Indications, risk factors, and outcomes of emergency peripartum hysterectomy: A 7-year retrospective study at a tertiary center in Turkey.

Objective: To determine the incidence, indications, the risk factors, complications, maternal morbidity and mortality of emergency peripartum hysterectomy (EPH), and perinatal outcomes at a tertiary hospital, Turkey. Methods: We analyzed 71 cases of EPH from 2012 to 2019 at a tertiary hospital in a retrospective study. There were 142 control patients. Results: There were 71 EPH out of 69,504 deliveries, for an overall incidence of 1.02 per 1000 births. The main indication for peripartum hysterectomy was abnormal placentation (67.6%), followed by uterine atony (28.1%), and uterine rupture (4.2%). Cesarean section (CS) and previous CS are major risk indicators for EPH. Other risk indicators are advanced maternal age (≥ 35 years) and multiparity. All patients with abnormal placentation had a previous CS. 93% of EPH were performed during and/or after CS, and 7% after vaginal delivery. 69% of EPH were made in total and 31% were subtotal. The three most common maternal morbidity included: wound infection and febrile morbidity (26.7%), bladder injury (16.9%), and disseminated intravascular coagulopathy (11.2%). There were no maternal deaths but perinatal mortality was 4%. Conclusion: The most common indication for EPH was abnormal placentation. Also, CS and previous CS are major risk factors of EPH. Other risk factors for EPH are advanced maternal age (≥ 35 years) and multiparity. Moreover, all unnecessary CS should be avoided.

Ischemia modified albumin levels in intrauterine growth restriction: levels are increased in fetal cord blood but not in maternal blood.

OBJECTIVES: In this study, our aim was to determine the differences between intrauterine growth restriction (IUGR) and normal birth weight fetuses in terms of ischemia modified albumin (IMA) levels. For this purpose, we measured ischemia modified albumin levels in the cord blood of fetuses and venous blood of mothers. MATERIAL AND METHODS: This study is a prospective study conducted at University of Health Sciences Tepecik Training and Research Hospital between January 2018 and December 2019. According to the inclusion/exclusion criteria, 227 patients were included in the study. Participants were divided into two groups according to the presence (patient group) or absence (control group) of intrauterine growth restriction (IUGR). In addition to routine parameters recorded during pregnancy, the IMA levels and Doppler USG findings of all participants were recorded. RESULTS: The mean cord blood serum IMA levels of the patient group were significantly elevated compared to controls (p = 0.038). Whereas mean maternal blood serum IMA levels were similar among groups (p = 0.453). The cord blood and mother blood serum IMA levels were not significantly different with regard to the presence or absence of perinatal asphyxia. CONCLUSIONS: In the literature, studies evaluating IMA levels in the cord and maternal blood of IUGR fetuses are limited. In IUGR patients, IMA level is expected to increase and in our study, IMA levels were significantly increased but the presence of oxidative stress has not been found to affect IMA levels.

Long-term outcomes and quality of life effects of single incision mini sling procedure in stress urinary incontinence patients.

OBJECTIVE: We aimed to evaluate the long-term outcomes and quality of life of patients who underwent single incision minisling (SIMS) procedure. STUDY DESIGN: 62 patients who were diagnosed with stress urinary incontinence (SUI) and received treatment with SIMS procedure (Ophira, Promedon, Argentina) were included in the study. Mean age was 50.73 ± 9.28 years and mean follow-up duration after surgery was 30.68 ± 7.52 months. Preoperative urological and gynecological features of the patients were recorded. Gynecological examination, pelvic ultrasonography, stress test, Q-tip test, cystometry were performed and incontinence and quality of life questionnaires (ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI) were completed by all patients before and after the operation. RESULTS: Stress urinary incontinence was observed in all patients during pre-op evaluations. 62 patients aged between 35-85 (mean age 50.73 ± 9.28) years were included and follow up duration ranged between 12-44 (average 30.68 ± 7.52) months. In regard to patient evaluations, 27 patients (43.5%) felt that the surgery was very effective, 25 (40.3%) felt surgery was effective and 10 (16.1%) did not report any difference after surgery. In the long-term postoperative follow up; 2 (3.2%) patients had dyspareunia and 7 (11.3%) patients had vaginal tape erosions which were diagnosed 2-40 months postoperatively. According to Q-tip test results, proximal urethral mobility was significantly decreased after surgery. All questionnaire scores were also significantly improved at post-operative evaluations. (P < 0.001) CONCLUSIONS: Our study confirmed that the Ophira mini sling technique provided high subjective cure rate and improved symptoms and quality of life in patients with SUI. These results suggest that the single incision mini sling procedure is an advisable alternative to other surgical procedures due to its low complication rates and ease of learning and applying the procedure. This procedure also demonstrated excellent tolerability, minimal pain, low morbidity and increased quality of life scores, in ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI.

Asprosin: a novel peptide hormone related to insulin resistance in women with polycystic ovary syndrome.

Asprosin associated with insulin resistance is a newly discovered peptide hormone. The peptide promotes hepatic glucose production. Polycystic ovary syndrome (PCOS) is a metabolic disorder. Insulin resistance plays a vital role in the pathogenesis of the disease. The aim of this study was to discover the association between insulin resistance and asprosin in women with PCOS. We recruited 78 subjects with PCOS and 78 age-matched and body mass index (BMI)-matched controls into this cross-sectional study. Circulating asprosin levels were validated using ELISA method. We also determined metabolic and hormonal parameters of the involved subjects. We found that circulating asprosin levels were elevated in women with PCOS with respect to controls. Asprosin levels showed a positive correlation with insulin resistance, BMI, and free androgen index (FAI). Moreover, subjects with the highest tertile of asprosin levels represented increased odds of having PCOS as compared to those subjects with the lowest tertile asprosin levels. Increased asprosin levels resulted to high possibility of having PCOS risk associated with insulin resistance.

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligament fixation (SSLF), and iliococcygeus fixation due to apical prolapse. Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgery performed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeus fixations. Patients' short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed. Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in the SSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter in the iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period, no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominal sacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332). Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedures were not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-related morbidity.

QF-PCR in invasive prenatal diagnosis: a single-center experience in Turkey.

BACKGROUND/AIM: QF-PCR has been used for more than 20 years. It is based on investigation of polymorphic short tandem repeats (STRs) and is widely used for prenatal rapid aneuploidy detection. MATERIALS AND METHODS: We report retrospectively our prenatal diagnosis results between January 2012 and May 2014 in Tepecik Training and Research Hospital Genetic Diagnostic Center. Prenatal diagnosis was recommended in 6800 high-risk pregnancies and 2883 patients agreed to invasive diagnosis. Chromosome analysis and QF-PCR were performed in all patients. RESULTS: Normal results were reported in 2711 cases by fetal karyotyping and in 2706 cases by QF-PCR. Anomaly detection rates were similar for the two methods (5.09% for karyotyping and 4.02% for QF-PCR). CONCLUSION: QF-PCR is a fast and reliable prenatal diagnosis method in all indication groups and may be preferred as the sole prenatal investigation in patients without fetal ultrasonographic findings.

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques.

OBJECTIVE: To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes. METHODS: In this case-control study, 412 women who underwent CVS at 11-14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution. RESULTS: The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4-2.7, P=0.008]. CONCLUSION: The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

Use of urea and creatinine levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes and delivery interval after membrane rupture.

OBJECTIVE: To determine whether urea and creatinine measurements in vaginal fluid could be used to diagnose preterm premature rupture of membranes (PPROM) and predict delivery interval after PPROM. METHODS: A prospective study conducted with 100 pregnant women with PPROM and 100 healthy pregnant women between 24 + 0 and 36 + 6 gestational weeks. All patients underwent sampling for urea and creatinine concentrations in vaginal fluid at the time of admission. Receiver operator curve analysis was used to determine the cutoff values for the presence of PPROM and delivery within 48 h after PPROM. RESULTS: In multivariate logistic regression analysis, vaginal fluid urea and creatinine levels were found to be significant predictors of PPROM (p < 0.001 and p < 0.001, respectively) and delivery within 48 h after PPROM (p = 0.012 and p = 0.017, respectively). The optimal cutoff values for the diagnosis of PPROM were >6.7 mg/dl for urea and >0.12 mg/dl for creatinine. The optimal cutoff values for the detection of delivery within 48 h were >19.4 mg/dl for urea and >0.23 mg/dl for creatinine. CONCLUSION: Measurement of urea and creatinine levels in vaginal fluid is a rapid and reliable test for diagnosing and also for predicting delivery interval after PPROM.

Can the Myocardial Performance Index Be Used as a New Predictive Factor for a Poor Prognosis in Fetuses With Idiopathic Polyhydramnios?

OBJECTIVES: The purpose of this study was to determine whether there are any changes in cardiac function in fetuses with idiopathic polyhydramnios and also to evaluate the value of the myocardial performance index for prediction of adverse perinatal outcomes. METHODS: A prospective case-control study was conducted with a total of 134 fetuses between 24 and 40 weeks' gestation. Polyhydramnios was defined as an amniotic fluid index of greater than 24 cm. Seventy-three fetuses of healthy mothers were assigned as the control group whereas 36 fetuses with an amniotic fluid index of 24 to 34 cm constituted the nonsevere polyhydramnios group, and 31 fetuses with an amniotic fluid index of 35 cm or greater constituted the severe polyhydramnios group. Fetal echocardiography was performed to compare cardiac function parameters among groups. To determine which perinatal outcomes were independently associated with an increased myocardial performance index, a multivariate logistic regression analysis was performed. RESULTS: The myocardial performance index was significantly higher in polyhydramnios groups compared with controls (P < .001). Among fetuses with polyhydramnios, the myocardial performance index was significantly higher in severe polyhydramnios compared with nonsevere polyhydramnios (P = .003). An increased myocardial performance index in polyhydramnios was independently associated with nonreassuring fetal status (odds ratio, 2.12; 95% confidence interval, 1.41-4.53; P = .005), emergency cesarean delivery (odds ratio, 1.54; 95% confidence interval, 1.12-2.37; P= .025), and respiratory distress syndrome (odds ratio, 1.79; 95% confidence interval, 1.21-3.87; P = .012). CONCLUSIONS: An increased myocardial performance index is an early indicator of adverse perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.

High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia.

OBJECTIVES: The aim of our study is to determine whether first-trimester neutrophil-to-lymphocyte ratio (NLR) and plate-let-to-lymphocyte ratio (PLR) would be useful as new predictors of subsequent preeclampsia. MATERIAL AND METHODS: Medical records of women with preeclampsia and healthy controls from a tertiary referral center were retrospectively evaluated. The two groups were compared in terms of clinical characteristics and first-trimester levels of hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, NLR and PLR. Receiver operating characteristic curve (ROC) analysis was performed to identify the optimal NLR and PLR levels predicting preeclampsia. RESULTS: Neutrophil (p < 0.001), platelet (p < 0.001), NLR (p < 0.001) and PLR (p < 0.001) levels were significantly elevated, whereas hemoglobin concentration (p = 0.003) was significantly lower in the group with preeclampsia as compared to the control group. On multivariate regression analysis, NLR (OR 1.43; 95% CI 1.21-1.76; p = 0.005) and PLR (OR 1.38; 95% CI 1.15-1.63; p = 0.008) were the most powerful predictive variables. The area under the ROC was 0.716 and 0.705 for NLR and PLR, respectively. The cut-off values of NLR ≥ 3.08 and PLR ≥ 126.8 predicted preeclampsia with the sensitivity of 74.6% and 71.8% and specificity of 70.1% and 72.4%, respectively. CONCLUSIONS: High NLR and PLR during the first trimester are independent predictors of subsequent preeclampsia.

Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction.

OBJECTIVES: Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes. METHODS: The transverse diameter of the fetal thymus was prospectively measured in 150 healthy and 143 IUGR fetuses between 24 and 40 weeks' gestation. The fetuses with IUGR were further divided according to normal or abnormal Doppler assessment of the umbilical and middle cerebral arteries and ductus venosus. Measurements were compared with reference ranges from controls. To determine which perinatal outcomes were independently associated with a small fetal thymus, a multivariate logistic regression analysis was performed. RESULTS: Thymus size was significantly lower in IUGR fetuses compared to controls (P < .05). Among IUGR fetuses, thymus size was significantly smaller in IUGR fetuses with abnormal Doppler flow compared to normal flow (P < .05). A small thymus in IUGR fetuses was independently associated with early delivery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.05-1.49; P= .023), respiratory distress syndrome (OR, 1.36; 95% CI, 1.09-1.78; P= .005), early neonatal sepsis (OR, 1.65; 95% CI, 1.11-2.42; P= .001), and a longer stay in the neonatal intensive care unit (OR, 1.33; 95% CI, 1.08-1.71; P = .017). CONCLUSIONS: Intrauterine growth restriction is associated with fetal thymic involution, and a small fetal thymus is an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study.

OBJECTIVES: To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation. METHODS: Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately. RESULTS: Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h. CONCLUSIONS: Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.

The effect of associated structural malformations in the prediction of chromosomal abnormality risk of fetuses with echogenic bowel.

OBJECTIVE: Our aim is to determine the frequency of chromosomal abnormalities and also to identify the role of structural malformations on the chromosomal abnormality risk among fetuses with echogenic bowel. METHODS: Over a 6-year period fetuses with echogenic bowel (FEB) were retrospectively evaluated. The pregnancies with intra-amniotic bleeding history, congenital infection, cystic fibrosis and intrauterine growth retardation were excluded from the study. Types and frequency of sonographically detected fetal malformations were identified. Chromosomal abnormality incidences according to association with soft markers and major fetal abnormalities were compared. RESULTS: Of the 281 fetuses with echogenic bowel, 105 (37.37%) were isolated, 78 (27.76%) were associated with soft markers and 98 (34.87%) were associated with major abnormalities. There were 30 (10.7%) fetuses with abnormal karyotypes. The chromosomal abnormality rate of the groups of isolated FEB, FEB + soft markers and FEB + major abnormalities were 6.7%, 7.7% and 17.4%, respectively. CONCLUSIONS: Chromosomal abnormality risk in fetuses with echogenic bowel should be evaluated according to additional sonographic findings. Association of structural malformations increases the chromosomal abnormality risk, although this risk is not significant with the presence of soft markers alone.

Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery.

OBJECTIVE: The aim of this study was to identify the prevalence of anemia and predisposing factors contributing to anemia in pregnant women prior to delivery. MATERIAL AND METHODS: A retrospective case-control study was conducted on 1221 women who delivered between 37 and 42 weeks of gestation between July 2014 and January 2015. Data on the subjects' socioeconomic and demographic characteristics, pregnancy outcomes, and hemoglobin levels within 24 h prior to delivery were collected. The study population was divided into two groups on the basis of the presence of anemia within 24 h prior to delivery. Anemia was defined as a hemoglobin level of <11 g/dL. The prevalence of pre-delivery anemia was estimated, and antenatal predictors of anemia were determined using multivariate logistic regression analysis. RESULTS: The prevalence of anemia in women attending our center for delivery was 41.6% [95% confidence interval (CI) =38.84-44.37]. After multivariate logistic regression analysis, parity >3 [odds ratio (OR) =1.82, 95% CI=1.24-2.96, p=0.002], illiterate (OR=2.23, 95% CI=1.35-3.45, p=0.001) and primary educational level (OR=2.01, 95% CI=1.28-3.39, p=0.008), household monthly income per person <250 Turkish liras (OR=2.34, 95% CI=1.49-3.89, p<0.001), first admission at second (OR=1.63, 95% CI=1.24-2.81, p=0.006) and third trimester (OR=2.45, 95% CI=1.41-4.06, p<0.001), number of antenatal visits <5 (OR=1.45, 95% CI=10.5-2.11) and 5-10 (OR=1.3, 95% CI=1.03-2.09), duration of iron supplementation <3 months (OR=2.62, 95% CI=1.51-4.17) and 3-6 months (OR=1.68, 95% CI=1.13-2.91), and occurrence of preeclampsia (OR=1.55, 95% CI=1.03-2.1, p=0.041) were independently associated with anemia. CONCLUSION: Socioeconomic determinants constitute most of the anemia cases and, hence, should be considered as major risk factors of anemia in women attending for delivery at term.

Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes.

AIM: The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes. MATERIAL AND METHODS: Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as <6, 6-11, 12-17, 18-23, 24-35 and ≥36 months. Adverse outcomes included spontaneous labor leading to preterm birth (n = 265), preterm premature rupture of membranes (n = 245), pre-eclampsia (n = 286), gestational diabetes (n = 302), abnormal placentation (n = 154), anemia (n = 314), congenital anomalies (n = 459), post-partum hemorrhage (n = 326) and small for gestational age (n = 168). Multivariate logistic regression analysis was performed to assess the association of each outcome with the interpregnancy interval categories. RESULTS: Spontaneous labor leading to preterm birth (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.13-1.97), preterm premature rupture of membranes (OR, 1.69; 95%CI, 1.28-2.39), congenital anomalies (OR, 1.38; 95%CI, 1.09-1.76) and small for gestational age (OR, 1.68; 95%CI, 1.14-2.34) were significantly associated with intervals of <6 months. Among congenital anomalies, short interpregnancy interval represents an increased risk for cardiac defects (OR, 1.55; 95%CI, 1.09-5.46), neural tube defects (OR, 2.06; 95%CI, 1.32-7.64) and central nervous system anomalies (OR, 1.45; 95%CI, 1.12-3.65). CONCLUSION: Short interpregnancy interval is an independent risk factor for adverse perinatal outcomes.

Predictors of severity in primary postpartum hemorrhage.

PURPOSE: To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH. METHODS: Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses. RESULTS: PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006). CONCLUSION: Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.

Perinatal outcomes in pregnancies with oligohydramnios after preterm premature rupture of membranes.

OBJECTIVE: Our purpose was to determine whether singleton pregnancies complicated by preterm premature rupture of membranes (PPROM) and oligohydramnios are at an increased risk of having maternal and neonatal morbidity. METHODS: We performed a retrospective analysis of 389 women with PPROM between 24 and 34 weeks of gestation in a single tertiary center during 2008-2014. Patients were divided into two groups on the basis of amniotic fluid index (AFI) < 5 cm (n = 188) or AFI ≥ 5 cm (n = 201). Perinatal outcomes were compared according to amniotic fluid volume. The Student's t-test and Mann-Whitney U test were used to compare variables with normal and abnormal distribution, respectively. Categorical variables were examined by the chi-square test. RESULTS: Patients with an AFI < 5 cm demonstrated a significantly shorter latency to delivery (p < 0.001), a higher rate of clinical chorioamnionitis (p = 0.029) and emergency cesarean delivery (p = 0.043) and a lower neonatal Apgar score at first minute (p = 0.004). CONCLUSION: Initial oligohydramnios after PPROM is associated with shorter latency to delivery, higher rate of clinical chorioamnionitis, higher rate of emergency cesarean delivery, and lower 1-min Apgar score.

Perioperative and postoperative complications after Ophira mini sling operations.

AIM: To evaluate perioperative and postoperative complications of mini sling operations in the surgical treatment of female urinary incontinence. METHODS: The study was comprised of 151 female patients with stress urinary incontinence (SUI) or mixed incontinence (MUI) with predominant SUI patients who underwent the mini sling procedure. The duration of the follow-up ranged from 6 to 21 months. All women had positive cough stress tests preoperatively. The procedure was performed under local (86.1 %) or spinal anesthesia (13.9 %) with the same mini slings for all cases. Patients were examined in the outpatient clinic at 1 and 6 months after surgery. RESULTS: The mean age was 49 years old (SD 10) with a range of 26-82. Of the 151 patients, 42 (27.8 %) presented MUI, while 109 (72.2 %) presented SUI. Mean parity was 3 ± 1. Mean body mass index was 28.9 ± 3.5. 60 (39.7 %) of the cases were postmenopausal. There were 73 women who participated in 6 months follow-ups and 78 women who did 1-year follow-ups. The mean operating time was 13 ± 3.1 min. There were no major intraoperative complications due to mini sling surgery. 120 (79.5 %) patients were discharged the day following the surgery. Ten patients (6.1 %) had de novo urge incontinence in their post-operative follow-ups which was resolved using anti-cholinergic drugs. Two patients (1.2 %) required sling sections due to prolonged bladder outlet obstruction. There were 15 patients that complained about de novo dyspareunia (9.9 %). Vaginal mesh extrusion was reported in 18 (11.9 %) patients. The mean preoperative and postoperative hemoglobin concentrations were 12.9 ± 1.3 and 12.5 ± 1.3 g/dL, respectively. CONCLUSION: The mini sling system can be considered an easy and effective method for treating stress urinary incontinence without major complication rates.

Can platelet count and mean platelet volume during the first trimester of pregnancy predict preterm premature rupture of membranes?

AIM: The aim of our study was to evaluate the values of platelet count and mean platelet volume (MPV) obtained from maternal serum during the first trimester to predict subsequent preterm premature rupture of membranes (PPROM). MATERIAL AND METHODS: The records of 318 women with PPROM and 384 healthy controls in a single center between 2009 and 2013 were retrospectively evaluated. Platelet count and MPV values between 7 and 14 weeks of gestation were compared. Receiver-operator curve analysis was performed to identify the optimal platelet count and MPV cut-off levels predicting PPROM. RESULTS: Compared with controls, women with PPROM had significantly increased levels of platelet count and significantly decreased levels of MPV in the first trimester (P < 0.001). The area under the receiver-operator curve was 0.642 for MPV and 0.579 for platelet count. The cut-off values of MPV ≤ 8.6 fL and platelet count ≥216 × 10(3) /µL predicted PPROM with a sensitivity of 58% and 65% and specificity of 62% and 44%, respectively. CONCLUSION: MPV can be used as a more efficient predictor for an early diagnosis of PPROM than platelet count. However, further research combining other markers is needed to increase the efficiency of prediction.

Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation.

PURPOSE: To identify risk factors and perinatal outcomes associated with the duration of latency period in women who experience preterm premature rupture of membranes (PPROM). METHODS: A retrospective study of women who experienced PPROM between 24 and 34 weeks of gestation was performed in a single tertiary center between 2009 and 2013. Patients were divided into two groups based on the duration of the latency period after PPROM: Group 1 ≤72 h and Group 2 >72 h. Risk factors and perinatal outcomes were compared according to latency period. Student's t test and Chi-square test were used to compare continuous and categorical variables, respectively, between the two groups. Multivariate regression analysis was performed to control for potential confounding variables. RESULTS: In total, 3,257 patients presented with PPROM during the study period; of these, 204 (6.3 %) met the inclusion criteria. Higher gestational age upon admission (odds ratio [OR] = 0.83, 95 % confidence interval [CI] = 0.79-0.87; p < 0.001), oligohydramnios (OR = 0.47, 95 % CI = 0.25-0.91; p = 0.018), and twin gestation (OR = 0.67, 95 % CI = 0.45-0.89; p = 0.032) were independently associated with a shortened latency period. In addition, prolonged latency significantly increased the occurrence of chorioamnionitis (OR = 2.23, 95 % CI = 1.48-3.14; p = 0.002), placental abruption (OR = 1.9, 95 % CI = 0.95-3.53; p = 0.033), and decreased the length of stay of neonates in the intensive care unit (OR = 0.85, 95 % CI = 0.39-1.79; p = 0.021). CONCLUSION: Gestational age at PPROM, twin gestation, and oligohydramnios significantly affected the latency period. Although a latency period >72 h was associated with chorioamnionitis and placental abruption, adverse neonatal outcomes were not affected.