The evaluation of diastolic function and myocardial performance index during pregnancy: A tissue Doppler echocardiography study.

BACKGROUND: The pregnancy process is characterized by several changes in the cardiovascular system, especially in left ventricle (LV) systolic and diastolic function. Tissue Doppler imaging (TDI) is a useful tool to evaluate global LV function. This study investigated changes in LV functions using TDI in third-trimester pregnant women. METHODS: A total of 86 consecutive third-trimester healthy pregnant women and 40 age-matched nonpregnant healthy women (control group) were enrolled in this cross-sectional study. LV diameter, standard Doppler and tissue Doppler parameters, and myocardial performance index (MPI) were measured for all patients. RESULTS: There was no significant difference in baseline characteristics between the pregnant and control groups. However, the cardiac chamber diameter was larger, the Am velocity was higher, and the E velocity, Em velocity, and E/A ratio were lower in the pregnant group. In addition, the MPI was significantly higher in the pregnant group compared to the control group (0.57 ± 0.11 vs 0.42 ± 0.02, P < .001). Correlation analysis showed that gestational week was positively correlated with the MPI (r = .407, P = .003). CONCLUSIONS: Detailed assessment of cardiac function is important during pregnancy. We demonstrated that pregnancy was associated with a significantly increased MPI, as well as structural and functional changes.

Acupuncture Enhances Chances of Pregnancy in Unexplained Infertile Patients Who Undergo A Blastocyst Transfer in A Fresh-Cycle.

OBJECTIVE: To analyze the effects of acupuncture on in vitro fertilization patients with unexplained infertility. METHODS: We retrospectively analyzed the charts of a total of 302 cycles performed in 273 patients attending Assisted Reproductive Technology (ART) Centre from August 2013 to August 2016. During the study period, embryo transfer with acupuncture (Acupuncture group, 46 cases) and without acupuncture (Control group, 42 cases) were applied. Prior to embryo transfer, the following points were used in the acupuncture group: Neiguan (CX 6), Diji (SP 8), Taichong (Liv 3), Baihui (Gv 20), and Guilai (S 29). These sessions were carried out two times before and after embryo transfer in a single day. In addition, auricular acupuncture was also performed at ear points, including ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi) and ear point 34 (Naodian). The biochemical pregnancy rate and clinical pregnancy rate after transplantation were compared between two groups. RESULTS: The clinical pregnancy rate in the acupuncture group was higher than that in the control group [60.9% (28/46) vs. 33.3% (14/42), respectively, P<0.05]. Likewise, the live birth rate in the acupuncture group was also higher than that in the control group [71.7% (33/46) vs. 31.0% (12/42), P<0.01). CONCLUSION: Administration of acupuncture on the day of embryo transfer dramatically improved fertility results in women who underwent in vitro fertilization/intra-cytoplasm sperm injection for reproduction.

Assessment of Clinical and Echocardiographic Findings of Pregnant Women with Dyspnea.

BACKGROUND In the present study we evaluated clinical and echocardiography findings of pregnant women with dyspnea. MATERIAL AND METHODS Pregnant women with and without dyspnea and admitted to the Gynecology and Obstetrics Clinic of a tertiary hospital between December 2017 and June 2018 were enrolled in this case-control study. All patients underwent echocardiography in the third trimester (≥27 weeks). Pregnant women who were older than 18 years, who had dyspnea, and who were in the third trimester of their pregnancy (≥27 weeks) were included in the study. RESULTS Left ventricle end-diastolic diameter (LVEDd) was 47.38±3.68 mm in the study group and 43,70±8,84 mm in the control group (P=0.041). On the other hand, left ventricle end-systolic diameter (LVESd) was determined to be 30.86±3.90 mm in the study group and 34,45±6,56 mm in the control group (P=0.013). Systolic pulmonary artery pressure (sPAP), calculated through tricuspid insufficiency and analyzed, was found to be 24.69±9.10 mmHg in the study group and 20.39±6.80 mmHg in the control group (p=0.038). CONCLUSIONS When echocardiography findings of pregnant women with dyspnea were analyzed, it was determined that their left ventricle end-diastolic diameter (LVEDd), left ventricle end-systolic diameter (LVESd), and systolic pulmonary artery pressure (sPAP), calculated through tricuspid insufficiency, were higher than those of women in the control group, although they were within normal limit range. Therefore, we recommend that women with dyspnea should see a cardiologist and undergo an echocardiogram test so that the cardiac causes of dyspnea can be clinically revealed.

Evaluation of Sexual Function in Women with Hypogonadotropic Hypogonadism Using the Female Sexual Function Index (FSFI) and the Beck Depression Inventory (BDI).

BACKGROUND Hypogonadotropic hypogonadism (HH), or secondary hypogonadism, results from reduced secretion of gonadotropins, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), by the pituitary gland, resulting in lack of production of sex steroids. The aim of this study was to evaluate self-reported sexual function in sexually active women with and without HH using two evaluation methods, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory (BDI). MATERIAL AND METHODS The study recruited 88 women who attended an outpatient in vitro fertilization (IVF) clinic in Turkey for primary infertility, between August 2013 and August 2016. All patients were sexually active with an age that ranged from 20-41 years. Following an initial examination, including measurement of FSH and LH levels, all study participants were asked to complete the FSFI and BDI self-reporting questionnaires. Patients were divided into Group 1 (with HH) (N=42) and Group 2 (the control group) (N=46). RESULTS Analysis of the patient responses to questions regarding their sexual function in the FSFI and BDI showed that of the 42 patients in Group 1 (the HH group), 27 patients (64.28%) reported sexual dysfunction; of the 46 patients in Group 2 (the control group) 14 patients (30.34%) reported sexual dysfunction. Analysis of the FSFI lubrication scores and orgasm scores showed a statistically significant difference between the two groups (both, p<0.01). CONCLUSIONS Women with HH require both physical and psychological support to improve their sexual function, self-esteem, mental health, and quality of life.

Thrombophilia and Recurrent Pregnancy Loss: The Enigma Continues.

BACKGROUND Thrombophilic gene polymorphism is known to be a risk factor for recurrent pregnancy loss (RPL), but few studies have confirmed a possible role of thrombophilic genes polymorphism in RPL risk. This study was conducted to understand the relationship of the mutations of some thrombophilia-associated gene polymorphism (heterozygous/homozygous) with RPL. We compared patients with 2 abortions to patients with 3 or more abortions among Turkish women. MATERIAL AND METHODS In this study, patients previously diagnosed with habitual abortus at Obstetrics and Gynecology outpatient clinics in Turkey between 2012 and 2016 were included. In their peripheral blood, we detected factor V Leiden H1299R, prothrombin G20210A, MTHFR C677T, MTHFR A1298C, PAI-1 4G/5G, and PAI-1 4G/4G gene mutations. RESULTS In this study, we have observed statistically meaningful data (P<0.01) related to the relationship between RPL and thrombophilia-associated gene polymorphisms such as heterozygous factor V Leiden H1299R, heterozygous prothrombin G20210A, PAI-1 4G/5G, and PAI-1 4G/4G. CONCLUSIONS We found that diagnosis of thrombophilic genes polymorphism is useful to determine the causes of RPL, recognizing that this multifactorial disease can also be influenced by various acquired factors, including reproduction-associated risk factors and prolonged immobilization.

Serum ischemia modified albumin level and its relationship with the thiol/disulfide balance in placenta percreta patients.

The pathogenesis of placenta percreta (PP) is not very well known. This study was designed to analyse the oxidative stress (OS), the thiol/disulphide balance, and ischaemia-modified albumin (IMA) the women with PP. The study included 38 pregnant women with PP and 40 similarly aged healthy pregnant women in their third trimester of gestation. We measured the IMA, native and total thiols, and disulphide concentrations in the maternal sera of all of the participating women. The IMA levels were higher and the native and total thiols were lower in the PP group than in the control group. However, there was no statistical significance with respect to the thiol/disulphide balance between the two groups. The results of this study suggest that an increase in the ischaemia and OS and a decrease in the antioxidant status may contribute to the pathogenesis of PP. Impact statement What is already known on this subject? Placenta percreta (PP) is a serious complication of pregnancy. Although there are several studies investigating the pathophysiological mechanism of PP, whether the pathology results from a lack of decidua or from the over-invasiveness of trophoblasts remains controversial. The pathology of PP is poorly understood. What do the results of this study add? This prospective study has shown an increased ischaemia modified albumin (IMA) and a decreased antioxidant capacity in the patients with placenta percreta. The results from 38 women with PP suggest that the serum concentrations of IMA and the oxidative stress parameters may be able to predict PP in cases of uncertainty. What are the implications of these findings for clinical practice and/or further research? The implication of these findings shed light on understanding the pathogenesis of PP for further research.

Human Papilloma Viruses and Their Genotype Distribution in Women with High Socioeconomic Status in Central Anatolia, Turkey: A Pilot Study.

BACKGROUND In the present study we retrospectively evaluated the results of outpatients who had an HPV analysis, and present objective evidence for the administration of preventive inoculation in our area. MATERIAL AND METHODS We retrospectively reviewed 532 outpatients who visited a single center between 2012 and 2016 and had an HPV infection analysis. The criteria for inclusion of patients with unhealthy cervix in the study were: erosion, chronic cervicitis, healed lacerations, hypertrophied cervix, and abnormal discharges from the cervix. RESULTS We found that 122 out of 532 patients were infected with HPV, and the rate of multiple infections was 59.0% (72/122). HR-HPV (group 1 carcinogens HPV-16 (18.9%, 23/122), HPV-18 (13.1%, 16/122), HPV- 31 (4.9%, 6/122), HPV-33 (3.3%, 4/122), HPV-35 (7.4.9%/122), HPV-39 (5.7%, 7/122), HPV-45 (5.7%, 7/122), HPV-51 (11.5%, 15/122); Group 3 LR-HPV; HPV-6 (31.1%, 38/122), HPV-11 (26.2%, 32/122), HPV-42 (9.0%, 11/122) and HPV-43 (4.9%, 6/122). In terms of linear-by-linear association test, no significant statistical difference was identified between years. The P value for HPV infection rate on year basis was P>0.05. CONCLUSIONS In this hospital-based retrospective analysis, HPV types were found to be similar to HPV types reported in developed countries. We firmly suggest that patients should be informed about the risk of HPV infection at early ages.

Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis.

This study was planned to investigate whether measuring of Doppler indices with TV-DUS improved the diagnosis of adenomyosis. Preoperative Doppler indices of subjects with a preliminary diagnosis of adenomyosis were compared with the histopathological results of excised specimens. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of the measured indices were also calculated. Sensitivity, specificity, PPV and NPV and positive and negative likelihood ratios (LR+) and (LR-) of TV-US in the diagnosis of adenomyosis were found to be 70.8%, 62.1%, 40.4%, 85.4%, 1.96 and 0.47, respectively. Sensitivity, specificity, PPV, NPV, LR + and LR - in the diagnosis of adenomyosis following the addition of TV-DUS were found to be 90%, 94.2%, 81.8%, 97%, 15.5 and 0.10, respectively. Concomitant use of TV-US and TV-DUS improved correct diagnosis of adenomyosis with high sensitivity.

There is a Positive Correlation Between Socioeconomic Status and Ovarian Reserve in Women of Reproductive Age.

BACKGROUND The purpose of this study was to investigate the potential association between socioeconomic status and ovarian reserve, anti-Mullerian hormone level, antral follicle count, and follicle stimulating hormone level in women of reproductive age. MATERIAL AND METHODS A total of 101 married women between 20-35 years of age who presented to the Department of Obstetrics and Gynecology, Health Research System In Vitro Fertilization (HRS IVF) Center between October 2014 and November 2015 and met the inclusion criteria were included in this study. The participants were divided into three socioeconomic groups using Kuppuswamy's socioeconomic status scale. Thirty-one participants were assigned to the low socioeconomic status group, 37 to the middle socioeconomic status group, and 33 to the high socioeconomic status group. On days 3-6 of the menstrual cycle, 10 mL of blood was collected from the participants for follicle stimulating hormone and anti-Mullerian hormone measurements. Transvaginal ultrasonography was performed for both ovaries for the purpose of counting antral follicles measuring 2-10 mm in diameter. RESULTS Both ovarian reserve parameters, namely anti-Mullerian hormone level and antral follicle count, exhibited a significant association with socioeconomic status (p=0.000 and p=0.000, respectively). The association between follicle stimulating hormone level and socioeconomic status was also significant (p=0.000). CONCLUSIONS A low socioeconomic status aggravated by sources of stress such as undernutrition and financial hardships affects ovarian reserve, which should be remembered in approaching infertile patients.

Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions.

BACKGROUND This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. MATERIAL AND METHODS The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman's and Chi-Square tests were used for statistical analysis. RESULTS Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. CONCLUSIONS Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.