and glucose homeostasis.

Association of insulin receptor substrate-1 G972R variant with baseline characteristics of the patients with gestational diabetes mellitus.

OBJECTIVE: Insulin receptor substrate-1 (IRS-1) expression and tyrosine phosphorylation is decreased during pregnancy. Pregnancy may be a suitable condition to detect any abnormalities related to IRS-1 polymorphisms. Therefore, we aimed to investigate the prevalence and metabolic impacts of IRS-1 G972R polymorphism in patients with gestational diabetes mellitus (GDM). STUDY DESIGN: Anthropometric and metabolic variables of 62 women who were diagnosed as having GDM according to 100 g oral glucose tolerance test were compared on the basis of IRS-1 polymorphism by univariate analysis of covariance. RESULTS: Patients with IRS-1 G972R were more obese at the beginning of pregnancy, had higher serum fasting insulin and glucose levels. Weight gain during pregnancy and insulin and glucose levels after glucose ingestion was comparable between groups. CONCLUSION: IRS-1 G972R was associated with the baseline characteristics of the patients with GDM, and might be related to insulin resistance that is seen in obese patients with GDM.

Concordant occipital encephalocele in monoamniotic twins.

Anomalies occur with a greater frequency in twin gestations. Due to its multifactorial inheritance, twins are usually discordant for encephalocele. We present a case of monoamniotic twins concordant for occipital encephalocele and discordant for lung and cord anomalies. Ultrasonographic examination at 17 weeks' gestation revealed occipital encephalocele in both fetuses. The maternal serum level of alpha-fetoprotein was increased. Fetal autopsy revealed occipital encepaholocele in both twins and right pulmonary hypoplasia and one umbilical artery in one sibling. Monoamniotic twins concordant for encephalocele occur with extreme rarity. To the best of our knowledge, monoamniotic twins concordant for this neural tube defect have not been previously reported.

Association of Gly972Arg variant of insulin receptor substrate-1 with metabolic features in women with polycystic ovary syndrome.

OBJECTIVE: To examine the prevalence and the effects of Gly972Arg (G972A) variant of insulin receptor substrate-1 (IRS-1) in women with polycystic ovary syndrome (PCOS). DESIGN: Controlled clinical study. SETTING: An academic clinical research center. PATIENT(S): Sixty women with PCOS and 60 control women matched for age. INTERVENTION(S): Biometric measures, metabolic and hormonal measures, genetic analyses. MAIN OUTCOME MEASURE(S): Serum androgens, glucose, and insulin were measured. Blood leukocytes were used for genetic analyses. RESULT(S): The G972A variant was encountered more often in women with PCOS. The G972A carriers were more obese than their counterparts, had higher fasting insulin levels, and were more insulin-resistant. However, androgen levels did not differ on the basis of IRS-1 genotype. CONCLUSION(S): We observed that the G972A variant of IRS-1 was more prevalent in women with PCOS, and that it had important metabolic effects without having a direct effect on the androgen levels. However, the G972A variant of IRS-1 may modulate reproduction by lowering sex hormone-binding globulin in both healthy women and women with PCOS.

The androgenic profile of women with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To evaluate the androgenic profile of women with non-insulin-dependent diabetes mellitus. STUDY DESIGN: This case-control study evaluated the clinical, hormonal and ultrasonographic characteristics of women of reproductive age with non-insulin-dependent diabetes mellitus and compared them with those of age- and weight-matched controls. Radioimmunoassays were used for total testosterone, estradiol, dehydroepiandrosterone sulfate (DHEAS) and androstenedione. Sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicle stimulating hormone (FSH) were analyzed by fluoroimmunoassays. Ovarian appearance and volume were assessed by transvaginal or transabdominal ultrasonography. RESULTS: The prevalence of polycystic ovary syndrome was higher in diabetic patients than in the general population as reported earlier. Hirsutism was also more prevalent in diabetic patients (p < 0.05). The serum levels of FSH, LH, estradiol, total testosterone, androstenedione and DHEAS were significantly higher in diabetic patients than in the control group (p < 0.05). In contrast, the levels of SHBG were lower in diabetic patients (p < 0.05). The rates of ultrasonographically apparent polycystic ovaries and greater ovarian volumes were also higher in diabetic patients (p < 0.05). CONCLUSION: Women with non-insulin-dependent diabetes mellitus seem to have biochemical and clinical hyperandrogenism when compared with nondiabetic controls.

Is stress urinary incontinence a familial condition?

BACKGROUND: Stress urinary incontinence (SUI) is a common problem of multifactorial origin. Some authors have claimed that it has a familial predisposition. This study was undertaken to investigate the prevalence of SUI among first-degree relatives of 154 women who had been operated on for this disorder and of 100 women without SUI. METHODS: This report is concerned with a questionnaire-based, case-control study. A total of 154 women who had undergone operations for SUI and 100 women who denied having SUI were included. A comparison was made of 413 first-degree relatives of incontinent women and 372 first-degree relatives of continent women according to the demographic characteristics, obstetric and gynecologic history and risk factors for SUI. The prevalence of SUI was investigated among the relatives. Furthermore, the characteristics of the women who had SUI operation were compared according to the continence state of their families. RESULTS: The prevalence of SUI was 71.4% among mothers and 24.6% among sisters of operated women compared with 40.3% among mothers and 11.6% among sisters of continent women (p < 0.05). Furthermore, the age at which symptoms began was significantly lower in the members of the 'incontinent families' (p < 0.001). CONCLUSIONS: The relatives of incontinent women displayed a higher prevalence of SUI than the relatives of continent women. Although this condition has a multifactorial origin, the familial aggregation of SUI and the appearance of symptoms at younger ages in women with a family history of SUI suggest that heredity may play a significant role.

The prevalence of stress urinary incontinence among women operated on for abdominal wall hernias.

The high co-occurrence of an abdominal wall hernia (AWH) and stress urinary incontinence (SUI) suggests that there is a common factor in the etiopathogenesis of these disorders in these patients.

The effect of circulating androgens on bone mineral density in postmenopausal women.

BACKGROUND: Osteoporosis is a common problem in postmenopausal period. Recent studies have suggested that endogenous and exogenous androgens may influence the bone mineral density in women. There is limited data about the effect of circulating androgens on bone density in postmenopausal women. AIM: The aim of this study was to evaluate the effect of circulating androgens of ovarian and adrenal origin on bone mineral density in postmenopausal women. MATERIALS AND METHODS: This cross-sectional study included 178 postmenopausal women, who had never been treated with hormonal therapy or calciotropic agents. Serum free testosterone, dehydroepiandrosterone sulfate and androstenedione levels and their relationship with bone mass (dual X-ray absorptiometry) were evaluated. RESULTS: Serum free testosterone and DHEAS levels were correlated positively with bone mineral density at lumbar spine and femoral neck (P < 0.001). However, stepwise linear regression analyses revealed a differential effect of androgens on bone density. Serum free testosterone was among the independent predictor of bone density at lumbar spine (trabecular bone), whereas serum DHEAS level was of bone density at femoral neck (cortical bone). CONCLUSION: This study suggests that endogenous androgens are influential on bone density in postmenopausal women. However, regression analyses revealed a differential effect of androgens on different bone types.