Comparative cosmetic outcome of surgical incisions created by the PEAK Plasma Blade and a scalpel after cesarean section by Patient and Observer Assessment Scale (POSAS): A randomized double blind study.

OBJECTIVE: To compare the cosmetic result of the PEAK Plasma Blade with traditional scalpel in patients who had primary cesarean delivery by using POSAS (Patient and Observer Assessment Scale). MATERIAL AND METHODS: Fourty women between 20 and 40 years, who were planning to have primary cesarean delivery, were randomized for skin incision with PEAK Plasma Blade (n:20) and with scalpel (n:20) were blinded to their group allocation. At six months, the cosmetic outcome of the cesarean scar was assessed using the POSAS. Subjective scar rating was performed using the patient component of the POSAS. Objective scar assessment was performed by an observer dermatologist blinded to the patient's group allocation. RESULTS: The observer scores (p = 0,003), patient scores (p = 0,001) and the total scores (p = 0,001) of the POSAS scale were significantly lower in favor of the Peak Plasma Blade group with respect to the scalpel group. CONCLUSION: The PEAK Plasma Blade has superior cosmetic outcome compared to traditional scalpel skin incision at cesarean section.

Association between Metabolic Syndrome and Serum Nerve Growth Factor Levels in Women with Overactive Bladder.

OBJECTIVE: This study aimed to determine the association between overactive bladder (OAB), metabolic syndrome (MetS) and serum nerve growth factors (NGF). STUDY DESIGN: Serum samples from a group of 90 women that included patients with OAB (group 1), patients with both OAB and MetS (group 2) and healthy women without OAB and MetS (group 3). Each group included 30 patients. Serum levels of NGF were compared among the groups. RESULTS: When the groups were compared with respect to NGF levels, group 2 was found to have significantly higher NGF levels (p = 0.001). A NGF threshold of >380 ng/mL had a sensitivity of 81.7% and a specificity of 100% to discriminate between groups 2 and 3. CONCLUSION: Our findings support the theory that possible sympathetic overactivity, proinflammatory status, oxidative stress and other pathological conditions associated with MetS and potentially involved in the development of OAB lead to increased serum NGF levels. These findings may help to shed light on the complicated pathogenesis of OAB.

Hormonal effect on the relationship between migraine and female sexual dysfunction.

It is not a well-established finding in migraine that female sexual dysfunction (FSD) emerging as a natural course of disease, as a result of accompanying depression/anxiety, or an underlying endocrinological abnormality. Our aim is evaluating the relationship among frequency and severity of migraine, FSD, depression, anxiety, and related hormones in migrainous women. We examined 80 migrainous female and 62 controls cross sectionally. Beck Depression and Anxiety Inventories, Female Sexual Dysfunction Inventory, Migraine Disability Assessment Test, and hormonal analysis were done. Independent risk factors were identified by logistic regression analysis and cut-off values were measured with Receiver Operating Curve. FSD was not related to frequency or severity of migraine. Although depression and anxiety was related to arousal and lubrication, they had limited effect in FSD. There were correlations between prolactin (PRL), desire and lubrication, follicular-stimulating hormone FSH and orgasm, luteinizing hormone (LH), and pain. Also FSH-LH combination and PRL were found as independent factors for FSD. FSH-LH combination and PRL were found as independent factors which had effect on FSD in migraine. Our study is a precursor study about the effect of several hormones on FSD and migraine relationship. Hormonal effect on FSD in migraine will be clearer with future studies.

A comparison of normal and high post-void residual urine and urodynamic parameters in women with overactive bladder.

OBJECTIVE: To investigate voiding functions and assess the relationships of voiding parameters to overactive bladder symptoms and postvoiding residue volumes. MATERIALS AND METHODS: This is a retrospective study analyzing urodynamic parameters in patients who were diagnosed as having overactive in our urogynecology clinic between April 2014 and April 2016. A total of 290 women who met the selection criteria were included in the study. The patients were divided into two groups according to postvoiding residue volumes: group 1, postvoiding residue volumes <100 mL (n=135); group 2, postvoiding residue volumes ≥100 mL (n=155). RESULTS: A total of 290 women were included in the study; the mean age was 71.4 years. A total of 158 (54.5%) patients had detrusor over-activity during urodynamic testing. The mean maximum bladder capacity in elevated group 2 (postvoiding residue volumes ≥100 mL) was significantly higher than in group 1 (postvoiding residue volumes <100 mL) (p<0.01). Additionally, there was a significant difference between detrusor pressure at Qmax in both study groups (p<0.05). There were no significant differences in the first-sensation volume between the normal and elevated postvoiding residue volumes groups. CONCLUSION: In conclusion, patients with overactive with elevated postvoiding residue volumes showed increased maximum bladder capacity, but detrusor over-activity was not more prevalent in these women compared with women with normal postvoiding residue volumes.

Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study.

PURPOSE: Prevention of postpartum haemorrhage (PPH) is essential in the pursuit of improved health care for women. Oxytocin, the most commonly used uterotonic agent to prevent PPH, has no established the route of administration. In this study we aimed to compare whether the mode of oxytocin administration, i.e., intravenous and intramuscular administration, has an effect on the potential benefits and side effects. MATERIALS AND METHODS: A total of 256 women were randomised into two groups: intramuscular group (128) or intravenous group (128). RESULTS: Estimated blood loss during the third stage of labour was similar between the two groups (p = 0.572). Further there were no statistically significant difference was noted between the two groups in terms of the mean duration of labor, duration of the third stage of labor, manual removal of the placenta, need for instrumental delivery, need for blood transfusion, PPH ≥500 mL, PPH ≥1000 mL, or length of hospital stay. CONCLUSION: Using oxytocin by intravenous and intramuscular route has a similar efficacy and adverse effects.

Ischemia-modified albumin as an oxidative stress biomarker in early pregnancy loss.

BACKGROUND/AIMS: This study aimed to determine the association between early pregnancy loss and serum ischemia-modified albumin (IMA) concentrations. METHODS: Serum samples of 180 women that included healthy pregnant women, women admitted for termination of pregnancy due to the absence of fetal cardiac activity or absence of fetal pole on ultrasonographic examination, and healthy non-pregnant women attending for gynecological examination. Each group included 60 patients. Serum concentrations of IMA were compared among the groups, and the correlations with patients' age, gravidity, BMI, gestational age and total serum albumin concentrations were calculated. RESULTS: When the groups were compared with respect to IMA concentrations, the group with early pregnancy loss was found to have significantly higher IMA concentrations (p < 0.001). An IMA threshold of >163 ng/mL had a sensitivity of 75%, specificity of 55% to discriminate between healthy pregnant patients and patients with early pregnancy loss in first trimester. CONCLUSION: Our findings support the theory that possible oxidative stress, a more hypoxic environment and defective placentation lead to increased serum IMA concentrations. These findings may help to shed light on the complicated pathogenesis of early pregnancy loss.

Ischemia-Modified Albumin (IMA): A Novel Marker for Preeclampsia Independent of Uterine Artery Notching Identified by Doppler Ultrasound.

OBJECTIVE: To determine the predictive value of second trimester serum ischemia-modified albumin (IMA) levels for preeclampsia (PE), small for gestational age (SGA) and gestational diabetes mellitus (GDM). METHODS: The study was conducted at a tertiary care hospital between May and August 2014. Healthy pregnant women (n = 88) who were screened for fetal anomalies with ultrasound at 20-24 weeks of gestation were included in the study. Doppler measurements of the bilateral uterine arteries were performed in all the patients. Serum samples were obtained for an IMA assay. The maternal serum IMA levels were compared in pregnant women who had normal and abnormal uterine artery Doppler findings, including notching, and also in pregnant women who subsequently developed PE, SGA, and GDM during the follow-up period. RESULTS: Uterine artery notching was not significantly predictive for PE, GDM or SGA (p > 0.05). There was no significant difference between notching of the uterine arteries and serum IMA levels (p > 0.05). Eight pregnant women (9.1%) subsequently developed PE. Serum IMA levels were significantly elevated in patients with PE compared with patients who did not subsequently develop PE (p = 0.002). However, serum IMA levels were not significantly different in patients who subsequently developed SGA and GDM compared with women who did not (p > 0.05). There was no correlation between serum IMA levels and maternal characteristics and laboratory findings. CONCLUSION: Maternal serum IMA levels at 20-24 weeks' gestation might be a predictive biomarker for PE, independent of notching of the uterine arteries, maternal characteristics and laboratory findings.

Plasma serotonin levels are elevated in pregnant women with hyperemesis gravidarum.

PURPOSE: This study aimed to determine the association between serotonin and hyperemesis gravidarum. MATERIALS AND METHODS: Plasma samples of 87 women in their first trimester pregnancies with HG (n = 28), morning sickness of pregnancy (n = 30) and control (n = 29) groups were obtained. Plasma levels of serotonin were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated. RESULTS: When the groups were compared with respect to serotonin levels, the group with hyperemesis gravidarum was found to have significantly higher serotonin levels (p = 0.001). A significant positive correlation was found between the serotonin level and the PUQE score in all study subjects (r = 0.578, p = 0.0001). A serotonin threshold of >277.58 ng/mL had a sensitivity of 75%, specificity of 86.4%, positive predictive value of 72.4%, negative predictive value of 87.9%, and a likelihood ratio of 5.53 (p = 0.0001). CONCLUSIONS: Our findings support the possible role of serotonin in the pathogenesis of hyperemesis gravidarum.

Comparison of serum anti-Müllerian hormone levels in normal weight and overweight-obese adolescent patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate serum concentration of anti-Müllerian hormone (AMH) in adolescent patients with polycystic ovary syndrome (PCOS) with respect to body mass index (BMI), and to investigate the relationship with clinical, metabolic and hormonal parameters. STUDY DESIGN: Fifty-eight adolescent girls (29 normal weight and 29 overweight-obese) diagnosed with PCOS and 28 apparently healthy girls (controls) were enrolled in the study. BMI was calculated in all cases. Serum AMH, hormonal and metabolic parameters were compared between patients with PCOS (normal weight and overweight-obese) and controls. RESULTS: Serum AMH did not differ between patients with PCOS and controls (p=0.283), and no correlation was found between BMI and AMH. A significant positive correlation was found between 2-h plasma glucose on 75-g oral glucose tolerance test and AMH (R=0.364, p=0.005). HOMA-IR index and insulin were significantly higher in overweight-obese patients with PCOS than in controls, but no significant difference was found between controls and normal-weight patients with PCOS. CONCLUSIONS: AMH was not found to be a reliable predictor for the presence of PCOS, and serum AMH did not differ between obese and non-obese adolescent patients with PCOS.

Role of subcutaneous closure in preventing wound complications after cesarean delivery with Pfannenstiel incision: a randomized clinical trial.

AIM: The aim of this study was to evaluate the role of suture closure of the subcutaneous tissue in preventing wound complications after cesarean section with a Pfannenstiel incision, and to investigate factors associated with wound complications. MATERIAL AND METHODS: Patients undergoing cesarean delivery were randomly assigned to either suture closure or non-closure of the subcutaneous tissue. The participants were invited to two follow-up examinations at the 1st and 4th postoperative weeks for the detection of wound complications. The two main outcomes were composite wound complication and superficial wound separation. Factors associated with wound complications were analyzed using multiple logistic regression. RESULTS: During the study period, a total of 361 patients (176 in the closure group, 185 in non-closure group) were analyzed. Composite wound complication occurred in 23.3% (41/176) of the closure group, and in 20% (37/185) of the non-closure group with no significant difference (P = 0.44). Wound separation occurred in 2.3% (4/176) of the closure group and 1.6% (3/185) of the non-closure group without any significant differences (P = 0.64). None of the factors were found to be associated with the rate of composite complication. The significant factors found to be associated with wound separation were subcutaneous tissue thickness of 4 cm or more (P = 0.01) and maternal diabetes mellitus (P = 0.01), however they lost their significance in multivariate analyses. CONCLUSION: The rate of wound complications, including superficial wound separation, did not differ according to the subcutaneous closure in cesarean delivery with Pfannenstiel incision. It is not possible to predict wound complications using previously defined clinical and operative risk factors, including subcutaneous tissue thickness.

Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding?

AIM: To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). METHODS: Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. RESULTS: Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. CONCLUSION: There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.

Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial.

PURPOSE: Almost 50% of the patients experience moderate-to-severe pain during endometrial biopsy. The study aimed to examine the effectiveness of intrauterine lidocaine for relieving pain during endometrial biopsy. METHODS: A randomised trial was conducted in 120 patients undergoing endometrial biopsy. Sixty-seven women were assigned to the paracervical block group and 53 were assigned to the intrauterine lidocaine group. The main outcome measure was pain intensity, measured using the visual analogue scale, during and after the procedure. RESULTS: The groups were similar with regard to age, body mass index, gravidity, total number of previous vaginal deliveries, menopausal status, and uterine depth. The pain scores immediately after the procedure were similar in the groups (p = 0.079). However, the pain scores 30 min after the procedure were significantly lower in the intrauterine group than in the paracervical group (p = 0.0001). CONCLUSIONS: Compared to paracervical block, intrauterine lidocaine may be the preferred anaesthesia for endometrial biopsy, and it does not cause any serious complications.

Relation of Preoperative Thrombocytosis between Tumor Stage and Grade in Patients with Endometrial Cancer.

OBJECTIVE: We aimed to evaluate the predictive value of preoperative thrombocytosis for postoperative tumor stage and tumor grade in patients with endometrial cancer. MATERIALS AND METHODS: This was a retrospective study carried out in our gynecologic oncology department between January 2000 and December 2011. We reviewed the medical charts of 190 patients diagnosed with endometrial carcinoma and underwent complete staging procedure. The clinicopathologic characteristics of the patients such as; age, gravidity, parity, menopausal status, body mass index, co-morbidities (diabetes, hypertension etc.), stage, grade, histological subtype, depth of myometrial invasion, peritoneal washing cytology and preoperative platelet count were recorded. Endometrioid adenocarcinomas were graded according to the FIGO classification. Blood samples for the measurement of platelet count were obtained 3 days prior to the surgery. Thrombocytosis was defined as a platelet count of 300×10(9)/L. P values less than 0.05 derived from two-tailed tests were considered statistically significant. RESULTS: The mean age of the study population was 55.4 (range 33-80) years. The mean gravidity was 3.8 (range 0-12) and the mean parity was 3.32 (range 0-11). 108 (56,8%) patients were with body mass index of >30 kg/m(2). The mean platelet count among women was 288, 6±90.7×10(9)/L (range 105-772×10(9)/L). The majority of the patients were with early stage diseases during the surgeries. 170 (89.5%) of the patients had stage I to II disease, and 20 (10.5%) of them had stage III to IV disease. There were no statistical significance between thrombocytosis and age, gravidity, parity, BMI, cancer grade and stage, histological subtype of the tumor, depth of invasion, cervical involvement, intrauterine tumor volume and peritoneal washing cytology. CONCLUSION: We found that preoperative platelet count was not correlated with the stage or grade of endometrial cancer.

Placental growth factor as a new marker for predicting abnormal glucose challenge test results.

BACKGROUND: To differentiate placental growth factor (PlGF) levels in pregnancies with normal and abnormal glucose challenge test (GCT) results. METHODS: A total of 94 pregnant women underwent a 50 -g GCT as part of our routine antenatal screening protocol from September 2011 to January 2012. The patients were divided into three groups: (i) normal GCT, (ii) abnormal GCT and (iii) gestational diabetes mellitus (GDM) based on the screening results for gestational diabetes. The main outcome measure of the study was the relationship between PlGF and GCT results in non-diabetic pregnancies. The Kolmogorov-Smirnov test was used to check the normality of the variables' distributions. The Kruskal-Wallis and analysis of variance tests (Tukey's test) were used to analyze the qualitative parameters. RESULTS: There were 53 (56.4%), 22 (23.4%) and 19 (20.2%) patients in the normal GCT, abnormal GCT and GDM groups, respectively. The PlGF level in the abnormal GCT group was 518 ± 307.6 pg/mL, which was the highest level in the study population, and there was a statistically significant difference compared with the other groups (p = 0.006). There were no statistically significant differences with respect to fetal birth weight among the three groups in our study. CONCLUSION: PlGF can be used as a laboratory marker to predict which patients will have abnormal GCT results.

Vaginal foreign body: Successful management with vaginoscopy.

The etiology of chronic vaginal discharge in children varies and can be seen as infection, sexual abuse, congenital malformations, vulvar skin disease, vaginal neoplasms and a foreign body. A vaginal foreign body is not a common problem in childhood but it should always be considered when a little girl consults a physician with a chronic vaginal discharge problem. We present the diagnosis and treatment management via vaginoscopy applied to a 6 year old girl who complained of a foul smelling vaginal discharge that had been resistant to medical treatment for the last two years.

Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism.

We present two cases of fetal hypothyroidism with goiter which were successfully diagnosed and treated in utero. In both cases, ultrasonographic examination demonstrated a bilobed solid anterior neck mass with increased vascularity compatible with enlarged thyroid gland. Fetal blood sampling revealed hypothyroidism. Intra-amniotic injection of L-thyroxin caused a reduction in thyroid gland size and enabled vaginal delivery without complication. In the first case, maternal thyroid hormone levels and autoantibodies were normal and the neonate had hypothyroidism suggesting the diagnosis of dyshormonogenesis. In the second case, the fetus had transient hypothyroidism, which resolved spontaneously after delivery. Maternal thyroid function tests and autoantibodies were normal and both the mother and neonate had normal urinary iodine, excluding the diagnosis of iodine deficiency or excess. Thus, we believe that transplacental transfer of undetermined factors might be a cause of transient congenital hypothyroidism. Also, we reviewed the literature and described controversial issues regarding the management of fetal goiter.

Prenatal diagnosis of abnormal course of umbilical vein and ductus venosus agenesis: report of three cases.

Ductus venosus connecting the portal and embryonic venous circulation into the inferior vena cava has a crucial role in fetal circulation. The absence of ductus venosus is a rare anomaly, in which the umbilical vein connection to the venous system may be extrahepatic, bypassing the liver or intrahepatic via the portal venous system. We report three cases of ductus venosus agenesis with associated anomalies. In two of them the connection was directly to the right atrium, whereas the umbilical vein drained to the left internal iliac artery in the third case.

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre.

OBJECTIVE: We reviewed the data of the termination of pregnancy (TOP) cases between 2002 and 2010 to evaluate the changes in fetal indications for both early and late TOPs in this period. MATERIAL AND METHODS: The data of 962 TOP cases were analysed in two groups according to the periods as in 2002-2006 and 2007-2010. The women were also subdivided into two categories according to their gestational age; <23 weeks' gestation (early termination) and ≥23 weeks' gestation (late termination). RESULTS: Four hundred and fifty-eight (47.6%) of TOPs were performed between 2002 and 2006 (Group 1) and 504 (52.3%) were performed between 2007 and 2010 (Group 2). The number of early (<23 weeks) and late (≥23 weeks) terminations were 583 (60.6%) and 379 (39.3%), respectively. The vast majority of anomalies were central nervous sytem malformations (51.8%). They were followed by multiple anomalies (10.2%) and chromosomal anomalies (9.4%). Chromosomal and cardiovascular system anomalies were significantly higher in 2007-2010 in comparison to 2002-2006 (p<0.0001 and p=0.002, respectively). There was no statistically significant difference between the fetal indications that led to early termination compared to those that led to late termination. CONCLUSION: The distribution of indications for TOP was influenced by the development in prenatal screening policy, resulting in a significant increase in terminations due to chromosomal and cardiovascular system anomalies. Cultural, educational, religious and legal factors cause differences in the indications for TOP as well as the gestational age that TOPS are performed.

Aortopulmonary septal defect with interrupted aortic arch in a monochorionic diamniotic twin pregnancy.

We report a monochorionic diamniotic twin pregnancy with prenatal diagnosis of aortopulmonary septal defect combined with type B interrupted aortic arch in one of the fetuses. The mother was referred for fetal echocardiography at 24 weeks' gestation due to suspected congenital heart disease. Prenatal echocardiography revealed a defect of 2.8 mm between the main pulmonary artery and the ascending aorta. The course of the ascending aorta was straight to the neck and head, and there was no continuity of the aortic arch after the origin of innominate and left common carotid arteries. Thus, aortopulmonary septal defect with type B interrupted aortic arch was suspected. Postnatal echocardiography confirmed the diagnosis, and surgical repair was performed on the 10th day after birth. The combination of aortopulmonary septal defect with type B interrupted aortic arch is a very rare condition that can be diagnosed by fetal echocardiographic examination in the second trimester of gestation. Prenatal diagnosis is important for the prognosis, since early surgical intervention is needed to prevent development of severe heart failure in the neonate.