Comparison of induction of labor with vaginal misoprostol plus oxytocin versus oxytocin alone in term primigravidae.

OBJECTIVE: To compare the efficacy and complications of intravaginal misoprostol application before starting oxytocin infusion with oxytocin infusion alone for labor induction in term primigravidae pregnancies with low-Bishop score. METHODS: This randomized study included 101 primigravidae women with singleton pregnancies >38 weeks and a Bishop score of <6. Group 1 (50 patients) received a 50-µg dose of intravaginal misoprostol, with an oxytocin infusion started 3 h later. Group 2 (51 patients) received only an oxytocin infusion for labor induction. The time from induction to delivery, the route of delivery and complications were analyzed. RESULTS: The mean time from induction to delivery was 10.4 ± 2.1 h in Group 1 and 13.7 ± 3.4 in Group 2 (p < 0.001). The rates of vaginal delivery, Apgar scores at 1st and 5th min, placental abruption, and postpartum hemorrhage were similar between the two groups. CONCLUSION: Intravaginal application of 50-µg misoprostol before starting oxytocin infusion is a more effective method of labor induction than oxytocin infusion alone in term primigravidae pregnant women with low-Bishop scores.

The effect of antenatal steroids on fetal lung maturation between the 34th and 36th week of pregnancy.

AIM: To evaluate the effect of antenatal treatment with a single dose of betamethasone between the 34th and the 36th week of pregnancy on the maturation of fetal lung. METHODS: To study 100 pregnant women in their 34th-36th week of pregnancy who were diagnosed as susceptible to have preterm delivery. Fifty patients did not receive betamethasone (group 1). The other 50 patients were administered 12 mg betamethasone in a single dose (group 2). Patients who delivered at least 24 h after the administration of betamethasone were included in this study. After delivery, the Apgar score and the development of respiratory distress syndrome (RDS) in the neonates were compared. RESULTS: Group 2 babies had better Apgar scores when compared to group 1, and the difference was statistically significant. Sixteen (32%) neonates of group 1 and 7 (14%) neonates of group 2 required resuscitation, and the difference was statistically significant (p = 0.032; OR = 0.34, 95% CI 0.12-0.93). RDS was detected in 8 newborns of group 1 and 2 of group 2. The difference was statistically significant (p = 0.046; OR = 0.21, 95% CI 0.04-1.08). CONCLUSION: The administration of a single dose of betamethasone to pregnant women in their 34th-36th week of pregnancy who are likely to have preterm delivery reduces RDS development. There is a need for larger studies to confirm these results.

The efficacy of multiple-dose methotrexate treatment for unruptured tubal ectopic pregnancy and conversion rate to surgery: a study on 294 cases.

In this prospective study 294 patients diagnosed with ectopic pregnancy (EP) were treated with multiple-dose methotrexate (MTX) to determine the conversion rate to surgery. We concluded that multiple-dose MTX treatment had a low success rate, and the success rate was not related to initial b-hCG value; it was more related to the size of gestational mass before treatment.

Management of ovarian cysts by laparoscopic extracorporeal approach using single ancillary trocar.

OBJECTIVE: This prospective study aimed to evaluate an alternative laparoscopic extracorporeal approach for the treatment of benign ovarian cysts. MATERIALS AND METHODS: The initial study population included 243 patients diagnosed with benign ovarian masses. Two patients with suspected malignancies and 21 patients with technical difficulties secondary to severe, dense pelvic adhesions were excluded from the study, and the final study population, therefore, comprised 220 patients. A primary 10-mm trocar was inserted, followed by a second incision on the side of the cyst and the introduction of an ancillary 5-mm trocar. The cystic content was aspirated using a needle. The capsule was held using an endograsper inserted through the ancillary trocar. The capsule was extracted from the abdomen. The 5-mm trocar and the endograsper were removed from the abdomen simultaneously. The capsule was completely detached. Homeostasis was performed and the ovary was then released. RESULTS: The mean duration of the operation was 20 +/- 5 minutes. The size of the cysts ranged from 5 cm to 15 cm (mean, 8.4 +/- 2.6 cm). The pathologies of the cysts were simple cyst in 86 cases, endometrioma in 68, serous cyst in 57, mucinous cyst in eight and borderline in one. The perioperative complication rate was 2.27%. CONCLUSION: This technique does not require the use of two or more ancillary trocars or widening of the trocar incision. The duration of surgery can be shortened considerably and complete excision of the cystic capsule can be performed. Homeostasis was achieved using 3-0 polyglactin sutures. No electrocoagulation was required.

Management and outcomes of adnexal masses during pregnancy: a 6-year experience.

AIM: To demonstrate adnexal masses detected during gestations in a 6-year period. METHODS: A retrospective study of pregnancy with adnexal masses requiring surgery over a 6-year period at the Selcuk University Hospital, a tertiary referral center, between June 2000 and June 2006. RESULTS: We detected 36 pregnancies with adnexal masses. The mean age of the patients was 26.6 years (range, 18-42). The mean gestational age at which adnexal masses were detected was 17 weeks (range, 5-36), and the mean gestational age at the time of surgery was 24 weeks (range, 6-41). Postoperative pathology results of the patients were functional ovarian cysts in 14 cases (41.1%), endometrioma in eight cases (23.5%), dermoid cyst in six cases (17.6%), serous cystadenoma in two cases (5.8%), mucinous cystadenoma in one case (2.9%), para-ovarian cyst in one case (2.9%), and borderline serous tumor in two cases (5.8%). Two patients operated on during the second trimester developed preterm birth risk (5.8%). Miscarriage occurred in only one patient (2.9%). CONCLUSION: In this report, we demonstrate a high rate of surgical intervention of adnexal masses at pregnancy which is secondary to the fact that our center works as a tertiary referral center. Most masses at pregnancies were benign in character and our malignity rate was low. We detected an acceptable complication rate due to surgery in pregnant women.