The effects of conservative and surgical approaches in tubal ectopic pregnancy on fertility.

BACKGROUND: Medical treatment, expectant approaches, and surgical treatment options are available in the treatment of ectopic pregnancy. Regardless of the treatment, in addition to its effectiveness, the main concern is to limit the risk of relapse and preserve fertility. OBJECTIVES: Determine the impact of medical or surgical treatment for ectopic pregnancy on future fertility. DESIGN: Retrospective. SETTING: Department of obstrtrics and gynecolgy at Ankara Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. PATIENTS AND METHODS: Patients who were treated for ectopic pregnancy between June 2016 and November 2019 were allocated into two groups. Expectant approach or medical treatment by methotrexate constituted the conservative treatment group while salpingectomy by laparoscopy indicated the surgical treatment group. MAIN OUTCOME MEASURES: Fertility rates within two years following treatment were evaluated according to treatment options. SAMPLE SIZE: 202 patients. RESULTS: Of the 202 patients, 128 had medical treatment and 74 patients had surgical treatment for ectopic pregnancy. Of 272 diagnosed with ectopic pregnancy, 70 were excluded for various reasons. Parity and unemployment rate was significantly higher in the surgical treatment (P=.006 and P=.12, respectively). Moreover, ectopic mass size and serum ß-hCG levels were significantly higher in the surgical treatment group (P<.001 and P<.001, respectively). There were no significant differences between the conservative and surgical treatment groups in time to pregnancy (17.0 months vs 19.0 months, P=.255). Similarly, there was no significant difference between the conservative and surgical treatment groups with respect to history of infertility (P=.12). There were no significant differences between the conservative and surgical treatment groups in terms of live birth (51.6% vs 44.6%) and ectopic pregnancy (2.3% vs 1.4%) (P=.72 for both). There was no significant difference between the conservative and surgical treatment groups with respect to infertility rate (35.9% vs 41.9%, P=.72) and admittance to the IVF program (3.9% vs 6.8%, P=.39) following ectopic pregnancy treatment. CONCLUSIONS: Reproductive outcomes did not differ significantly in women undergoing expectant management, medical treatment, and surgery for ectopic pregnancy. This finding suggests that clinicians should not hesitate to act in favor of surgical treatment for ectopic pregnancy even if there were concerns for future fertility. LIMITATIONS: Retrospective study.

Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases.

OBJECTIVE: To demonstrate the effectiveness and safety of the defined manual vacuum aspiration (MVA) technique for treatment of type 2 cesarean scar pregnancies (CSPs). METHODS: We treated 40 patients with CSP by MVA at the Early Pregnancy Clinic of our hospital between 1 January 2012 and 31 December 2014. The files of patients were reviewed and evaluated retrospectively. Eligibility criteria were hemodynamic stability and at least 2 mm myometrial thickness at the anterior part of the CSP. The key-point of successful MVA procedure is to keep away from entering the cesarean scar cavity directly; instead, CSP is displaced from the implantation site by applying vacuum, only while the cannula is passing near. RESULTS: During the study period, the ratio of CSP to total pregnancies was 1/1000. The ratio of CSP to cesarean delivery (CD) was 1/372. In that time period, CSPs were constituted 4.41% of all ectopic pregnancies. Total of 40 patients were treated with dilatation and MVA. Complications such as excessive hemorrhage, persistence of CSP, and any need of extra intervention were not observed. The beta-hCG values of 21 patients (52.5%) decreased below 10 mIU/mL after the first 15 days, and the rest decreased below 10 mIU/mL after 3 weeks following MVA. CONCLUSIONS: This MVA technique for treatment of CSP is easily applicable and effective method with high success and low complication rates. For appropriately selected patients, we think that this method can be considered as the first- line treatment.

Depression and anxiety disorder in hyperemesis gravidarum: A prospective case-control study.

OBJECTIVE: To assess the anxiety and depression status of women with hyperemesis gravidarum (HG); the risk factors for developing both depression and anxiety in women with HG were evaluated. MATERIALS AND METHODS: A total of 200 women, 100 diagnosed as having HG before the 20th week of gestation at a tertiary referral center and 100 gestational-age-matched controls were enrolled. The socio-demographic data and the depression and anxiety scores, as assessed using the Beck depression and anxiety inventory were compared between the two groups. RESULTS: The median depression and anxiety scores were significantly higher in the HG group compared with controls (19.5 vs. 9.0 and 22.0 vs. 10.0). Women with HG have the highest relative risks for moderate depression and severe anxiety [relative risk (RR): 16.88 and RR: 20.50, respectively]. In the univariate analysis, having HG, low education level, low income and poor social relationships were significant predictors of depression and having HG. Moreover, poor social relationships significantly predicted the presence of anxiety disorder. However, having HG and poor social relationships were found as the only independent predictors of both depression and anxiety. Patients with HG were 5.5 and 6.7 times more prone to having depression and anxiety disorder compared with controls, respectively. CONCLUSION: Both depression and anxiety disorder were more frequent in women with HG who have weak family and social relationships, lower education and income levels. Therefore, the determination of the psychological status of women with HG should be an integral part of the evaluation.

Sonographic Assessment of the Fetal Penile Development.

The intrauterine diagnosis of micropenis is an important clue in the discernment of some syndromes and hormonal deficiencies. In this study, we tried to establish reference ranges for the fetal penile length and penile width. This prospective cross-sectional study included 179 healthy singleton male fetus pregnancies that were between 17 and 37 weeks of gestation. Of these pregnancies, the fetal penile length and width were measured using trans-abdominal ultrasound. The correlation coefficients of gestational age with penile measurements were calculated. We observed that as the gestational age increased both the penile length and width increased (p < .0001, correlation coefficients R(2) = 0.854 and R(2) = 0.883; respectively). Reference values of the penile length in the Turkish Population were similar to previously evaluated populations including English, American and Israeli populations. The penile width measurement is a convenient way to diagnose micropenis, but penile width measurement alone might miss some penile abnormalities including chordee and hypospadias.

Success rates of single-dose methotrexate and additional dose requirements among women with first and previous ectopic pregnancies.

OBJECTIVE: To compare the success of the single-dose methotrexate regimen and the requirement for a second or third dose of methotrexate between women with their first ectopic pregnancy (EP) and those with previous EP. METHODS: In a retrospective cohort study, data were analyzed from women treated for EP by single-dose methotrexate at a Turkish tertiary referral center between January 2010 and December 2013. Data were compared between women with at least one previous EP and those with their first EP. RESULTS: The success rate of the protocol in the first and previous EP groups was similar: 93.0% (320/344) and 87.3% (48/55), respectively. History of previous EP was not a predictor of treatment failure. However, the requirement for additional methotrexate doses was significantly higher in the previous EP group (16/48 [33.4%]) than in the first EP group (55/320 [17.2%]; P=0.03). Multivariate analysis showed that history of tubal surgery (P=0.006) and initial levels of the ß-subunit of human chorionic gonadotropin (P=0.001) were significant predictors of treatment failure. CONCLUSION: Although the single-dose regimen had similar success rates in the previous EP and first EP groups, additional doses of methotrexate were more frequently required in the previous EP group.

Influence of threatened miscarriage on pregnancy and early postpartum period: a case-control report.

OBJECTIVE: To evaluate the influence of threatened miscarriage on obstetric complications during pregnancy and early postpartum period. METHODS: In this case-control study, hospital records of 12,050 first-trimester patients between January 2011 and December 2012 at the Research and Educational Hospital in Ankara, Turkey, were used. Of the 12,050 patients, 481 threatened miscarriage patients were evaluated. The control group was formed by age- and body mass index-matched cases without first trimester bleeding. Abortion, intrauterine foetal demise, preterm birth, preeclampsia, antenatal haematoma, uterine atony placental abruption and low birth-weights were compared between the study and the control group. RESULTS: When compared with the control group, the risk of having a preterm birth (p = 0.014; OR: 1.95; 95% CI: 1.15-3.24), low-birth-weight infant (p = 0.001; OR: 2.33; 95% CI: 1.45-3.83) and abortion (p = 0.00; OR: 2.55; 95% CI: 1.62-3.91) increased in cases of threatened miscarriage. However, the risk of uterine atony was decreased (p = 0.006; OR: 0.09; 95% CI: 0.12-0.7) in the threatened miscarriage group when compared with the control group. Threatened miscarriage did not increase the risk of placenta praevia, placental abruption or intrauterine foetal demise. CONCLUSION: Increased complications after threatened miscarriage is probably due to the persistence of a triggering mechanism. As preterm birth and abortion rate increased, whilst uterine atony rate decreased, one of the mechanisms causing threatened miscarriage might be increased uterine contractility.

Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen.

PURPOSE: To investigate the predictive factors for the requirement of additional doses of methotrexate in women with ectopic pregnancy treated with single-dose methotrexate regimen. METHODS: This retrospective cohort study was conducted on women treated with single-dose methotrexate regimen for ectopic pregnancy at a tertiary referral center. Control group included the patients who were treated only with a single dose of methotrexate (n = 131) and study group included the patients who need a second dose or third dose methotrexate (n = 76). The sonographic variables such as size of the ectopic mass, the endometrial thickness and biochemical variables were analyzed via Chi square and student t test. Logistic regression analysis used to determine independent predictors of the additional dose requirement. RESULTS: The size of the ectopic mass and the endometrial thickness were similar in both groups. However, all human chorionic gonadotropin values on day 1, 4 and 7 were significantly higher in study group than the control group (p = 0.0001). Logistic regression analysis revealed that the human chorionic gonadotropin changes between day 1 and 4 is a predictive factor for requirement of additional doses of methotrexate (area under curve: 0.763, p < 0.001) and the cutoff value for human chorionic gonadotropin change was calculated as 22%. The probability of the requirement for an additional dose of methotrexate is 6.45 times more in patients who had less than 22% reduction in human chorionic gonadotropin levels from day 1 to 4 compared to those who had >22% reduction from day 1 to 4. CONCLUSION: Less than 22% reduction in human chorionic gonadotropin levels from day 1 to 4 can be used as a predictive factor for the requirement of an additional dose of methotrexate in single-dose regimen. This cutoff value can be used for patients to inform about the probable longer resolution time and refer to alternative treatment modalities such as two-dose, multiple-dose regimens or surgery.

Is meconium stained amniotic fluid related to occult myocardial injury in term low risk pregnancies?

AIM: The present study aimed to compare Troponin T (Tp T) levels of infants born with meconium stained amniotic fluid (MSAF) to those with clear amniotic fluid. STUDY DESIGN: Case-control study SUBJECTS: Thirty-five women who had delivery complicated by MSAF between 37 and 41weeks of gestation were defined as the study group and women with healthy uncomplicated pregnancies with clear amniotic fluid who were matched for age, parity, and gestational age were defined as the control group. OUTCOME MEASURES: Cord blood Tp T level, gas analysis and neonatal outcomes were compared between groups. RESULTS: Tp T levels of the study and control groups were 0.026±0.013ng/ml and 0.031±0.016ng/ml, respectively. The difference was not statistically significant (p=0.132). On the other hand, the study group had a statistically lower HCO(3) level (21.80 vs 23.60mmol/l ) and higher rate of base deficit (4.85 vs 3.25mmol/l) than the control group. CONCLUSION: The presence of meconium during labor is not related to occult myocardial injury in low-risk term pregnancies.

Cord blood S100B levels in low-risk term pregnancies with meconium-stained amniotic fluid.

OBJECTIVE: The aim of this study was to compare cord blood S100B levels and cord blood gas parameters of term infants with meconium-stained amniotic fluid (MSAF) to those infants with clear amniotic fluid. METHODS: Term pregnant women at an active phase of labor and having MSAF were defined as the study group (n = 35) and pregnant women with clear amniotic fluid, and matched for age, parity, and gestational age were defined as the control group (n = 35). Cord blood S100B levels and gas parameters were measured. RESULTS: LogS100B values of study and control groups were 2.40 ± 0.21 and 2.43 ± 0.29 pg/ml, respectively. The difference was not statistically significant (p = 0.675). LogS100B levels slightly increased as meconium thickened. (2.32 ± 0.16, 2.41 ± 0.17, and 2.44 ± 0.28 pg/ml, respectively). However, no difference was found between groups (p = 0.438). Moreover, the study group had a statistically lower HCO(3) level (21.80 vs 23.60 mmol/l) and a higher rate of base deficit (4.85 vs 3.25 mmol/l) than the control group. However, median HCO(3) and base deficit values were within normal limits in both groups. CONCLUSION: The present study showed that cord blood S100B levels of infants born through MSAF were not different from those with clear amniotic fluid. This finding suggests that MSAF, regardless of its thickness, may not be related to brain damage in low risk term pregnancies.

Neuroprotective effect of magnesium sulfate treatment on fetal brain in experimental intrauterine ischemia reperfusion injury.

OBJECTIVE: The aim of this study was to demonstrate the neuroprotective effect of magnesium sulfate on ischemia-reperfusion-induced injury in fetal rat brain. METHODS: Twenty-four, 19-days pregnant rats were randomly allocated into four groups. Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 20 min and reperfusion was achieved by removing the clamps for 30 min. The control group consisted of noninjured rats. No treatment was given in the ischemia-reperfusion group; whereas 1 ml saline and 600 mg/kg magnesium sulfate was administered in the vehicle and the treatment groups 30 min before ischemia reperfusion injury. Lipid peroxidation in the brain tissue was determined as the concentration of thiobarbituric acid-reactive substances (TBARS) for each fetal rat. A one-way analysis of variance and post hoc test were used for statistical analysis. RESULTS: TBARS levels were found to be increased after ischemia reperfusion injury when compared with controls. Magnesium sulfate treatment prevented the increase in TBARS after ischemia reperfusion injury. CONCLUSIONS: We have shown that magnesium sulfate decreases TBARS levels significantly in fetal rat brain subjected to ischemia reperfusion injury and may have potential therapeutic benefits by reducing oxidative stress after intrauterine ischemia-reperfusion-induced fetal brain damage.

Diagnostic accuracy and efficacy of color Doppler mapping for tubal patency.

AIM: To evaluate the diagnostic accuracy of color Doppler mapping for tubal patency, comparing its results with those of hysterosalpingography (HSG) and laparoscopy. MATERIAL AND METHODS: A prospective clinical study was conducted in 36 subfertile women who were offered laparoscopy after HSG evaluation. All infertile couples were evaluated with basic infertility procedures. After HSG assessment, laparoscopy was offered when evidence of either unilateral or bilateral tubal obstruction was observed. One day before the operation, transvaginal ultrasound scanning of the pelvis and color Doppler mapping were performed. The findings of sonography, HSG and laparoscopy were compared. RESULTS: Sixty-four of 72 fallopian tubes were evaluated and four patients were excluded from the analysis because of technical difficulties. The sensitivity of color Doppler mapping for detecting tubal patency was 76.2% with a specificity of 81.4%. The positive and negative predictive values were 66.7% and 87.5%, respectively. The concordance rate was 79.7%. The false positivity rate for color Doppler mapping and HSG were observed as 19% and 35%, respectively. CONCLUSION: Color Doppler mapping as an adjunct to an abnormal HSG may decrease the need for laparoscopic intervention for the diagnosis of tubal disorders.

The management of recurrent cases after the Burch colposuspension: 7 years experience.

PURPOSE: We aimed to discuss our approach to the failure cases whose primary surgery was Burch colposuspension. METHODS: Total cases who underwent Burch colposuspension was 298, however, 36 cases lost follow-up therefore the study population was 262 cases. Forty-two patients having recurrent stress urinary incontinence (16.0%) after Burch procedure enrolled for the study. Twenty-nine of the recurrent cases were treated with mid-urethral slings tension-free vaginal tape or transobturator tape (TOT) as a secondary procedure, whereas thirteen of the recurrent cases preferred to take medical therapy. Seven of the failed patients after the repeat surgery accepted TOT as a tertiary procedure. RESULTS: The cumulative cure rates after the secondary and tertiary interventions were 62.1 and 57.1%, respectively. No complications were noticed during the secondary and tertiary surgical interventions. CONCLUSION: Our study showed that suburethral sling surgery can be an effective choice for the treatment of recurrent cases after Burch colposuspension.

Nonreassuring fetal heart rate patterns and nucleated red blood cells in term neonates.

PURPOSE: The aim of this study was to evaluate the association between nonreassuring fetal heart rate patterns during labor and umbilical cord nucleated red blood cell counts. METHODS: Nucleated red blood cell data was collected prospectively from 41 singleton term neonates presented with nonreassuring fetal heart rate patterns and/or meconium stained amniotic fluid during labor (study group) and from 45 term neonates without any evidence of nonreassuring fetal status (controls). Umbilical artery pH, blood gases and base excess were also determined to investigate the correlation between independent variables. RESULTS: The median nucleated red blood cells per 100 white blood cells were 13 (range 0-37) in the study group and 8 (range 0-21) in the control group. Stepwise regression analysis have identified meconium stained amniotic fluid (R(2) = 0.15, p < 0.0001) and umbilical artery PO(2) (R(2) = 0.1, p = 0.002) as independent variables associated with elevated NRBC counts in patients with nonreassuring fetal heart rate patterns. CONCLUSIONS: Nucleated red blood cells in the cord blood of newborns were found to be elevated in patients with nonreassuring FHR patterns during labor. However, the wide range and the poor correlation of NRBC count with umbilical artery pH and blood gas values limit its clinical utility as a marker for fetal hypoxia.

Second trimester serum alpha-fetoprotein level is a significant positive predictor for intrauterine growth restriction in pregnant women with hyperemesis gravidarum.

OBJECTIVE: The aim of this study was to determine the association between three parameters of second trimester serum secreening and preterm labor and intrauterine growth restriction (IUGR) in patients with hyperemesis gravidarum (HG). MATERIAL AND METHODS: A prospective study on 429 pregnancies with HG was designed to determine the association between alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotropin (HCG) and pregnancy prognosis in terms of preterm labor, IUGR and birth weight. RESULTS: In our study group the mean age of patients was 25.4±3.8 years. Mean birth weight was 3180±555 g. Mean AFP, uE3, hCG levels in the study group were 1.44±0.65 MoM, 0.91±0.38 MoM, 1.09±0.64 MoM, respectively. Twenty nine (6.8%) patients delivered before 37 weeks of gestation and 52 (12.1%) patients developed IUGR. Mean MoM values of AFP among patients with preterm labor, IUGR and normal delivery were 1.35±0.45, 1.97±0.81, 1.34±0.58 MoM, respectively (p<0.001). Mean MoM values of hCG among patients with preterm labor, IUGR and normal delivery were 1.46±0.90, 1.35±0.89, 1±0.5 MoM respectively (p<0.001). Mean MoM values of uE3 among patients with preterm labor, IUGR and normal delivery were 0.75±0.25, 0.80±0.30, 0.95±0.40 MoM, respectively (p=0.003). Odds ratio of AFP>1.55 was 3.73 (95% CI, 1.99-6.98, p<0.001) for IUGR after adjustment for HCG. CONCLUSION: Our study suggests that AFP levels of the second trimester screening test higher than 1.55 MoM is significantly associated with IUGR in hyperemesis gravidarum. The second trimester screening test can predict poor outcome in HG.

Laparoscopic management of primary abdominal pregnancy: a case report.

This is a case report of a primary abdominal pregnancy managed by laparoscopic intervention. A 22 year old, gravida 1, woman was admitted to our emergency room with vaginal bleeding and pain in lower abdomen. She was 4 weeks pregnant according to her last menstrual period. She had undergone right salpingoophorectomy previously. Pelvic examination revealed cervical motion tenderness, bilateral adnexal tenderness and rebound tenderness. Her vital signs were normal. Beta hCG was 15826 IU/ml and hemoglobin was 10.0 g/dl. Transvaginal sonography showed an endometrium of 3 mm thickness and free fluid in the pelvis. Upon admission to the Early Pregnancy Clinic, abdominal pain became worse and hemoglobin decreased to 8.0 g/dL. Therefore, we performed a laparoscopy which showed that the uterus, left tube and ovary were completely normal with absence of the right ovary and tube. Approximately 500 cc blood was aspirated from the pelvis. Between the right sacrouterine ligament and rectum, there was a bleeding area 2 cm in width which was removed with forceps and sent for frozen pathological examination,which revealed 'placental tissue fragments'. Endometrial sampling was reported to be 'secretory endometrium'. A rapid decrease in the beta HCG post operative titer confirmed the resolution of the pregnancy. Primary abdominal pregnancy is extremely rare. The diagnosis is confirmed according to Studdiford's criteria. In the literature, there only a few cases of abdominal pregnancy in which laparoscopic procedure has been used effectively as treatment. However, laparoscopic procedure is usually successful in treatment of abdominal pregnancy if the gestational age is early enough.

[Investigation of Listeria monocytogenes serotype O antibodies in maternal and cord sera and the evaluation of risk factors for listeriosis in pregnant women]. / Anne ve kordon serumlarinda Listeria monocytogenes serotip O antikorlarinin arastirilmasi ve gebelerde listeriyoz risk faktörlerinin degerlendirilmesi.

Listeria monocytogenes may lead to intrauterine infections which can be treated if diagnosed promptly. However, there is not a rapid routine screening test with high specificity and sensitivity for the diagnosis of listeriosis during pregnancy. We investigated the presence of different L. monocytogenes O antibodies for diagnosis of listeriosis in 275 paired maternal-cord sera using the agglutination test, and aimed to evaluate the correlation between poor pregnancy outcomes, level of L. monocytogenes serotype O antibodies and risk factors for listeriosis. Maternal-cord bloods were collected from a total of 275 pregnant women (age range 16-38 years) between April-August 2002 from a State Hospital in Ankara. A total of 550 sera were tested against antigens with the O formulation of serotypes 1/2c, 3b, 4ab, 4c, 4d by tube agglutination method and titers > or = 1/320 were considered as positive. Sixtynine patients with the history of poor pregnancy outcomes were in group I, while 206 patients with no obstetric pathology in previous pregnancies were in group II. L. monocytogenes antibodies to one or more serotypes were detected in 21.5% (59/275) of the patients, the rate being 20.3% in group I and 21.8% in group II. No statistically significant difference was detected between the two study groups (p > 0.05), indicating that this test was not an appropriate marker for the diagnosis of listeriosis during pregnancy. The total rate of positive results in cord sera was 0.7% (2/275) and the positive two sera were from samples in group II. The follow-up of the newborns, including the two cord blood positive ones, revealed no fetomaternal infection. The most frequently detected serotypes were 4ab (40%) and 1/2c (37%). Risk factors such as non-specific febrile illness during pregnancy (p < 0.001), consumption of ready-made food (p = 0.008), consumption of raw milk and milk products (p < 0.001) were found to be related to the presence of > or = 1/320 titers of L. monocytogenes antibodies. The major limiting factor in this study was the inability to obtain second serum samples from the mothers and newborns following delivery, to confirm the diagnosis by seroconversion. These results emphasize the need for the development of rapid, simple and reliable tests, alternative to culture methods, for the early and proper diagnosis of Listeria infections during pregnancy.

Residents performance in transobturator tape procedures for stress urinary incontinence.

OBJECTIVES: The purpose of this study was to investigate the operative time, surgical complications and patient outcomes of the TOT surgery performed by an experienced surgeon compared to those performed by a senior resident under proper supervision by a senior surgeon. PATIENTS AND METHODS: A prospective, open label, randomized study was conducted at the department of urogynecology of the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching Research Hospital between June 2003-June 2004. The study included 60 women who had stress urinary incontinence. Patients were randomly allocated to either the TOT surgery performed by an experienced surgeon group (Group 1, n=30) or the TOT surgery performed by a senior resident under proper supervision by a senior surgeon group (Group 2, n=30). The operative time, intraoperative and postoperative complications, intraoperative blood loss and the effectivity of the TOT procedure were recorded by a senior surgeon who did not participate to the operation. RESULTS: The study was completed by 55 women. Baseline characteristics were comparable between the two groups. The mean operative time was significantly long in Group 2 compared with Group 1 (27 min [15-48]; 13 min [7-22], respectively). There was no difference between the Groups 1 and 2 in terms of the intraoperative and postoperative complications. No bladder injury was noted in Group 1. One bladder injury was observed in Group 2 and the bladder was repaired in the usual form by the assisting senior surgeon. Urinary retention was observed in two patients in Group 2 and the tapes were cut 7 days after the operation. Both of the patients have been dry since the intervention. The mean follow up period was 30 months. After the follow up period, there were no statistically significant differences in terms of cure, partial recovery and failure between two groups. CONCLUSION: There is no difference in the outcome when TOT is performed by residents under proper supervision.

Posterior sling (infracoccygeal sacropexy): an alternative procedure for vaginal vault prolapse.

This study of 30 patients evaluated the effectiveness and safety of the posterior sling (infracoccygeal sacropexy) in the surgical treatment of vaginal vault prolapse. The patients were reevaluated 3 months, 6 months and yearly postoperatively. Coexisting preoperative symptoms of pelvic pain, urgency, nocturia and 'obstructed' micturition feeling were followed-up. There was remarkable improvement in vault prolapse and in coexisting symptoms.

Unsucessful labour induction in women with unfavourable cervical scores: predictors and management.

BACKGROUND: Misoprostol fails to induce labour in 5-20% of women at term. AIM: To analyse possible predictors of unsuccessful induction with 50 microg vaginal misoprostol and effectiveness and the safety of intracervical Foley catheter application in induction failures. METHODS: An observational study was conducted on 1030 women with singleton, live fetuses, vertex presentation, > 34 weeks of gestation and Bishop score < 5. Induction of labour with 50 microg vaginal misoprostol repeated every 6 h was attempted. Women without regular uterine contractions and cervical changes at the end of 24 h were considered to be unsuccessful, and a transcervical Foley balloon catheter was placed and inflated with 50 mL saline. Possible predictors of induction failures were analysed via logistic regression analysis. Neonatal outcomes and vaginal delivery achieved after Foley catheter were also determined. RESULTS: Induction was successful in 918 cases (89.1%) and Foley catheter was placed in 112 (10.8%) women. Increasing gestational age in weeks (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.68-0.88) and increasing Bishop score (OR 0.73, 95% CI 0.60-0.90) decreased the risk of failed induction. Failure rates were 16% (27/169) in post-term nulliparous women with Bishop score