The effects of latency period in PPROM cases managed expectantly.

Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery time is controversial in cases with the expectant approach. The fetal effects of long-term exposure to PPROM are unknown. This study aimed to evaluate the maternal and fetal outcomes of expectantly-managed PPROM cases with different latency periods at 240/7-346/7 weeks of gestation.Material and method: The study group consisted of 206 patients at 240/7-346/7 weeks of gestation who met the inclusion criteria. Patients were divided into three groups according to their weeks of PPROM diagnosis as 240/7-286/7, 290/7-316/7, and 320/7-346/7. The period from membrane rupture to delivery was defined as the latency period and divided into three subgroups as 3-7 days, 8-13 days and ≥14 days. In addition to the demographic characteristics of the patients, maternal and obstetric complications, primary and secondary neonatal outcomes were compared between the groups. Primary neonatal outcomes were determined in terms of pathological Apgar scores (<5 at minute 1, <7 at minute 5), requiring resuscitation, admission to Neonatal Intensive Care Unit (NICU) and NICU length of stay. Secondary neonatal outcomes were determined in terms of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, and neonatal sepsis. In addition, for the prediction of morbidity and mortality, newborns were evaluated by SNAPPE II (Score for Neonatal Acute Physiology with Perinatal extension-II) consisting of the combination of biochemical and physiological parameters, using the parameters including mean blood pressure (mm/Hg), corporal temperature (°C), PO2/FiO2 ratio, lowest serum pH, multiple seizures, urine output (ml/kg/hr), Apgar score, birth weight, and small for gestational age. The higher the score of SNAPPE II, the higher the morbidity and mortality risk of neonates. For the statistical analysis, the Kruskal Wallis and one-way ANOVA tests were utilized for the numerical data. Categorical data were compared using the chi-square test. The receiver operating characteristic (ROC) test was used to determine the threshold value of the data affecting neonatal morbidity.Results: The mean PPROM week was found to be 29.7 ± 3.0 weeks and the mean delivery week was 31.8 ± 2.5 weeks. The mean latency period for all the patients was 15.1 ± 13.8 days. Clinic chorioamnionitis was observed in 17% of the cases. The lowest chorioamnionitis rate (8.6%) was in the 3-7-day latency period group. Total complications were significantly lower in the 290/7-316/7 week PPROM group in which the latency period was ≥14 days, compared to those in 3-7 days and 8-13 days (p = .001). Total complications were lower in the < 32 weeks PPROM groups in which the latency period was ≥14 days compared to those obtained in 3-7 days and 8-13 days. There was no significant difference between the latency period and total complications after 32 weeks (p = .422). The best discriminative cutoff value of SNAPPE-II for neonatal morbidity was 11.0 (sensitivity 82%, specificity 80%). In the present study, the optimal latency period for the best neonatal outcomes was found to be 34.5 days (sensitivity 70% and specificity 84%) between weeks 240/7-286/7, and 11.0 days between weeks 290/7-316/7 (sensitivity 68% and specificity 85%).Conclusions: Our findings indicated that a long latency period did not increase neonatal morbidity and there was no increase in neonatal complications after 32 weeks of the gestational period compared to those obtained before 32 weeks.

Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7-336/7 Gestational Weeks.

Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) to those with normal end-diastolic umbilical artery blood flow (NEDF). Methods: This study included preterm births (280/7-336/7 gestational weeks) with IUGR with AREDF (n = 86) or NEDF (n = 27). Results: There were lower mean gestational weeks, birth weights, and a higher ratio of corticosteroid application in the AREDF group (p < 0.05). The mean length of neonatal intensive care unit stay of the AREDF group was significantly longer (p < 0.001). Sepsis and feeding intolerance ratios in the AREDF group were also significantly higher (p = 0.041 and p < 0.001 respectively). Conclusions: Patients with IUGR and umbilical Doppler abnormalities have longer neonatal intensive care unit stays.

Effect of the delivery way and number of parity in the subsequent incidence of placenta previa.

Aim: To appraise the impact of previous birth type and the number of deliveries on placenta previa incidence and the extent of intrapartum massive hemorrhage.Materials: Placenta previa complications among healthy singleton subsequent pregnancies following previous pregnancies without placenta previa history were classified according to their birth types and previous numbers of parity. Subgroups of subsequent pregnancies with massive hemorrhage and placental adhesion anomalies were compared.Result: One, two, three or more previous cesarean births triggered a significant increase in the rate of massive hemorrhage when compared to subgroups of previous vaginal births (31.5% versus 50.9%, p = .02; 32.7% versus 69.0%, p = .001; and 42.9% versus 81.9%, p = .035, respectively). The rate of placental adhesion anomalies in all subgroups of previous cesarean births were statistically higher than subgroups of previous vaginal births (12.4 versus 32.7%, p = .003; 10.2% versus 52.2%, p = .001; and 9.5% versus 63.6%, p = .001, respectively). Urogenital complications in women with one previous cesarean birth were higher than those of the vaginal birth group (9.1 versus 0%, p = .004).Conclusion: Previous cesarean births are more frequently associated with increased massive hemorrhage and placental adhesion anomalies in subsequent pregnancies with placenta previa when compared to previous vaginal births.

Effects of Surgical Anatomical Correction of Pelvic Anterior Compartment Defect on Lower Urinary Tract Symptoms.

OBJECTIVE: To evaluate the effects of surgical anatomical correction on lower urinary tract symptoms (LUTS) in patients with a pelvic anterior compartment defect (PACD). METHODS: This prospective study was carried out on 30 women who had stage II-IV PACD. The women were questioned regarding LUTS symptoms such as urgency, urge incontinence, frequency, hesitancy, abnormal emptying, nocturia and dysuria pre and postoperatively. After a 7-month follow up, the comparison of LUTS symptoms with respect to their healing, existence or de novo appearance was performed using the McNemar and Bowner and Wilcoxon signed-rank tests. RESULTS: For the repair of ACD, 15, 8 and 7 women were operated on using site-specific surgery, transvaginal mesh placement and anterior colporrhaphy, respectively. Surgery has significantly improved the LUTS: urgency (100 vs 26.7%, urge incontinence (70 vs 16.7%), frequency (76.7 vs 13.3%), abnormal emptying (56.7 vs 10%), hesitancy (30 vs 6.7%), nocturia (83.3 vs 60%) and dysuria (30 vs 6.7%). The differences were statistically significant (P < 0.05). CONCLUSIONS: The correctional surgery on anterior compartment defects not only maintains the anatomy but also significantly heals the LUTS.

The Effect of the Amniotic Fluid Index on the Accuracy of Ultrasonographic-Estimated Fetal Weight.

BACKGROUND: Fetal weight estimation is one of the most important aspects of antenatal care. The effects of amniotic fluid volume on the accuracy of estimated fetal weight (EFW) depend on the amount of fluid, in particular whether it is polyhydramnios or oligohydramnios. Previous studies have reported conflicting results of the effects of amniotic fluid volume on EFW accuracy. AIM: The aim of the study was to evaluate the effects of isolated oligohydramnios cases and polyhydramnios on the accuracy of EFW. MATERIALS AND METHODS: A retrospective study was conducted at a tertiary center. The study groups consisted of 1069 term isolated oligohydramnios cases, 182 term isolated polyhydramnios cases, and 392 term-matched cases with a normal volume of amniotic fluid. Estimated fetal weight error was determined and expressed in terms of systematic error, calculated from mean percentage error and random error. RESULTS: The systematic error did not differ significantly between polyhydramnios and oligohydramnios cases (-3.60 [8.94%] vs -2.73 [9.7%]). The random error was 8.94% in polyhydramnios cases and 9.7% in oligohydramnios cases. The overestimation rate was 63.6% in polyhydramnios cases and 66.3% in oligohydramnios cases. CONCLUSIONS: There were no significant differences in the accuracy of EFW between oligohydramnios and polyhydramnios. However, there was a tendency for overestimation in both types of cases.

Nifedipine increases fetoplacental perfusion.

AIM: Our aim is to evaluate the effect of nifedipine on fetoplacental hemodynamic parameters. METHODS: A retrospective study was conducted at a tertiary center with 30 patients for whom nifedipine treatment was used as a tocolytic therapy for preterm labor. Initiation of this treatment was at 31.6±2.5 weeks of gestation. We combined the pulse Doppler imaging parameters with grayscale imaging via the Bernoulli theorem, which is called the "continuity equation", to get the fetoplacental perfusion (FPP). Evaluated parameters were the resistance index (RI), the pulsatility index (PI), systole/diastole ratios (S/D), the velocity-time integral of the umbilical artery (VTI), the radius of the umbilical artery, the peak systolic velocity and the mean pressure gradient in the umbilical artery. From these parameters, the FPP was acquired. RESULTS: We found that the RI, the PI and the S/D ratio did not change after treatment with nifedipine. The mean pressure gradient, the VTI and the peak systolic velocity increased after treatment with nifedipine. Nifedipine increases FPP from 166±73.81 beat.cm3/min to 220±83.3 beat.cm3/min. DISCUSSION: Although nifedipine had no effect on the PI, the RI or the S/D, it increased the mean pressure gradient, the VTI and FPP.

Predictivity of mean platelet volume in severe preeclamptic women.

INTRODUCTION: To evaluate the predictive and clinical utilization of the mean platelet volume (MPV) in severe preeclamptic women. MPV is known as platelet size and associated with platelet activation or new platelet synthesis. Platelet count is decreased by vascular endothelial damage in cases of severe preeclampsia. It leads to increased turnover of platelets. METHODS: The severe preeclamptic women with and without preeclampsia during pregnancy were divided into subgroups depending on the gestational birth week early, (<34), late (34-37) preterm birth and term (≥37) gestational weeks. Their MPV was measured 24 hours prior to birth and compared with all subgroups according to the gestational week. RESULT: The study subgroups were performed from early (n = 87), late (n = 48) preterm and term (n = 76) birth with severe preeclampsia, whereas early (n = 69), late (n = 63) and term (n = 228) without gestational hypertensive disorders were recruited in the control subgroups. The MPV of the early, late preterm and term preeclamptic subgroups was statistically higher than that of the control subgroups (9.4 ± 1.3fL vs 8.6 ± 1.2 fL, p < 0.001; 9.5 ± 1.0 fL vs 8.5 ± 0.9 fL, p < 0.001 and 10.2 ± 1.1 fL vs 8.9 ± 1.2 fL, p < 0.001), whereas the mean platelet count of all the study subgroups was significantly lower (237.3 ± 81.3 × 109 /L, 270.0 ± 83.9 × 109/L, p = 0.015; 232.3 ± 80.1 × 109/L vs 268.8 ± 92.7 × 109/L, p < 0.001 and 221.8 ± 70.3.9 × 109/L vs 232.9 ± 82.3 × 109/L, p = 0.03). The sensitivity and specificity of the cut-off MPV for all the subgroups were each less than 80%. CONCLUSION: The MPV may be a predictive marker of severe preeclampsia.

Late Preterm and Term Birth: Neonatal Hyperbilirubinemia and Birth Model.

AIM: To evaluate the mode of delivery's influence on development of neonatal hyperbilirubinemia in term or near term infants. METHODS: The hyperbilirubinemic neonates were divided into two groups according to their mode of delivery (i.e., vaginal or cesarean). The birth weight and gestational age at the time of birth, the age of the neonates in days, and the serum levels of bilirubin of the neonates at the time of hyperbilirubinemia were compared from the date of hospitalization until treatment, based on the birth model. RESULTS: 288 were fulfilled the inclusion criteria during the neonatal period. The vaginal delivery group consisted of 157 infants (16.8%) with hyperbilirubinemia, whereas the cesarean group included 131 (22.6%) infants with hyperbilirubinemia. Neonates in the cesarean group had a significantly higher rate of hyperbilirubinemia (p = 0.01). CONCLUSION: This study revealed that compared with vaginal births, cesarean births led to higher rates of neonatal hyperbilirubinemia.

Intrapartum, postpartum characteristics and early neonatal outcomes of idiopathic polyhydramnios.

This paper investigates the effect of idiopathic polyhydramnios on the intrapartum and postpartum characteristics of labour and early neonatal outcomes. In this study, intrapartum and early neonatal outcomes of 207 women with idiopathic polyhydramnios and 336 matched healthy pregnant patients were evaluated. In the case of idiopathic polyhydramnios, the active phase of labour became longer when compared to the control group (5.76 ± 3.56 h vs. 4.38 ± 2.8 h, p: 001). The risk of preterm birth (OR 5.23; 95% CI: 2.04-13.42) and caesarean section (OR 2.26; 95% CI: 1.56-3.28) was higher in women with IP. Patients with IP had a higher rate of transcient tachypnoea of the newborn (TTN), newborn resuscitation, admission to neonatal intensive care unit (NICU), ventilator requirement, newborn jaundice, newborn hypoglycaemia and structural anomalies. IP did not cause any appreciable maternal risk during the intrapartum or postpartum periods. However, neonatal morbidity and post-natal anomaly rates were higher in the case of IP.

Is late adolescence a real risk factor for an adverse outcome of pregnancy?

OBJECTIVE: To compare the obstetrical and neonatal outcomes of late adolescent (LA) and adult pregnancies. METHODS: Between January 2012 and December 2012, a total of 313 late adolescent pregnant aged between 16 and 19 years and 418 adult pregnant women aged between 20 and 35 years having given birth in our maternity service were enrolled into this case-control study. The demographic and clinical data were reviewed from hospital database and patients' medical records. RESULTS: The incidence of preterm birth (PB) in the LA group was significantly higher than in the adult group (p = 0.001), while the incidence of gestational diabetes mellitus was significantly lower (p = 0.001). The mean birth weight and the rate of delivered macrosomic fetuses in the study group were lower than in the control group (p = 0.03). The LA group had significantly higher rate of vaginal delivery when compared to the adult group (p = 0.001). Both the rate of pregnancy induced hypertensive disorders and postpartum hemorrhage were not statistically different between the two groups (p = 0.31; p = 0.38, respectively). The LA group had lower rate of stillbirth when compared to the adult group; however, the difference was statistically insignificant (0.3% versus 1.2%) (p = 0.24). CONCLUSIONS: The LA pregnancy should be closely followed up during their antenatal care period due to the significantly higher rate of PB.

Obstetric outcome of second trimester antenatal bleeding.

OBJECTIVE: To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks. METHODS: This retrospective case-control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes. RESULTS: Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9 ± 2.8 versus 38.9 ± 1.4 and 3071 ± 710 versus 3349 ± 446 for groups p < 0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5-26.1]; OR: 12.0, 95% CI: [3.5-40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p = 0.031; 1.9% versus 0%, p = 0.025). CONCLUSION: Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.

The effect of serum and follicular fluid anti-Mullerian hormone level on the number of oocytes retrieved and rate of fertilization and clinical pregnancy.

OBJECTIVE: The objective of this study was to evaluate the relationship between oocyte yield, fertilization, and clinical pregnancy (CP), and anti-Mullerian hormone (AMH) level in serum and follicular fluid during in vitro fertilization treatment. METHODS: Forty-four infertile women who underwent IVF treatment using multiagonist protocol were included in this study. Baseline level of AMH in serum and follicular fluid was measured on third day of menstrual cycle. AMH level in serum and follicular fluid was then measured again on day of oocyte pick-up. Pearson correlation and binary regression tests were used for statistical analysis. For Type 1 error, p=5% was selected as cut-off value for statistical significance. RESULTS: Serum AMH level was positively correlated with total number of oocytes retrieved and rate of fertilization and CP (r=0.397, p=0.008; r=0.401, p=0.007; and r=0.382, p=0.011, respectively). There was significantly negative correlation between serum level of follicle-stimulating hormone (FSH) and fertilization rate (r=-0.320; p=0.034), as well as serum FSH level and CP rate (r=-0.308; p=0.042). There were no significant correlations between AMH level in follicular fluid and IVF treatment outcomes. CONCLUSION: Serum AMH levels may be more reliable for prediction of total number of oocytes retrieved and rate of fertilization and CP than AMH levels in follicular fluid.

Risk factors for clavicle fracture concurrent with brachial plexus injury.

PURPOSE: The aim of this study was to evaluate the risk factors for clavicle fracture concurrent with brachial plexus injuries. METHODS: A retrospective study was conducted at a tertiary centre. The hospital records of 62,288 vaginal deliveries were evaluated retrospectively. There were 35 cases of brachial plexus injury. Of these patients, nine had brachial plexus injuries with clavicle fracture and 26 without clavicle fracture. The analysed risk factors for clavicle fracture concurrent with brachial plexus injury were gestational diabetes, labour induction and augmentation, prolonged second stage of labour, estimated foetal weight above 4000 g, birth weight above 4000 g, risky working hours, and the requirement of manoeuvres to free the impacted shoulder from behind the symphysis pubis. RESULTS: Labour augmentation with oxytocin increased the risk of clavicle fracture in cases of brachial plexus injury (OR 6.67; 95% CI 1.26-35.03). A birth weight higher than 4000 g also increased the risk of clavicle fracture. Risky working hours, gestational diabetes, estimated foetal weight higher than 4000 g, and requirement of shoulder dystocia manoeuvres did not increase the risk of clavicle fracture. CONCLUSIONS: Labour augmentation and actual birth weight higher than 4000 g were identified as risk factors for clavicle fracture in cases of brachial plexus injury.

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

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

Oxytocin versus sustained-release dinoprostone vaginal pessary for labor induction of unfavorable cervix with Bishop score ≥ 4 and ≤ 6: a randomized controlled trial.

AIM: To compare the efficacy and safety of high-dose intravenous oxytocin and sustained-release dinoprostone vaginal pessaries for cervical ripening and labor induction in pregnant patients at term with poor Bishop scores. MATERIAL AND METHODS: Women at term with a Bishop score ≥ 4 and ≤ 6 were randomized into two groups to undergo induction of labor with either high-dose oxytocin administered intravenously (n = 90) or dinoprostone-only vaginal pessary without oxytocin augmentation (n = 90). The main outcome measures were rate of cesarean delivery, induction to delivery interval, number of deliveries achieved within 4, 8, 12, and 16 h of labor induction, maternal complications during induction, fetal outcome, and total hospital stay. In this study, per-protocol analysis was performed. RESULTS: There were fewer cesarean deliveries with oxytocin compared to dinoprostone-only groups (7/79 vs 14/89); however, the difference was not statistically significant. The induction-delivery intervals (7.9 h vs 12.0 h, P < 0.001; and 5.7 vs 10.4 h, P < 0.001; oxytocin vs dinoprostone-only for primiparous and multiparous patients, respectively) were significantly shorter in oxytocin-induced patients compared to dinoprostone-only. A significantly higher percentage of patients delivered in the oxytocin group compared to the dinoprostone-only group in 4, 8, 12, 16, and 20 h. CONCLUSION: Intravenous oxytocin is effective to stimulate labor at term for patients with Bishop scores ≥ 4 and ≤ 6, with a shorter time interval from induction to vaginal delivery.

Is cesarean section a real panacea to prevent pelvic organ disorders?

INTRODUCTION AND HYPOTHESIS: The aim of this study is to compare the pelvic floor muscle strength after vaginal delivery vs. after cesarean section. METHODS: Five groups of 50 cases each were designated as follows: nullipara (control group), spontaneous vaginal delivery (SVD), repeat SVD (SVD-R), cesarean section (CS), and repeat CS (CS-R). Perineometric measurements, stress urinary incontinence (SUI) symptoms, pelvic organ prolapse quantification examinations, and Incontinence-Specific Quality of Life Questionnaire (IQOL) were evaluated. RESULTS: In all delivery groups, pelvic muscle strength was significantly lower than the control group (65.10 ± 15.69, 56.29 ± 17.39, 54.28 ± 20.08, 56.82 ± 17.62, and 57.92 ± 16.45 (cm H(2) ± SD) for the control, SVD, SVD-R, CS, and CS-R groups, respectively; p < 0.05). However, no significant difference was found among the delivery groups. There were significant differences in SUI symptoms between the control (2%) and SVD-R (26%) groups and between the SVD (10%) and SVD-R groups (p < 0.001 and p = 0.037, respectively). No statistically significant correlations between IQOL and perineometric measurements were noted (r = 0.097 and p = 0.598). CONCLUSIONS: Pregnancy increases postpartum muscle weakness independent of the mode of delivery. Increased SUI symptoms are associated with vaginal delivery.

In vivo evaluation of the genotoxic effects of gonadotropins on rat reticulocytes.

BACKGROUND: Gonadotropins, as ovulation-inducing drugs, have been used widely to treat infertility. An epidemiologic correlation between infertility therapy and ovarian cancer development has been reported. However, the effect of gonadotropins in the formation of reproductive tract cancers is controversial. OBJECTIVE: The aim of the study was to determine the in vivo genotoxic effects of gonadotropins on rat reticulocytes. METHODS: In this prospective, randomized, controlled study, rats were randomly assigned to 1 of 5 groups. The calculated rat doses of 0.65 human menopausal gonadotropin (hMG), 0.95 hMG, 0.65 follitropin beta (FB), 0.95 FB, or normal saline (control group) were injected, respectively. These calculated rat doses (U/g) are based on average human gonadotropin doses of 150 and 225 IU/d for a 70-kg woman given in 2-mL saline (the control group received 2 mL of saline). Injections were administered once per day for 5 days, followed by 5 days of rest. Each treatment was repeated for 6 estrus cycles in the rats for a total of 12 estrus cycles. Six months after the last day of the 12(th) cycle, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situ micronuclei assay under light microscopy. The proportion of micronucleated cells, cells with anaphase bridge, nuclear buds, and other nuclear abnormalities were measured. RESULTS: The number of cells with nuclear buds and binuclear abnormalities in the hMG 225 and FB 225 groups was significantly higher (P < 0.05) than that from the hMG 150, FB 150, and control groups in the cytogenetic analysis of bone marrow stem cells. An increased rate of genotoxicity in all gonadotropin groups versus that of placebo was found. CONCLUSION: In rats, the micronucleus genotoxicity assay suggests a dose-dependent gonadotropin effect on genomic instability in bone marrow stem cells in vivo.

Left ventricular diastolic function assessment by tissue Doppler echocardiography in relation to hormonal replacement therapy in postmenopausal women with diastolic dysfunction.

The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.