Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study.

AIM: To investigate the efficacy of intraoperative superior hypogastric plexus (SHP) block for postoperative pain relief in patients undergoing a cesarean section. METHODS: One hundred and fifteen pregnant women scheduled for an elective cesarean under general anesthesia were randomly divided into an SHP block (n=65) and a control group (n=50). SHP block was administered with bupivacaine injection. The controls received saline injection in the SHP area. Postoperative pain was assessed by the 10-cm visual analog scale (VAS). The presence of side effects and complications, including opioid or non-steroidal anti-inflammatory drugs (NSAID) requirement, gastrointestinal function, nausea, and vomiting were evaluated. RESULTS: The SHP block group had significantly lower VAS scores 2, 6, 24, and 48 hours postoperatively (P<0.001) and required a significantly lower rescue dose of NSAID or opioids (P=0.003, P<0.05, respectively). CONCLUSIONS: SHP block may be an effective and safe pain relief treatment after a cesarean section.

Comparison of anxiety scores between unexplained primary and secondary infertile couples.

OBJECTIVE: To investigate the anxiety levels among infertile women and their partners also factors that may affect the anxiety status. STUDY DESIGN: A total of 403 infertile couples who applied to Infertility Outpatient Clinics of a University-affiliated Teaching and Research Hospital were included in the study. The infertile group was divided into two groups as primary and secondary infertile. One hundred and thirty-two fertile couples who applied to Gynecology Outpatient Clinics composed the control group. Hamilton Anxiety Rating Scale (HAM-A) form was filled by the infertile couples to evaluate the anxiety status before they started their treatment. RESULTS: Three hundred and twenty infertile and 84 fertile couples completed the study. The mean total scores of HAM-A of women were similar between the groups. So were the scores of their husbands. In all groups, women had significantly higher mean total HAM-A scores than their husbands. There was no association between the mean HAM-A score of women and age, BMI, AFC, duration of marriage, duration of infertility, number of previous treatment cycles. Education status, working status and family structure of women did not correlate with the mean HAM-A score. CONCLUSION: Unexplained primary and secondary infertile couples had similar anxiety scores before the commencement of fertility treatments. However, the scores were higher in women than their male partners. Since the burden of treatment and the likelihood of treatment failure might increase the level of anxiety the women could be offered proper cognitive coping and relaxation interventions.

The effect of PCOS status on atherosclerosis markers and cardiovascular disease risk factors in young women with vitamin D deficiency.

OBJECTIVE: To investigate whether polycystic ovary syndrome (PCOS) had further deteriorating influence on endothelial function or cardiometabolic parameters in women with vitamin D deficiency during reproductive age. STUDY DESIGN: The study group was composed of women with PCOS and vitamin D deficiency and insufficiency between the ages of 18 and 35 years. Age and body mass index (BMI)-matched women were chosen as controls. Serum 25(OH) Vit D levels below 20 ng/mL were considered as vitamin D deficiency. The cutoff level of vitamin D insufficiency was suggested at 30 ng/mL. Serum FSH, LH, estradiol, testosterone, DHEA-S, fasting glucose, total cholesterol, HDL, LDL, triglyceride levels were analyzed. Carotid artery intima-media thickness (CIMT) was measured, and the flow-mediated vasodilation (FMD) was calculated. RESULTS: CIMT and FMD values in both vitamin D deficiency and insufficiency subgroups showed no significant difference between PCOS and non-PCOS groups. There was a weak negative correlation between BMI, waist/hip ratio, CRP, and 25(OH) Vitamin D. CONCLUSION: PCOS is a heterogeneous disease with different combinations of the diagnostic components. Vitamin D is an important variable for a healthy cardiovascular system. We did not find any difference in early atherosclerotic markers and cardiometabolic features between PCOS and non-PCOS group with Vitamin D deficiency.

Comparison of depression between primary and secondary infertile couples.

OBJECTIVE: We aimed to compare the depression levels between primary and secondary infertile couples and to investigate the related factors that may affect depression. STUDY DESIGN: Two hundred and fifty primary and secondary infertile couples, who admitted to Gynecology and Infertility Clinics of Pendik Teaching and Research Hospital affiliated with Marmara University were enrolled in this study. Sixty-four BMI-matched fertile female patients who applied to the General Gynecology Clinic and their husbands were taken as the control group. Beck Depression Inventory (BDI) form was filled by the infertile couples to evaluate the depression status before they started their cycles. RESULTS: The mean total BDI scores were alike between groups among women. Mild depression was found to be higher in the primary infertile women and moderate depression was higher in women of the control group. Women had statistically higher depression scores than male partners. Primary infertile, secondary infertile, and fertile women had higher depression scores than their male partners in the corresponding groups. There was no significant difference in mean total BDI scores among males between the groups. The percentage of distribution of male partners in each level of depression was similar between the groups. CONCLUSIONS: Only a weak positive correlation between the mean total BDI score and the number of previous treatment cycles was found. Psychiatric support before and during the upcoming fertility treatment might reduce the perception of the probable treatment failure.

Quality of life among infertile PCOS patients.

OBJECTIVE: To investigate whether quality of life differs between PCOS and non-PCOS infertile women. STUDY DESIGN: Two questionnaire forms of quality of life (PCOSQ, SF-36) were given to 238 women. Patients were asked to answer all of the questions in both of the questionnaires. Of these 238 women, only 49 infertile PCOS patients, 47 infertile non-PCOS patients and 62 fertile PCOS patients filled the forms completely. RESULTS: Both PCOSQ and SF-36 scores are lowest in infertile PCOS group. Although total PCOSQ score of infertile non-PCOS group was better than non-infertile PCOS and fertile PCOS groups; there was trend for lower scores when infertility is added on PCOS status. CONCLUSION: The quality of life is lowest among infertile PCOS women. Both PCOS and infertility as individual factors may have negative impact in quality of life of reproductive age women.

Does cardiovascular risk vary according to the criteria for a diagnosis of polycystic ovary syndrome?

AIM: The risk of cardiovascular disease is higher in women with polycystic ovary syndrome (PCOS) compared to healthy individuals. Chronic inflammation, insulin resistance, hyperandrogenemia, hyperlipidemia and increased oxidative stress are known to have a role in the formation of atherosclerosis and cardiovascular disease. The aim of our study was to evaluate if cardiovascular risk varied according to different PCOS criteria, using carotid intima-media thickness (CIMT), which is an important marker of major cardiovascular events in the later stages of life. METHODS: The study group included 52 women aged 18-35 diagnosed with PCOS, and the control group comprised 45 age-matched healthy women. Body mass index, CIMT, fasting serum glucose and insulin levels and hormonal and lipid profiles were compared between the groups. RESULTS: There was no significant difference in CIMT levels between the groups. The CIMT levels in the PCOS group did not differ whether hyperandrogenism, polycystic ovary-like appearance on ultrasound or oligo/anovulation status were present or not. Furthermore, when all cases were divided into subgroups according to BMI values, the CIMT values were similar between the groups. CONCLUSION: Because PCOS and atherosclerosis both have a complex nature, it is likely that the evaluation of CIMT alone may not be sufficient to determine endothelial dysfunction in a reproductive age group.

The evaluation of endothelial function and structure in hirsute patients in reproductive age.

OBJECTIVE: To evaluate the endothelial function and structure in patients with hirsutism in reproductive age. STUDY DESIGN: The study was conducted on 69 consecutive women admitted with complaints of hirsutism and 63 voluntary healthy women, as controls. A total of 132 subjects who applied to the Gynecology and Infertility Outpatient Clinics were included. Participants with modified Ferriman Gallway (mFG) score over 8 were considered to be hirsute. The demographic, metabolic, hormonal characteristics, risk factors of cardiovascular disease, CIMT (carotis intima media thickness) and FMD (flow-mediated dilatation) were compared between hirsute women and those in the control group. A prospective case-control study was performed. RESULTS: There was no statistically significant difference in CIMT (0,50±0,08 vs 0,52±0,08, p=0.38) and FMD (10,80±6,83 vs 9,57±6,52, p=0.34) values between the study and control groups, respectively. There was no statistically significant correleation between CIMT and FMD values with age, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, CRP (C-reactive protein), total cholesterol, LDL (low density lipoprotein), HDL (high density lipoprotein), total testosteron, FAI (free androjen index), androstenedion, SHBG (sex hormone binding globuline), DHEA-S, hirsutism score, sistolic blood pressure, diastolic blood pressure, HOMA-IR (homeostatic model of assesment insuline resistance) value. CONCLUSION: The effect of the presence of hirsutism on either CIMT and FMD values, among young patients was not significant. Since endothelial dysfunction might became evident after a long period of physio-pathological process, our findings obtained from younger patients may not really show the impact of hirsutism on endothelial function in short term.