Lower vitamin D levels during the second trimester are associated with developing gestational diabetes mellitus: an observational cross-sectional study.

In this study, we aimed to compare serum 25(OH)D levels in women with and without gestational diabetes mellitus (GDM), and to identify the serum 25(OH)D levels associated with GDM. We recruited 40 women with GDM and 40 healthy pregnant women, aged 20-40 years and in the second trimester, at Gulhane Education and Research Hospital. We excluded women with chronic diseases, preeclampsia, pre-GDM, multiple pregnancies, and those taking medications related to calcium or vitamin D metabolism. We took anthropometric measurements and blood samples during the second trimester. Of the 80 pregnant women, pre-pregnancy body mass index was significantly higher among the GDM group than the healthy group (26.4 ± 5.73 kg/m2 vs. 22.6 ± 3.56 kg/m2, p = .001). Serum 25(OH)D levels in women with GDM were significantly lower than those in healthy women (16.8 ± 9.90 ng/mL vs. 20.9 ± 8.16 ng/mL, p = .016). The prevalence of severe vitamin D deficiency was as high as 72.5% among women in the GDM group, with a 1.74-fold increased risk of deficient status. Levels of 25(OH)D lower than a cutoff value of 14.0 ng/mL were determined to be related to GDM. These study results suggest that maternal vitamin D deficiency in mid-pregnancy is significantly associated with development of GDM.

Plasma Free Fatty Acids in Hyperemesis Gravidarum Pregnancy.

We evaluated the free fatty acids differences in plasma between hyperemesis gravidarum(HG) and healthy pregnant in first trimester pregnancy. OBJECTIVE: We aimed to compare the plasma levels of DHA, AA and EPA, between HG patients and healthy pregnant women. DESIGN: Fifty-two pregnants were involved in the study. Twenty-six pregnants of them were HG as study group, and twenty-six pregnants were enrolled as healthy pregnant women at the similar gestational age. The saturated fatty acids C14, C15, C16, C18, C20, C22, and C24; the omega-3 fatty acids eicosapentaenoic acid, (EPA) and docosahexaenoic acid, (DHA); the omega-6 fatty acids linoleic acid, arachidonic acid (AA), and homo-gamma-linolenic acid; and the omega-9 fatty acids oleic acid, erucic acid, and nervonic acid were analysed by gas chromatography. RESULTS: Statistically differences was not seen between the groups with maternal age, gestational age, or plasma levels of EPA, DHA, and AA. Statistically significant difference was seen between the groups with plasma levels of C20 and C22(p<0.05). C20 was declined but C22 was rised in the HG patients. CONCLUSION: EPA, DHA, or AA, which related to placental and fetal neural development are not changing from Hyperemesis gravidarum.

Value of vaginal cervical position in estimating uterine anatomy.

The anatomy of the uterus is defined with the angles of the vagina, cervix and uterine corpus. Hereunder there are angles of version and flexion. The cervical position observed during the vaginal speculum examination, may give information about the uterine anatomy. In this study, we investigated the place of the cervical position in the estimation of the uterine anatomy observed during the cervical examination. We enrolled 240 patients in our study, who applied to our routine gynecology outpatient clinic with various complaints. We divided these patients into two groups according to the cervical position (anterior cervical position and posterior cervical position) observed during the speculum examination. We recorded the uterine anatomy also with the transvaginal ultrasonography. During the speculum examination, we determined that 90% of the cases with posterior fornix position were anteverted and 10% retroverted; 64.2% of the cases with anterior fornix position were anteverted and 35.8% retroverted. According to these findings, cervical position observed during the speculum examination might be useful in the estimation of the uterine anatomy regarding the angles of the version. However, the ultrasonographic examination is essential for a definitive determination of the uterine anatomy. Clin. Anat. 30:404-408, 2017. © 2017 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Polycystic Ovary Syndrome and Increased Soluble Tumor Necrosis Factor Like Weak Inducer of Apoptosis Levels Are Independent Predictors of Dyslipidemia in Youth.

BACKGROUND/AIMS: Dyslipidemia is common in women with polycystic ovary syndrome (PCOS) irrespective of age. Our aim was to investigate soluble tumor necrosis factor like weak inducer of apoptosis (sTWEAK), a cardiovascular risk marker in PCOS, and to determine if it is associated with dyslipidemia in youth. METHODS: A prospective-observational study was carried out including 35 PCOS patients and 35 healthy controls. Serum sTWEAK levels were measured using commercially available kits. Multiple logistic regression analysis was then performed to verify the statistically significant differences in the possible predictors of dyslipidemia. RESULTS: Serum sTWEAK levels and the percentage of women with dyslipidemia were significantly higher in the PCOS group (p = 0.024 and p < 0.001, respectively). Participants were further divided into 2 subgroups based on the presence of dyslipidemia. The percentage of women with PCOS was significantly higher in the dyslipidemic group when compared with controls; 70.7 vs. 20.7%, respectively (p < 0.001). Multiple logistic regression analysis revealed that both the presence of PCOS (OR 7.924, 95% CI 2.117-29.657, p = 0.002) and increased levels of sTWEAK (>693 pg/ml; OR 3.810, 95% CI 1.075-13.501, p = 0.038) were independently associated with dyslipidemia. CONCLUSIONS: Increased levels of both sTWEAK and PCOS were found to be independently associated with dyslipidemia in youth.

Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina.

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26-68) years; mean body mass index (BMI) was 25.3 (17.6-33.2); and mean parity was 2.5 (2-5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p < 0.01), 3.06 and 4.04 (p < 0.01), and 9.43 and 9.43 (p = 0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n = 4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina.

Are serum gamma-glutamyl transferase, high-sensitivity C-reactive protein, and ischaemia-modified albumin useful in diagnosing PCOS?

We assessed the serum levels of gamma-glutamyl transferase (GGT), high-sensitivity C-reactive protein (hsCRP) and ischaemia-modified albumin (IMA) in patients with polycystic ovary syndrome (PCOS). Fifty-three patients with PCOS were included in our study along with 40 women with no PCOS as the control group. The patients were divided according to their body mass index (BMI). GGT levels were significantly higher in the women with PCOS than the women in the control group (p < 0.05). They were also significantly higher in the PCOS women who were normoweight and overweight than the normoweight and overweight women in the control group (p < 0.001). There was no significant difference in the circulating levels of hsCRP and IMA between the women with PCOS and the controls or between the normoweight and overweight subgroups. GGT may be associated with the diagnosis of PCOS when the threshold is set at >15.5 U/L. With the application of this threshold, raised GGT levels had 83% sensitivity (95% CI 0.70-0.90) and 67.5% specificity (95% CI 0.52-0.79), for the diagnosis of PCOS. In our study, GGT levels were elevated in the PCOS patients independent of BMI and could thus be an important marker of PCOS.

How important is the butyrylcholinesterase level for cesarean section?

OBJECTIVES: Butyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants. STUDY DESIGN: We designed a prospective, controlled, pilot single-center study. Thirty (n=30) pregnant women who were scheduled for cesarean section under general anesthesia (refusal of regional anesthesia) with RSI involved. Group 1 included ten (n=10) preeclamptic pregnancies, Group 2 included ten (n=10) gestational diabetic (GD) pregnancies and Group 3 included ten (n=10) healthy pregnancies. MAIN OUTCOME MEASURES: BChE levels of all patients were measured prior to the initiation of cesarean section. Train-of-four recovery of 90% (TOF T1) was used to monitor the degree of neuromuscular block beginning from the administration of succinylcholine. RESULTS: No statistically significant difference was found between the groups comparing BChE levels and the duration between tracheal intubation and formation of TOF T1 (p>0.05). CONCLUSIONS: As similar results were gathered from normal and high-risk pregnancies (preeclamptic pregnancy or gestational diabetic pregnancy) who underwent cesarean section under general anesthesia, we believe that succinylcholine is still neuromuscular agent of choice in cesarean section.

Comparison of the Perioperative Outcomes of a Vessel Sealing Instrument-Assisted Technique with a Conventional Technique in Abdominal Myomectomy.

INTRODUCTION: In gynaecologic practice, LigaSure Precise(TM) is generally used in endoscopic and open surgeries, such as hysterectomy, adnexectomy, and cancer surgery. However, there is no case report or main research article where LigaSure Precise(TM) has been used for myomectomy. We want to compare a technique using a vessel sealing instrument with a conventional technique in abdominal myomectomy. MATERIALS AND METHODS: Fifty-five women who underwent abdominal myomectomy were divided two groups: (1) a vessel sealing instrument-assisted technique (24 patients); and (2) a conventional technique (31 patients) between January 2011 and December 2014 at the Department of Gynaecology and Obstetrics, Gulhane Military Medical Academy, Ankara, Turkey. The data for the operation times, the occurrence of perioperative complications, the hospitalization times, and changes in haemaglobin and haematocrit levels for the two techniques were collected and compared. RESULTS: The mean operation time was 48 minutes for the vessel sealing instrument-assisted technique and 54 minutes for the conventional technique. No statistically significant differences were determined for haemoglobin and haematocrit changes, hospital stay and perioperative complications. CONCLUSION: We did not find any difference in the occurrence of complications, changes in haemoglobin or haematocrit levels, or hospital stay. The vessel sealing instrument-assisted technique is feasible and effective in reducing operation times.

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.

Using narrow-band imaging with conventional hysteroscopy increases the detection of chronic endometritis in abnormal uterine bleeding and postmenopausal bleeding.

AIM: A preliminary study was designed to evaluate whether a narrow-band imaging (NBI) endoscopic light source could detect chronic endometritis that was not identifiable with a white light hysteroscope. MATERIAL AND METHODS: A total of 86 patients with endometrial pathology (71 abnormal uterine bleeding and 15 postmenopausal bleeding) were examined by NBI endoscopy and white light hysteroscopy between February 2010 and February 2011. The surgeon initially observed the uterine cavity using white light hysteroscopy and made a diagnostic impression, which was recorded. Subsequently, after pressing a button on the telescope, NBI was used to reevaluate the endometrial mucosa. RESULTS: The median age of the patients was 40 years (range: 30-60 years). Endometritis was diagnosed histologically. Six cases of abnormal uterine bleeding (6/71, 8.4%, 95% confidence interval [CI] 0.03-0.17) and one case of postmenopausal bleeding (1/15, 6%, 95%CI 0.01-0.29) were only diagnosed with chronic endometritis by NBI (7/86, 8.1%, 95%CI 0.04-0.15). CONCLUSION: Capillary patterns of the endometrium can be observed by NBI and this method can be used to assess chronic endometritis.

Evaluation of obstructive sleep apnea symptoms in pregnant women with chronic disease.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a disease which is estimated to be undiagnosed to a large extent. Hence, the prevalence of OSAS in pregnant women is unknown. We aimed to evaluate the symptoms of obstructive sleep apnea in pregnant women with chronic diseases. METHODS: In the study, 97 pregnant women with chronic diseases and 160 healthy pregnant women were included. A form questioning socio-demographic characteristics and pregnancy characteristics, Epworth scale and the Berlin questionnaire to evaluate the risk of OSAS were applied to participants. RESULTS: It has been determined that 10-12.5% of healthy pregnant women, 34-45.4% of pregnants with chronic diseases and 20.6-23.3% of all pregnant women had a high risk of OSAS, the pregnants with chronic disease compared to healthy pregnant women had statistically significant higher risk of OSAS. The risk of OSAS was found to be significantly higher especially in pregnant women with hypertension and diabetes. CONCLUSIONS: OSAS can lead to the adverse consequences in pregnancy, should be questioned for all pregnants especially those with chronic diseases. Pregnant women with OSAS should be monitored more carefully in terms of diabetes and hypertension in antenatal care.

Does obesity have detrimental effects on IVF treatment outcomes?

BACKGROUND: The aim of this study was to investigate the influence of body mass index (BMI) on the in vitro fertilization (IVF) treatment outcomes in a cohort of women undergoing their first IVF, using an intracytoplasmic sperm injection (ICSI). METHODS: This retrospective cohort study included 298 cycles from women younger than 38 years old undergoing IVF-ICSI at a university infertility clinic. The treatment cycles were divided into three groups according to the BMI of the women involved: normal weight (18.5 ≤ BMI < 25 kg/m(2), 164 cycles), overweight (25 ≤ BMI < 30 kg/m(2), 70 cycles), and obese (BMI ≥ 30 kg/m(2), 64 cycles). The underweight women (BMI < 18.5 kg/m(2)) were not included in the analysis due to small sample size (n = 22). The patient characteristics and IVF-ICSI treatment outcomes were compared between the BMI groups. RESULTS: The total gonadotropin dose (p <0.001) and duration of stimulation (p = 0.008) were significantly higher in the obese group when compared to the normal BMI group. There were no significant differences across the BMI categories for the other IVF-ICSI cycle outcomes measured, including the number of retrieved oocytes, mature oocytes, embryos suitable for transfer, proportion of oocytes fertilized, and cycle cancellation rates (p >0.05 for each). Additionally, clinical pregnancy, spontaneous abortion, and the ongoing pregnancy rates per transfer were found to be comparable between the normal weight, overweight, and obese women (p >0.05 for each). CONCLUSION: Obese women might require a significantly higher dose of gonadotropins and longer stimulation durations, without greatly affecting the pregnancy outcomes.

Using Wood's Light as a Diagnostic Tool for Vaginal Atrophy.

INTRODUCTION: Wood's light lamp is a device that emits ultraviolet (UV) light and is a useful diagnostic tool for dermatologic disorders. The change in the thickness of vaginal mucosa, in vaginal atrophy, causes a change in its colour under Wood's light. We wanted to assess the feasibility of Wood's light (WL) as a diagnostic tool for vaginal atrophy. MATERIALS AND METHODS: The study was conducted at the Department of Obstetrics and Gynaecology from 1 March 2013 to 1 September 2014. We evaluated 45 healthy postmenopausal women with atrophic vaginitis (study group) and 45 healthy, reproductive-aged women as a control group. All patients underwent WL and routine gynaecological examinations for this study. RESULTS: Ninety patients were selected for this study: 45 postmenopausal women suffering atrophic vaginitis symptoms like vaginal dryness, dyspareunia, vulvar pruritus, and signs like pale, smooth, dry, fragile vaginal epithelium, areas of petechiae, and rash, and 45 healthy reproductive-aged women without vaginal atrophy. Thirty-six of the postmenopausal women's vaginal mucosa appeared pale royal green under WL indicative of vaginal atrophy. Thirty-nine of reproductive-aged women's (n: 45) vaginal mucosa were not visualized as pale royal green fluorescent images under the WL. CONCLUSION: Using Wood's light to diagnose vaginal atrophy is a new use for the old device and may be a reliable, and cheap tool for diagnosing vaginal atrophy. Diagnostic accuracy and cost-effectiveness of Wood's light will be better optimized in further trials.

Green serum and pregnancy: Case report.

OBJECTIVES: This report investigates the etiology of green serum within pregnancy. PATIENT AND METHODS: A 24-year-old patient applied to our clinic for a routine control examination at her 25th week of pregnancy. In her repeated blood analysis, green serum was observed after centrifugation of the blood sample taken for an oral glucose tolerance test. After that, records of the patient's blood samples collected at the 9th and 12th weeks of pregnancy to verify that these serum samples were yellow were retrospectively examined. RESULTS: In the literature, no green serum case without an accompanying increase in serum ceruloplasmin level has been reported. The routine blood biochemistry of alanine transaminase: 8 U/L (10-40 U/L), aspartate amino transferase: 10 U/L (10-40 U/L), gamma glutamyl transferase: 17 U/L (7-40 U/L), indirect bilirubin 5.13 µmol/L (0.0-18 µmol/L), and total bilirubin 11.9 µmol/L (0.0-24 µmol/L). The level of serum copper detected was 0.172 µmol/L (0.14-0.173 µmol/L) and of ceruloplasmin was 600 mg/L (260-630 mg/L) within the normal reference interval. CONCLUSIONS: This case proves that generation of green serum in pregnancy is not only due to an increased serum ceruloplasmin but can also be caused by other factors. Additional studies need to be performed to understand the pathophysiological mechanism and future effects of the appearance of green serum during pregnancy.

A modified technique to reduce spillage and the operative time in laparoscopic dermoid cyst excision.

INTRODUCTION: To determine whether controlled drilling, cyst excision, and removal in a bag can reduce the operative time and intraperitoneal spillage in dermoid cysts. MATERIALS AND METHODS: Laparoscopic dermoid cyst excision was performed in 45 women using a different technique: controlled drilling of dermoid cysts in a bag, excision of these cysts, and their removal in the same bag. RESULTS: The median age of the patients was 29.5 years (range, 18-42 years), the median size of the cysts was 55 mm (range, 30-100 mm), the median operative time was 40 minutes (range, 25-60 minutes), the median level of cancer antigen 19-9 was 28.5 U/mL (range, 1.2-127 U/mL), the median parity was 1 (range, 0-3), and the median hospitalization time was 1 day (range, 1-2 days). Twenty-five cysts were in the right ovary, and 20 were in the left ovary. In all cases, the dermoid cysts were ruptured with the controlled drilling. There was no intraperitoneal spillage of the cyst contents in the abdomen. No complication occurred intraoperatively or postoperatively. There was no recurrence 3 months after the operation. CONCLUSIONS: Controlled drilling, excision, and removal of a dermoid cyst inside the same bag seems to be a feasible method to prevent intraperitoneal spillage and to reduce the operative time.

Comparison of efficacy of bromocriptine and cabergoline to GnRH agonist in a rat endometriosis model.

OBJECTIVE: To determine the effect of dopamine agonists in a surgically induced endometriosis model on rats. STUDY DESIGN: In this prospective randomized experimental study, surgical induction of endometriosis was performed by autotransplantation technique on 52 adult female Wistar-Albino rats. Endometriosis formation was confirmed by a second-look laparotomy (n:48) 1 month later. Four study groups were randomly generated according to their treatment regimens: group 1 (leuprolide acetate, n = 12), group 2 (bromocriptine, n = 12), group 3 (cabergoline, n = 12) and group 4 (control, n = 12). Endometriotic implants were excised for histopathological examination after treatment at the setting of laparotomy. The mean surface areas and histopathological glandular tissue (GT) and stromal tissue (ST) scores of endometriotic implants were studied and compared among groups. RESULTS: After 30 days of treatment, the mean surface area of the endometriotic implants of leuprolide acetate, bromocriptine and cabergoline groups was significantly decreased. The regression of endometriotic foci size in comparison to control was highest in group 1, followed by group 2, then group 3. In the histopathological evaluation both the ST and GT scores of group 1, 2 and 3 were significantly decreased in comparison to controls without a statistically significant difference between the groups. CONCLUSION: Dopamine agonists are as effective as GnRH agonists in the regression of experimental endometriotic implants in rats. Further trials are needed to elucidate the pathways affected by dopamine agonists.

A simple set for intrauterine fetal blood transfusion constructed by readily available materials in every clinic.

Intrauterine fetal transfusion needs extensive experience and requires excellent eye-hand coordination, good equipment and experienced team workers to achieve success. While the needle is in the umbilical vein, an assistant withdraws and/or transfuses blood. The needle point should be kept still to prevent lacerations and dislodging. We propose a simple set for Intrauterine Fetal blood transfusion is constructed by readily available materials in every clinic to minimize needle tip movement and movements during syringe attachments and withdrawals during the intrauterine fetal transfusion. This makes possible to withdraw fetal blood sample, and to transfuse blood with minimal intervention.

Case report of a rare dermatosis in pregnancy: impetigo herpetiformis.

Impetigo herpetiformis (IH) is a very rare type of dermatosis seen in pregnancy. According to the published work, IH during pregnancy is associated with the risk of stillbirth, and obstetric management in such cases is very important. Early recognition is important to reduce both maternal and fetal morbidity. We present a case of IH resistant to corticosteroid therapy in a 27-year-old pregnant woman where the pregnancy was terminated by the induction of labor.

Long Term Patient Satisfaction of Burch Colposuspension with or Without Concomitant Total Abdominal Hysterectomy.

INTRODUCTION: Urinary incontinence negatively affects the quality of life. Various methods are used in the treatment of stress incontinence. Burch colposuspension (BC) is the classical treatment of urinary incontinence. AIM: To compare the long-term satisfaction in patients receiving BC with or without concomitant total abdominal hysterectomy. MATERIALS AND METHODS: One hundred and twenty patients with stress incontinence underwent burch colposuspension with or without concomitant total abdominal hysterectomy. Ninety-three (77.5%) patients were interviewed by telephone. Of these, 91(75, 8%) patients agreed to participate in the study. The patients were divided into two groups according to the type of the surgical procedure. Group 1(N=48, 52.7%) had received burch colposuspension with concomitant total abdominal hysterectomy. Group 2 (N=43, 47.3%) had received burch colposuspension without concomitant total abdominal hysterectomy. RESULTS: In Group 1, 41 patients (85%) were satisfied with the surgery and did not complain of urinary incontinence (p<0.05). In Group 2, 37 (86%) patients were satisfied with the surgery (p<0.05). CONCLUSION: There were no difference in patient satisfaction between hysterectomy and BC and only BC to treat incontinence.

Prenatal diagnosis of the acute meconium peritonitis secondary to ileum volvulus perforation: a case report.

This is an unusual case in comparison to other sonographically described prenatal cases due to very early diagnosis and surgical intervention following prompt delivery. A 40-year-old pregnant, ultrasonography showed presence of cystic structure in the fetal abdomen that was consistent with intestinal dilatation. At 32 weeks' of gestation, repeat ultrasound showed collapse of the bowel dilatation along with the presence of hyperechogenic fluid in the fetal abdominal cavity. Cesarean section was performed. The clinical utility of this report is the recognition that meconium peritonitis (MP) may be diagnosed in the acute phase with typical ultrasound features, and should be considered in the differential diagnoses of cases presented with reduced fetal movements. Although it appears that morbidity and mortality in MP cases depend upon gestational age, this case report may help to manage similar cases for defining the appropriate delivery time and treatment modality after prenatal identification of the problem.