Can first-trimester aspartate aminotransferase/platelet ratio index score predict intrahepatic cholestasis of pregnancy?

Background and Aim: The study aimed to investigate the effectiveness of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet values in predicting intrahepatic cholestasis of pregnancy (ICP) in the first trimester, together with the aspartate aminotransferase/platelet ratio index (APRI) score. Materials and Methods: This study consisted of a patient group diagnosed with ICP (n=49) and a control group (n=62). Laboratory tests of both groups were analyzed retrospectively. Results: The first-trimester APRI score and AST and ALT values were found to be statistically significantly higher than those of the control group. The platelet value was found to be statistically significantly lower in the study group, even though it was within the normal reference range. Conclusion: The first-trimester APRI score was found to be effective in predicting ICP. In addition, the first-trimester AST, ALT, and platelet values were found to be effective in predicting ICP diagnosed in the third trimester even though if not as much as the APRI score.

The effects of maternal smoking on fetal cranial development. Findings from routine midtrimester sonographic anomaly screening.

The aim of this study was to assess the effect of continued smoking before and during pregnancy on mid-trimester fetal head development. A total of 250 pregnant women enrolled in the study. All participants were confirmed to be smokers or non-smokers by verifying breath carbon monoxide readings. Biparietal diameter (BPD), head circumference (HC), lateral ventricle (LV), and cisterna magna (CM) were evaluated by ultrasound between 20-22 weeks of pregnancy. Gender and gestational age-adjusted BPD z- scores were not statistically different between smokers and non-smokers (-0.75 ± 1.6 vs -0.51 ± 1, p = .3). HC measurements and z- scores were significantly lower in the smoking group than in the non-smoking groups (183.38 ± 14.56 vs. 189.28 ± 12.53, p = .003, 0.18 ± 1.39 multiple of median (MoM) vs. 0.56 ± 0.92, respectively, p = .023). At linear regression analysis, maternal smoking was the only independent factor associated with fetal HC z score (p = .041). In conclusion, continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV, or CM measurements at mid-gestation.IMPACT STATEMENTWhat is already known on this subject? Smoking during pregnancy is one of the most common environmental factors affecting fetal and neonatal growth and well-being. Despite the well-known effects of smoking on somatic growth, current studies have shown that it selectively affects some parts of the fetal brain, even in appropriately growing fetuses.What do the results of this study add? Continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV or CM measurements at mid-gestation. Since smoking is well known for its early and late childhood behavioral and neurological consequences, smaller mid-trimester fetal HC measurements should bring maternal smoking to mind as one of the potentially reversible causes.What are the implications of these findings for clinical practice and/or further research? The harmful effects of smoking start before the third trimester and antenatal counseling should be started early in the gestation. Every effort should be made to quit smoking before or early in pregnancy.

Evaluation of chronotype and sleep quality in infertile population and comparison with fertile population: a cross-sectional study.

PURPOSE: Infertility is a stressful condition for couples and can affect patients' circadian rhythm and sleep quality. The goal of this study is to assess differences in chronotype and sleep quality between infertile and fertile people. METHODS: A cross-sectional study was conducted. The infertile patient population consisted study group. Primiparous patients without any known gynecological disease who presented for routine cervical cancer screening follow-up were included in the control group. The Turkish version of the Morningness-Eveningness Questionnaire (MEQ) and Pittsburg Sleep Quality Index (PSQI) scores were evaluated between groups. RESULTS: A total of 227 patients were assessed. There were 110 patients in the study (infertile) group and 117 patients in the control (fertile) group. The evening chronotype proportion (23.6 vs. 0.9%, p < 0.001) was higher in the infertile group. The median of MEQ score was significantly higher in the fertile patients (50, IQR = 43 - 55 vs. 56, IQR = 51 - 59; p < 0.001), and the median of PSQI score was significantly higher in the infertile patients (5, IQR = 4 - 6, vs. 4, IQR = 3 - 5; p < 0.001). CONCLUSIONS: In this study, we found significantly worse sleep quality, and more evening chronotype in the patients with infertility.

Impact of the first, second and third peak of the COVID-19 pandemic on anxiety, depression and stress symptoms of healthcare workers.

BACKGROUND AND OBJECTIVES: Numerous studies have been conducted on the psychological effects of the COVID-19 pandemic. However, how the mental health of health workers will be affected among the number of peaks during the pandemic has not been evaluated yet. The study aims to investigate the effects of the first, second, and third peaks of COVID-19 on anxiety, depression, and stress symptoms in healthcare workers. METHODS: The current study included 4031 healthcare workers, 1051 during the first peak period, 1409 during the second peak period, and 1571 during the third peak period. The Depression-anxiety-stress scale-21(DASS-21) was used to assess the participants' levels of anxiety, depression, and stress symptoms. RESULTS: The mean age of the participants was 33.74 ± 7.95, and 2634 (66.3 %) were female. 36.9 %(n = 1486) of the participants were physicians, 41.1 % (n = 1655) were nurses and 22.1 % (n = 890) were other healthcare workers. A statistically significant difference was documented in the DASS-21 anxiety (F(2:4028) = 502.893, p 2. Peak > 1. Peak), DASS-21 depression (F(2:4028) = 46.034, p 2. Peak > 1. Peak), DASS-21 stress (F(2:4028) = 65.548, p 1. Peak), and DASS-21 total scores (F(2:4028) = 156.860, p 2. Peak > 1. Peak) of healthcare workers during all three peak periods. CONCLUSIONS: Our findings show that as the peak number rises, so do the levels of anxiety and depression among healthcare workers. As a result, it is possible to assert that prolongation of the COVID-19 pandemic worsens mental problems (Tab. 2, Fig. 3, Ref. 35).

Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy.

OBJECTIVE: This study aimed to evaluate the effectiveness of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes for intrahepatic cholestasis of pregnancy. METHODS: A cross-sectional study was conducted, including 51 women with intrahepatic cholestasis of pregnancy and 80 healthy controls. Using Doppler ultrasonography, E-wave, A-wave, isovolumetric contraction time, isovolumetric relaxation time, and ejection time were recorded and the left ventricular modified myocardial performance index was measured. RESULTS: Findings showed that the mean left ventricular modified myocardial performance index, isovolumetric contraction time, and isovolumetric relaxation time values were statistically significantly higher while the ejection time and E/A ratios were statistically significantly lower in the intrahepatic cholestasis of pregnancy group than the control group. In the intrahepatic cholestasis of pregnancy group, a statistically significant positive correlation was found between left ventricular modified myocardial performance index and adverse perinatal outcomes in the intrahepatic cholestasis of pregnancy group (r=0.478, p<0.001), while a statistically significant negative correlation was found between the E/A ratio and adverse perinatal outcomes (r=-0.701, p<0.001). CONCLUSIONS: For intrahepatic cholestasis of pregnancy cases, high fetal left ventricular modified myocardial performance index values were an indicator of ventricular dysfunction, and this correlated with negative perinatal outcomes.

Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

SUMMARY OBJECTIVE: This study aimed to evaluate the effectiveness of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes for intrahepatic cholestasis of pregnancy. METHODS: A cross-sectional study was conducted, including 51 women with intrahepatic cholestasis of pregnancy and 80 healthy controls. Using Doppler ultrasonography, E-wave, A-wave, isovolumetric contraction time, isovolumetric relaxation time, and ejection time were recorded and the left ventricular modified myocardial performance index was measured. RESULTS: Findings showed that the mean left ventricular modified myocardial performance index, isovolumetric contraction time, and isovolumetric relaxation time values were statistically significantly higher while the ejection time and E/A ratios were statistically significantly lower in the intrahepatic cholestasis of pregnancy group than the control group. In the intrahepatic cholestasis of pregnancy group, a statistically significant positive correlation was found between left ventricular modified myocardial performance index and adverse perinatal outcomes in the intrahepatic cholestasis of pregnancy group (r=0.478, p<0.001), while a statistically significant negative correlation was found between the E/A ratio and adverse perinatal outcomes (r=-0.701, p<0.001). CONCLUSIONS: For intrahepatic cholestasis of pregnancy cases, high fetal left ventricular modified myocardial performance index values were an indicator of ventricular dysfunction, and this correlated with negative perinatal outcomes.

Administration of rectal cytotec versus rectal buscopan before hysteroscopy.

INTRODUCTION: Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming. MATERIAL AND METHODS: This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30° lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure. RESULTS: Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively (p = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (p=.11). There was no difference with regard to other studied parameters. SUMMARY: HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.

Adverse Outcomes of Preeclampsia in Previous and Subsequent Pregnancies and the Risk of Recurrence.

OBJECTIVES: We evaluated the fetal and maternal outcomes of pregnant women with preeclampsia who gave birth in our hospital; we also evaluated preeclampsia recurrence rates in these patients and their fetal and maternal outcomes in their subsequent pregnancy. METHODS: In this retrospective cohort study, 126 patients whose medical records were accessed completely and who got pregnant again and gave birth in our hospital were analyzed. The primary aim was to show the recurrence rate of preeclampsia, while the secondary aim was to evaluate the maternal and fetal results of the first pregnancy in which preeclampsia developed and the subsequent pregnancy. RESULTS: The incidence of preeclampsia was found to be 2.1% in our clinic. The first pregnancy in which preeclampsia developed; 111 (80.2%) pregnancies resulted in a live birth, 7 (5.6%) resulted in termination, and 8 (6.3%) resulted in stillbirth. Neonatal death occurred in 10 (7.9%) pregnancies. While 105 of the subsequent pregnancies resulted in a live birth, 10 (7.9%) resulted in abortion, 9 (7.1%) resulted in stillbirth, and 2 (1.6%) resulted in termination due to preeclampsia. Neonatal death developed in 3 (2.6%) pregnancies. In the subsequent pregnancy, preeclampsia developed in 70 (55.5%) patients and 39 (55.7%) of these had preeclampsia with severe features. CONCLUSION: The present study guides us on the risk factors related to preeclampsia and the rate of fetomaternal adverse outcomes and emphasizes the need for strict and regular antenatal follow-up in the subsequent pregnancies of women who have a history preeclampsia. Improvement of maternal and fetal morbidity and mortality in this way is the utmost goal.

The impact of COVID-19-related mental health issues on menstrual cycle characteristics of female healthcare providers.

AIM: To investigate the association between menstrual cycle regularity in healthcare providers and COVID-19 pandemic-related anxiety, depression, stress. METHODS: A cross-sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18-40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID-19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS-21). RESULTS: A total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18-40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS-21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score. CONCLUSION: The current study showed the association between the COVID-19 pandemic-induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.

The comparison of anxiety, depression and stress symptoms levels of healthcare workers between the first and second COVID-19 peaks.

BACKGROUNDS: Although the psychological effects of the COVID-19 pandemic have been investigated, there is no study comparing the effects between the peaks. This study aims to compare the levels of anxiety, depression, and stress of healthcare workers struggling with pandemic between the first and second peaks. METHODS: A total of 2460 healthcare workers, 1051 from the first peak period and 1409 from the second peak period, were included in the study. The first peak measurements of the participants were made between 07.04.2020 and 05.05.2020 and the second peak measurements were made between 22.11.2020 and 20.12.2020 according to the peak period in Turkey. Depression-Anxiety-Stress-21(DASS-21) scale was applied to the participants online by the purpose of the study. RESULTS: The mean age of the participants was 32.63 ± 7.70, and 66.5% of them were female. A statistically significant difference was found between the income status (p < 0.001), lifestyle (p < 0.001) and COVID-19 test result (p < 0.001), DASS-21 Depression (p < 0.001, t = -5.311), Anxiety (p < 0.001, t = -8.244), Stress (p < 0.001, -10.056) and total(p < 0.001, t = -8.719) scores of the two groups. CONCLUSION: The present study results showed that healthcare workers meticulously struggling with the pandemic had increased anxiety, depression, and stress levels at the second peak of the pandemic compared to the first peak.

Identification of predictive factors for the probability of pregnancy following ovulation stimulation-intra-uterine insemination cycles in terms of female and male.

AIM: To identify which positive prognostic parameters contribute to successful treatment outcomes and the probability of pregnancy by analyzing the results of infertile couples underwent ovulation stimulation (OS) and intra-uterine insemination (IUI) in our clinic. METHODS: Five hundred and nineteen couples who underwent OS-IUI treatment because of a mild-moderate male factor, unexplained infertility, or anovulation were retrospectively analyzed. The data collected included patient demographics, cycle characteristic, sperm parameters and pregnancy rates. The main outcome measure was pregnancy rate (PR). RESULTS: Our overall PR was 17.72% (n = 92). In women who did not achieve pregnancy, age, BMI and duration of infertility were significantly higher (P < 0.001, P < 0.001 and P = 0.03, respectively). The IUI indications of higher PR were unexplained infertility (P = 0.018) and primary infertility (P = 0.003). AFC was significantly lower and the total dosage of gonadotropins was significantly higher in women who did not achieve pregnancy (P = 0.001 and P = 0.017, respectively). The number of progressive motile spermatozoa inseminated and the morphology were significantly higher in women who did not achieve pregnancy (P = 0.056 and P = 0.001, respectively). Female age ≤ 30 (OR = 0.87; 95% CI: 0.81-0.95; P < 0.01), BMI ≤23.3 kg/m2 (OR = 0.87; 95% CI: 0.80-0.95; P = 0.002) and AFC > 9 (OR = 1.07; 95% CI: 1-1.15; P = 0.034) increase the pregnancy. CONCLUSION: Younger women, especially those with unexplained infertility, primary infertility, shorter duration of infertility, normal ovarian reserve, higher motile spermatozoa inseminated and sperm morphology, could benefit from OS-IUI.

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.

The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage.

INTRODUCTION AND HYPOTHESIS: Uterine fundal pressure is applied to accelerate birth by increasing the expulsive force of the uterus in the second stage of delivery. The aim of the study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on the rate of pelvic floor damage among primiparous women using three-dimensional transperineal ultrasonography. METHODS: The women were divided into two groups: the fundal pressure group included women where the fundal pressure maneuver was applied (n = 39); the control group included women who delivered spontaneously without fundal pressure (n = 47). 3D-TPU was performed within 48 h of delivery, and LAM biometry, LAM defect and loss of tenting were determined. RESULTS: Anteroposterior hiatal dimensions on resting, maximal Valsalva and maximal PFMC were found to be higher in the fundal pressure group (p < 0.0001, p = 0.008, p = 0.007, respectively). The mean hiatal area at rest was larger in the fundal pressure group than in the control group (p = 0.04). The rate of LAM defect was significantly higher in the fundal pressure group (p = 0.001). The rate of loss of tenting was significantly higher in the fundal pressure group (p < 0.0001). According to multivariate regression models, the fundal pressure was the only independent factor associated with LAM defect (OR = 5.63; 95% CI = 12.01-15.74) and loss of tenting (OR = 8.74; 95% CI = 2.89-26.43). CONCLUSIONS: Fundal pressure during the second stage of delivery is associated with a higher risk of LAM defect and loss of anterior vaginal wall support. CLINICAL TRIAL REGISTRATION: NCT03752879.

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.

Prenatal Sonographic Detection of Monochorionic Twins with Bipartite Placenta.

Background Determination of placentation and amnionicity is important for antenatal and intrapartum management in twin gestations. We present an typical monozygotic twin placenta and underscore the sonographic features and diagnostic pitfalls that may interfere with antenatal diagnosis. Case report: A 35-year-old G4P2 with a spontaneous pregnancy applied for routine second trimester anomaly screening. Upon prenatal ultrasonography at 20 weeks, an anatomically normal, same sex twin pregnancy was detected. A thin dividing membrane and a T-sign suggestive of a monochorionic diamniotic pregnancy were visualized. Antenatal follow-up was uneventful. Cesarean delivery was performed at 37 week. Postpartum examination revealed two distinct placental discs connected with each other through membranes. Microscopic examination of the membranes supported monochorionicity. Short Tandem Repeat Profile Analysis revealed identical pattern and confirmed monozygosity. Conclusion: Two separate placentas with a T-sign in same-sex twins should raise the suspicion of monozygosity, and should be followed accordingly.

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.

The protective effect of platelet-rich plasma administrated on ovarian function in female rats with Cy-induced ovarian damage.

PURPOSE: We evaluated the protective effect of PRP on ovarian function in female rats with cyclophosphamide (Cy)-induced ovarian damage. METHODS: Thirty-two adult female Sprague-Dawley rats were randomly divided into four groups. Group 1 (control-sodium chloride 0.9%; 1 mL/kg, single-dose ip injection), group 2 (Cy); 75 mg/kg, single-dose ip injection and sodium chloride 0.9% (1 mL/kg, single-dose ip injection), group 3 Cy plus PRP, Cy (75 mg/kg, single-dose and PRP (200 µl, single-dose) ip injection), group 4 (PRP, 200 µl, single-dose ip injection). Primordial, antral, and atretic follicle counts; serum anti-Müllerian hormone (AMH) levels; AMH-positive granulosa cells; and gene expression analysis of Ddx4 were assessed. RESULTS: Serum AMH levels were significantly lower in group 2 compared to groups 1, 3, and 4 (p < 0.01, p < 0.01, and p = 0.04, respectively). A significant difference was found in the primordial, primary, secondary, antral, and atretic follicle counts between all groups (p < 0.01). There was a statistically significant difference in AMH-positive staining primary, secondary, and antral follicles count between the groups (p < 0.01). There was a statistically significant difference in primary, secondary, and antral AMH positive staining follicle intensity score between the groups (p < 0.01). Ddx4 expression in group 4 was highest compared to other groups. CONCLUSION: Our study may provide evidence that PRP could protect ovarian function against ovarian damage induced by Cy. It could lead to improved primordial, primary, secondary, and antral follicle numbers.