The evaluation of the efficacy of etofenamate spray in postoperative cesarean pain: Randomized, double-blind, placebo-controlled trial.

OBJECTIVE: It was aimed to investigate the effect of etofenamate spray to be applied around the postoperative incision on pain control in cesarean section in this trial. MATERIAL AND METHODS: This was a prospective, randomized, double-blind, and placebo-controlled trial. 187 patients (93 cases and 94 controls) were recruited for the study. In the trial group, we applied the etofenamate spray (Doline® 50 ml) after closing the cesarean skin incision and go on four times a day on the skin incision for 24 h. In the control group, we applied a placebo. All patients received paracetamol IV (Paracerol®) as standard analgesic doses. If analgesia was insufficient, tramadol (Contramal®) 50 mg IV doses were added and recorded. A visually analog pain scale (VAS) was performed on both groups at 6-12-18-24th hours. Independent t-tests were performed for data showing normal distributions. RESULTS: There were no significant differences in the mean of differences VAS scores between the two groups at 6-12, and 6-18 h. However, a significant difference was obtained in the mean of differences VAS score at the 6-24th hour (p < 0.05). When the groups were compared in terms of additional paracetamol need, a significant difference was found again (p < 0.05). There was no significant difference between the groups in terms of tramadol need. CONCLUSION: Postoperative administration of etofenamate spray provided an analgesic effect at 24 h and additional analgesic usage decreased. Postoperative analgesia can also be used by administering NSAIDs around the cesarean section incision. In this way, the side effects of other systemic analgesics are avoided. CLINICAL TRIAL ID: PACTR201811864509898. CLINICAL TRIAL WEB LINK: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5745.

Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study.

PURPOSE: This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). METHODS: This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. RESULTS: In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). CONCLUSIONS: This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.

Comparison of cord blood and 6-month-old vitamin D levels of healthy term infants supplemented with 400 IU/day dose of vitamin D.

OBJECTIVES: To determine the prevalence and risk factors of vitamin D deficiency in pregnant women and their infants at birth (cord blood) and at six months of age in Turkey, as well as to assess the compliance rates of families with vitamin D supplementation. METHODS: Serum 25-hydroxyvitamin D [25(OH)D] level was measured of the mothers before delivery and of the infants both at birth (cord blood) and at six months of age. Infants who received and did not take regular vitamin D supplements were compared in terms of 25(OH) levels. Independent risk factors were determined by multiple logistic regression analysis. RESULTS: The study included a total of 140 pregnant women and their infants. Vitamin D deficiency was found in 95.7% of the mothers. The prevalence of vitamin D deficiency was 87.1% in infants at birth but decreased to 5.8% at sixth month. 65.7% of infants received vitamin D supplements regularly. Despite regular vitamin D use, it was determined that 2.2% of the infants in the supplementation compliant group had vitamin D deficiency. Maternal age, maternal education level, and the number of siblings were determined to be determining factors on infants' 25(OH)D levels at six months (p < 0.05). CONCLUSIONS: In Turkey, vitamin D deficiency still exists in both pregnant women and infants. Healthcare professionals and the public need to be more educated about the importance of regular supplementation. Serum 25(OH)D levels of infants should be tested periodically and personalized vitamin D supplementation planning is required based on test results.

Evaluation of the Pelvic Floor of Women with Breast Cancer Using Tamoxifen by Transperineal 3D Ultrasonography.

Objective: This study aimed to investigate the anatomical changes in the pelvic floor of women with breast cancer using tamoxifen by transperineal 3D ultrasonography and their effect on the urinary incontinence and sexual dysfunction. Methods: Ninety-four patients with breast cancer using TAM in the study group and ninety-five healthy women of the same age in the control group were included in this prospective cohort study. Female Sexual Function Index and Incontinence Questionnaire-Short Form scales were applied to both groups. Ultrasonographic evaluation was performed at resting and Valsalva Maneuver with a convex (3-8 MHz) probe transperineally and the levator urethra gap and levator hiatus diameter were measured after 3-dimensional imaging. Independent t-tests were performed for statistical analysis. Results: The mean age and body mass index of the experimental group versus control groups were 46.3 ± 6.12 years versus 46.4 ± 5.23 years and 27.6 ± 4.34 kg/m2 versus 29.2 ± 6.45 kg/m2, respectively. LUG and LH values were found significantly higher for the experimental groups compared to control groups at 17.23 ± 2.53 mm versus 14.1 ± 2.23 mm and 21 ± 2.45 cm2 versus 18 ± 4.56 cm2, respectively. (p < 0.05). The FSFI score significantly decreased (12.49 ± 3.58 versus 20.89 ± 3.69) and the ICIQ-SF score increased (4.02 ± 0.34 versus 2.34 ± 0.45) in the experimental group in comparison to control group (p < 0.05). Conclusion: This study demonstrated that the effects of TAM usage on pelvic floor can be detected by measuring the changes in the levator ani muscle using the transperineal 3D USG. With transperineal USG screening, pelvic floor changes can be early diagnosed and clinical measures can be taken before they become symptomatic.

Psychosocial outcomes of the COVID-19 pandemic on pregnant women.

The aim of this study was to compare the levels of anxiety and social support evaluated in pregnancy before and during the COVID-19 pandemic. This study was designed prospectively and observationally. Participants were asked to fill in two different questionnaire forms for the Multidimensional Scale of Perceived Social Support and The State-Trait Anxiety Inventory. Independent t-test and Pearson correlation analysis were used for statistical analysis. The mean age of 386 pregnant was 29.1 ± 4.91 years, and the gestational week was 29.12 ± 4.54. The values of the total social support scale were determined 61.52 ± 5.53-51.15 ± 5.86 before and during the pandemic, while the total state anxiety scale was found 39.81 ± 9.04 and 63.38 ± 10.55, respectively. The total trait anxiety scale was found at 38.23 ± 7.39 and 53.22 ± 8.74 in the same respect. A significant difference was obtained in the data between before and during the pandemic (p < .05). The study showed that pregnant are deprived of social support and their anxiety levels increase during the COVID-19 pandemic.IMPACT STATEMENTWhat is already known on this subject? During the COVID-19 pandemic, the prevalence of depression and anxiety in pregnant women have been reported as 25.6 and 30.5%, respectively. Social support is an important determinant of physical and psychological well-being, especially during pregnancy when individuals take on new responsibilities and roles.What do the results of this study add? The study showed that pregnant women were deprived of social support and their anxiety levels increased during this pandemic. The results highlight that there is a high need to mitigate mental health risks and adjust interventions under pandemic conditions.What are the implications of these findings for clinical practice and/or further research? It is necessary to provide social support from family, friends, and close circles. States and health professionals need to put forward serious programs and studies to reduce the stress and anxiety experienced by the society and especially pregnant women and to provide accurate information about COVID-19.

Direct hysteroscopic endometrial sampling and pipelle sampling in perimenopausal women.

BACKGROUND: Abnormal uterine bleeding is a common cause of hospital admission in perimenopausal women. It can be the first sign of many diseases such as endometrial cancer and endometrial hyperplasia. Endometrial sampling is valuable in early diagnosis and treatment. Although hysterectomy is the gold standard in the diagnosis of endometrial pathology, it is not considered an acceptable method for diagnosis. With the principle of "see and treat, hysteroscopy seems to be the most successful method. METHODS: After obtaining the necessary ethics committee approval, we obtained liquid-based cytology samples of our perimenopausal patients who frequently applied to our outpatient clinic with abnormal uterine bleeding. To conduct endometrial sampling of our patients, we used pipelle aspiration method in our 75-disease group and direct hysteroscopic sampling method in our other 75 disease group. We then compared the pre- and postoperative pathology results. RESULTS: There was no statistically significant difference between preoperative and postoperative pathological results in both pipelle and hysteroscopic sampling groups. CONCLUSIONS: Evaluation of endometrial pathologies by hysteroscopic method and pipelle method has high sensitivity and specificity. Gynecologists may determine the method preference according to the status of the health system together with their patients.

Emergency peripartum hysterectomy - our 6 years of experience.

OBJECTIVE: Peripartum hysterectomy is a life-saving procedure performed during and after vaginal delivery or cesarean section. The incidence of placental invasion anomaly is increasing in parallel with the increase in the number of births by cesarean section. It was aimed to evaluate the frequency, risk factors and outcomes of peripartum hysterectomy performed in a tertiary hospital. MATERIALS AND METHODS: Research data were obtained by a retrospective review of patient files. Patients who underwent peripartum hysterectomy because of postpartum hemorrhage in the Gynecology and Obstetrics Clinic of Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Turkey, were included in the present study. The patients were divided into two groups as those who underwent emergency peripartum hysterectomy (EPH) and those who did not. Demographic variables, fetal and maternal mortality, EPH indications, additional surgeries performed during EPH, and intra- or postoperative complications were collected. Pearson chi-square test was used for statistical analysis. RESULTS: There were 22,464 deliveries, of which 13,514 were delivered vaginally and 8,950 by cesarean section. Peripartum hysterectomy was performed on 42 patients (vaginal 16, cesarean section 26). The most common EPH indications in both groups were placenta accreta spectrum (42.9/ 3.2%), followed by uterine atony (38.1/ 2.5%). The most common risk factor for EPH was found to be a history of previous cesarean sections. CONCLUSION: Placental invasion anomalies that cause severe postpartum hemorrhage are due to increased cesarean rates. Currently, the most common indication of EPH is placental invasion anomalies.

A prospective cohort study of the relationship of female genital mutilation with birth outcomes in Somalia.

BACKGROUND: Female genital mutilation (FGM) is defined as the partial or complete removal of the external female genitalia for non-medical reasons. There are some complications related to childbirth that concern both the mother and the baby. In this study, we aimed to evaluate the birth outcomes of FGM, which is widely applied in Somalia. METHODS: The study included 268 women who gave birth at 37-42 weeks of gestation with a cephalic singleton, 134 with FGM and 134 without FGM. This study was designed a prospective cohort study and conducted between January 2019 and December 2020. Patients' ages, duration of delivery, FGM types, caesarean section requirements, before and after birth hemoglobin levels, birth weeks, baby birth weights and perineal tear data were recorded. In addition, we analyzed neonatal intensive care needs and APGAR scores for infants. RESULTS: In patients with FGM, it was determined that the outlet obstruction increased 2.33 times, perineal tears increased 2.48 times, the need for caesarean section increased 2.11 times compared to the control group, and the APGAR score below 7 at the 5th minute in the children increased 2 times and the need for neonatal intensive care increased 1.87 times. CONCLUSIONS: FGM causes increased risk of perineal tear, prolongation in the second stage of labour, increased need for emergency caesarean section, and increased need for NICU for infants. Prevention of FGM will help reduce both obstetric and neonatal complications.

Psychosocial outcomes of COVID-19 pandemic on healthcare workers in maternity services.

AIM: We investigated the effects of the COVID-19 outbreak on social support and anxiety levels in healthcare professionals working in maternity services situated in Trabzon, Turkey. MATERIALS AND METHODS: Our study was designed retrospectively and observationally. Social support to the participants was measured using a scale called the multidimensional scale of perceived social support (MSPSS). State anxiety scale (STAI TX-1) and trait anxiety scale (STAI TX-2) were used to determine the level of anxiety. All scales were measured before and during the pandemic. Independent t-test and one-way ANOVA were used to analyze the data where p < 0.05 was considered significant. RESULTS: The participants' demographic data (n = 96) included the mean age of doctors (n = 30), midwives (n = 34), and nurses (n = 32) which were 41.38 ± 4.16/38.58 ± 1.79/37.34 ± 2.19, respectively. Mean gravida was 1.69 ± 2.87/2.23 ± 0.12/2.31 ± 0.14, respectively. Mean BMI was 24.69 ± 2.87/26.04 ± 0.8/25.69 ± 1.98 in the same order (p > 0.05). The total mean values of the MSPSS, STAI TX-1, STAI TX-2 scales before and during the pandemic were found as 66.55 ± 6.63 - 55.25 ± 4.76, 36.71 ± 10.04 - 50.08 ± 11.65, 37.33 ± 8.09 - 53.32 ± 9.94, respectively. A significant difference was found for the mean of all scales amongst the groups (p < 0.05). CONCLUSION: During the COVID-19 pandemic, a significant number of healthcare workers were deprived of social support and their anxiety levels increased.

The Efficiency of Temporary Uterine Artery Ligation on Prevention of the Bleeding in Cesarean Section.

OBJECTIVE: We aimed to evaluate the effect of temporary ligation of the uterine artery on postpartum bleeding during uncomplicated cesarean section. DESIGN: This was a prospective, randomized, and controlled study. We recruited a total of 200 patients, including 100 cases and 100 controls. METHODS: The bilateral uterine artery was temporarily clamped 2 cm below the uterine incision in the study group and compared with controls. Patient demographics, the amount of intraoperative bleeding, the duration of the operation, the closure time of the uterine incision, the need for additional uterotonics, the need for additional sutures, and the hemoglobin values before and after birth were assessed. RESULTS: The mean value of the amount of bleeding in the clamped and control groups was 267.3 ± 131.8 mL and 390.2 ± 116.4 mL, respectively. The amount of bleeding was significantly decreased for clamped group (p < 0.001). A significant reduction occurred in the results of pre- and postoperative values of hemoglobin and hematocrit difference, operation duration, and the closing time of the uterine incision in the experimental group which has temporary uterine artery clamping. LIMITATIONS: The cases of recurrent cesareans were not included in this study. CONCLUSION: Temporary uterine artery ligation can be used to reduce the amount of bleeding during uncomplicated cesarean delivery and prevent postpartum hemorrhage.