Phenotypic subgroups of polycystic ovary syndrome have different intra-renal resistance symptoms.

OBJECTIVE: The polycystic ovary syndrome (PCOS) is known to be related with increased metabolic and cardiovascular risks. Various phenotypic subgroups of PCOS have been proven to have metabolic and endocrine disorders with varying degrees of severity However, intra-renal vascular resistance, which is an indirect indication of atherosclerosis, remains unknown in PCOS subgroups. In this study we examined whether PCOS subgroups have different intra-renal resistance symptoms. MATERIAL AND METHODS: 98 PCOS patients (diagnosed according to the Rotterdam criteria) 30 controls were included in the study The diagnosis of PCOS was established in the presence of at least two of the following criteria: 1-oligo and/or amenorrhea (OM); 2-clinic and/or biochemical signs of hyperandrogenism (HA); 3-polycystic ovarian morphology (PCO) detected by transvaginal ultrasonography 37 patients (Group 1) met all three criteria (HA+OM+PCO), 29 patients (Group 2) met two of the criteria including hyperandrogenism (HA+OM or HA+PCO) and the remaining 32 patients (Group 3) had no hyperandrogenism but fulfilled the other two criteria; PCO+OM. Renal Doppler ultrasonography and hormonal/biochemical analyses were carried out. The first outcome measure was designated as the differences in the renal resistive index (RRI) values of the groups, and the second outcome measure was designated as the relation of RRI with the insulin resistance and lipid profile. RESULTS: In Group 1, the RRI and the homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly higher than in Group 3 and controls (P < 0.031, P < 0.001, respectively after adjusting for age and BMI). The RRI and HOMA-IR values in Group 3 were similar to those of the control group. It was determined that RRI has a positive correlation with HOMA-IR (r = 0.784, P < .0001) and BMI (r = 0.645, P < .0001). CONCLUSIONS: In this study we demonstrated that PCOS subgroups have metabolic and endocrine disorders and cardiovascular risks of varying degrees of severity Moreover, we showed that there was no increase of metabolic and cardiovascular risks in PCOS patients without hyperandrogenism.

Membrane sweeping to induce labor in low-risk patients at term pregnancy: a randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of membrane sweeping at initiation of labor induction in low-risk patients at term pregnancy (38-40 gestational weeks). METHODS: This prospective study included 351 antenatal women who were randomly assigned to one of two groups: a sweeping of the membranes group (n = 181) and a no sweeping control group (n = 170). The primary outcome measure was the proportion of women who entered spontaneous labor within 1 week of entry into the study. Secondary outcome measures included mode of delivery and maternal and fetal complications. RESULTS: Five patients (two in the sweeping group and three in the no sweeping group) were excluded from the study because of breech presentation at labor. There were no statistically significant differences between the two groups regarding maternal age, parity or Bishop score. The proportion of subjects who entered spontaneous labor before 41 weeks of gestation was significantly different between the two groups (p < 0.0001). The mode of delivery did not differ significantly between the groups and there was no statistically significant difference in maternal or fetal complications. CONCLUSIONS: Sweeping of membranes is a safe method to reduce the length of term in pregnancy and the incidence of prolonged gestation in a low-risk population. There is no evidence that sweeping the membranes increases the risk of maternal or neonatal adverse outcomes.

Effect of controlled ovarian hyperstimulation treatment on cardiac function.

OBJECTIVE: To evaluate the effects of controlled ovarian hyperstimulation (COH) treatment on cardiac functions using tissue Doppler imaging (TDI). STUDY DESIGN: Twenty-one patients aged 22-35 years were enrolled to COH cycles. Each subject underwent a conventional transthoracic echocardiographic examination that included an assessment of cardiac function. Measurements were taken twice--the first on the second day of the cycle and the second on the day when human chorionic gonadotropin was administered. Twenty-one healthy women were chosen for the control group. RESULTS: The COH treatment did not cause favorable cardiac function changes. The parameters showing the left ventricular diastolic function such as early diastolic peak flow velocity (E), late diastolic peak flow velocity (A), mitral E/A ratios, mitral E wave, deceleration time (DT), lateral isovolumic relaxation time (IVRT), and left ventricular myocardial performance index (LVMPI) were not changed. The COH treatment did not affect the right ventricular diastolic functions such as tricuspid valve E wave, DT, right ventricular (RV) IVRT, or right ventricular myocardial performance index (RVMPI). Concurrently, the COH treatment showed no effects on the right and left ventricular systolic functions. CONCLUSION: TDI findings reveal no effects of the COH treatment on cardiac function.

Perinatal and neonatal outcomes of growth restricted fetuses with positive end diastolic and absent or reversed umbilical artery doppler waveforms.

OBJECTIVE: To evaluate the outcome of intrauterine growth restriction fetuses with absent or reversed end-diastolic flow in the umbilical artery. METHODS: This was a retrospective study conducted at the Department of Maternal Fetal Medicine of the Bakirkoy Women and Children's Teaching Hospital, Istanbul, Turkey between 2002 and 2006. Three hundred and ten pregnant women with growth-restricted fetuses confirmed by ultrasound were followed up with Doppler studies of the umbilical artery. The population was subdivided into 2 groups. Group 1, intrauterine growth restriction with positive end diastolic flow velocity waveforms, (n=137) and group 2, intrauterine growth restriction with absent or reversed end diastolic velocities, (n=163). Perinatal and neonatal outcomes of the 2 groups were recorded. RESULTS: Group 1 was associated with a higher perinatal mortality and morbidity rate than group 2 (p=0.02), odds ratio [OR]: 1.09, 95% confidence interval [CI] 1-3.5, (p=0.03, OR: 2, 95% CI 1.2-3.2). In group 1, significantly more neonates were admitted to the neonatal intensive care unit, but no difference was seen in neonatal intensive care unit stay. The frequency of respiratory distress syndrome, septicemia, and necrotizing enterocolitis increased in group 1. There was no significant difference in need for ventilation of respiratory distress syndrome. CONCLUSION: Our data suggest that pregnancies with absent or reversed end-diastolic flow in the umbilical arteries have high perinatal mortality and morbidity.