An evaluation of the effects on the ovaries of hyperbaric oxygen therapy in a rat model of premature ovarian failure created with cyclophosphamide.

Objective: To evaluate hyperbaric oxygen therapy (HBO) based on ovarian histology, total antioxidant status (TAS), total oxidant status (TOS), and anti-müllerian hormone (AMH), in the ovarian insufiency (POI) model created with cyclophosphamide (CYP). Materials and Methods: The rats were separated into 3 groups of the control group (n=6), the CYP group (n=6), and the CYP+HBO group (n=6). The rats in the CYP group and the CYP+HBO group were injected intraperitoneally with 200 mg/kg CYP on day 1, followed by 8 mg/kg/day for 14 days to create POI. From the 15th day onwards, the rats in the CYP+HBO group were placed in a hyperbaric cabin and exposed to 100% oxygen at 2.4 atm pressure for one h, and were then returned to their cages at the end of the hour. Results: A statistically significant decrease was determined in the primordial and primary follicle counts in the CYP group compared with the control group (p<0.05). In the CYP+HBO group, a statistically significant increase was determined in the primordial and primary follicle counts (p<0.05). The serum AMH levels were seen to be significantly decreased in the CYP group compared with both the control group and the CYP+HBO groups. The HBO was seen to decrease TOS and increase TAS. Conclusion: HBO could be an alternative treatment to minimize the effect of ovarian follicle loss caused by CYP, which is used for treating tumors that commonly occur in young females of reproductive age.

Is local methotrexate therapy effective in the treatment of cesarean scar pregnancy? A retrospective cohort study.

AIM: To evaluate the success of local methotrexate (MTX) treatment, the side-effect profile and its fertility effect in patients diagnosed with cesarean scar pregnancy. MATERIALS: This retrospective cohort study included 56 cesarean scar pregnancy patients who applied to Erciyes University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2012 and January 2022 and were treated with ultrasound-guided local MTX. The results of 56 patients with cesarean scar pregnancy who underwent transvaginal ultrasound-guided single-dose local MTX treatment were evaluated. First, the contents of the sac were aspirated, and then 50 mg of MTX was injected into the gestational sac. RESULTS: The median gestational age at diagnosis was 7 weeks 2 days. The mean beta human chorionic gonadotrophin level was 31 345 ± 37 838 (range: 113-233 835 mIU/mL). Fifty-four patients were successfully treated with local MTX therapy. The interval between the first MTX injection and the normalization of beta human chorionic gonadotrophin was 55.2 ± 41.0 days. None of our patients required surgical treatment. Beta human chorionic gonadotrophin values did not decrease in one patient and she was treated with systemic MTX. Local MTX therapy could not be applied to one patient for technical reasons. Only one patient needed blood transfusion after local MTX. Thirteen patients become pregnant after treatment (76%). No systemic side effects related to MTX were observed in any of the patients. CONCLUSION: Transvaginal ultrasound-guided single-dose local MTX treatment is an effective, safe, and fertility-preserving treatment method for cesarean scar pregnancy.

Does endometrial thickness affect pregnancy outcomes in isolated male infertility IVF cycles? A retrospective cohort study.

In our retrospective cohort study, we aimed to determine the role of endometrial thickness (ET) in isolated male factor infertile women in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo cycles. The patients were classified as having an endometrial thickness of <7 mm (n: 80), 7-9.9 mm (n: 335), 10-14 mm (n: 579) and >14 mm (n: 50) according to their ETs on the human chorionic gonadotropin (hCG) day. The overall clinical pregnancy rate was 37.4%, and no significant difference was found between the groups (p = .262). There was no significant difference between live birth rates (p = .094), but the highest pregnancy (46%) and live birth (34%) rates were found in the group with >14 mm ET. The increase in ET in IVF cycles increases pregnancy rates, albeit partially. When it is desired to determine a cut-off value, it can be said that pregnancy rates increase significantly in thicknesses of 14 mm and above.Impact StatementWhat is already known on this subject? When the literature is examined, many studies conclude that clinical pregnancy rates increase with the increase in endometrial thickness (ET) in IVF cycles, but there are also studies that argue the opposite. There is no study in the literature investigating the effect of ET on clinical pregnancy rates in patients with isolated male factor infertility.What do the results of this study add? In support of the literature, an increase in ET was found to be associated with an increase in clinical pregnancy rates, regardless of male and female factors. Although pregnancy occurs in thin endometriums, abortion rates are undesirably high.What are the implications of these findings for clinical practice and/or further research? Although the risk of abortion is high in thin endometriums, live birth rates are satisfactory. As a result, thin endometrium does not require cycle cancellation.

Serum Galectin 7 is Not Useful to Predict Abortion in the First Trimester.

OBJECTIVE: Galectins are animal lectins that bind to surface glycoproteins expressed at the fetal-maternal interface. The aim of this prospective case-control study was to investigate the possible relationship between levels of maternal serum galectin-7 and threatened abortion (TA) and to determine whether serum galectin-7 had any prognostic value. METHODS: This prospective study was conducted between August 2014 and February 2015. Included in the study were 31 consecutive pregnant women who were hospitalized for TA between 6 and 14 weeks of gestation and 33 healthy gestational age matched pregnant women without any symptoms of miscarriage. Serum galectin-7 levels were measured via ELISA. RESULTS: The mean serum galectin-7 levels of the two groups were not significantly different (31 TA patients: 2.84 ± 0.43 pg/mL, 33 controls: 2.785 ± 0.32 pg/mL, p = 0.543). Six pregnancies in the TA group resulted in abortion (19.4%). CONCLUSION: Serum galectin-7 was not useful for predicting prognosis in TA.

A comparison of two different oral contraceptives in patients with severe primary dysmenorrhoea.

Pain relief of two different oral contraceptive pills (OCPs) in severe primary dysmenorrhoea (PD) was compared. Sixty-six nulliparous patients with severe PD requiring contraception were evaluated. Group 1 comprised 33 healthy controls. Patients with severe PD were divided into two groups. Patients in Group 2 were administered oestradiol valerate/dienogest and patients in Group 3 were administered ethinylestradiol/drospirenone. Doppler indices of both uterine arteries (left and right) including systolic/diastolicrates (S/D), pulsatility index (PI) and resistance index (RI) were measured, and a visual analogue scale (VAS) was applied to patients before treatment. VAS scores and Doppler indices were repeated after 3 months of OCP treatment and the changes in values were compared. The demographic and clinical characteristics of the patients were similar. The mean value of RI was significantly lower after therapy in Groups 2 and 3 in the right and left uterine arteries (p = .001 and p = .039, respectively). The clinical trial number was NCT03124524. Impact Statement What is already known on this subject: OCPs are the most appropriate treatment option for PD. There is no clear data about OCP containing dienogest for treatment in PD. Dienogest has been reported to be highly effective in the treatment of endometriosis and is also recommended as first-line therapy for pelvic pain-associated endometriosis. What the results of this study add: In this study, although there was no superiority in pain relief between the treatment groups, lower VAS scores and lower RI values of uterine arteries were seen after treatment. Both OCPs relieve pain in severe PD. There was no serious adverse effect in the patients. What the implications are of these findings for clinical practice and/or further research: Estradiol valerate/dienogest, which is a routinely prescribed drug for heavy menstrual bleeding in women who desire oral contraception, is as effective as ethinylestradiol/drospirenone in pain relief.

Hyperemesis gravidarum is not a negative contributing factor for postpartum bone mineral density.

BACKGROUND: Hyperemesis gravidarum (HG), related to protracted vomiting and nausea, is a common cause of hospitalization during the first trimester of pregnancy. It can be accompanied by ketonuria, dehydration, and weight loss. Our aim was to investigate bone loss in patients with HG. METHODS: In our study, we investigated decreased bone mineral density (BMD)in a total of 79 patients (40 HG and 39 control) by means of dual energy X-ray absorptiometry (DEXA) measurements and laboratory parameters related to HG. All patients received DEXA measurement during the early postpartum period (usually two days after delivery, prior to discharge).This study was registered in the database via the Protocol Registration and Results System (PRS) (NCT03127293). RESULTS: There was no significant difference in DEXA results (lumbar spine and total hip) and laboratory parameters between case and control groups, although a significant difference in vitamin intake was identified between cases and controls (65% vs. 92%, respectively, p = 0.003). Except for low serum levels of vitamin D, other laboratory parameters were in normal range in both groups. CONCLUSION: Pregnancies complicated by HG did not have decreased bone mineral density compared to those without HG. There is no evidence to relate HG to future osteoporosis.

The Efficacy of Dienogest in the Treatment of Simple Endometrial Hyperplasia without Atypia.

AIM: The aim of the study was to compare the effectiveness of dienogest (DIE), depo medroxyprogesterone 17-acetate (MPA), and micronized progesteron (MP) regimens for treatment of simple endometrial hyperplasia (EH) without atypia. METHODS: One hundred and twenty premenopausal patients aged between 35 and 55, with simple EH without atypia, were offered 3 types of progestins (MPA, MP, and DIE) and were randomized to one of them. After 6 months of treatment, patients were reevaluated. The efficacy of different progestins in treatment of EH was compared with regard to resolution and regression rates. We classified the terms of resolution and regression as "complete response" and persistence as "no response". RESULTS: A total of 99 patients continued the study (31 in MP, 35 in MPA, and 33 in the DIE group). None of the results of endometrial pathology were progressed to atypia or complex hyperplasia. The complete response resolution rate was 93.5% in the MP, 88.5% in the MPA, and 96.9% in the DIE group. The highest complete response rate was in the DIE group, although there was no statistically significant difference between groups (p = 0.39). The efficacy of progestins was similar between the groups. CONCLUSION: DIE is an effective and convenient method for thinning the endometrium.

Is there any relationship between low PAPP-A levels and measures of umbilical vein and placental thickness during first trimester of pregnancy?

OBJECTIVE: Low pregnancy-associated plasma protein A (PAPP-A) level is associated with adverse perinatal outcomes. The purpose of this study was to evaluate relationship between umbilical cord diameter (UCD), umbilical vein and artery diameters (UVD, UAD), placental thickness, and PAPP-A level at gestational age of between 11 and 14 weeks. METHODS: UCD, UVD, UAD, and placental thickness of 246 women were assessed during ultrasound examination at between 11 and 14 weeks of gestation, as well as measurement of nuchal translucency (NT) and crown-rump length (CRL). Patients were divided into 2 groups according to PAPP-A percentile. Group 1 comprised 23 patients who had low PAPP-A (<0.44 multiple of medians [MoM], <10th percentile) and Group 2 was made up of 223 patients with PAPP-A of >0.44 MoM, >10th percentile. Calipers used for measurement were placed inner edge to inner edge of echogenic boundaries of the vessel. Largest sections of all vessels (UV and both arteries) were evaluated. Thickest part of the placenta was used for placental thickness measurement. RESULTS: Narrow UCD (<4.5±0.6 mm) was associated with low PAPP-A level (p=0.02). There was no significant difference in UVD, UAD, or placental thickness between groups. There was no significant difference in gestational age, CRL, or NT between groups. Fetal birth weight was significantly lower in Group 1 (p=0.03). CONCLUSION: Closer attention to women with low-risk, healthy pregnancies and low PAPP-A level in first trimester screening results is recommended. They should be routinely screened for background medical risk factors and umbilical cord morphology in first trimester scan.

Nuchal cord: is it really the silent risk of pregnancy?

OBJECTIVE: To evaluate the relationship between entanglement of umbilical cord around the fetal neck and adverse perinatal outcomes. METHODS: In this prospective cohort study, perinatal outcomes of 218 pregnancies complicated with nuchal cord (NC) (study group) were compared with 190 uncomplicated pregnancies (control group). Main outcome measures were umbilical cord pH values, APGAR scores and cesarean section (C/S) rates. Fetal distress was stated as an abnormal heart rate pattern on electronic fetal heart monitorization. RESULTS: There were no statistically significant differences in maternal demographic and obstetric features, between groups. There were no statistically significant differences regarding C/S rates between groups, even though fetal distress was significantly the leading indication for cesarean delivery, in the study group (p = 0.021). The number of entanglement was significantly related with fetal distress (p < 0.001). There were no statistically significant differences in umbilical cord gas values, one-minute and five-minute APGAR scores between the groups. Furthermore, there was a significant male dominance in the study group (p = 0.014) and also, amniotic fluid indexes (AFI) were significantly higher in this group (p = 0.002). CONCLUSION: This study demonstrated that, entanglement of umbilical cord around the fetal neck or NC is not related with adverse perinatal outcomes such as acidosis and low APGAR scores. So that, a targeted care on NC via ultrasound during labor, is not an essential part of the examination.

Depression levels in patients with hyperemesis gravidarum: a prospective case-control study.

Hyperemesis gravidarum (HG) is a condition characterized by severe, intractable nausea and vomiting in early pregnancy. It affects about 0.3-2% of all pregnancies and is thought that HG is a multifactorial disease resulting from the combination of various unrelated conditions such as genetic, hormonal and psychiatric. Although there are studies investigating the relationship between anxiety, depression and HG; however, none have sufficiently clarified this link. The aim of this prospective case-control study was to investigate the possible relationship between depression and HG and compare the prevalence of depression disorders in pregnant women with and without HG. A prospective case-control study was performed at our tertiary referral centre between December 2013 and July 2014. The study group consisted of 78 pregnant women with HG and the control group consisted of 82 healthy pregnant women who never had experienced any nausea and vomiting. No study participants had any pre-pregnancy history of any psychiatric disorder including depression. Structured Clinical Interview for Diagnostic (SCID-I) and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) was used to evaluate symptoms of depression. Beck Depression Inventory (BDI) was administered to patients during the psychiatric interview and was evaluated by the same psychiatrist. The mean BDI scores in HG study and healthy control groups were 18.97 ± 9.85 and 6.36 ± 5.61, respectively (p < 0.001). Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression. In conclusion, the findings of this study indicated that psychological distress associated with HG was a direct consequence rather than a cause of HG. Therefore, patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions.