The effect of lavender aromatherapy on the level of intraoperative anxiety in caesarean case under spinal anesthesia: A randomized controlled trial.

BACKGROUND: Preoperative anxiety can be reduced by aromatherapy. This study aimed to evaluate the effect of lavender aromatherapy in reducing intraoperative anxiety in patients undergoing caesarean section (CS) under spinal anesthesia. METHODS: This study was two-armed and randomized controlled trial. A total of 96 patients who were scheduled for CS were randomly divided into two groups: the aromatherapy (A) group (n=48), comprising patients who were randomized to receive lavender aromatherapy with mask oxygen after the birth of the baby, and the control (C) group (n=48), comprising patients who inhaled carrier oil. During the preoperative period, baseline anxiety levels and Visual Analog Scale (VAS) pain scores were recorded using the State-Trait Anxiety Inventory (STAI-I) scale. After birth, two drops of oil were inhaled in an oxygen mask for 5 min. After 5 min, the Ramsey Sedation Scale was evaluated, and patients with a score of 1 received 2 mg of intravenous midazolam for sedation. The STAI-I and VAS pain scores were re-evaluated at the third postoperative hour. RESULTS: The primary outcome was the significant reduction in the need for midazolam brought about by lavender aromatherapy, and the secondary outcomes included postoperative third-hour STAI-I scores, intraoperative complications and patient satisfaction. CONCLUSION: The effectiveness of lavender aromatherapy, which reduced the need for intraoperative anxiolytics, can be offered as an alternative for pregnant women who undergo CS under spinal anesthesia.

Cardiac electrical and structural alterations in preeclampsia.

BACKGROUND: Preeclampsia increases the risk of cardiovascular mortality and morbidity both during pregnancy and long term after the labor by causing cardiac changes that may lead to atrial and ventricular arrhythmias. OBJECTIVE: We aimed to investigate noninvasive predictors of atrial and ventricular arrhythmias and cardiac structural changes in preeclampsia. METHODS: The study included 34 preeclampsia patients as the study group and 33 healthy pregnant women as the control group. The presence of fragmented QRS morphology, P dispersion, QT dispersion, Tp-e/QTc ratio, inter- and intra-atrial electromechanical delay, left ventricular mass index was evaluated in the groups by 12 lead- ECG and standard and tissue Doppler echocardiography. RESULTS: Left ventricular mass index and relative wall thickness, and E/Em ratio was significantly higher in preeclampsia. Inter- and intra-atrial electromechanical delay and Tp-e were prolonged, and P dispersion, QT dispersion, and Tp-e/QTc ratio were increased significantly in patients with preeclampsia. In addition, fragmented QRS morphology was seen in 76.5% of patients with preeclampsia while it was present in only 27.3% of the control group (p < .001). CONCLUSION: Preeclampsia causes significant cardiac structural and electrocardiographic alterations that may increase the risk of atrial and/or ventricular arrhythmias. A more thorough and earlier cardiac assessment and closer follow-up of these patients would be useful to avoid further complications.

Comparison of the Toxoplasma Seroprevalence Rates in Syrian Refugee Pregnant Women and Turkish Pregnant Women

Objective: This study evaluated the Toxoplasma seroprevalence rates of pregnant women among Syrian refugees and local residents and examined the effect of large-scale migrations of communities on Toxoplasma seroprevalence. Methods: A total of 29,424 pregnant women (age range: 15-45 years) who presented to Kahramanmaras Necip Fazil City Hospital Gynecology and Obstetrics Outpatient Clinic between January 2012 and January 2021 for routine follow-up during the first trimester of pregnancy were retrospectively examined and included in the study. Anti-Toxoplasma gondii IgM and IgG values of the pregnant women were divided into two groups: Local residents and refugees. Each group was divided into three age subgroups: 5-25 years, 25-35 years, and 35-45 years. Results of the refugees and local residents were compared in general terms and based on age groups. Results: The seropositivity rate for Toxoplasma IgM was higher in refugees than in local residents (2.7% vs. 1.6%; p=<0.05). Similarly, the prevalence of IgG seropositivity was higher in the refugee group (64% vs. 41%; p=<0.05). According to age groups, this statistical difference was preserved for both Toxoplasma IgM and IgG. Conclusion: It has been found that local residents and refugees in our province were above the global average in terms of Toxoplasma seropositivity rate. Seropositivity rates in the refugees appeared to be higher than those in countries with a routine screening program. Therefore, routine Toxoplasma screening should be performed in pregnant women, especially in our region.

TCM use in pregnant women and nursing mothers: A study from Turkey.

BACKGROUND: This study aimed to specify the frequency of traditional and complementary medicine (TCM) usage and the most commonly used methods by the pregnant. MATERIALS AND METHODS: The cross-sectional and definitive study included 212 pregnant and 152 nursing women who applied to obstetric, pediatrics, and family practice polyclinics. FINDINGS: Of the pregnant women, 38.7% applied to the TCM method during pregnancy, and of the nursing women, 63.2% during nursing. The most commonly used herbal products were mint, thyme and linden by the pregnant women while anise and mint were most commonly used by nursing.Women commonly used TCM methods to increase breast milk and for upper respiratory tract infection's symptoms. CONCLUSIONS: Every health personnel who provides pregnancy care should be aware of the latest data published on the usage of TCM in the literature and educate patients about the usage of TCM which may have negative outcomes.

The serum level of soluble CXCL16 is increased in preeclampsia and associated with hepatic/renal damage.

OBJECTIVE: To compare the serum level of the chemokine, CXCL 16, in preeclamptic and healthy pregnant patients. METHODS: This prospective case control study was conducted between January and December 2018 in a tertiary level hospital. The study group was formed of 70 pregnant women diagnosed with preeclampsia, and the control group was formed of 70 healthy pregnant women matched to the study group in respect of age, gestational week and body mass index (BMI). The study group was separated into two subgroups of mild preeclampsia (n = 35) and severe preeclampsia (n = 35). The groups were compared in terms of demographic and clinical parameters and the levels of serum CXCL 16. RESULTS: No statistically significant difference was determined between the study and control groups in respect of maternal age, gravida, parity, BMI, and gestational age at sampling. Neonatal birth weight was significantly lower in the study group than in the control group. Mean serum alanine aminotransferase (ALT), aspartate amino transferase (AST) and creatinine levels of the study group were significantly higher than those of the control group (p < .05 for all). There was a statistically significant difference between the study and control groups regarding the mean platelet count. Compared to the control group, the severe and mild preeclampsia groups had a significantly higher serum level of CXCL 16. The serum level of CXCL 16 was significantly higher in patients with severe preeclampsia than in patients with mild preeclampsia (2.94 ± 3.89 pg mL-1 vs. 1.08 ± 1.87 pg mL-1, p = .14). Correlation analysis revealed a significant positive correlation of serum CXCL 16 level with serum ALT level (r = 0.320, p ≤ .001) and serum AST level (r = 0.373, p ≤ .001) and serum creatinine level (r = 0.279, p = .01) in both groups. High values indicated presence of preeclampsia, with a diagnostic cut-off point of 0.225, sensitivity of 75.7% and specificity of 72.9% for CXCL 16 (area under curve: 0.820, p < .001 CI: 0.753-0.888). CONCLUSIONS: This is the first study in literature to show a significantly higher level of CXCL 16 in patients with severe preeclampsia compared to those with mild preeclampsia. The study can also be considered of value in respect of showing that CXCL 16 could play a role in the etiopathogenesis of preeclampsia and the emergence of renal-hepatic damage. Blocking the CXCL 16/CXCR six axis in preeclampsia treatment could lay the ground for the development of new drugs which could be used in the treatment of preeclampsia.

Copper/Zinc Ratio Can Be a Marker to Diagnose Ectopic Pregnancy and Is Associated with the Oxidative Stress Status of Ectopic Pregnancy Cases.

It was aimed to evaluate serum zinc and copper levels and oxidative stress parameters in ectopic pregnancy cases, healthy pregnant women, and healthy non-pregnant women. In this cross-sectional case-control study, 30 patients diagnosed with tubal ectopic pregnancy in the gynecology clinic of a tertiary hospital constituted the study group. A healthy pregnant control group (n = 30) was formed of age, body mass index (BMI), and gestational week-matched subjects, and a healthy non-pregnant control group (n = 30) was formed of age and BMI-matched women. The groups were compared in terms of demographic characteristics and laboratory parameters including serum zinc (Zn) level, serum copper (Cu) level, serum malondialdehyde (MDA) level, serum catalase (CAT) activity, serum glutathione peroxidase (GPX) activity, and serum superoxide dismutase (SOD) activity. The groups were similar in respect of demographic characteristics. In the ectopic pregnancy group, serum GPX activity and Cu level were significantly lower, and serum SOD and CAT activity and Zn and MDA levels were higher compared with those of the healthy pregnant and healthy non-pregnant groups. The Cu/Zn ratio showed a significant, positive correlation with the serum GPX activity and serum progesterone level and a negative correlation with serum SOD and CAT activity. When 1.14 was taken as the cutoff value, sensitivity and specificity of the Cu/Zn ratio to determine ectopic pregnancy were 73.3% and 80.0%, respectively. Comparing the area under curve (AUC) in the ROC (receiver operating characteristic) curve analysis, the Cu/Zn ratio was determined to be more valuable than the Cu or Zn values alone in predicting ectopic pregnancy. In correlation analysis, serum beta hCG level showed a negative correlation with SOD and CAT activities and Zn levels. Serum progesterone level showed a negative correlation with serum CAT and SOD activities and MDA and zinc levels and a positive correlation with serum GPX activity and serum copper level (p < 0.05 for all). The current study can be considered of value as the first study in literature to show a significantly lower serum Zn level and higher serum Cu level in ectopic pregnancy cases compared with healthy pregnant control cases. This is also the first study to have revealed an association between the serum Cu/Zn ratio, oxidative status, and ectopic pregnancy. Furthermore, the serum Cu/Zn ratio was found to be useful in the diagnosis of ectopic pregnancy cases.

Antenatal and postpartum comparison of HD-OCT findings of macula, retinal nerve fiber layer, ganglion cell density between severe preeclampsia patients and healthy pregnant woman.

AIM: To investigate the effects of severe preeclampsia on the retinal nerve fiber layer (RNFL), macula thickness and ganglion cell density in pregnancy and postpartum, using High Definition Optical Coherence Tomography (HD-OCT). MATERIAL AND METHOD: The study group included 28 stable pregnant patients diagnosed with severe preeclampsia and the control group, 28 age and gestational week-matched healthy pregnant women. HD-OCT measurements were taken by the same researcher using a Cirrus HD-OCT device and were repeated at 8 weeks postpartum. RESULTS: The mean systolic pressure, diastolic pressure, and intraocular perfusion pressure (IPP) values measured in pregnacy were determined to be higher in the preeclampsia group than in the control group (158.4 ± 7.3 vs.113.6 ± 6.8, 97.0 ± 5.7vs.73.8 ± 5.9 and 68.1 ± 3.9 vs.48.8 ± 3.3 mm Hg, respectively) (p < 0.05 for all). The mean RNFL, macula thickness, ganglion cell analysis, and intraocular pressure (IOP) values during pregnancy were determined to be similar in both groups (p > 0.05 for all). No significant difference was determined postpartum between the groups in respect of mean systolic pressure, diastolic pressure, RNFL, macula thickness, ganglion cell analysis, and IOP values (114.3 ± 5.0 vs 114.6 ± 5.9 mm Hg, 74.6 ± 5.1 vs.74.5 ± 5.5 mm Hg, 96.0 ± 7.3 vs. 95.9 ± 6.7 µm, 228.2 ± 18.9 vs.234.5 ± 15.4 µm, 81.8 ± 8.0 vs. 84.2 ± 4.6 µm, 14.1 ± 2.4 vs.13.8 ± 2, respectively) (p < 0.05 for all). Mean IPP during pregnancy was higher than the mean postpartum IPP in the severe pre-eclampsia group (68.1 ± 3.9 vs 49.1 ± 3.1 mm Hg) (p < 0.001). CONCLUSION: This is the first study to have evaluated ganglion cell density of the retina, macula thickness, and RNFL using HD-OCT in severe pre-eclampsia cases, both during pregnancy and postpartum.

The role of omentin in early pregnancy losses.

This prospective case-control study aimed to investigate the role of omentin, an anti-inflammatory adipokine in early pregnancy losses. The study comprised 47 women with spontaneous miscarriage at a gestational age of 8-12 weeks and 36 healthy pregnant women, matched for age, body mass index and gestational age, gravdity and parity. A significant negative correlation was determined between plasma omentin concentrations and body weight (r= -0.242, p = .027) and gestational age (r= -0.249, p = .023). Although not statistically, the women with spontaneous miscarriage had higher plasma concentrations of omentin compared to those with healthy pregnancies (7.798 ± 3.453 ng/ml vs. 7.200 ± 3.442 ng/ml, p = .435). This finding might support the hypothesis that increased inflammation plays a role in the etiopathogenesis of early pregnancy losses. These results revealed the potential use of omentin to predict unhealthy pregnancies.Impact statementWhat is already known on the subject of the paper? The exact mechanism of early pregnancy loss with euploid foetal karyotype has not been elucidated yet. An alteration in the physiological inflammatory response of pregnancy might be one of the mechanisms responsible for miscarriage.What does this study add? To the best of our knowledge, this is the first study to investigate the role of omentin in early pregnancy loss. The results obtained from this current study could be used to clarify the relationship between inflammatory processes and miscarriage.What are the implications for clinical practice and/or further research? Identification of the role of omentin in the process of early pregnancy losses would be helpful in order to design further studies to determine the feasibility of using omentin as a serum marker to predict the risk of miscarriage in early pregnancies. Additionally, understanding of the etiopathogenesis of early pregnancy losses with euploid karyotype will give a lead to further researches which could focus on exploring new interventions to detect and treat altered inflammation in early pregnancies.

Ocular perfusion pressure and intraocular pressure in pregnant women with severe preeclampsia.

OBJECTIVES: The aim of this study was to investigate whether severe preeclampsia (SPE) affects intraocular pressure (IOP) and ocular perfusion pressure (OPP). MATERIAL AND METHODS: This prospective and comparative study included 64 pregnant females, allocated into 2 groups as Group 1 (31 pregnant women with SPE) and Group 2 (33 normotensive pregnant women). IOP, systolic and diastolic blood pressure, OPP of all the subjects were measured after 20 weeks of gestation and prior to labor and medical therapy. RESULTS: The mean IOP values in Group 1 were not significantly different from those of Group 2 (p = 0.528). The mean OPP values in Group 1 were significantly higher than those of Group 2 (p < 0.001). There was no significant correlation between IOP and OPP levels. No significant differences were determined between the groups in respect of age, gestational age body mass index (BMI) (p < 0.269, p < 0.219 and p < 0.556 respectively). The mean systolic and diastolic blood pressure values were statistically significantly higher in Group 1 than in Group 2 (p < 0.001 and p < 0.001). CONCLUSIONS: Although high IOP was expected in SPE patients, it was found to be constant. This could have been due to an increase in aqueous humor outflow because of changes occurring in angiogenic and anti-angiogenic factors in SPE.

Anti-müllerian hormone levels as a predictor of the pregnancy rate in women of advanced reproductive age.

PURPOSE: To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in women who underwent IVF cycles at the age of 35 and older METHODS: A total of 240 consecutive women who underwent IVF cycles at the age of 35 and older were enrolled in this crsoss- sectional study. Pregnant and nonpregnant women were compared. RESULTS: The median AMH level of pregnant women was higher than non-pregnant women [3.20 (0.63-9.60) vs 1.15 (0.01-14.90) ng/ml, p < 0.001]. On logistic regression analysis, AMH was an independent predictor of clinical pregnancy rate (CPR) (OR 1.353; 95 % CI 1.141-1.605; P < 0.001). After controlling for the other independent variables (the number of retrieved oocytes, AFC and age), the significant association between AMH and clinical pregnancy rate remained strong (OR 1.677; 95 % CI 1.216-2.311; p = 0.002) on multivariate logistic regression analysis. CONCLUSIONS: AMH is an effective measure of quantitative ovarian reserve and it can predict ovarian response to controlled stimulation for advanced age women. The CPR tends to increase as AMH increases.

Estradiol plus drospirenone therapy increases mammographic breast density in perimenopausal women.

OBJECTIVE: To investigate the effects of 17ß-estradiol 1mg plus drospirenone 2mg (E2/DRSP) treatment on mammographic breast density in perimenopausal women. STUDY DESIGN: In this prospective study, 80 healthy perimenopausal women aged 41-49 years were enrolled and assigned to either E2/DRSP (n=40) or a control group (n=40). Mammograms were performed at baseline and after 12 months of treatment. Mammographic breast density was quantified according to the Wolfe classification. RESULTS: We demonstrated an increase in mammographic breast density in 37% (95% CI (confidence interval): 18.8-55.3%) of women treated with E2/DRSP after 12 months. The percentage of women with increased density was 0% (95% CI: 0.0-0.0%) in the control group. The difference in breast density between the E2/DRSP group and the control group was statistically very significant (p<0.001). CONCLUSIONS: E2/DRSP therapy for 12 months in perimenopausal women significantly increased mammographic breast density in comparison to a control group. Further long-term and large scale prospective studies are needed to evaluate this issue.