Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?

OBJECTIVE: The aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. MATERIAL AND METHODS: Our study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. RESULTS: No correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). CONCLUSION: There may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.

The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone.

PURPOSE: The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. METHODS: This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. RESULTS: The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. CONCLUSION: Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.

Prediction model for residual high-grade cervical intraepithelial lesions.

BACKGROUND: The aim of the study was to evaluate risk factors associated with high-grade cervical intraepithelial lesions (HSIL) in patients undergoing a second cervical excision procedure due to positive surgical margins and to create a prediction model for residual disease. METHODS: This study included patients with HSIL positive surgical margins following loop electrosurgical excision procedures (LEEP) between March 2015 and August 2019. HSIL in the second cervical excision pathology in these patients was accepted as residual disease. For residual disease prediction, a multivariate logistic regression and stepwise elimination analysis of 14 variables including demographic characteristics, clinical characteristics, pathology results and HPV genotypes of the patients was performed. RESULTS: Second cervical excision procedures were performed in 290 patients 85(29.4%) of these patients had CIN 2 (cervical intraepithelial neoplasia) and 205 (70.6%) had CIN 3. In the second excision procedure, 166 patients (57.2%) had ≤CIN 1, 124 patients (42.8%) had ≥CIN2. The prediction model of residual disease includes only 3 variables out of the 14 different clinical characteristics (AUC=0.605 [0.539-0.671]). These variables are gravida (adjusted OR: 1.15 [0.97-1.38], P=0.107), CIN2-3 presence in the endocervical canal in the first LEEP specimen (adjusted OR: 1.52 [0.94-2.47], P=0.091) and the presence of HR-HPV except 16/18 lesions (adjusted OR: 0.64 [0.38-1.06], P=0.083). CONCLUSIONS: A prediction model was designed with our data, from variables reported to be risk factors for residual disease in previous studies. While this model was statistically significant, it was poor at distinguishing residual disease. A prediction model can be designed to guide clinicians with future studies.

Planned and unplanned pregnancy and its association with coping styles and life quality.

We aimed to compare women who have a planned pregnancy with women who have an unwanted pregnancy, in terms of quality of life, coping attitudes, and demographics. 172 pregnant women were enrolled, of whom 128 of them had planned pregnancy, and 44 of them had not. A survey of socio-demographics, COPE inventory, and SF-36 tools are used to investigate and compare coping attitudes and quality of life. The chi-square test was used to compare categorical variables between groups. The overall quality of life was found to be similar between the two groups. Problem-focused coping attitudes of expectant mothers and dysfunctional coping behaviors were more common among mothers with planned pregnancies (p = 0.047 and p = 0.036, respectively). The planning status of the pregnancy doesn't seem to be affecting the expectant mothers' quality of life substantially. On the other hand, unplanned pregnancies appear to be associated with some coping behaviors, as well as low-income level, exposure to violence and not having social support. This outcome may be helpful for pre-conceptional consultations, especially for pregnant with a lack of coping attitudes.

Volumetric PET parameters are predictive for the prognosis of locally advanced cervical cancer.

BACKGROUND: The present study evaluates the relationship between PET/CT findings and survival in patients with locally advanced cervical cancer (LACC) with a squamous cell histology. METHODS: The study included 70 patients with LACC (FIGO stage IB2-IVA). The relationship between pretreatment PET/CT parameters, age, stage, lymph node metastasis and survival was evaluated using the univariate and multivariate Cox proportional hazards model. RESULTS: The mean age of the 70 patients was 57.4 years and the mean duration of follow-up was 33.6 months. Disease progression occurred in 36 patients and 32 patients died during the follow-up period. In the univariate analysis, MTV-P and TLG-P were found to be related to progression-free survival (PFS), and stage, MTV-P, TLG-P and SUVmax-Ps were found to be related to overall survival (OS). However, only MTV-P and TLG-P were found to be independent prognostic factors for both PFS and OS. CONCLUSIONS: The present findings suggest that volumetric PET parameters (MTV-P, TLG-P) predict the progression and survival of the patients with LACC.

Identifying the Risk Factors Associated with Surgical Site Infection Following Cesarean Section in Adolescent Mothers.

STUDY OBJECTIVE: This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. DESIGN: Retrospective case-control study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Pregnant adolescents (≤ 19 years) who underwent cesarean section at our institution between January 2014 and March 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: To determine the modifiable and nonmodifiable risk factors associated with SSI following cesarean section in adolescents. The diagnosis of SSI was made according to the criteria defined by the Centers for Disease Control and Prevention (CDC). RESULTS: SSI was diagnosed in 62 (2.9%) of 2105 adolescent mothers who underwent cesarean section. Univariate and multivariate analyses confirmed that body mass index (BMI) (OR = 2.35; 95% CI, 1.3-4.78), induction of labor (OR = 1.9; 95% CI, 1.2-3.71), and preoperative hemoglobin values less than 10 g/dl (OR = 2.1; 95% CI, 1.2-4.46) were risk factors for SSI in adolescent mothers. Patient- and operation-related risk factors did not reach the level of statistical significance. CONCLUSIONS: BMI, labor induction, and antenatal anemia were independent risk factors for SSI in adolescents. Among these, BMI and anemia were modifiable patient-related risk factors. Addressing obesity in adolescents and treating prenatal anemia could be the first steps toward preventing SSI.

Obstetric Perineal Tears in Pregnant Adolescents and the Influencing Factors.

STUDY OBJECTIVE: The incidence and risk factors of obstetric perineal tear occurrence in vaginal delivery of adolescent pregnant patients are not well established. We aimed to describe the incidence of obstetric perineal tears in adolescents and the maternal obstetric risk factors associated with this situation. DESIGN: Retrospective cohort study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Adolescent pregnant patients (≤19 years) who delivered vaginally in our institution between January 2014 and January 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: The main outcome measures were the incidence of perineal tears, the degree of perineal tears, and the risk factors associated with severe perineal tears in adolescents. Severe perineal tears include third- and fourth-degree lacerations. A third-degree tear is defined as partial or complete disruption of the anal sphincter muscles, and a fourth-degree tear is defined as lacerations involving the rectal mucosa. RESULTS: A total of 3441 adolescents who had a vaginal delivery were included in the study. The rate of severe perineal tear was 5.8% (200/3441). Risk factors associated with obstetric laceration in adolescents in multivariate analysis were nulliparity (OR = 1.72; 95% CI, 1.14-2.41; P = 0.007), high birth weight (OR = 4.1; 95% CI, 2.71-6.21; P < 0.001), and labor induction (OR = 1.36; 95% CI, 1.01-1.85; P = 0.02). Spontaneous onset of labor and previous delivery reduced the risk of severe perineal tear in adolescent pregnant patients (respectively, OR = 0.68; 95% CI, 0.51-0.94; P = 0.02 and OR = 0.51; 95% CI, 0.33-0.79; P = 0.007). CONCLUSIONS: In adolescents, the risk of severe perineal tear was associated with nulliparity, birth weight, and labor induction. The only possible modifiable risk factor was labor induction.

Comparison of transendometrial myomectomy versus conventional myomectomy in cesarean section.

OBJECTIVE: To compare the surgical results of transendometrial myomectomy (TEM) and conventional myomectomy (CM) procedures for fibroid in cesarean section. MATERIAL AND METHODS: This retrospective study was conducted with computer-based medical records of patients who underwent myomectomy during cesarean section between January 2013 and March 2019. During the study period, 41 patients underwent transendometrial myomectomy, and 52 patients with had conventional myomectomy. In all patients included in the study, myoma was single, intramural, and localized in the anterior of the uterus. RESULTS: The total duration of surgery was shorter in the TEM group than in the CM group (50,5 ± 10 min vs 63,6 ± 15,2, p = 0,001). There was no difference in terms of length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement and postoperative fever (respectively, p = 0,65, p = 0,81, p = 0,33 and p = 0,9). Patients who underwent TEM (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent CM (1,76 ± 1,1) (p = 0,001). CONCLUSION: Transendometrial myomectomy technique seems to be more advantageous in selected patients compared to the conventional technique due to the shorter operation time.

Ovarian Torsion in Adolescents with and without ovarian mass: A Cross-sectional Study.

STUDY OBJECTIVE: The aim of this study was to compare the characteristics of adolescents with and without adnexal mass who were diagnosed with ovarian torsion (OT). DESIGN: Retrospective cross-sectional study. SETTING: Gynecology Department at Tepecik Education and Reseach Hospital, Izmir, Turkey. PARTICIPANTS: Adolescent girls who received surgery for OT between March 2012 and October 2020 in our institution. INTERVENTIONS AND MAIN OUTCOME MEASURES: The patients were divided into 2 groups according to the presence or absence of an ovarian mass and compared. Demographic and clinical characteristics, imaging findings, surgery, and pathology reports of the patients were obtained. Differences in initial symptoms, ultrasound findings, the diagnostic process, and the degree of torsion in patients with and without ovarian mass. RESULTS: Seventy-six patients were diagnosed with OT. Of the 76 patients, 41/76 (53.9%) had an ovarian mass (OTwM), and 35/76 (46.1%) had no pathology (OTnP). The admission to surgery interval was longer in the OTnP group (P = .03). Ultrasound findings of ovarian edema and the appearance of free fluid were significant in the OTnP group (P = .001). The largest dimension of the nontorsion ovary in the OTnP group was greater than in the OTwM group (P = .03). In addition, it was found that torsion more than 360° was more common in the OTnP group than in the OTwM group (24/35, 68.5% vs 41/18, 43.9%; P = .03). CONCLUSION: In symptomatic adolescents without an ovarian mass, the presence of follicle peripheralization suggesting ovarian edema on ultrasound and the presence of free fluid in the abdomen are important in terms of suspicion of torsion for clinicians. In addition, the degree of torsion was increased in these patients.

Does fetal sex affect placental delivery times? A prospective observational study.

Objective: The aim of this study was to determine the potential effect of fetal sex on placental delivery times.Study design: This was a prospective observational study of term, singleton, and primiparous pregnant women who underwent vaginal delivery and subsequently delivered a phenotypically normal live infant. Women with labor or pregnancy complications and comorbid diseases were excluded. Women with factors who could lengthen the placental delivery time were also excluded. The cohort was divided into two groups according to fetal sex. A total of 299 vaginal deliveries were included, and placental delivery times were analyzed in both groups.Results: There were 3938 vaginal deliveries during the study period. Of these, 150 male-bearing pregnant women and 149 female-bearing pregnant women who met the inclusion criteria were included in the analysis. The mean placental delivery time was significantly longer in the male-bearing group than the female-bearing group (12.20 versus 8.21 min, p = .01). Birth weight was significantly greater in the male-bearing group than the female-bearing group (3194 versus 3059 g, p = .004). There was no significant between-group difference in maternal age, gestational age, and preconception body mass index (BMI).Conclusion: Fetal sex had a significant effect on the placental delivery time in the present study. Fetal sex should be considered in future clinical trials of placental delivery times.

Can anemia predict perinatal outcomes in different stages of pregnancy?

OBJECTIVE: To investigate the effect of anemia on perinatal outcomes as preterm delivery (PTD) and low birth weight (LBW) in the different stages of pregnancy. METHODS: Medical records of 39,587 Turkish pregnant women who delivered between January 2011 and September 2014 were reviewed. Anemia during pregnancy was defined as hemoglobin (Hb)< 11 g/dl, low birth weight was defined as birth weight <2500 gr and PTD was defined as <37 weeks. The pregnant women were divided into three groups (Hb<10 gr/dl, Hb 10-11 gr/dl, Hb>11 gr/dl). Perinatal outcomes were compared between these anemic and non-anemic groups. RESULTS: The anemia prevalence in our study was 25.1%. In the first and second trimester of Hb<10g/dl group LBW ratio was significantly higher (respectively 13.5%, 9.8%, p=0.03; 22.7%, 14.7%, p=0.01). In the second and third trimesters of Hb<10 g/dl group PTD ratio was significantly higher (respectively 29.1%, 19%, p=0.00; 17.7%, 15.4% p=0.02). In the first trimester Hb<10 g/dl group cesarean section rate was significantly higher (respectively 65.2%, 57.6%, p = 0.01). CONCLUSIONS: LBW infants and preterm birth rate was higher in Hb <10 gr/dl group than non-anemic in the first, second and third trimester. Hb <10 gr/dl group had higher cesarean rate in first trimester. The mean birth weight was significantly lower in anemic pregnant women in the second trimester. Preterm birth and cesarean section rate, in the group of anemic throughout pregnancy was higher than those of non-anemic in the whole pregnancy period.

Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer.

OBJECTIVE: The aim of this study is to investigate the influence of pregnancy on prognosis of thyroid cancer. METHODS: A total of 72 patients aged between 15-45 years who underwent total or subtotal thyroidectomy and subsequently radioablation were followed up under suppression. Individuals who had term pregnancies after diagnosis of cancer (group 1, n: 36) and who were non-pregnant (group 2, n:36) were included in the study. Both groups were compared in terms of scintigraphic relapse and metastasis, ultrasonographic relapse, stage change of lympadenopathy at the beginning and at the end of the study. RESULTS: Relapse was detected in 4 out of 36 pregnant patients (11.1%) and in 5 out of 36 non-pregnant patients (13.9%) with no significant difference between groups (p=1.00). Pathologic lymphadenopathy was detected in 2 out of 36 pregnant patients (5.6%) and in 2 out of 36 non-pregnant patients (5.6%) (p=1.00), and metastasis in 3 (8.3%) and in 1 (2.8%), respectively (p=0.61). While stage change was detected in only one pregnant patient (2.8%), and none of the non-pregnant again there was no significant difference (p=1.00). CONCLUSIONS: We conclude that pregnancy does not have an influence on prognosis of thyroid cancer.