The effect of suture materials with different absorption times on isthmocele: a retrospective study.

OBJECTIVES: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches. MATERIAL AND METHODS: This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl® in 49 patients and Vicryl® in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate. RESULTS: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002). CONCLUSIONS: The formation of niches and associated PMS rates were less with suture materials that were absorbed faster.

Investigation of anxiety sensitivity levels of cancer patients in terms of COVID-19 vaccine: a cross-sectional study.

INTRODUCTION: Our study's purpose was to investigate the viewpoints of cancer patients who had not yet been vaccinated. Cancer patients usually cannot get every vaccine because their immunity is low. For this reason, we aimed to detect their anxiety and curiosity for new vaccines for a new disease. METHODS: The goal of this descriptive cross-sectional study was to investigate cancer patients' perceptions of COVID vaccination. Over 18 years of age who have not yet been vaccinated for COVID-19 and who agreed to participate were included in the study. We applied three questionnaires between May and June 2021, one of them was prepared by us; the other two questionnaires were The State-Trait Anxiety Inventory (STAI) form and Anxiety Sensitivity index to a total of 497 participants. Chi-square, Spearmen correlation test, and multivariable multinomial logistic regression tests were used when comparing. RESULTS: Our participants' ages were between 21 and 88, with a mean age of 61.38 (SD = 11.68), 48.6% (n = 251) of the participants were female. We discovered that 79.1% (n = 408) of respondents were not afraid of getting the COVID-19 vaccine. 27.7% (n = 143) of these patients were concerned about the COVID-19 vaccine's adverse effects, and 24.2% (n = 125) were afraid of its side effects with their treatments. 91.1% (n = 470) of the patients did not know which vaccine they would have and the type of the vaccine. Since the anxiety level is generally higher in women, anxiety scores were also higher in cancers seen in women, such as breast and ovarian cancer. Of course, in parallel with this, anxiety scores were lower in prostate cancers. Special patient groups should not be neglected during this vaccine season, and their concerns should be addressed. When a new vaccine is found, it can have long-term effects, which should not be ignored.

Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures

Objective: Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes. Material and Methods: Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center. Results: Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery. Conclusion: Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

Intrahepatic cholestasis of pregnancy: are in vitro fertilization pregnancies at risk?

AIM: Single pregnancy patients with intrahepatic cholestasis of pregnancy (ICP) were divided into two groups according to the conception method, as spontaneous and in vitro fertilization (IVF). We aim to compare the maternal, laboratory and perinatal characteristics of both groups. MATERIALS AND METHOD: The records of 10,929 patients who gave birth in the center between October 2011 and July 2019 were analyzed retrospectively from the data processing system records. Maternal, laboratory and perinatal characteristics of 109 single pregnancies (spontaneous n: 91; IVF n: 18) diagnosed with ICP were compared. FINDINGS: The maternal demographic data of both groups were similar (p: .05). In both groups, gestational week, gestational age at birth, birth weight, neonatal intensive care admission rate, meconium-stained amniotic fluid, umbilical cord pH, the 5-minute APGAR score, and the presence of pregnancy complications were similar (p > .05). RESULT: Although ICP is reported with a higher incidence in IVF pregnancies, ICP findings and prognosis are similar to those of spontaneous pregnancies.

Role of prophylactic and therapeutic red blood cell exchange in pregnancy with sickle cell disease: Maternal and perinatal outcomes.

BACKGROUND AND AIM: The incidence of fetomaternal complications during pregnancy is high for women with sickle cell disease (SCD), which is the most common hematologic genetic disorder worldwide. Prophylactic red blood cell exchange (pRBCX) has been shown to be efficient, safe, and feasible for preventing complications. The aim of this study was to observe maternal, perinatal, and neonatal outcomes of pregnancies in which pRBCX was. METHOD: This was a single-center, retrospective, cross-sectional study, which recruited 46 consecutive adult pregnant women with SCD between January 2012 and June 2019. Obstetric features, SCD-related complications, and fetomaternal outcomes were compared between the 27 patients who received prophylactic exchange and the 19 who did not (therapeutic exchange was performed in 7 and was not performed in 12 cases). RESULTS: Painful crises, preeclampsia, and preterm birth rates were significantly higher in the group that did not receive prophylactic exchange (control group; P = .001, P = .024, and P = .027, respectively). There was one maternal mortality in the control group (P = .41). Incidence of adverse fetal or maternal complications was significantly higher in the control group (P = .044 and P = .007, respectively). CONCLUSIONS: Our center's experience over a 7.5-year period, as described above, demonstrates that pRBCX in SCD affects the course of pregnancy positively by ameliorating negative fetomaternal outcomes.

Single- or double-layer uterine closure techniques following cesarean: A randomized trial.

INTRODUCTION: Cesarean deliveries are commonly performed throughout the world. Although the uterine closure technique following this procedure may influence how the uterine scar heals, there is insufficient evidence for choosing the appropriate technique and so preventing long-term negative consequences. This prospective, randomized study examined the effects of single- and double-layer uterine closure techniques on uterine scar healing following cesarean delivery. MATERIAL AND METHODS: This study assessed a total of 282 women aged 18-45 years who were in gestational weeks 24-41 of singleton pregnancies. None had previously undergone uterine surgeries. These participants completed their first cesarean deliveries at the time of study and were randomized into the following two treatment groups: single-layer closure with locking and double-layer closure with locking in the first layer, but not in the second layer (NCT03629028). However, the decidua was not included for treatment in either group. Participants were evaluated at 6-9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. These procedures were conducted by experienced sonographers who were not aware of the uterine closure technique. RESULTS: Of the 225 final participants, 109 received the single-layer closure technique, whereas 116 received the double-layer technique. The niche rates were 37% (n = 40) for the single-layer group and 45.7% (n = 53) for the double-layer group (P = .22, relative risk 1.4, 95% CI = 0.8-4.4). CONCLUSIONS: The single- and double-layer closure techniques did not produce different impacts on uterine scar niche development.

Does abnormal ductus venosus pulsatility index at the first-trimester effect on adverse pregnancy outcomes?

AIM: The ductus venosus pulsatility index for veins (DV PIV) has become a popular marker of the first-trimester scan. The aim of this study is to search for any difference between groups with normal and abnormal DV PIV values in terms of adverse pregnancy outcomes. METHODS: We retrospectively evaluated 556 women whose first-trimester scan was performed. The ductus venosus pulsatility indices were examined at singleton pregnancies between 11 and 14 weeks of gestation. Patients were categorized as Group-I with normal DV PIV (DV PIV ≥ 0.73, ≤1.22) and as Group-II with abnormal DV PIV. Group-II was subgrouped as Group-IIA which composed of patients with DV PIV < 0.73 and as Group-IIB with DV PIV > 1.22. RESULTS: There were 451 subjects in Group-I and 105 subjects in Group-II (Group-IIA = 32 and Group-IIB = 73). The comparisons between major groups revealed a statistically significant increase about miscarriage (p = 0.002), stillbirth (p < 0.001), small for gestational age (p = 0.033), low birth weight (p < 0.001), fetal growth restriction (p = 0.048), and major congenital heart defect (p=<0.001) in Group-II. This difference is mainly due to Group-IIB. There is no difference in preterm delivery, preeclampsia and gestational diabetes between Group I and II. CONCLUSION: Routinely monitoring DIV PIV as a first-trimester screening should provide valuable information regarding adverse pregnancy outcomes such as miscarriage, stillbirth, small for gestational age, low birth weight, fetal growth restriction and major congenital heart defect.

Outcomes of nerve-sparing laparoscopic sacropexy on one hundred fifteen cases.

STUDY OBJECTIVE: To evaluate the postoperative anatomic and functional outcomes of patients who underwent laparoscopic nerve-sparing sacrocolpopexy or sacrocervicopexy for pelvic organ prolapse (POP) POP-Q stage III and IV apical prolapse, and to delineate the contributing factors for recurrence. STUDY DESIGN AND CLASSIFICATION: The file records of patients who underwent sacropexy in the last five years were reviewed retrospectively and compared in terms of preoperative and postoperative anatomic findings and symptoms. PATIENTS: Patients who underwent laparoscopic nerve-sparing surgery for treatment of POP-Q Stage III and IV/prolapse of uterine or vaginal cuff were included. INTERVENTIONS: Postoperative anatomic and functional outcomes were evaluated using POP-Q classification and urinary/anal function by questioning during visits. RESULTS: The mean follow-up duration was 24.2 ± 17.6 months. Anatomic recovery was achieved in 104 (90.4 %) cases. Advanced age (≥70 years), longer duration of symptoms, and low body mass index were determined as parameters related to recurrence risk.

Reappraisal of the relationship between 24-hour proteinuria and preeclampsia in terms of the maternal and perinatal outcomes.

Objective: This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications.Methods: We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia.Results: Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery.Conclusion: Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant.

Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes

Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodies can cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy, and to investigate neonatal outcomes. Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed between October 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITP diagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route of delivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed. Results: Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperative and postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenital anomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancy were mostly treated for preparation of delivery. Treatment modalities were similar. Conclusion: Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy when compared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients should be followed closely in cooperation with the hematology department.

Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13+6 weeks of gestation.

Purpose: The ductus venosus pulsatility index velocity (DV PIV) has become a popular ultrasonographic measurement during the first trimester of pregnancy. The value of the DV PIV has been the topic of ongoing discussion in the literature, and its reference value in the normal population has not yet been established. Therefore, we aimed to determine a reference value for the DV PIV.Materials and Methods: We retrospectively evaluated our records of first-trimester ultrasonography performed between 2016 and 2017. Our inclusion criteria were as follows: singleton pregnancy; crown-rump length (CRL) between 45 and 84 mm; absence of structural abnormalities on the ultrasound examination; and absence of chromosomal abnormalities. Records of 820 patients were evaluated. According to the inclusion criteria, records of 458 patients were included in this study. All ultrasound examinations were performed by a single operator with the Voluson E8 (5- to 8-MHz 3 D transducer; General Electric Healthcare, Little Chalfont, UK) via the transabdominal route. Gestational weeks were designated according to CRL measurements at the beginning of the examination. Nuchal translucency (NT), nasal bone visualization (NB), tricuspid valve regurgitation (TR), "a"-wave pattern, DV PIV, S-wave (peak systolic velocity), D-wave (peak diastolic velocity), a-wave (atrial contraction in late diastole), and time-averaged maximum velocity (TAMXV) measurements were performed. To evaluate the DV Doppler images, a mid-sagittal view of the fetal profile was obtained. Color Doppler and pulse Doppler gate were used in the distal portion of the umbilical sinus, and at least three typical DV waveforms were detected. The SPSS 21.0 statistical program (IBM, Armonk, NY) was used to analyze variables.Results: The mean age, body mass index, CRL, gestational age, and NT values were 30.3 years (range, 18-45), 23.9 kg/m2 (range, 15.5-46.6), 59.5 mm (range, 45-79), 12.3 weeks (range, 11.2-13.6), and 1.58 mm (range, 0.73-2.62), respectively. The median gravidity and parity were 2 (1-8) and 0 (0-4), respectively. The "a"-wave pattern was identified in all cases, but TR was not detected in any of the cases. Measurements of DV PIV with a Gaussian distribution were suitable according to the Shapiro-Wilk test (p = .252). The mean DV PIV was 0.98, and the fifth and 95th percentiles were 0.73 and 1.22 (±2 SD), respectively. A statistical analysis of our cohort revealed that DV PIV values less than 0.73 and more than 1.22 were beyond the normal range. The mean S-wave, D-wave, a-wave, and TAMXV values were 31.18, 25.64, 8.68, and 22.72 cm/s, respectively.Conclusions: The value of DV PIV measurements is debated in the literature. Using our cohort, we defined the means and ranges of DV PIV. Determining the normal ranges of DV PIV could be helpful to anticipate congenital or chromosomal abnormalities. Further studies are needed to demonstrate the clinical importance of DV PIV, especially for patients with abnormal DV PIV measurements.

Is fetal magnetic resonance imaging indicated in patients with isolated ventriculomegaly?

OBJECTIVE: Ventriculomegaly is one of the most common anomalies encountered at obstetric ultrasound and it necessitates follow up. Fetal magnetic resonance imaging (MRI) can be used to confirm the ultrasound diagnose or to detect additional anomalies. Aim of this study is to assess follow up and management of fetal ventriculomegaly shown by ultrasound, and to evaluate additional diagnostic contribution of MRI. STUDY DESIGN: This study was conducted retrospectively including 89 patients who had fetal MRI subsequent to ultrasound diagnose of ventriculomegaly in between 2011-2017. Medical records of patients were investigated and accompanying anomalies, congenital infection, chromosomal examination, degree and progression of ventriculomegaly, neonatal imaging and diagnose, and neurodevelopmental findings on follow up were evaluated. Patients were classified in two groups as isolated and nonisolated ventriculomegaly, and subgroups mild, moderate, severe were formed according to their findings. SPSS 23.0 programme was used for statistical analysis. RESULTS: Ultrasound and following MRI was performed in a range of 18-35th gestational weeks, diagnoses were isolated ventriculomegaly for 56 patients and nonisolated ventriculomegaly for 33 patients. Progression and neurodevelopmental delay was higher in severe nonisolated ventriculomegaly group. There was not significant contribution of MRI in the follow up of isolated ventriculomegaly (p < 0.001), and diagnostic imaging findings declined in neonatal period with proceeding normal neurodevelopment in 92.7% of patients followed with diagnosis of isolated ventriculomegaly. CONCLUSION: When isolated ventriculomegaly is detected, ultrasound performed by an experienced team is mostly sufficient. MRI can be used in suspicious cases or when ventriculomegaly progresses.

The nomogram of prenasal thickness and nasal bone ratio and its relationship with nuchal fold in second-trimester fetal ultrasound.

AIM: We aimed to define the normal values of second-trimester fetal prenasal thickness and nasal bone length ratio (PNT/NBL) in a low-risk Turkish population and investigate the relationship between the increased PNT and nuchal fold (NF). METHOD: We retrospectively reviewed the data of 650 cases considered to be euploid fetuses who presented to our clinic between December 2013 and September 2014 for a second-line ultrasound between 17 and 24 weeks. Their PNT, NBL, NF and biometric (BPD, HC, AC, FL and HL) measurements were recorded. RESULTS: A total of 650 cases considered to be euploid fetuses were included in this study. There was a linear increase in PNT with the gestational weeks (mean value 3.01 at weeks 17-18 and 3.76 at weeks 23-24). The PNT/NB ratio showed a slight decrease in advancing gestational weeks (mean value 0.57 at weeks 17-18 and 0.50 at weeks 23-24). The 95th percentile value of the PNT/NB ratio, independent of the gestational week, was 0.76. The values of both PNT and NF increased with advancing gestational weeks, but there was no statistically linear increase between PNT and NF (R2 : 0.115). CONCLUSION: In this study, we provided a nomogram of the PNT/NB ratio. Both NF thickness and PNT should be dealt with as two separate markers. Although the formation mechanisms are thought to be the same in both of them, a strong linear relationship does not exist between them.

Is the presence of corpus callosum predictable in the first trimester?

Corpus callosum agenesis (CCA) is a clinical condition accompanied by various aneuploidy and genetic syndromes. We identified the development of the corpus callosum (CC) in 278 patients before 18 weeks of gestational age by visualising the pericallosal artery (PCA) in the callosal sulcus and changes in the lengths and ratios of the midbrain (MB) and falx (F), which suggested elevation of the third ventricle and thalamus due to CCA in the first trimester. We succeeded in visualising the path of the PCA in 273 patients. As expected, we observed an increase in the lengths of the MB and F throughout the pregnancies. The MB:F ratio was 0.5-0.6, and it was independent of gestational age. In all 278 patients, the MB:F ratio was <0.6 (95th percentile = 0.79). We observed the presence of the CC during anatomical screening at gestational weeks 18-24. Visualisation of the PCA path (98% sensitivity) and calculation of the MB:F ratio <95th percentile (0.79-100% sensitivity) had very high sensitivity that indirectly confirmed the presence of the CC in the first trimester of pregnancy. Impact statement What is already known on this subject: After reading the articles for detecting the absence of corpus callosum (CC) at first trimester with midbrain (MB) and falx (F) measurement by Lachmann et al. ( 2013 ) and visualising pericallosal artery (PCA) as an indirect sign of CC agenesis by Pati et al. ( 2012 ), we aimed to have a look for our records visualising PCA in callosal sulcus and measure MB-F, as well as their ratios for an indirect sign of 'presence' of CC at first trimester. What the results of this study add: In recent literature, it is not possible to find many articles suggesting the presence of CC between 11 and 13 weeks of gestation. Díaz-Guerrero et al. ( 2013 ) and Pati et al. ( 2012 ) has researched visualising PCA path. Lachmann et al. ( 2013 ) reported an article for MB and F measurements in early suspicion of CC agenesis. Our study will be the first article in visualising PCA path and measuring MB-F lengths as well as their ratios for 'presence' of CC with high sensitivity rates (98% and 100%). What are the implications of these findings for clinical practice and/or further research: This study encourages clinicians visualising PCA path and measure MB-F lengths when they will try to visualise repetitive times and see how it is an easy procedure when you get used to it.

Effect of pigtail catheter application on obstetric outcomes in in vitro fertilization/intracytoplasmic sperm injection pregnancies following hyperstimulation syndrome.

OBJECTIVE: To evaluate the effects of percutaneous pigtail catheter drainage on the outcomes of intracytoplasmic sperm injection (ICSI) pregnancies following moderate or severe ovarian hyperstimulation syndrome (OHSS). MATERIALS AND METHODS: This retrospective study included 189 patients hospitalized for OHSS following ICSI treatment in a tertiary in vitro fertilization unit between 2006 and 2014. Pigtail catheters were applied in 63 patients; the other 126 patients did not need that treatment. The obstetric reports of 173 patients could be accessed and were examined to investigate the pregnancy outcomes of those with and without catheters. RESULTS: No complications such as infection or vascular or intra-abdominal organ trauma were observed related to the pigtail application. There were no differences in abortus, preterm labor, gestational diabetes mellitus, and preeclampsia ratio between the pigtail and control groups (p>0.05). The rate of readmission to hospital for OHSS was lower in the pigtail group than in the control group although not statistically significant (p=0.08). CONCLUSION: Pigtail application is a safe and effective method for draining ascites in patients with OHSS after ICSI treatment. The use of pigtail catheters had no adverse effects on the perinatal outcomes of patients hospitalized with OHSS who became pregnant after ICSI treatment. In addition, the percutaneous drainage of ascites via a pigtail catheter helped prevent the readmission of patients with moderate or severe OHSS.

Is primiparity a risk factor for advanced maternal age pregnancies?

OBJECTIVE: Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients. METHODS: The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015. RESULTS: Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups. CONCLUSION: Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor.

Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial.

STUDY OBJECTIVE: To evaluate the analgesic effect of preoperative single dose intravenous paracetamol on postoperative pain and analgesic consumption within 24hours after elective cesarean surgery. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: University Teaching Hospital. PATIENTS: American Society of Anesthesiologists (ASA) I and II 60 patients between 18-40years of age who were scheduled to undergo elective cesarean section. INTERVENTIONS: Patients were randomized into two groups to receive either intravenous 1g paracetamol (100mL) (Group P) or 0.9% NaCl solution (100mL) (Group C) 15minutes before the induction of general anesthesia. After delivery of newborn 0.15mg kg(-1) morphine was administered to all patients in both groups. Postoperative analgesia was provided with patient-controlled intravenous analgesia with morphine in the postoperative period. MEASUREMENTS: Pain which is the primary outcome measure was assessed at 15th, 30th minutes and 1st, 2nd, 4th, 6th, 12th, 24th hours by the Visual Analogue Scale. Patients' demographics, hemodynamics, Apgar score, additional analgesic requirement, side effects, patients' satisfaction and postoperative total morphine consumption within 24hours were recorded. MAIN RESULTS: Median visual analogue scale for pain in Group P was significantly lower compared to Group C at all time points except for the score at 24th h postoperatively (P<.05). Additional analgesic requirement during postoperative first hour was lower in Group P (P<.05). Total morphine consumption was higher in Group C compared with Group P (P<.05). There was no difference between groups with respect to Apgar scores, side effects, and patient satisfaction (P>.05). CONCLUSIONS: Preoperative use of single-dose intravenous 1g paracetamol was found to be effective in reducing the severity of pain and opioid requirements within 24hours after cesarean section.

The effect of preserving prepared sperm samples at room temperature or at 37 °C before intrauterine insemination (IUI) on clinical pregnancy rate.

OBJECTIVE: The comparison of the effect of preserving prepared sperm samples at room temperature or at 37 °C before intrauterine insemination (IUI) on clinical pregnancy rate. MATERIALS AND METHODS: Retrospective clinical research. University hospital, infertility clinic. Patients with one or two follicles, between the ages of 20 and 40, whose infertility period was less than 6 years and the injected total motile sperm count was more than 10 million. Preserving sperm samples prepared for IUI at 37 ºC or at room temperature before IUI. The clinical pregnancy rate of IUI cycles between 1st of January 2004 and 1st of December 2011 in which prepared sperm samples were preserved at 37 ºC and the clinical pregnancy rate of IUI cycles between 1st of December 2011 and 31st of May 2014 in which prepared sperm samples preserved at room temperature. RESULTS: Clinical pregnancy rates were similar in IUI cycles in which prepared sperm samples were preserved at 37 ºC and at room temperature (9.3% vs. 8.9%). Clinical pregnancy rates in IUI cycles with 2 follicles were higher than IUI cycles with 1 follicle (10.8% vs. 7.6%) (p=0.002). Further statistical analysis after splitting data according to the number of the follicles revealed that there was no statistical difference between clinical pregnancy rates after IUI cycles in which prepared sperm samples were preserved at 37 ºC or at room temperature in both one follicle (7.6% vs. 7.6%), and two follicle cycles (11.5% vs. 10.1%). CONCLUSIONS: Preserving prepared sperm samples at room temperature had no negative effect on clinical pregnancy rates when compared with reserving prepared sperm samples at 37 ºC during IUI cycles.

Transvaginal ultrasound-guided local methotrexate administration as the first-line treatment for cesarean scar pregnancy: Follow-up of 18 cases.

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, which occurs in previous cesarean section scar tissue, with an incidence of 1 in 1800-3000 pregnancies. Transvaginal ultrasound-guided local methotrexate (MTX) administration presents as a non-systemic option with possible better penetration to the pregnancy site. We present the management of 18 patients with CSP solely by transvaginal ultrasound-guided local MTX administration. All patients were treated with local MTX with a dose of 50 mg/m(2) . Eleven (61.1%) of the patients did not need any further intervention. Four patients (22.2%) were treated with additional single-dose systemic MTX due to inadequate alteration in blood ß-human chorionic gonadotrophin levels. Three patients (16.7%) required hysteroscopy and/or laparotomy. We suggest that transvaginal ultrasound-guided local MTX treatment may be considered as a first-line treatment for CSP.