Maternal, fetal and perinatal characteristics of preeclampsia cases with and without abnormalities in uterine artery Doppler indexes.

OBJECTIVE: To compare the maternal and fetal characteristics and perinatal outcome in mild and severe preeclampsia cases with and without uterine artery Doppler abnormalities. METHODS: Two hundred and fifty-nine mild and severe preeclampsia cases were evaluated retrospectively. Doppler measurements were done in the section where uterine artery raised from the hypogastric artery. Pulsatility index above the 95th percentile of the corresponding gestational age was accepted as abnormal. RESULTS: In mild and severe preeclampsia cases with abnormal Doppler (AD), the rate of intrauterine growth restriction, preterm birth and low birth weight was higher than, but the neonatal intensive care unit stay was similar to the cases with normal Doppler. Base excess was higher in the AD group, in mild and severe preeclampsia. The rate of low Apgar score at 5 min and perinatal mortality was higher in the AD group, in the mild preeclampsia. The strongest independent predictor of the perinatal morbidity and mortality was the presence of prematurity and of the prematurity was the presence of abnormal uterine artery Doppler. CONCLUSIONS: Maternal and perinatal morbidity and perinatal mortality increase in mild to severe preeclampsia cases with abnormal uterine artery Doppler. The abnormal uterine artery Doppler increases the morbidity and mortality by increasing the risk of prematurity.

Seroprevalence and Seroconversion Rates of Cytomegalovirus pp65 Antigen and Cord Blood Screening of Pregnant Women in Malatya, Turkey.

OBJECTIVE: The rates of seropositivity, seroconversion and fetal infection with human cytomegalovirus were analyzed in pregnant women and newborn cord blood in this study. The relationships between maternal age, parity, cytomegalovirus serology and polymerase chain reaction results were evaluated. MATERIALS AND METHODS: A total of 217 pregnant women attended our pregnancy clinic between April 2004 and October 2005. During each trimester, 5 cc of maternal blood was obtained and 5 cc of cord blood was collected after birth. An enzyme-linked immunosorbent assay (ELISA) was used to assess these samples for the presence of human cytomegalovirus protein pp65 antigen (in leukocytes) and cytomegalovirus DNA (in plasma). RESULTS: The mean age of the pregnant women in our study was 28.1±5.3 years. No seroconversion was observed. Among the pregnant women, 212 (97.7%) were IgG positive, and 29 (13.4%) were IgM positive. Five of the pregnant women were positive for IgM alone (2.3%), whereas 24 (11.3%) were positive for both IgM and IgG. The 29 IgM-positive patients were reevaluated using the polymerase chain reaction, and no seropositivity was found. None of the cord blood samples were IgM positive, whereas 211 (97.3%) were IgG positive. There was no significant correlation between parity and seropositivity (p=0.487). The relationship between human cytomegalovirus seropositivity and maternal age was evaluated by dividing the pregnant women into two groups, with a cut-off age of 35 years. There was a significant difference in seropositivity between these two groups (p=0.045). CONCLUSION: Clearly, there is no need to screen pregnant women for Human cytomegalovirus (HCMV) in the Malatya region. Confirming serology results using the polymerase chain reaction and antigenemia testing to detect false positive results offers the advantage of avoiding unnecessary invasive interventions.

The effect of bitter almond oil and massaging on striae gravidarum in primiparaous women.

AIM: This study aims to identify the effect of applying bitter almond oil with and without massage on preventing striae gravidarum during pregnancy. BACKGROUND: Striae gravidarum is a dermatological problem bringing about cosmetic concerns in about 90% of pregnant women. On the onset, striae gravidarum appears as a pink-purple atrophic strip. Striae appear pale atrophic in the postnatal period, but they never disappear completely. DESIGN: In view of the physiology of striae gravidarum formation, this study employs a posttest-only quasi-experimental design with a control group. METHODS: The participants of this study were the primiparous women who visited the pregnancy unit of a medical centre in the eastern region of Turkey between February 1st, 2010 and April 15th, 2011. The participants were divided into three groups: the primiparous women who applied bitter almond oil with massage (n = 47), who merely applied bitter almond oil (n = 48) and who were in the control group (n = 46). RESULTS: The frequency of striae gravidarum was 20% among the women who applied bitter almond oil with massage, 38·8% among those who merely applied almond oil and 41·2% in the control group. A statistically significant difference was observed in the frequency of striae gravidarum between the groups, and it was the group who applied almond oil with massage that accounted for the difference (p < 0·001). The frequency of striae gravidarum was also found to be lower in the group who applied almond oil with massage compared to the others (p < 0·05). CONCLUSION: It was found that a 15-minute massage applied with almond oil during pregnancy reduced the development of striae gravidarum, but using bitter almond oil had no effect on this in itself. It is recommended that pregnant women be informed about the positive effects of massaging applied with almond oil early during their pregnancy. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives can use the findings of this study in preventing the development of striae gravidarum during pregnancy.

[The rates of seropositivity and seroconversion of toxoplasma infection in pregnant women]. / Gebelerde Toksoplazma Enfeksiyonunun Seropozitiflik ve Serokonversiyon Oranlari

Infections caused by Toxoplasma gondii are frequently asymptomatic in healthy adults, however they may be serious in pregnant women and immunocompromised patients. The aims of this study were to investigate the rates of seropositivity and seroconversion in pregnant women and newborn cord blood samples, and to evaluate those data in the view of relation to lifestyle and nutrition. A total of 312 pregnant women (mean age: 28.1 ± 5.2 years) who were admitted to and followed by gynecology clinics of Inonu University Medical School Hospital, Malatya, Turkey were included in this observational and cross-sectional study. Anti-toxoplasma IgG and IgM antibodies in pregnants and newborn cord sera were screened by commercial ELISA and immunofluorescence antibody (BioTek; USA) methods. A total of 312 sera from pregnant women and 312 cord blood samples during delivery were collected. IgG seropositivity rate in pregnants was found as 37.5% (117/312), seroconversion was not determined in restrained pregnants and T.gondii IgM was found negative in all pregnants. Also in all newborns IgM was negative and IgG seropositivity was determined as 33.3% (104/312) in cord blood. There was a statistically significant relationship between IgG seropositivity and raw meat consumption (p< 0.001) and being engaged in agriculture (p< 0.005). It was concluded that toxoplasma antibodies should routinely be searched on the first visit of the pregnants and the seronegative cases should be trained about the preventive measures related to toxoplasmosis. The follow-up of toxoplasma seronegative cases during pregnancy can be achieved by only detecting the IgM class antibodies and this will also reduce the cost of screen test.

Prevalence of celiac disease in parents of preterm or low birthweight newborns.

AIM: Celiac disease (CD) may present with atypical symptoms, including poor pregnancy outcomes, such as preterm and low birthweight (LBW) deliveries, thus we aimed to investigate the frequency of CD in mothers and fathers of preterm or LBW newborns. MATERIALS AND METHODS: In this study, 316 parents of 164 preterm or LBW newborns and 246 parents of 123 healthy newborns were included. CD was screened using tissue transglutaminase immunoglobulin A. Endoscopic duodenal biopsy was provided in the seropositive cases. RESULTS: Positive tissue transglutaminase immunoglobulin A was found in six (1.1%; 1/94) individuals (three mothers and three fathers); five were from the study group (1.6%; 1/63) and one was from the control group (0.4%; 1/246). CD prevalence in mothers, fathers and parents of preterm newborns was 1/57 (1.8%), 1/57 (1.8%) and 1/29 (3.5%), respectively. In the LBW group, seropositivity in fathers was 1/50 (2%) with no seropositive mothers. Biopsy-proven CD was found in 1/159 mothers (0.6%) and 1/79 fathers (1.3%). Mean birthweights of the newborns of seropositive mothers and fathers were 214 g (P < 0.05) and 320 g lower than those of seronegative ones, respectively. However, in logistic regression analysis it was found that seropositivity of mothers or fathers did not affect gestational age or birthweight of the newborns. CONCLUSION: Because the prevalence of CD in parents of preterm or LBW newborns is not statistically higher than the healthy population, routine CD screening in that group cannot be recommended at the time being. For more definite conclusions further studies are needed.

Asymmetric dimethylarginine level in hyperglycemic gestation.

We aimed to evaluate plasma asymmetric dimethylarginine (ADMA) concentrations and its relation with insulin sensitivity/resistance indices in pregnant women with different degrees of carbohydrate intolerance. This study included a two step approach; 50 g glucose challenge test (GCT) followed by 100 g oral glucose tolerance test (OGTT) was used for diagnosis of carbohydrate intolerance within 24-28th weeks of gestation. Pregnant women with positive GCT but negative OGTT (AGCT group, n=30) and gestational diabetics (GDM group, n=58) were compared to healthy pregnant controls (n=50). Plasma ADMA concentration and its relationship with glucose and insulin levels and insulin sensitivity/resistance indices (HOMA-IR, QUICKI, ISIOGTT) were evaluated. Both AGCT and GDM groups were found to have similarly higher plasma ADMA levels than control subjects (3.60±1.21; 4.00±1.70; 2.65±0.82 µmol/l, respectively, P=0.001). ADMA was significantly but slightly correlated with insulin sensitivity/resistance indices and moderately correlated with 2-h insulin level. The 2-h insulin value of the OGTT was the independent influencing constant for ADMA (R=0.57, P=0.0001). In conclusion, plasma asymmetric dimethylarginine level was higher in cases with abnormal glucose challenge test but normal OGTT as well as in gestational diabetics, compared to pregnant women with normal glucose tolerance. The elevated ADMA level in pregnant women with carbohydrate intolerance may possibly be due to elevated insulin level.

Independent predictors of cardiovascular risk in polycystic ovarian syndrome.

We aimed to determine the independent predictors of cardiovascular risk in polycystic ovarian syndrome (PCOS). Ninety-one PCOS and 51 control patients were enrolled to our prospective cross sectional case-control study. In early follicular phase hormonal and lipid profile, fasting insulin and CRP (hs-CRP) levels and glucose levels on fasting and 2 h after the 75 g glucose intake were determined. Insulin resistance (IR) was evaluated with homeostasis model assessment and free testosterone was determined with free androgen index. PCOS was found to be associated with dyslipidemia, hyperandrogenism, IR and sub-clinical inflammation. The prevalence of overweight-obesity (41.8% vs. 25.5%, p = 0.038), IR (42.9% vs. 23.5%, p = 0.035) and glucose intolerance (15.38% vs. 1.96%, p = 0.043) were significantly higher in PCOS compared to control group. Independent predictors of the risk of elevated hs-CRP level were PCOS status (OR = 5, 95% CI: 1.55-16.14, p = 0.007) and high BMI (OR = 4.2, 95% CI: 1.2-14.2, p = 0.022) and high BMI (OR = 1.2, 95% CI: 1.05-1.4, p = 0.007) and of TC/HDL ratio was high BMI (OR = 1.21, 95% CI: 1.05-1.4, p = 0.009) and increasing age (OR = 1.11, 95% CI: 1.01-1.2, p = 0.04). The presence of PCOS, independent from obesity and IR, is the strongest predictor of elevated hs-CRP level. Obesity and advanced age further increases the cardiovascular risk in PCOS.

Evaluation of asymmetric dimethylarginine, nitric oxide levels and associated independent variables in obese and lean patients with polycystic ovarian syndrome.

OBJECTIVE: To evaluate the asymmetric dimethylarginine (ADMA) and nitric oxide (NO) levels in obese and lean patients with polycystic ovarian syndrome (PCOS) and find out their relation with hormonal and metabolic parameters. METHODS: Twenty-two obese, 18 lean patients with PCOS and 11 obese, 24 lean healthy control patients were enrolled prospectively. Plasma ADMA and NO levels and arginine/ADMA ratio were evaluated on 3rd day of menstrual cycle after at least 10 h overnight fasting. RESULTS: Plasma ADMA, NO levels and arginine/ADMA ratio were similar in the groups. ADMA level did not correlate with the hormonal and metabolic parameters in patients with PCOS. However, NO correlated inversely with fasting insulin (r =  -0.353, p = 0.041) and homeostasis model of insulin resistance (HOMA-IR) (r =  -0.379, p = 0.027). Arginine/ADMA ratio also correlated inversely with fasting insulin (r =  -0.339, p = 0.050). In multinomial regression analysis the risk of low NO was associated independently with high fasting insulin (OR = 1.19, 95% CI 1.001-1.42, p = 0.049) and high HOMA-IR in patients with PCOS (OR = 2.26, 95% CI 1.03-4.98, p = 0.042). CONCLUSIONS: Insulin resistance may be the underlying mechanism of endothelial dysfunction through NO pathway in PCOS.

Glu298Asp polymorphism of the endothelial nitric oxide synthase gene and plasma concentrations of asymmetric dimethylarginine in Turkish pre-eclamptic women without fetal growth retardation.

AIMS: Pre-eclampsia (PE) is a leading cause of maternal death worldwide, affecting 3 to 5% of all pregnancies. We analyzed the Glu298Asp polymorphism of the endothelial nitric oxide synthase gene and asymmetric dimethylarginine (ADMA) in 55 Turkish patients with PE without fetal growth retardation (FGR) and in 54 healthy pregnant women. METHODS: Restriction fragment length polymorphism analysis of Glu298Asp of the endothelial nitric oxide synthase gene was evaluated by amplification of genomic DNA isolated from whole blood followed by digestion with the restriction enzyme Frio. PE was defined according to the Working Group(2000) criteria as high blood pressure (>or=140/90 mmHg after 20 weeks of gestation) and proteinuria (>300 mg/24 h). We excluded the women with FGR Serum arginine, with only ADMA and symmetric dimethylarginine (SDMA) levels measured by high-performance liquid chromatography. RESULTS: Genotypes were defined as GG, GT and TT according to the presence of the G and T alleles. In this case-control study, we did not find any significant difference in either the genotypic distribution or allelic frequency of Glu298Asp gene polymorphism between the pre-eclamptic patients and healthy pregnant women. Serum ADMA, arginine and SDMA levels were higher in patients with PE compared with healthy pregnant women (respectively, P < 0.0001, P < 0.0001, P < 0.0001). CONCLUSIONS: The results suggested a lack of association between the Glu298Asp gene polymorphism and pre-eclampsia without FGR in the Turkish population. But elevated ADMA and SDMA levels suggest that ADMA has a role in the pathogenesis of PE.

Risk of malignancy index is not sensitive in detecting non-epithelial ovarian cancer and borderline ovarian tumor.

OBJECTIVE: To determine the value of risk of malignancy index in detection of ovarian cancer and referral of adnexal masses. MATERIAL AND METHOD: Patients scheduled for surgery due to adnexal mass between May 2008 and August 2009 were prospectively included in the study. Risk of malignancy index (RMI) was calculated for each patient with a published formula (RMI=Ultrasonic score X menopausal status X Ca-125 (IU/ml) level). RMI >200 was accepted as positive for malignancy and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RMI in detecting malignant cases were calculated. RESULTS: One hundred consecutive patients of whom 80 (80%) had benign ovarian cyst, 4 (4%) had borderline lesion and 16 (16%) had invasive ovarian cancer were included in the study. Forty-five percent (9/20) of malignant cases were epithelial ovarian cancer, 20% (4/20) were borderline ovarian tumor, 30% (6/20) were non-epithelial ovarian tumor and 5% (1/20) was a metastasis from the appendix. All the cases with epithelial ovarian cancer had positive RMI but only 1 of 4 borderline lesions, 2 of 6 non-epithelial ovarian cancers had positive RMI. The sensitivity of RMI was 60%, specificity was 88.8%, PPV was 57.1% and NPV was 89.9% for all cases. When the cancer cases other than epithelial ovarian cancers were excluded, the sensitivity, specificity, PPV and NPV of RMI was 76.92%, 88.75%, 52.63% and 95.95% respectively. CONCLUSIONS: RMI is not adequate in detecting malignant cases in a population with high non-epithelial ovarian cancer and borderline ovarian tumor prevalence.

Effect of intranasal estrogen on vocal quality.

The objective of this study was to evaluate the effect of intranasal estrogen therapy on female vocal quality. Thirty-two women who had surgically induced menopause were included into the study group and examined through hall year for this study. Estrogen treatment was proposed to all of the patients. Twenty-three of them accepted the treatment protocols including oral (n=12) (2mg estradiol; Estrofem; Novo Nordisk, Denmark) and intranasal (n=11) (300 mc g 17beta-estradiol; Aerodiol; Servier, Chambray-les-Tours, France) form of estrogen. The rest of patients refused estrogen treatment and those patients constituted the control group (n=9). Vocal changes were evaluated with Voice Handicap Index (VHI) and acoustic analysis of voice variations (fundamental frequency [F0], SD F0, jitter, shimmer, normalized voice energy, and harmonics-to-noise ratio) at baseline and after 1-year follow-up. According to VHI, while voice improvement was not clear in oral estrogen group, it was significant at intranasal estrogen group. Voice quality in patients treated with hormone replacement therapy (HRT) was significantly higher than patients without HRT. But between two treatment groups, there were no any statistical discrepancy. According to acoustic analysis, vocal stability among the women who use HRT was significantly better than those who did not use. Intranasal estrogen exerted the most significant effects on vocal stability. The data of our study support that voice undergoes changes in lack of estrogen in surgically induced menopausal women. Taken together with the relevant studies, while oral estrogen replacement therapy shows a favorable influence on voice quality, it seems to be more pronounced with intranasal estrogen than oral form.

Short-term effect of tibolone on C-reactive protein in hypertensive postmenopausal women.

OBJECTIVE: To evaluate the effects of tibolone on the serum C-reactive protein (CRP) in hypertensive postmenopausal women. METHODS: We enrolled 45 postmenopausal patients with hypertension and 17 normotensive postmenopausal women. Inclusion criteria were surgical menopause, the presence of vasomotor symptoms, and normal mammogram within 1 year, the absence of documented coronary artery disease, and normal electrocardiography. Forty hypertensive women and 17 normotensive women completed the 3-month period. Twenty-one hypertensive women received tibolone, whereas 19 served as control. At baseline and at 3 months, blood lipids and CRP were evaluated. RESULTS: Changes in lipid profile and CRP in the hypertensive and normotensive control groups during 3 months were not statistically significant. Total cholesterol levels decreased significantly after 3 months of tibolone treatment. A significant increase in CRP values was observed in the tibolone group (p=0.001). CONCLUSION: This trial demonstrated that tibolone treatment induced a significant increase in CRP and a significant decrease in total cholesterol in postmenopausal hypertensive women.

Meydanli compression suture: new surgical procedure for postpartum hemorrhage due to uterine atony associated with abnormal placental adherence.

AIM: To inform about the clinical results of a new uterine compression suture technique used in the surgical management of postpartum hemorrhage due to uterine atony associated with abnormal placental adherence. METHODS: Postpartum hemorrhage due to uterine atony associated with abnormal placental adherence was diagnosed in seven out of 1819 (0.38%) cesarean sections performed between January 2004 and February 2007, and a new uterine compression suture technique was used for surgical management. Age, parity, gestational age and cesarean section indications, amount of transfusion performed, length of hospital stay, postoperative complications, and number of patients in whom the uterus was preserved were evaluated. RESULTS: The mean age of the cases was 30.5 +/- 3.7 (24-35) years. Cesarean indications were previous cesarean section plus placenta previa totalis in three cases (43%), previous cesarean section in two cases (29%), a twin pregnancy as a result of in vitro fertilization-embryo transfer in one case (14%) and preterm premature rupture of membranes in one case (14%). Six out of seven cases (85%) were successfully treated with the Meydanli compression suture and the uterus was preserved. CONCLUSION: The Meydanli compression suture seems to be a simple, quickly applicable and safe uterine compression suture technique, which decreases maternal mortality and peripartum hysterectomy rates.

Tracheal agenesis and esophageal atresia with proximal and distal bronchoesophageal fistulas.

Tracheal agenesis (TA) is an extremely rare, typically fatal congenital tracheal malformation. Lack of prenatal symptoms and emergent presentation usually lead to a failure to arrive at the correct diagnosis and manage the airway properly before the onset of irreversible cerebral anoxia. Esophageal atresia (EA) encompasses a group of congenital anomalies comprising an interruption of the continuity of the esophagus with or without a persistent communication with the trachea. In 86% of cases, there is a distal tracheoesophageal fistula (TEF); in 7%, there is no fistulous connection, whereas in 4%, there is a TEF without atresia. We report the case of an infant born with TA and EA with proximal and distal bronchoesophageal fistulas. During 3 consecutive antenatal ultrasound examinations, there had been polyhydramniosis, difficulty visualizing the stomach, and dilatation of proximal esophagus, leading to a presumptive diagnosis of EA. The clinical presentation, embryology, classification, and surgical management are discussed.

The effect of resveratrol on prevention of the development of postoperative adhesions in a rat model.

OBJECTIVE: Our aim was to investigate the anti-adhesion potential of resveratrol, a phytoestrogen naturally found in wine, in a rat uterine horn model. METHODS: Lesions were created by laparotomy in the uterine horn of 70 rats, randomized before the operation into seven groups consisting of ten animals each: (1) control group, no adjuvant therapy; (2) intraperitoneal (IP) application of the resveratrol dilution vehicle, 10 mg/kg, before closing the laparotomy; (3) subcutaneous (SC) injection of dilution vehicle, 10 mg/kg, 30 min before the operation; (4) IP application of resveratrol, 10 mg/kg, before closing the laparotomy; (5) SC injection of resveratrol, 10 mg/kg, 30 min before the operation; (6) IP application of resveratrol, 10 mg/kg, before closing the laparotomy and continued SC daily for 5 days; and (7) SC injection of resveratrol, 10 mg/kg, 30 min before the operation and continued SC daily for 5 days. On the 14th postoperative day adhesion scores were determined. Levels of thiobarbituric acid-reactive substances and total antioxidant capacity (TAC) were also measured. RESULTS: In animals treated with repeated SC resveratrol, adhesions were graded as significantly less severe than in the vehicle control group or the groups treated with resveratrol IP or IP plus SC. TAC of control group rats was significantly lower than that of animals treated with repeated SC resveratrol. CONCLUSION: Repeated SC resveratrol significantly reduces adhesion formation.

Activity of adenosine deaminase in mothers who have conceived a fetus with central nervous system malformations.

OBJECTIVE: To establish the adenosine deaminase (ADA) activity in women who had been pregnant with a child suffering from central nervous system (CNS) anomaly. METHODS: The study group comprised 68 women who had been pregnant with an affected child, and 68 controls matched for age, gestational age and body mass index. Maternal venous blood was collected for measurement of ADA levels. We defined the diagnostic sensitivity, specificity and area under receiver-operating characteristic curve for ADA. RESULTS: Plasma ADA activity was significantly higher in the study group (12.3 U/L, range 1.7-33.3) compared to the median value of 3.3 U/L (range 1.1-34.4) in normal pregnancies (P<0.05). The cut-off point of ADA >5.9 U/L was associated with the highest combination of specificity (58.8%) and sensitivity (86.8%). CONCLUSION: ADA activity in women who have conceived a fetus with CNS malformations was significantly higher than that in normal pregnant women.

Serum amyloid A levels are increased in pre-eclampsia.

AIM: The purpose of this study was to examine serum amyloid A (SAA) levels in normal pregnant and pre-eclamptic women. METHODS: SAA levels were measured in 25 normotensive and 25 pre-eclamptic pregnant women by enzyme linked immuno-sorbent assay. RESULTS: In pre-eclampsia, SAA level and C-reactive protein (CRP) averaged 28.2 (7.2-135) ng/l and 21 (6.13-91) mg/l, respectively, which were significantly higher than those of normal pregnancy (7.8 [4.65-24.6] ng/l and 6.05 [0.3-19] mg/l, respectively) (p < 0.05). In addition, SAA level was positively correlated to CRP (r = 0.468, p < 0.05). CONCLUSION: Marked increases of both SAA level and CRP in pre-eclampsia, and their inter-relation, may at least in part contribute to the pathogenesis of pre-eclampsia.

Effect of postpartum counseling on postpartum contraceptive use.

OBJECTIVE: The aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use. METHODS: One hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked. RESULTS: Just after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods. CONCLUSION: In spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods.

Effects of intranasal 17beta-estradiol and raloxifene on lipid profile and fibrinogen in hypercholesterolemic postmenopausal women: a randomized, placebo-controlled clinical trial.

AIM: To compare the effects of 17beta-estradiol given intranasally (intranasal E2) and raloxifene on serum lipid profile and fibrinogen in hypercholesterolemic postmenopausal women. METHODS: The study population consisted of 46 women after menopause. The placebo group (n = 11) was given calcium, while the intervention groups were given intranasal E2 (Aerodiol; Servier, Chambray-les-Tours, France) (n = 16) or raloxifene (Evista; Lilly SA, Madrid, Spain) (n = 19). Blood lipids and fibrinogen were compared between groups at baseline and after 3 months of treatment. RESULTS: The group receiving intranasal E2 showed a significant decrease in triglyceride levels (p<0.05) and a marked increase in high-density lipoprotein cholesterol levels (p<0.05). No changes in lipid profile were observed in the raloxifene and placebo groups. Raloxifene caused a significant decrease in fibrinogen levels (p<0.05). CONCLUSION: Intranasal E2 exerts significant effects on lipid profile in hypercholesterolemic postmenopausal women. Raloxifene has a greater impact on fibrinogen than intranasal E2 application.

Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome?

AIM: Our aim was to assess C-reactive protein (CRP) levels and insulin resistance in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO). METHODS: The study population included 30 women with PCOS, 30 with PCO and 30 healthy controls. CRP and insulin resistance index (IRI) (fasting glucose/insulin) were measured. A receiver-operator characteristic (ROC) curve was constructed to determine the cut-off value of CRP to predict increased cardiovascular risk. RESULTS: There were no statistically significant differences between the three groups with regard to age and body mass index. IRI was significantly lower in the PCOS group than in the PCO and control groups. No difference existed between the PCO and control groups. Median CRP levels in the control, PCO and PCOS groups were 0.75, 1.3 and 1.5 mg/l, respectively (p = 0.005). CRP could differentiate between women with and without increased cardiovascular risk at a cut-off value of 2.42 mg/l, with a sensitivity of 79% and a specificity of 81%. CONCLUSION: As in PCOS patients, women with PCO have higher serum CRP levels than healthy control women. This may contribute to increased cardiovascular disease risk in patients with PCO.