Do Meteorological Variations and Climate Changes Affect Hyperemesis Gravidarum?

BACKGROUND: To estimate a possible association between the effects of daily meteorological variation and climatological changes (temperature, air pressure, humidity, sunniness level) on pregnant women with hyperemesis gravidarum (HG) according to symptoms grade and hospitalization state. METHODS: A retrospective study was conducted with 118 patients diagnosed and hospitalized with HG. HG patients were graded as mild, moderate, or severe according to the Pregnancy Unique Quantification of Emesis (PUQE-24) scale. Data regarding demographic characteristics, PUQE scale value, gestational week on hospitalization, hospital admission and discharge dates, weather conditions, daily meteorological values during hospitalization ( temperature, air pressure, humidity, sunniness level), seasonal averages, and daily changes were recorded. Weather records were obtained from the Ankara Meteorology General Directorate (Ankara, Turkey). Differences between groups were compared according to HG grade. RESULTS: HG cases were classified as mild (33.1%), moderate (44.9%), or severe (22.0%). The number of hospitalization days significantly differed between these three groups (p<0.05). In contrast, no statistically significant differences were identified between the HG grade level groups in regard to humidity, pressure, temperature, and sunniness level data (p>0.05). In addition, no statistically significant relationship was identified between HG grades and seasonal conditions according to the chi-square test (p>0.05). CONCLUSION: Changes in the meteorological and climate values examined were independent of symptom severity and hospitalization rate for our HG patients. However, it is possible that climate changes occurring around the world may affect the pregnancy period and should be further investigated.

Low Anti-Mullerian Hormone Levels Are Associated with the Severity of Anxiety Experienced by Healthcare Professionals During the COVID-19 Pandemic.

The objective of this study is to investigate a possible correlation between anxiety status and anti-Mullerian hormone (AMH) levels among healthcare professionals who provide medical care directly to COVID-19-positive patients during the recent pandemic. Fifty-two healthcare professionals (nurses, midwives, and residents) who provide medical care directly to COVID-19-positive patients in inpatient clinics or intensive care units were enrolled in this study. Serum AMH levels were analyzed to reflect ovarian reserve. The Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI-S and STAI-T, respectively) were completed by participants to assess their anxiety status. A linear regression model with participant age as the constant variable was applied to analyze the relationship between inventory scale scores and AMH levels. P-values less than 0.05 were considered statistically significant. The mean AMH value was significantly lower for the participants in the moderate/severe anxiety group compared to the minimal/mild anxiety group (p = 0.007). A linear regression analysis revealed a significant negative correlation between AMH levels and both BAI (B = -0.030, standard error = 0.010, p = 0.004) and STAI-S and STAI-T scores when age was controlled (both p = 0.003). The severity of anxiety experienced during the recent COVID-19 pandemic among healthcare professionals, who provide medical care directly to COVID-19-positive patients, is found to be related to low AMH levels.

Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures

Objective: To evaluate the attitudes of medical students and professionals towards female genital cosmetic procedures (FGCPs) in terms of medical justification, applicability in practical life, ethical concerns, patient autonomy, and the clinical/social/psychological benefits-harms of these procedures. Materials and Methods: A semi-structured questionnaire providing information about the attitudes of medical students and specialists (n=623) towards FGCPs including G-spot amplification, clitoral hood reduction, vaginoplasty, labia majora augmentation/reduction, labia minora augmentation/reduction, hymenoplasty, laser procedures, vulvar/perianal bleaching, and liposculpture, was completed by a target population and evaluated statistically. Results: Participants stated that FGCPs could be performed only upon patient request and there could rarely be a medical indication for their performance (p<0.05). Nearly half (44.5%) of the participants regarded hymenoplasty as controversial in terms of ethical issues, and 44.6% of participants do so for G-spot amplification. Over half (54.5%) of the participants agreed on the positive effect of FGCPs on improving the quality of life, 55.4% on improving self-esteem, and 54.1% on improving sexual functions of women. About half (49.3%) of respondents thought that the advertising and encouragement of FGCPs should be forbidden and 47% were indecisive about whether FGCPs constituted genital mutilation. Conclusion: The majority of the participants declared that FGCPs could be performed only upon patient request and improve self-esteem, quality of life, and sexual functions. The most controversial procedures in terms of ethics were hymenoplasty and G-spot amplification. Detailed guidelines for the protection of both patients and physicians are needed because the recommendations on FGCPs are insufficient to define the boundaries of medical justification, genital mutilation, advertising, and ethical concerns.

The rate of SARS-CoV-2 positivity in asymptomatic pregnant women admitted to hospital for delivery: Experience of a pandemic center in Turkey.

OBJECTIVE: To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in asymptomatic pregnant women admitted to hospital for delivery in a Turkish pandemic center. STUDY DESIGN: This prospective cohort study was conducted in Ankara City Hospital between April, 15, 2020 and June, 5, 2020. A total of 206 asymptomatic pregnant women (103 low-risk pregnant women without any defined risk factor and 103 high-risk pregnant women) were screened for SARS-CoV-2 positivity upon admission to hospital for delivery. Detection of SARS-CoV2 in nasopharyngeal and oropharyngeal samples was performed by Real Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) method targeting RdRp (RNA dependent RNA polymerase) gene. Two groups were compared in terms of demographic features, clinical characteristics and SARS-CoV-2 positivity. RESULTS: Three of the 206 pregnant women participating in the study had positive RT-PCR tests (1.4 %) and all positive cases were in the high-risk pregnancy group. Although, one case in the high-risk pregnancy group had developed symptoms highly suspicious for COVID-19, two repeated RT-PCR tests were negative. SARS-CoV-2 RT-PCR positivity rate was significantly higher in the high-risk pregnancy group (2.9 % vs 0%, p = 0.04). CONCLUSION: Healthcare professionals should be cautious in the labor and delivery of high-risk pregnant women during the pandemic period and universal testing for COVID-19 may be considered in selected populations.

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.

Vaginoplasty Using Human Amniotic Membranes A Report of Five Patients.

OBJECTIVE: To present our experiences with an innovative surgical approach for vaginal agenesis that uses amnion as the allograft to create a functional neovagina. STUDY DESIGN: This study involved 5 patients with diagnosed vaginal agenesis. One patient had karyotype 46,XY and was diagnosed with complete androgen insensitivity syn- drome, whereas the others had karyotype 46,XX and were diagnosed with Mayer-Rokitansky-Kiister-Hauser syndrome. All patients underwent Mclndoe vagino- plasty using amnion and were followed up at 2 weeks, 3 months, 6 months, and 12 months postsurgery. Functionality of the neovagina was assessed by Rosen Female Sexual Function Index (FSFI) questionnaire. RESULTS: At the 12-month follow-up 1 patient report- ed. an inability to use the vaginal dilator effectively; for the other 4 patients the mean depth of the neovagina was 9.5 cm and the mean width was 3.5 cm. The mean overall FSFI score was 28.3. CONCLUSION: McIndoe vaginoplasty is a simple, safe, and quick operative method that results in a ftnctional vagina. The amnion is a suitable material to apply to the surface of the neovagina because it is readily avail- able and does not have any associated immune reiection problems or costs.