Comparison of Perinatal, Newborn, and Audiometry Results of COVID-19 Pregnant Women.

Objective: There are studies on the perinatal outcomes of COVID-19, but the audiometric effects of the maternal immune system against COVID-19 in the newborn are not clear. In this study, we aimed to investigate the relationship between the perinatal outcomes of COVID-19 positive pregnant women and the audiological outcomes of newborns. Materials and Methods: This retrospective, single-center cohort study was conducted with 65 polymerase chain reaction (PCR) positive pregnant women and newborns and 66 normal pregnant women and newborns who were admitted between January 2020-December 2021. Pregnancy data, perinatal outcomes, and newborn hearing test results of pregnant women and newborns were recorded and compared. Results: A total of 131 patients were enrolled in the study. The number of normal pregnant women was 66 (50.4%) and the number of pregnant women who had COVID-19 disease was 65 (49.6%). In general, gestational week, age, parity, biochemical parameters, duration of hospital stay, week of delivery, fetal weight, and apgar scores were compared between pregnant women with COVID-19 and normal. White blood cell (WBC), neutrophil, aspartate aminotransferase (AST), and C-reactive protein (CRP) parameters were found to be significantly higher, and lymphocyte and neutrophil/lymphocyte (N/L) ratios were significantly lower (p < 0.05). There was no statistically significant difference between the two groups (χ 2=0.001; p = 1,000). The normal delivery status, the normal delivery rate in patients with COVID-19 was found to be statistically significantly higher than the cesarean section delivery status (p = 0.012). In the statistical comparison between the COVID-19 and normal pregnant groups in the cesarean section group, the gestational week, delivery week, and apgar1 scores of the pregnant women with COVID-19 were found to be significantly higher. There was no statistically significant difference between the distributions of the rate of infants with hearing impairment in the comparison with hearing tests in pregnant women with COVID-19 (n=1) and normal pregnant women (n=1) (χ 2=0.001; p = 1,000). Conclusion: Although the negative effects of COVID-19 on pregnancy outcomes are rare, it was determined that there was no increased audiological risk factor, and the most important predictor of COVID-19 was lymphopenia.

Pregnancy outcomes after abdominal sacrocervicopexy.

INTRODUCTION AND HYPOTHESIS: Various methods are used in pelvic organ prolapse (POP) surgery. Organ-preserving methods are gaining importance and popularity. Although the success rates of abdominal sacrocervicopexy, which is one of these methods, are known, data on pregnancy outcomes are insufficient. The aim of this study was to investigate pregnancy outcomes after abdominal sacrocervicopexy. METHODS: This study included 72 patients with a diagnosis of POP who underwent abdominal sacrocervicopexy with monofilament polypropylene mesh in Diyarbakir Gazi Yasargil Training and Research Hospital between 2008 and 2016. Anterior and posterior colporrhaphy operations were performed. Postoperatively, these patients were followed up for a mean of 29.68 ± 6.55 (20-49) months. Pregnancy and recurrence outcomes of those who became pregnant were recorded and analyzed. RESULTS: On average, pregnancies occurred 23.2 (18-30) months after the operation. During follow-up, eight patients became pregnant and gave birth without any issues or complications. One had a normal vaginal delivery, and seven gave birth by cesarean section. One of the pregnant women had a twin pregnancy. When 24 patients who underwent bilateral tubal ligation and postmenopausal (n = 2) were excluded, the pregnancy rate was found to be 17.3%. The weeks of the deliveries were 35 weeks (twin pregnancy), 38 weeks (n = 2), 39 weeks (n = 3), and 40 weeks (n = 1), for an average of 38.5 weeks. CONCLUSIONS: Eight patients who had undergone abdominal sacrocervicopexy had healthy pregnancies and deliveries.

Double Foley catheter for labor induction: An alternative method.

OBJECTIVE: To introduce a new handmade device, the double Foley catheter (DFC), and compare it with the Foley catheter (FC) and Cook cervical ripening balloon for its effectiveness in labor induction. METHODS: This prospective randomized controlled trial included 222 patients with unfavorable cervices. The patients were randomly allocated to the DFC, FC, and Cook cervical ripening balloon groups (n = 74 patients per group). The outcomes were evaluated using SPSS v. 23. RESULTS: Bishop scores successfully increased with all three methods (P = 0.000 for all groups), and the rates of vaginal delivery within 24 and 48 h were similar (P = 0.101 and P = 0.390, respectively). The pain scores of the DFC and Cook cervical ripening balloon groups were similar, but were lower than those of the FC group (P = 0.011). The overall maternal satisfaction scores of the DFC and Cook cervical ripening balloon groups were not significantly different but were higher than those of the FC group (P = 0.014). CONCLUSION: The maternal safety and success rate of labor induction were comparable between groups. However, the FC group had a higher pain score during catheter insertion and a lower maternal satisfaction rate. Moreover, considering the high cost of the Cook cervical ripening balloon, the DFC has an advantage, especially in low-resource countries.

Potential adverse effects of prophylactic bilateral salpingo-oophorectomy on skin aging in premenopausal women undergoing hysterectomy for benign conditions.

OBJECTIVE: This study aimed to assess the effects of hysterectomy and bilateral salpingo-oophorectomy (BSO)--compared with the effects of hysterectomy alone--on skin aging in premenopausal women undergoing hysterectomy for benign conditions. METHODS: One hundred thirty-five premenopausal women who underwent hysterectomy with BSO were compared with a control group of women who underwent hysterectomy alone based on skin parameters (including wrinkling, laxity/sagging, and texture/dryness) and Skindex-29 questionnaire scores. The inclusion criteria were as follows: aged between 40 and 50 years, follicle-stimulating hormone level lower than 40 mIU/mL, undergoing hysterectomy with or without BSO for benign conditions, and not receiving estrogen or progesterone treatment. The exclusion criteria were as follows: adrenocortical hyperplasia or Cushing's syndrome; use of corticosteroids for autoimmune diseases; malignancy, connective tissue diseases (eg, Ehlers-Danlos syndrome), or dermatological diseases (eg, lichen sclerosus); or regular use of medications known to interfere with the condition of the skin. RESULTS: All skin parameters in the hysterectomy group and the hysterectomy with BSO group worsened on weeks 24 and 48. Laxity/sagging and texture/dryness scores on weeks 24 and 48 were significantly worse in the BSO group; laxity/sagging and texture/dryness scores continued to worsen between 24 and 48 weeks. Scores for the Skindex-29 questionnaire emotion and symptom subscales were significantly higher in the BSO group compared with the non-BSO group. CONCLUSIONS: Prophylactic BSO during hysterectomy is a significant independent risk factor for worsening skin laxity/sagging and texture/dryness in premenopausal women undergoing hysterectomy for benign conditions. Prophylactic BSO in the presence of dermatological conditions is also associated with reduced quality of life.

Pregnancy and Vaginal Delivery after Sacrohysteropexy.

Pregnancy and birth after a Pelvic Organ Prolapse (POP) surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT) procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.

Outcomes of Transobturator Tape Surgery with Safyre T® Slings for Female Stress Urinary Incontinence after 96 Months of Follow-Up.

BACKGROUND/AIMS: To report the outcomes of transobturator tape (TOT) surgery with Safyre T® (Promedon, Argentina) slings for female stress urinary incontinence (SUI) at a 96- month follow-up. METHODS: We conducted a clinical follow-up study of 153 patients diagnosed with SUI between January 2005 and December 2014. Patients were provided with detailed a priori information pertaining to the TOT procedure and were invited to attend follow-up visits at 1, 3, 12, 24, 48, 72 and 96 months. Follow-up visits included physical examination involving sling palpation, checking of the vaginal mucosa for erosion, cough test, as well as validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires. RESULTS: The overall objective success rates, based on cough test results, were 91.3% at 12 months, 86.8% at 48 months and 77.6% at 96 months. Similarly, the overall subjective success rate, based on the validated UDI-6 and IIQ-7 scales, was 77.6% at 96 months. CONCLUSION: The cure rates achieved, following TOT treatment of SUI at 1-year follow-up, showed a statistically significant decline over an 8-year period, especially at months 48 and 96. © 2015 S. Karger AG, Basel.

Severe pre-eclampsia complicated by HELLP syndrome alterations in the structure of the umbilical cord (morphometric and immunohistochemical study).

The aim of this study was to evaluate the morphometric and immunohistochemistry in umbilical cords from patients with severe pre-eclampsia with and without haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. The patient and control groups were similar according to baseline obstetric characteristics. White blood cell count in patients with HELLP syndrome and the control group was significantly increased among patients with HELLP syndrome (p < 0.001). Morphometric examination and endothelial core length were significantly different between the groups. In the umbilical cord cross-section of the HELLP group, endothelial cell degeneration in the vessel wall and basement membrane thickening were observed. In the muscle layer of blood vessels, the following disorders were found: increased collagen fibres in the muscle cell, hyperplasia and separation of muscle fibres as well as edema in the intermediate connective tissue. Immunohistochemical analysis showed that endothelial cells, basal membrane and fibroblast cells in the HELLP group expressed high levels of CD44. Vessel wall and amniotic epithelial basement membrane thickening were observed in the HELLP group. Matrix metalloproteinase 9 (MMP9) was expressed. Fibroblast and smooth muscle cells were fusiform and showed a positive reaction to immunohistochemical staining of α-actin smooth muscle.

Association of endothelial nitric oxide synthase gene G894T polymorphism and serum nitric oxide levels in patients with preeclampsia and gestational hypertension.

OBJECTIVE: Pregnancy-induced hypertension is one of the most important cause of maternal-fetal morbidity and mortality. Pregnancy-related hypertensive disorders are usually associated with diminished nitric oxide (NO) levels. We aimed to evaluate the role of serum NO levels and eNOS gene G894T polymorphism on hypertensive disorders of pregnancy. METHODS: Eighty patients with gestational hypertension or preeclampsia, and 80 healthy pregnants were enrolled to analyze serum NO levels and G894T polymorphism of the eNOS gene. NO level was analyzed by high-performance liquid chromatography (HPLC) method. The G894T polymorphism of the eNOS gene was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS: There was no significant difference between groups in terms of G894T/eNOS genotype and allele frequencies (p > 0.05). Serum NO levels were significantly lower in the patients group. In the control group, subjects with thymine-thymine (TT) genotype had significantly lower NO levels when compared to subjects with guanine-guanine (GG) or guanine-thymine (GT) genotype (p < 0.05). CONCLUSIONS: We failed to demonstrate an association between eNOS gene G894T polymorphism and serum NO levels in patients with pregnancy-induced hypertensive disorders. We established a relation between pregnancy-induced hypertension and low NO levels.

Effects of Potentilla fulgens as a Prophylactic Agent for Ischemia/Reperfusion Injury in the Rat Ovary.

OBJECTIVE: To investigate the effects of Potentilla fulgens as a prophylactic agent on ischemia/reperfusion (I/R) injury in the rat ovary. STUDY DESIGN: A total of 32 Wistar rats were divided into 4 equal groups: (I) sham, (II) ischemia, (III) ischemia + reperfusion, and (IV) IR + Potentilla fulgens. In groups I and II, ovary torsion was not performed and no drug was administered. In group III, 1 hour of ischemia and 2 hours of reperfusion were performed and no drug was given. Group IV received 400 mg/kg/day Potentilla fulgens intraperitoneally 5 days before I/R injury. RESULTS: The detorsion group showed preantral ovarian follicles and corpus luteum around the blood vessels and positive expression of vascular endothelial growth factor (VEGF). In the Potentilla fulgens group (IV) the stromal vascular endothelium with weak expression of VEGF was detected in small areas, and the ovarian follicles and the corpus luteum showed negative expression of VEGF. In the detorsion group the theca cells and apoptotic cells in preantral follicles showed positive expression of E-cadherin in the ovarian surface epithelium. Moreover, the E-cadherin expression was found to be positive in terms of follicular development, theca cells, granulosa cells, and corpus luteum. Potentilla fulgens, given after ischemic injury and apoptosis, was seen to decrease the effect of Bcl-2 expression. CONCLUSION: These results provide compelling evidence that the expression of E-cadherin in the ovary is an important component of ovarian function.

Ramadan fasting and pregnancy: implications for fetal development in summer season.

AIMS: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women. METHODS: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July-7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan. RESULTS: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05). CONCLUSION: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.

Comparison of hysterosalpingography and transvaginal hydrolaparoscopy in patients with tubal factor infertility: a prospective cohort study.

AIM: To evaluate the usefulness, diagnostic accuracy, and cost-effectiveness of transvaginal hydrolaparoscopy (THL) in infertile women with abnormal hysterosalpingogram (HSG) results without obvious pelvic pathology. MATERIAL AND METHODS: THIRTY INFERTILE WOMEN (AGE: 20-40 years) who had tubal pathology in HSG were enrolled in the study. All patients underwent THL instead of standard laparoscopy. A cost analysis was performed comparing HSG and THL methods. RESULTS: In comparison of the HSG of cases by considering the chromopertubation results by THL, the sensitivity and specificity of HSG were 85.1% and 56%, respectively. The reasons for preferring standard laparoscopy rather than THL were: failure in accessing of Douglas (n = 3), insufficient monitoring of pelvis (n = 1), hydrosalpinx (n = 1), and intense peritubal adhesion (n = 1), which were 10%, 3%, 3%, and 3%, respectively. The complication rate was 3.8%. Cost analysis of the procedures showed that the total cost of the THL group was 34.8% lower than the HSG group. CONCLUSIONS: In the elective patients group, THL is more feasible than HSG. Transvaginal hydrolaparoscopy is effective, simple and safe, avoiding the cost, possible complications, time and postoperative patient discomfort compared to conventional laparoscopy.

Emergency cervical cerclage: effect on pregnancy outcome and mode of delivery.

AIM: To evaluate the effectiveness of emergency cervical cerclage (ECC) and its effect on the mode of delivery. PATIENTS AND METHODS: Between April 2007 and July 2011 patients attending MH Diyarbakir Obstetrics and Gynecology Hospital and MH Seferihisar State Necat Hepkon Hospital who underwent ECC were included in this retrospective analysis. RESULTS: At the time of ECC, the mean gestational age, cervical length and cervical dilatation were 21.4 ± 2.2 weeks, 4.3 ± 0.8 cm and 11 ± 2.4 mm, respectively. The average time between the procedure and birth was 13.8 ± 4.9 weeks and this period was sufficient to maintain a viable pregnancy (p < 0.05). In this study, 12 patients (60%) were delivered vaginally and eight (40%) patients delivered with CS (40%). the difference was statistically insignificant (p = 0.371). Regarding the gestational age at time of delivery, 55% of patients delivered at 36 weeks, 70% at 32 weeks, and 80% of them delivered at 28 weeks. The total live birth rate was 90%. CONCLUSION: ECC provides satisfactory time for the fetus to gain sufficient viability. Pregnancies with emergency cerclage show no difference in terms of birth method, whether cesarean or vaginal birth, and delivery type does not appears to be linked to ECC.

Treatment of Vaginal Cuff Prolapses with Posterior Intravaginal Sling and Evaluation of Efficiency with International Consultation on Incontinence Questionnaire-Vaginal Symptoms Method in the Long Term: Preliminary Results.

OBJECTIVES: The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long-term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse. METHODS: PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence Questionnaire-Vaginal Symptoms before and after operation. RESULTS: The average follow-up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively). CONCLUSION: PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly.