2-D and 3-D ultrasonographic characteristics of the ovary in women with PCOS and multifollicular ovaries.

In this prospective study, seventy-six patients (PCOS group; n = 36, multifollicular ovary group; n = 40) were evaluated by 2-D and 3-D ultrasonography. VOCAL programme, echogenicity, number of follicles and blood flow parameters were evaluated. The patients with PCOS had a higher total ovarian volume, mean stromal volume and stromal echogenicity (18.6 ± 4.75 to 10.2 ± 3.4 p < .01; 12.23 ± 2.53 to 5.02 ± 2.44 p = .02; score 1:28 to 10 p < .01, respectively). There was no statistically significant difference in terms of mean RI and PI values between the groups (p > .05). 3 D power Doppler parameters included VI, FI, and VFI values of the patients with PCOS were higher when compared to those of the patients with multifollicular ovary (3.82 ± 2.65 to 1.78 ± 1.2, p < .01; 50.76 ± 4.45 to 40.6 ± 3.64, p = .03; and 2.34 ± 1.02 to 1.12 ± 0.65, p = .02, respectively). Our results revealed that total ovarian volume, stromal volume and echogenicity; VFI, VI, and FI could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.Impact statementWhat is already known on this subject? Ultrasonography is considered the new diagnostic tool for PCOS. Enlarged ovaries with multiple small follicles peripherally located around increased ovarian stroma with increased stromal echogenicity are the sonographic features of polycystic ovaries.What do the results of this study add? 3-D Doppler ultrasonography may be more specific in the determination of multifollicular and polycystic ovaries when compared to RI and PI in 2-D Doppler ultrasonography. Moreover, 3-D power Doppler ultrasonography could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.What are the implications of these findings for clinical practice and/or further research? In clinical practice, the differentiation of multifollicular ovaries and polycystic ovaries (PCO) is difficult with the use of 2-D sonography alone. Therefore, 3-D ultrasound and power Doppler may also be used in addition to 2-D ultrasound for the differentiation of multifollicular ovaries and PCO.

Hydrosonographic Assessment of the Effect of Two Different Suture Materials on Healing of the Uterine Scar after Cesarean Delivery: A Prospective Randomized Controlled Trial.

PURPOSE: This study aimed to compare the effects of two different suture materials, monofilament synthetic absorbable sutures versus multifilament synthetic absorbable sutures, on healing the uterine scar after a cesarean delivery. METHODS: A total of 95 women between the ages of 18 and 40 who had undergone a primary cesarean section (CS) after the 38th week of gestation. In Group I (n=48), continuous double-layer unlocked closure of the low transverse uterine incision was performed using monofilament synthetic absorbable sutures. In Group II (n=47), continuous double-layer unlocked closure of the low transverse uterine incision was performed using multifilament synthetic absorbable sutures. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed using hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing. RESULTS: No statistically significant differences were observed between the groups with regard to the preoperative hemoglobin concentrations, the change in the hemoglobin concentrations, operating time, and the number of intraoperative additional hemostatic uterine sutures. Mean thickness of the residual myometrium covering the defect was thicker in the monofilament suture group in comparison to the multifilament suture group (7.76±2.11 vs. 5.96±1.69, respectively; p<0.01). The mean healing ratio was significantly higher in the monofilament suture group in comparison to the multifilament suture group (0.76±0.13 vs. 0.60±0.12, respectively; p<0.01) CONCLUSION: Continuous double-layer unlocked closure of the uterine incision at cesarean delivery using monofilament synthetic absorbable sutures decreases the risk of CS scar defect.

Does the use of microfluidic sperm sorting for the sperm selection improve in vitro fertilization success rates in male factor infertility?

AIM: To evaluate the clinical outcome of assisted reproductive technology (ART) cycles in couple with male infertility, where the spermatozoa were selected using either a conventional gradient-density centrifugation technique or microfluidic sperm sorting. METHODS: A total of 181 patients who underwent in vitro fertilization (IVF) because of male factor infertility at the IVF center of Bezmialem and Yeditepe University Hospital were included in this study. All patients were divided into two groups according to the sperm selection method: group I (n = 91): microfluidic sperm-sorting chip; group II (n = 90): density-gradient centrifugation. Data collected included male and female age, type of infertility, duration of infertility, previous IVF attempts, smoking, antral follicle count, total dosage of gonadotropins, maximum estradiol levels, duration of stimulations, endometrial thickness on human chorionic gonadotropin day, total number of oocytes retrieved, number of mature oocytes retrieved, number of pronuclear (PN), sperm parameters, clinical PR and ongoing PR. RESULTS: There was no statistically significant difference in clinical PR and ongoing PR between groups (49.5% vs 40%, P = 0.2; 44% vs 36.7%, P = 0.3; respectively). The improvement in pregnancy rate was more prominent in patients where the female partner's age is higher than 35 (P = 0.09) and men have a total motile sperm count between 1 and 5 million (P < 0.01). CONCLUSION: Microfluidic devices, "labs-on-a-chip," are a disposable, easy to use, and inexpensive method for sperm sorting. Our results show that IVF success rates might improve with the use of a microfluidic sperm-sorting chip for sperm selection in male infertility.

Less Blood Loss by Earlier Oxytocin Infusion in Cesarean Sections? A Randomized Controlled Trial.

PURPOSE: The aim of our study was to evaluate the positive effect of starting an IV oxytocin infusion early before uterine incision on intraoperative blood loss. METHODS: A total of 101 women between 18-40 years who underwent a primary elective cesarean section (CS) were included in this randomized controlled trial. The patients were divided into two groups. In Group I (n=51), oxytocin infusion was administered immediately after incision of the visceral peritoneum during CS. In Group II (n=50), infusion was administered immediately after clamping the umbilical cord. The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean reduction in hemoglobin and hematocrit levels, need for additional uterotonics and hemostatic uterine sutures, blood transfusion, post-operative pain score, and additional surgical procedures. RESULTS: There were statistical significant differences either in the change of the hemoglobin concentration (1.27±0.75 vs.1.74±0.81; p<0.01) or in the change of hematocrit concentration (3.89±2.24 vs. 5.41±2.93; p<0.01). Intraoperative blood loss was significantly lower in Group I when compared to Group II (475.86±150.11 vs. 605.1±203.2; p<0.01). CONCLUSIONS: Our findings suggest that the starting IV oxytocin infusion early before uterine incision reduces intraoperative blood loss. This could be effective to replace starting IV oxytocin infusion late after umbilical cord clamping or delivery of the placenta. EINLEITUNG: Das Ziel unserer Studie war es. die positive Wirkung der beginnenden IV Oxytocin-Infusion früh vor der Uterusinzision auf den intraoperativen Blutverlust zu bewerten. MATERIAL UND METHODIK: In diese randomisierte kontrollierte Studie wurden insgesamt 101 Frauen zwischen 18 und 40 Jahren eingeschlossen, die sich einem primären elektiven Kaiserschnitt unterzogen hatten. Die Patienten wurden in 2 Gruppen eingeteilt. Gruppe I (n=51); Die Oxytocin-Infusion wurde unmittelbar nach der Inzision des viszeralen Peritoneums während der CS verabreicht. Gruppe II (n=50); Die Infusion wurde unmittelbar nach dem Klemmen der Nabelschnur verabreicht. Das primäre Ergebnis war das mittlere Blutverlustvolumen während der CS. Zu den sekundären Ergebnissen gehörte die mittlere Verringerung der Hämoglobin- und Hämatokritwerte, Bedarf an zusätzlichen Uterotonika und hämostatischen Uterusnähten, Bluttransfusion, postoperativer Schmerzscore und zusätzliche chirurgische Eingriffe. ERGEBNISSE: Es gab statistisch signifikante Unterschiede zwischen der Änderung der Hämoglobinkonzentration 1,27±0,75 vs.1,74±0,81; p<0,01) oder der Änderung der Hämatokritkonzentration(3,89±2,24 vs. 5,41±2,93; p<0,01). Der intraoperative Blutverlust war in Gruppe I im Vergleich zu Gruppe II signifikant geringer (475,86±150,11 vs. 605,1±203,2; p<0,01). DISKUSSION: Unsere Ergebnisse legen nahe, dass die beginnende intravenöse Oxytocin-Infusion früh vor der Uterusinzision den intraoperativen Blutverlust verringert. Dies könnte wirksam sein, um eine beginnende intravenöse Oxytocin-Infusion zu einem späten Zeitpunkt nach dem Klemmen der Nabelschnur oder der Abgabe der Plazenta zu ersetzen.

One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials.

INTRODUCTION: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches. MATERIAL AND METHODS: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM. RESULTS: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach. CONCLUSIONS: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.

Clinical and metabolic characteristics of Turkish adolescents with polycystic ovary syndrome.

The aim of this study was to investigate the clinical, endocrine, metabolic features and prevalence of metabolic syndrome (MBS) in Turkish adolescents with polycystic ovary syndrome (PCOS) and the differences in metabolic parameters between adolescent PCOS with or without the presence of polycystic ovaries (PCO) on ultrasound. Subjects (n = 77) were classified into two groups: oligomenorrhea (O) and clinical and/or biochemical hyperandrogenism (HA) (n = 38), without PCO and O + HA with PCO (n = 39). The control group consisted of 33 age-matched adolescents. Adolescents with PCOS had a significantly higher body mass index (BMI), waist circumference and levels of LH, LH/FSH ratio, triglyceride, insulin, HOMA-IR, free androgen index and lower levels of SHBG and FSH. After adjustment for BMI, LH, LH: FSH ratio remained significantly higher. Adolescents with PCOS had a higher prevalence of MBS. No significant differences in lipid profiles, insulin levels and insulin sensitivity in both the PCOS groups were seen. HDL-C levels were lower in the O + HA + PCO group compared to the controls. BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS. Impact statement Many studies have investigated the effect of PCOS on metabolic and cardiovascular risks. It is thought that PCOS increases metabolic and cardiovascular risks. Increase in metabolic and cardiovascular risks associated with PCOS may be handled with early diagnosis and early intervention of PCOS in adolescents, although the diagnosis of PCOS in adolescents could be hard because of the features of PCOS overlapping normal pubertal physiological events. However, early identification of adolescent girls with PCOS may provide opportunities for prevention of well-known health risks associated with this syndrome and reduction of long-term health consequences of PCOS by reducing androgen levels and improving metabolic profile. Our results also support that BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS.

Effects of Apigenin on Experimental Ischemia/Reperfusion Injury in the Rat Ovary.

BACKGROUND: Apigenin is a plant-derived compound belonging to the flavone class, which possess antioxidant, free-radical-scavenging and anti-inflammatory properties. AIMS: To address the effects of apigenin on serum anti-mullerian hormone levels, tissue oxidative stress parameters and histopathological changes in ovarian ischemia/reperfusion injury. STUDY DESIGN: Animal experiment. METHODS: Twenty-eight female Wistar albino rats were randomly separated into four sections: Sham operation (group 1), ischemia/reperfusion plus saline (group 2), ischemia/reperfusion plus dimethyl sulfoxide (group 3) and ischemia/reperfusion plus apigenin (group 4). In all ischemia/reperfusion groups, a bilateral adnexal 3-h period of ischemia was performed, followed by 3-h of reperfusion. A single dose of 15 mg/kg apigenin was given intraperitoneally 60 min before reperfusion in group 4. After 3-h of reperfusion, both ovaries were removed, and blood samples were collected. The main outcome measures were serum anti-mullerian hormone levels, ovarian tissue malondialdehyde, total nitric oxide, Cu/Zn superoxide dismutase, catalase and glutathione levels and histopathological damage scores. RESULTS: The ovarian tissue nitric oxide level was significantly lower, and the glutathione level was significantly higher in group 4 compared with groups 2 and 3. There was no significant difference in anti-mullerian hormone levels among the three ischemia/reperfusion groups. The histopathological damage score was lower in group 4 than in groups 2 and 3 (p>0.05). CONCLUSION: Administration of apigenin has no significant protective effect on ovarian reserve and tissue damage in ovarian ischemia/reperfusion injury.

Vitamin D status in the first-trimester: effects of Vitamin D deficiency on pregnancy outcomes.

OBJECTIVE: To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes. METHODS: Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry. RESULTS: The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01). CONCLUSION: A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally.

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination.

INTRODUCTION: Intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) was applied to selected infertile patients to determine the effect of gonadotropin-releasing hormone (GnRH) antagonists in IUI cycles, in which recombinant follicle-stimulating hormone (rFSH) had been used for COH. METHODS: This study was conducted between April 1, 2009 and June 10, 2009, and involved a total of 108 patients. These patients had primary or secondary infertility, which resulted in an indication for IUI, and they each received two cycles of ovarian stimulation treatment with clomiphene citrate. The patients were randomised into two groups--patients in group A received rFSH + GnRH antagonist (n = 45), while those in group B received only rFSH (n = 63). RESULTS: The mean age of the patients was 31.84 ± 3.73 years and the mean body mass index (BMI) was 24.40 ± 1.88 kg/m(2). The mean age and BMI of the patients in groups A and B were not significantly different. There was no significant difference in the mean total rFSH dose administered (988.33 IU in group A and 871.83 IU in group B). When compared to group B, the mean number of follicles that were > 16 mm on the human chorionic gonadotropin (HCG) trigger day was significantly higher in group A (1.58 and 1.86, respectively; p < 0.05). When the two groups were compared, there were no statistically significant differences in the number of cancelled cycles due to premature luteinisation (none in group A vs. two in group B) and the rate of clinical pregnancy (8.9% in group A vs. 7.9% in group B). CONCLUSION: No significant improvement in the clinical pregnancy rates was observed when GnRH antagonists were used in COH + IUI cycles, despite the significant increase in the number of follicles that were > 16 mm on HCG trigger day.

Minimum 1-year results of mesh spiral-sling procedure in managing refractory and primary disabling stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: We present our minimum 1-year results with a mesh spiral-sling procedure (MSSP) for managing refractory and disabling stress urinary incontinence (SUI) in women. METHODS: Thirty-four women were treated with MSSP between 2007 and 2011. Six had incomplete data and were excluded from analysis. Study cohort comprised 21 women with refractory (mean number of previous surgeries 2.2; range 1-6) and seen with primary disabling SUI. All patients had marked intrinsic sphincter deficiency (ISD) with a Valsalva leak-point pressure (VLPP) <60 cm H2O. Preoperative workup included assessing the impact of voiding symptoms using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF), estimating the daily number of pads, and urodynamic studies. Preoperative and postoperative findings were compared using the Wilcoxon signed-rank test. RESULTS: Intraoperative unilateral bladder-neck perforation occurred in two women during dorsal urethrolysis. With a mean follow-up of 26 months (range 12-48), SUI was cured in 71.4% of patients. Distal urethral reconstruction with vaginal mucosal flaps was performed in two patients with short urethral length (<2.5 cm) due to recurrence of SUI 10 months after MSSP. Mean ICIQ-SF score decreased from 19.4 ± 3.6 preoperatively to 7.3 ± 2.8 postoperatively (p = 0.001). Mean daily pad number decreased from 5.2 preoperatively to 1.2 postoperatively (p = 0.02). Urethral or vaginal erosion was not observed in any case during follow-up. CONCLUSION: Using spiral slings may be a viable option in managing refractory and disabling SUI.

Comparison of metabolic profile and abdominal fat distribution between karyotypically normal women with premature ovarian insufficiency and age matched controls.

OBJECTIVE: We designed a prospective case-control study in order to investigate the lipid profiles, insulin sensitivity, presence of metabolic syndrome (MetS) and the abdominal fat distribution in karyotypically normal women with premature ovarian insufficiency (POI). METHODS: Anthropometric measurements, FSH, estradiol, total testosterone (T), sex hormone binding globulin (SHBG), free androgen index (FAI), fasting glucose and insulin, homeostatic model for insulin resistance (HOMA-IR), lipid profile, the prevalence of MetS and ultrasonographic abdominal fat measurements were assessed in 56 women with POI and 59 healthy controls at the same age range. RESULTS: Serum levels of T, SHBG and FAI were not significantly different between both groups. Total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were higher in women with POI. There were no differences in glucose, insulin, HOMA-IR, low-density lipoprotein cholesterol (LDL-C), triglyceride levels between the two groups. A significant positive correlation was identified between T and TG and also between FAI and LDL-C; SHBG levels were correlated inversely with FSH, and positively with HDL-C in women with POI. The presence of MetS was significantly higher in women with POI. The subcutaneous, preperitoneal and visceral fat thicknesses were not significantly different between the groups. CONCLUSIONS: Early cessation of ovulatory function may associated with higher levels of serum TC and HDL-C, but does not seem to cause differences in abdominal fat distribution in women with POI. POI is associated with higher risk of MetS.

Natural history of prenatal isolated muscular ventricular septal defects.

OBJECTIVE: To evaluate the natural history of isolated muscular ventricular septal (m-VSD) defects during gestation and up to 1 year postnatally, as well as the association with chromosomal anomalies. MATERIAL AND METHODS: Between August 2007 and July 2012, 76 fetuses with isolated m-VSDs represented the study population. The following variables were evaluated: site and size of the m-VSDs, presence of chromosomal anomalies, pregnancy outcome, and spontaneous closure rate from diagnosis up to 1 year postnatally. RESULTS: Of the 76 cases with m-VSD, 1 fetus died after birth and 31 cases were lost to follow-up after birth. Thus, a total of 44 fetuses reached their first year of postnatal life, and these cases were available for analysis. Three (6.8%) of 44 defects closed spontaneously in utero, 33 (75%) closed within 1 year, and 8 (18.2%) remained patent. Overall, spontaneous closure occurred more frequently in the apical defects, but no significant difference was found for spontaneous closure between the mid-muscular and apical defects (p>0.05). Also, 83.8% (36 of 44) of defects ≤3 mm closed during gestation or the first year of life. CONCLUSION: We infer that m-VSDs have a high spontaneous closure rate during the first year of life. Also, small m-VSDs frequently close spontaneously.

Hydrosonographic assessment of the effects of 2 different suturing techniques on healing of the uterine scar after cesarean delivery.

OBJECTIVE: To compare the effects of 2 suturing techniques (single versus double layer) on healing of the uterine scar after a cesarean delivery. METHODS: In the present randomized, prospective study, 36 women with a term pregnancy who had an elective cesarean delivery were randomly assigned to closure of the uterine incision with a single-layer locked suture or with a double-layer locked/unlocked suture. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed by hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing. RESULTS: There were no significant differences between the groups in terms of estimated blood loss, operation time, or additional hemostatic suture. However, the mean thickness of the residual myometrium covering the defect was 9.95 ± 1.94 mm after a double-layer closure and 7.53 ± 2.54 mm after a single-layer closure (P = 0.005). The mean healing ratio was significantly higher after a double-layer closure (0.83 ± 0.10) than after a single-layer closure (0.67 ± 0.15; P = 0.004). CONCLUSION: A double-layer locked/unlocked closure of the uterine incision at cesarean delivery decreases the risk of poor uterine scar healing.

Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage?

OBJECTIVE: This study evaluated the clinical outcomes and safety of treating caesarean scar pregnancy (CSP) by means of suction curettage followed when required by Foley tamponade, with or without methotrexate (MTX) therapy preceding the curettage. METHODS: Twenty-five patients with CSP were identified between August 2008 and April 2012. The first team of doctors treated Group A patients (n = 11) with systemic MTX followed by dilatation and suction curettage whereas the second team of doctors carried out only a suction curettage on women of Group B (n = 14). If uncontrolled vaginal bleeding occurred in either group during or after the operation, a Foley catheter, guided by real time transabdominal ultrasound, was placed in the uterine cavity against the site where the CSP had been implanted. RESULTS: Clinical outcomes in the two groups - including mean estimated blood loss, major complication rate, and hospital length of stay - were comparable. Surgeons used Foley catheter balloons for tamponade in six of the 11 patients in Group A and in seven of the 14 patients in Group B. Treatment was successful in ten of 11 cases in group A and 13 of 14 cases in group B. Group B's mean duration of treatment (2.36 ± 0.49 days) was significantly shorter than that of Group A (14.45 ± 4.96 days; p < 0.001). CONCLUSION: Suction curettage, followed when needed by Foley catheter tamponade, is an effective treatment for CSP.

To evaluate the prevalence and clinical outcomes using a one-step method versus a two-step method to screen gestational diabetes mellitus.

OBJECTIVE: The goal of this study is to compare the prevalence and clinical outcomes of a one-step with a two-step screening method, both of which are commonly used for the diagnosis of gestational diabetes mellitus (GDM). METHODS: Women who presented for GDM screening and who consented to participate in this study were randomized into two groups. The women in Group 1 (n = 386) were screened using a one-step method (2-h, 75 g oral glucose tolerance test (OGTT)) and in Group 2 (n = 400) by a two-step method (the 50 g glucose challenge test (GCT) followed by the 100 g OGTT). The pregnancies were then classified into three subgroups as follows: women who had negative 2-h 75 g OGTT results according to IADPSG criteria (IADPSG-negative), women with negative 50 g GCT results (GCT-negative) and women with positive 50 g GCT results but negative 3-h 100 g OGTT results according to C&C criteria (C&C-negative). RESULTS: The prevalence of GDM using the one-step and two-step methods was 14.5% and 6%, respectively. In adjusted multivariable regression models, women in the GCT-negative and the C&C-negative groups had greater risk of polyhydramnios than women in the IADPSG-negative group [adjusted prevalence risk ratios (aPR), 1.40; 95% confidence intervals (CI), 1.03-1.91; aPR, 2.76; 95% CI, 1.27-6.02, respectively]. Women in the C&C-negative group had greater risk of pre-eclampsia than women in the IADPSG-negative group (aPR, 3.30; 95% CI, 1.57-6.91). CONCLUSIONS: Women who were defined as having normal glucose tolerance by IADPSG had better perinatal outcomes than women who were defined as having normal glucose tolerance by GCT and women who were GCT-positive with a negative OGTT.

Different phenotypes of polycystic ovary syndrome in Turkish women: clinical and endocrine characteristics.

This study presents the differences in clinical, endocrine and metabolic parameters among different polycystic ovary syndrome (PCOS) phenotypes in Turkish women. Four hundred and ten women with PCOS were evaluated, while 97 healthy women served as controls. PCOS were defined by oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovaries on ultrasound (PCO). Patients were subdivided into four phenotypes: OA + HA + PCO (phenotype 1), OA + HA (phenotype 2), HA + PCO (phenotype 3), OA + PCO (phenotype 4). Phenotypes 1-4 were present in 47.1%, 13.2%, 21.2% and 18.5% of patients, respectively. They were also divided into three groups according to the BMI (<25 kg/m(2); 25≤ and ≤30 kg/m(2); and >30 kg/m(2)). ANOVA and Tukey post-hoc HSD tests were used. The LH levels and LH/FSH ratio were higher in phenotype 1 and 2 than phenotype 3. The LDL-C levels were higher in women with phenotype 1 and 4 than in women with phenotype 2. Women with BMI <25 kg/m(2) had higher levels of LH, LH/FSH ratio, and the HDL-C than other two groups. The levels of TG, LDL, fasting insulin and HOMA-IR increased with increasing BMI in four phenotypes. Results suggest that obesity seems to be the primary cause of metabolic disturbances in PCOS women.

Bishop score versus ultrasound of the cervix before induction of labor for prolonged pregnancy: which one is better for prediction of cesarean delivery.

OBJECTIVES: To find an effective way to predict Cesarean section (CS) before induction of labor. METHODS: Nulliparous women at ≥ 41 weeks of pregnancy were enrolled in the study. Bishop score (BS), cervical length (CL), posterior cervical angle (PCA), quantification of the cervical stromal echogenicity by tissue histograms and opening of the internal cervical os (funnelling) were recorded. The vaginal delivery and CS groups were then compared in terms of the clinical and ultrasonographic cervical findings. RESULTS: BS, CL, PCA and funnelling were the significant predictors of CS, whereas no such relationship existed for the quantitative echogenicity of the cervical stroma. Although the difference was not statistically significant, the area under the curve was higher for the BS than that for sonographic CL and PCA in the prediction of all CSs. The best cut-off values to predict CS for BS, CL and PCA were <5, >27 mm and <98°, respectively. Combination of all three parameters had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 82% for the prediction of CS. CONCLUSIONS: In nulliparous women with prolonged pregnancy, the BS predicts the need for CS better than the ultrasonographic assessment of the cervix.

The effects of ranibizumab on surgically induced endometriosis in a rat model: a preliminary study.

OBJECTIVE: To examine the effect of ranibizumab on surgically induced endometriosis in rat models. STUDY DESIGN: Endometrial tissue was implanted onto the abdominal peritoneum of 20 rats that were randomized into 2 groups. The rats in group 1 (n = 9) were given 0.6 mg/kg ranibizumab on the 1st and 14th days after the second operation. The rats in group 2 (control group, n = 9) received no medication. All the rats were observed for a total of 28 days. RESULTS: At the end of the treatment, the mean volume and weight of the explants in group 1 (11.49 ± 6.87 mm(3) and 36.61 ± 17.84 mg) were significantly lower than that of the control group (190.6 ± 177.4 mm(3) and 187.3 ± 174.5 mg; both Ps < .01). Mean epithelial histologic scores were significantly lower in group 1 (1.11 ± 0.78) than that of the control group (2.33 ± 0.71; P < .01). When compared with the control group, vascular endothelial growth factor (VEGF) immunoreactivities in group 1 showed statistically significant reductions (1.67 ± 0.50; 2.67 ± 0.50; P < .01). CONCLUSION: Ranibizumab has significantly regressed the size of the endometriotic implants and caused atrophy of these lesions in rats by decreasing explant levels of VEGF.

Aberrant right subclavian artery in Down syndrome fetuses.

OBJECTIVES: The aim of this study is to determine the frequency of aberrant right subclavian artery (ARSA) in trisomic and normal fetuses during the routine detailed ultrasonography in the second trimester and to evaluate the potential value of ARSA as an ultrasonographic marker for trisomy 21. METHODS: The presence of normal brachicephalic trunk/or ARSA was confirmed in all pregnant women undergoing second trimester detailed fetal anomaly screening beyond 16th week of pregnancy. Amniocentesis following genetic councelling was recommended to all women having either any positive ultrasonographic marker including ARSA or a positive biochemical screening test (triple test) result. RESULTS: During the 17-month period, 2081 patients were screened, and 23 patients with ARSA (1,1%) and 20 patients with trisomy 21 were detected. Of those 20 patients with trisomy 21, ARSA was detected in seven (%35). On the other hand, 30.4% of the fetuses with ARSA had also trisomy 21. The positive and negative likelihood ratios of ARSA for trisomy 21 were 45.08 and 0.65, respectively. CONCLUSIONS: In our study, the ARSA in combination with other ultrasound signs increased the risk for trisomy 21 by factor of 45, but the independent ability of ARSA as an isolated marker to predict fetal Trisomy 21 is unclear.

Pregnancy Outcome of Multiparous Women Aged over 40 Years.

Objective. The aim of this study was to evaluate the effect of maternal age on prenatal and obstetric outcome in multiparaous women. Materials and Methods. A retrospective case control study was conducted, including women aged 40 years and over (study group, n = 97) who delivered at 20 week's gestation or beyond and women aged 20-29 years (control group, n = 97). Results. The mean age of women in the study group was 41.2 ± 1.7 years versus 25.4 ± 2.3 years in the control group. Advanced maternal age was associated with a significantly higher rate of hypertension, diabetes mellitus, fetal complication, and 5-minute Apgar scores <7 (P < 0.05). Caeserean section rate, incidence of placental abruption, preterm delivery, and neonatal intensive care unit admission were more common in the older group, but the differences were not statistically significant. Conclusions. Advanced maternal age is related to maternal and neonatal complications.