The efficiency of different irrigation solutions and techniques for the removal of triple antibiotic paste from simulated immature root canals.

INTRODUCTION: The purpose of this study was to evaluate the efficiencies of different irrigation protocols in the removal of triple antibiotic paste (TAP) from root canals. MATERIALS AND METHODS: A total of 127 extracted human maxillary incisor teeth were prepared. Then, root-end resection of 3 mm was accomplished to simulate immature apex model. The root canals were filled with TAP, after 21 days, randomly divided into nine groups according to irrigation systems and solutions (n = 13). Conventional irrigation (CI) groups - Group 1: Root canal irrigation was performed with CI by Peracetic acid (PAA) solution, Group 2: Root canal irrigation was performed with CI by etidronic acid 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) + sodium hypochlorite (NaOCl) solution, Group 3: Root canal irrigation was performed with CI by ethylenediaminetetraacetic acid (EDTA)/NaOCl solutions. Vibringe system groups - Group 4: Root canal irrigation was performed with Vibringe system by PAA solution, Group 5: Root canal irrigation was performed with Vibringe system by HEBP + NaOCl solution, Group 6: Root canal irrigation was performed with Vibringe system by EDTA/NaOCl solution. EndoVac system groups - Group 7: Root canal irrigation was performed with EndoVac system by PAA solution, Group 8: Root canal irrigation was performed with EndoVac system by HEBP + NaOCl solution, Group 9: Root canal irrigation was performed with EndoVac system by EDTA/NaOCl solution. Control Group: (n = 0). Samples were sectioned vertically, and the amount of remaining medicament was scored for each root half and data were statistically analyzed. RESULTS: Among the irrigation systems, CI groups showed the highest scores at both apical and coronal parts (P < 0.05). In comparisons among the solutions, at the apical part, PAA groups showed the highest scores (P < 0.05). At the coronal part, EDTA + NaOCl groups showed the lowest score values (P < 0.05). CONCLUSION: The use of irrigation systems improved the removal of TAP from the simulated immature root canals. Also, as an irrigation solution EDTA gives more promising results than PAA and HEBP solutions.

Evaluation of fracture resistance in root canal-treated teeth restored using different techniques.

OBJECTIVE: This study aimed to evaluate the effects of different coronal restoration techniques on fracture resistance of root canal-treated mandibular premolars with mesio-occluso-distal (MOD) cavities. MATERIALS AND METHODS: A total of 105 mandibular premolars were selected and randomly distributed into seven groups (n = 15). MOD cavities were prepared except the control group. Root canal treatments were performed. Each tooth was embedded in acrylic resin. Groups were classified as follows; G1: intact teeth (control), G2: unfilled MOD cavity, G3: MOD + composite resin, G4: 10-mm-long fiber post + composite resin, G5: 5-mm-long fiber post + composite resin, G6: Ribbond in the occlusal surface + composite resin, and G7: horizontal fiber post + composite resin. Specimens were loaded using a universal testing machine until fracture occurs. Fracture loads were recorded and statistical interpretations were made (α = 0.05). RESULTS: In Groups 1, 6, and 7, the greatest fracture resistance was shown and there were no significant differences among these groups (P > 0.05). No significant differences were detected among the Groups 3, 4, and 5 (P > 0.05), whereas the fracture resistances of Groups 1, 6, and 7 were significantly greater than these three groups (P < 0.05). Group 2 had the lowest fracture resistance of all groups (P < 0.05). CONCLUSION: Usage of horizontal post or occlusal Ribbond usage increased the fracture resistance of root canal-treated premolars with MOD cavities.

Effect of chitosan on sealer penetration into the dentinal tubules.

OBJECTIVE: The objective of this study is to compare the effectiveness of final irrigation with chitosan, ethylenediaminetetraacetic acid (EDTA), and citric acid (CA) on a resin-based sealer (AH plus sealer [Dentsply DeTrey, Konstanz, Germany]) penetration into dentinal tubules using confocal laser scanning microscopy. MATERIALS AND METHODS: Seventy recently extracted human mandibular premolars were instrumented and irrigated with sodium hypochlorite (NaOCl), then divided into four groups according to the final irrigation regimen used: (1) the EDTA group: 17% EDTA + 2.5% NaOCl, (2) the CA group: 10% CA + 2.5% NaOCl, (3) the chitosan group: 0.2% chitosan + 2.5% NaOCl, and (4) the control group: 2.5% NaOCl. All teeth were obturated using the cold lateral condensation technique with gutta-percha and AH Plus sealer labeled with fluorescent dye. The apical 2 mm of specimen was discarded, and slices were obtained for apical, middle, and coronal thirds of the root with 1 mm intervals. Maximum, mean, and percentage of sealer penetration (SP) inside tubules were measured using confocal laser scanning microscopy. RESULTS: The percentage of SP was significantly higher in chitosan, EDTA, and CA group than control group for coronal thirds (P < 0.05), whereas there was no significant difference among all groups for middle and apical thirds. Chitosan and EDTA showed increased mean values of SP depth for middle thirds (P < 0.05). In all sections, the maximum depth of SP was significantly lower in EDTA group than other groups (P < 0.05). CONCLUSIONS: Chitosan, EDTA, and CA significantly improved the percentage of SP for coronal thirds.

Efficacy of manual and mechanical instrumentation techniques for removal of overextended root canal filling material.

OBJECTIVE: To compare the efficacy of manual and mechanical instrumentation techniques, including ProTaper Universal retreatment system, Mtwo retreatment system, Reciproc system, and Hedström files, regarding removal of overextended root canal filling material. MATERIALS AND METHODS: Eighty extracted human mandibular premolar teeth were prepared at the apical foramen level using Revo-S rotary files and subsequently obturated. The root canal filling material was deliberately extruded from the apex. Samples were transferred to glass vials that simulated the periapical area. Eighty samples of overfilled teeth were randomly assigned to four equal groups (n = 20) for removal of the root filling material with ProTaper Universal retreatment files (Group 1), Mtwo retreatment files (Group 2), Reciproc system (Group 3), and hand files (Group 4). Removal of the root canal filling material and additional preparation were performed by individual instruments from each different system up to a #40 size. The external apical surface of the teeth and the surrounding glass vials were checked using a dental operation microscope with ×12.5 magnification. Samples were divided into two groups based on whether removal of the overextended root canal filling material was successful or not. The Fisher's exact test was used to detect any significant difference between the groups (α = 0.05). RESULTS: The success rate for removal of overextended gutta-percha was greater for the Mtwo (30%) and hand files (30%) compared with the ProTaper (20%) and Reciproc (10%). However, no significant statistical differences existed among the experimental groups (P > 0.05). CONCLUSIONS: This study demonstrated that all tested systems had similar efficacy in removing overextended root canal filling material.

Evaluation of calcium silicate cement bond strength after using gutta-percha solvents.

OBJECTIVES: To determine the effect of different gutta-percha solvents (chloroform, Endosolv E, orange oil, and eucalyptol) on the push-out bond strength of calcium silicate cements (CSCs; white mineral trioxide aggregate [WMTA]; capsule-form mineral trioxide aggregate [CMTA], and Biodentine). MATERIALS AND METHODS: One hundred and fifty extracted single-rooted human mandibular premolars were sectioned into 3-mm-thick slices. The canal lumens were enlarged for 1.35-mm-diameter standardized cavities. The samples were randomly divided into five groups (n = 30) according to the solvent type: G1, chloroform; G2, Endosolv E; G3, eucalyptol; G4, orange oil; G5, no solvent (control). After application of the solvents for 5 min, the specimens were divided into three subgroups (n = 10): (i) WMTA, (ii) CMTA, and (iii) Biodentine. The push-out bond strength was measured. Two-way ANOVA analysis of variance and post hoc Tukey tests were used for analyses (P = 0.05). RESULTS: The highest push-out bond strength was observed in the Biodentine (P < 0.05), and the values of WMTA and CMTA were not significantly different in all solvent groups (P > 0.05). There were no statistically significant differences among the gutta-percha solvents and control group in WMTA (P > 0.05). CONCLUSIONS: Gutta-percha solvents used during retreatment decreased the bond strength of Biodentine and CMTA to root dentin. The bond strength of WMTA was not affected by the use of gutta-percha solvents.

Effect of coronal flaring on apical extrusion of debris during root canal instrumentation using single-file systems.

AIM: To evaluate the effect of coronal flaring on the amount of debris extruded apically during root canal preparation using the Reciproc, WaveOne (WO) and OneShape (OS) single-file systems. METHODOLOGY: Ninety extracted single-rooted mandibular incisor teeth were randomly assigned to six groups (n = 15 for each group) for canal instrumentation. Endodontic access cavities were prepared in each tooth. In three of the six groups, coronal flaring was not performed; coronal flaring was performed with Gates-Glidden drills on all teeth in the remaining three groups. The canals were then instrumented with one or other of the following single-file instrument systems: Reciproc, WO and OS. Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. Data were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests (P = 0.05). RESULTS: Reciproc and WO files without coronal flaring produced significantly more debris compared with the other groups (P < 0.05). There was no significant difference in apical extrusion of debris amongst the other groups (P > 0.05). CONCLUSIONS: All single-file systems caused apical extrusion of debris. Performing coronal flaring prior to canal preparation reduced the amount of apically extruded debris when using Reciproc or WO systems.

N terminal-pro brain natriuretic peptide in fetal umbilical cord meconium-stained amniotic fluid: a prospective case control study.

PURPOSE OF INVESTIGATION: To evaluate the value of N terminal-pro brain natriuretic peptide (NTpBNP) levels in fetuses with meconiumtained amniotic fluid (MSAF). MATERIALS AND METHODS: In this case control study, of 36 fetuses, 19 had MSAF and 17 had normal, as controls. The blood samples were taken from the fetal umbilical cord just after birth to measure NTpBNP levels. RESULTS: Mean NTpBNP values were 1.01 ± 0.49 ng/ml in the patient group and 1.70 ± 0.93 ng/ml in the control group. The difference between the groups was statistically significant (p = 0.01) and power was 78% at 95% confidence interval. CONCLUSION: Serum NTpBNP levels were decreased in the study group. The result suggests that NTpBNP may be a valuable marker for fetuses with MSAF.

The effects of different irrigation protocols on removing calcium hydroxide from the root canals.

OBJECTIVE: The aim of this study was to evaluate the efficiencies of different irrigation protocols and solutions in the removal of calcium hydroxide (Ca[OH]2). MATERIALS AND METHODS: Sixty-eight maxillary incisors were used. Root canals were prepared and filled with Ca(OH)2. Two control (n = 4) and six experimental groups (n = 10) were adjusted: Group 1:1% peracetic acid (PAA) + master apical file (MAF); Group 2: 17% ethylenediaminetetraacetic acid (EDTA) + MAF; Group 3: 9% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) + MAF; Group 4: 1% PAA + ultrasonic activation (UA); Group 5: 17% EDTA + UA; Group 6: 9% HEBP + UA. The cleanliness of root canal thirds were evaluated with scanning electron microscopy. Statistical analysis were performed (α = 0.05). RESULTS: At coronal thirds; PAA + UA was superior to EDTA + MAF, HEBP + MAF; and PAA + MAF was superior to EDTA + MAF, HEBP + MAF (P < 0.05). At middle thirds; PAA + MAF and PAA + UA were superior to EDTA + MAF and EDTA + UA; and, PAA + UA was superior to HEBP + MAF (P < 0.05). There were no significant differences among the rest of the experimental groups (P > 0.05). CONCLUSION: Complete removal of Ca(OH)2could not be achieved by none of the irrigants at all root thirds.

The effect of reciprocation versus rotational movement on the incidence of root defects during retreatment procedures.

AIM: To compare the incidence of dentinal defects caused by reciprocating and rotary techniques during retreatment procedures. METHODOLOGY: One hundred and twenty extracted mandibular premolars with single canals were selected. Twenty teeth were left unprepared. The root canals in the remaining 100 teeth were prepared with K-files up to size 35 and filled with Gutta-percha and AH Plus sealer using a passive cold lateral compaction technique. Twenty canals were filled and received no further treatment. Eighty teeth were divided into four groups (n = 20 in each) to undergo the removal of the root filling. In groups 1 and 2, the root filling was removed using ProTaper Retreatment files and Reciproc files, respectively, and the canals were not refilled. In groups 3 and 4, the root filling was removed using ProTaper Retreatment files and Reciproc files, respectively, and the canals were then refilled using a conventional cold lateral compaction technique. The roots were sectioned horizontally at 3, 6 and 9 mm from the root apex and observed under a stereomicroscope at 20× magnification. Defects were categorized as no defect, incomplete defect and fracture. The differences between the groups were analysed using the chi-square exact test (P = 0.05). RESULTS: No defects were observed in the unprepared and filled groups, in contrast to the experimental groups. In the coronal thirds, groups 2 and 4 had more dentinal defects than groups 1 and 3 (P < 0.05). In the middle thirds, group 4 had more defects than group 1 (P < 0.05). In the apical thirds, group 2 had fewer defects than did group 3 and group 4. Also, group 3 had more defects than group 1 (P < 0.05). When comparing the experimental groups, there were no significant differences with regard to fracture (P > 0.05). CONCLUSIONS: Both nickel-titanium systems were associated with dentinal defects during retreatment procedures in extracted premolar teeth.

Evaluation of apically extruded debris associated with several Ni-Ti systems.

AIM: To evaluate the apical extrusion of debris associated with several root canal preparation systems in vitro. METHODOLOGY: Forty-five extracted human mandibular premolars with single canals and similar lengths were used. The root canals were instrumented using ProTaper Next (Dentsply Maillefer, Ballaigues, Switzerland), Twisted File (SybronEndo, Orange, CA, USA) or WaveOne (Dentsply Maillefer, Ballaigues, Switzerland). Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70 °C for 5 days. The Eppendorf tubes were weighed to obtain the final weight of the Eppendorf tubes plus extruded debris. Three consecutive weights were obtained for each tube. The groups were compared using the Kruskal-Wallis one-way analysis of variance on Ranks and Tukey's test. RESULTS: The ProTaper Next group produced the highest mean extrusion value whilst WaveOne produced less debris compared with all the other instruments (P > 0.05). There was a significant difference between the ProTaper Next and WaveOne group (P < 0.05). CONCLUSIONS: Apically extruded debris was associated with all instrumentation techniques. The WaveOne system extruded less debris compared with the Twisted File and ProTaper Next.

Low cord blood serum levels of vitamin D: cause or effect of fetal macrosomia?

UNLABELLED: Aim: The aim of the study was to compare cord blood vitamin D levels of macrosomic large for gestational age (LGA) and appropriate gestational age (AGA) newborns. MATERIALS AND METHODS: Seventy-nine healthy, normal term newborns were included in the study. They were divided by birth weight into two groups: 37 in the LGA group above 4,000 g, and 42 newborns in the AGA group birth weight between 3,000 g and 4,000 g. Cord blood samples from groups were collected. Circulating 25(OH)D was measured as 25 hydroxyvitamin D3 (25(OH)D3) by high-performance liquid chromatography (HPLC) in serum using a kit. RESULTS: Maternal characterstics (age, body mass index [BMI], and gestational age) did not differ between the AGA and LGA groups. Cord blood 25 OH vitamin D levels were significantly low in neonates with LGA (p = 0,02). CONCLUSIONS: The authors found that macrosomic infants had low levels of vitamin D. Providing vitamin D supplements to pregnant women may prevent macrosomia. Randomized controlled trials are needed to prove this assertion.

Pregnancy-associated plasma protein a levels are decreased in obstetric cholestasis.

OBJECTIVE: Obstetric cholestasis is a cholestatic disease usually commencing in the third trimester of pregnancy and characterized by pruritus, elevation of liver enzymes, and increase in bile acids. The objective of this study was to compare the first trimester serum indicators of obstetric cholestasis with normal pregnancies. MATERIALS AND METHODS: Thirty-five patients diagnosed with obstetric cholestasis in a three-year period with first trimester biochemical assessment available were included in the study. Seventy patients with concordant pregnancy weeks, matched-age normal pregnancies were included as the control group. Pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) levels were analyzed. RESULTS: No difference was observed between the two groups in terms of age and week of pregnancy. While the mean PAPP-A level was 0.76 ± 0.31 multiples of the medians (MoM) in the obstetric cholestasis group, it was determined to be 1.5 ± 0.84 in the control group (p = 0.0001). Among the two groups, the hCG levels were found to be higher in the obstetric cholestasis group (1.2 ± 0.79 MoM vs. 0.98 ± 0.53, p = 0.041). CONCLUSION: In this study, the first trimester PAPP-A levels in the obstetric cholestasis cases were found to be significantly lower than the control group. Low PAPP-A levels should be a warning for obstetric cholestasis.

First and second trimester biochemical markers in familial mediterranean fever.

OBJECTIVES: Our aim was to investigate whether the maternal serum concentrations of first and second trimester serum analytes are altered in familial Mediterranean fever (FMF) pregnancies. MATERIALS AND METHODS: The screening tests were compared in a series of 16 serum samples from FMF pregnancies and in a cohort of 48 pregnant women with normal pregnancy. Serum samples were obtained between 11 and 13 weeks; 16 and 18 weeks gestation. RESULTS: Serum pregnancy-associated plasma protein-A (PAPP-A) levels, expressed as multiples of the median (0.9 ± 0.45 MoM) in the control group, were significantly higher than FMF patients (0.6 ± 0.3 MoM) (p = 0.027). Analyses of alpha-fetoprotein, human chorionic gonadotropin and oestriol levels showed no significant differences between FMF and normal pregnancies. CONCLUSIONS: Our study revealed that low levels of PAPP-A are associated with FMF.

Vaspin and C-reactive protein levels in hyperemesis gravidarum.

OBJECTIVES: To determine vaspin and C-reactive protein (CRP) concentrations in hyperemesis gravidarum (HEG). MATERIALS AND METHODS: Twenty-six women with HEG and 26 control subjects matched for gestational age and body mass index were examined. The levels of vaspin, CRP and lipid profile in all subjects were measured. RESULTS: The vaspin levels were significantly higher in hyperemetic patients than in the healthy pregnant women (1308.3 ± 116.5 vs. 1145.9 ± 335.1 ng/ml, respectively) (p < 0.05). Women with HEG had significantly higher levels of CRP than the control group. Serum vaspin concentrations inversely correlated with total cholesterol, triglyceride, very low-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol levels. CONCLUSIONS: We found evidence of inflammation in HEG.

The effect of diet on pregnancy outcomes among pregnant with abnormal glucose challenge test.

OBJECTIVES: Gestational diabetes mellitus (GDM) is defined as glucose intolerance, first time detected in pregnancy. Diagnostic criteria for GDM have changed over the decades. The aim of the study was to examine the effect of diet on birth weight, number of large for gestational age (LGA) (birth weight > 90th percentile) babies, total maternal weight gain, gestational age and route of delivery among patients with positive 50 g glucose challenge test (GCT) and negative 100 g oral glucose tolerance test (OGTT). PATIENTS AND METHODS: A prospective randomized controlled study was conducted among patients with positive 50 g GCT and negative 100 g OGTT. A plasma glucose value of 140 mg/dL was used as the threshold to define an abnormal GCT result. In group 1 50 patients were given a caloric diet and compared with group 2 with 50 patients without a given diet. Patients were followed up until delivery and evaluated for birth weight, number of LGA babies, total maternal weight gain, gestational age and route of delivery. RESULTS: There were no significant differences between the groups in maternal age, parity, body mass index and gestational age at delivery. There were significant differences in birth weight, number of LGA babies, total maternal weight gain during pregnancy. The mean gestational age at delivery was 38.7±1.2 weeks in group 1 and 38.9±1.1 weeks in group 2 (p = 0.615). The mean birth weight in group 1 was 3328±399 g and 3623±485 g in group 2 (p = 0.007), cesarean rate was 32% in group 1 and 40% in group 2 (p = 0.405). CONCLUSIONS: In the management of patients with positive 50 g GCT and negative 100 g OGTT, patients who were prescribed medical nutrition therapy by a dietitian experienced in GDM management had better perinatal outcomes.

Clavicular fracture: its incidence and predisposing factors in term uncomplicated pregnancy.

BACKGROUND AND OBJECTIVES: Our aim was to evaluate fetal and maternal predisposing factors associated with clavicular fracture. PATIENTS AND METHODS: In this study we reviewed all term uncomplicated deliveries in our Hospital between January 2009 and April 2010. The diagnosis of clavicular fracture was established by physical examination and in clinically diagnosed patients confirmed by radiology. We compared deliveries with clavicular fracture (study group) with a sample of 150 patients (control group) matched for time at active phase of labor from all vaginal deliveries. The data included maternal age, gestational age, fetal weight, and infant sex, presence of gestational diabetes, labor duration and induction and shoulder dystocia. RESULTS: In the Unit 16819 deliveries occurred during the period. The study included 9700 uncomplicated pregnancies at > or = 37 weeks of gestation delivered vaginally. We identified 73 cases of clavicular fracture with an prevalence of (73/9700) 0.75%. The study group had a significantly higher prevalence of shoulder dystocia (6.8% vs. 0.6%). Logistic regression analysis revealed maternal age and fetal weight as significant risk factors influencing clavicular fractures. CONCLUSIONS: Main risk factors for clavicular fracture identified from our study seem as maternal age and birth weight.  

Effect of solvents on the accuracy of the Mini Root ZX apex locator.

AIM: To evaluate ex vivo, the effects of three solvents on the accuracy of a contemporary electronic root canal length measurement device (ERCLMD), the Mini Root ZX. METHODOLOGY: The actual working length (AWL) of 56 extracted maxillary incisor teeth were measured with an ERCLMD. All root canals were prepared with the ProTaper system to AWL. Of them, 20 were filled with gutta-percha and a resin-based sealer (Group A), 20 with gutta-percha and a zinc oxide/eugenol-based sealer (Group B), and 16 roots were used as the control group (Group C). Removal of the root filling and repreparation processes were performed using the ProTaper system. Guttasolv and Resosolv were used as the solvents in Group A and Guttasolv and Endosolv E in Group B. After the removal of the root fillings had been achieved, the same ERCLMD was used to measure the working length (WL). Differences between AWL and WL measurements were analysed by paired t-test, and the accuracy of ERCLMD was assessed using chi-squared tests. RESULTS: There were significant differences between AWL and WL measurements in subgroups A2 (Resosolv group) and B2 (Endosolv E group). In these subgroups, WL was shorter than AWL (P < 0.05). Also, the accuracy of the Resosolv group was significantly lower than the others (P < 0.05) at a ±0.5 mm margin of error. CONCLUSIONS: Removing root fillings may require use of a solvent. In these cases, ERCLMDs may exhibit a lower accuracy, thus operators must exercise additional care when measuring the working length using ERCLMDs.

Ankaferd blood stopper in episiotomy repair.

BACKGROUND AND OBJECTIVE: Ankaferd blood stopper (ABS) is a new hemostatic agent that is licensed for external hemorrhages. ABS comprises of a standard mixture of Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica which has also been approved in Turkey for the management of bleeding. The authors, aim was to evaluate the efficacy of ABS spray in terms of blood loss during episiotomy repair. MATERIALS AND METHODS: The authors included pregnant women with a term singleton fetus (37-40 wks) in a vertex position, who were at least 18-years-old, had delivered vaginally, and required a mediolateral episiotomy. The patients were randomly assigned to one of the two approaches: 20 (Group 1) to ABS and 20 (Group 2) to isotonic saline solution (0.9% NaCl). The authors applied 4 ml ABS spray solution (1 ml/puff X 4) or isotonic saline solution (0.9% NaCl) (4 ml) topically on a sponge applied on the episiotomy. The sponge was weighed before and after the episiotomy repair to determine the amount of bleeding. Hemoglobin values were also recorded on admission and 12 hours after delivery. RESULTS: Both groups were similar in terms of maternal age, parity, body mass index and gestational age. The sponges weighed heavier in Group 2. Baseline hemoglobin values measured on admission showed no significant differences between the groups. Hemoglobin on the first postpartum day was significantly higher in the ABS group (p < 0.05). The operative time for episiotomy repair for the two groups was also statistically insignificant. No major immediate or delayed complications were observed in either group. CONCLUSION: In this study group, the application of 4 ml of ABS instead of isotonic saline solution lessened bleeding.

Severe preeclampsia and fetal virilization in a spontaneous singleton pregnancy complicated by hyperreactio luteinalis.

UNLABELLED: BACKGROUNDr: Hyperreactio luteinalis is a rare condition that stems from theca cell hyperplasia in the ovaries due to a high level of human chorionic gonadotropin during gestation. It occurs commonly in pregnant patients with trophoblastic disease, occasionally in multiple pregnancies, and rarely in normal singleton pregnancy. CASE REPORT: A 24-year-old pregnant woman, G3 P0, who was admitted to the Perinatology Clinic with increasing findings of virilization during pregnancy was presented. The patient had bilaterally enlarged multicystic ovaries on sonographic examination and elevated serum androgen levels She was managed conservatively until 38th week of gestation as a presumptive diagnosis of hyperreactio luteinalis. Elevated blood pressure and prominent proteinuria were detected during the follow-up of the patient and labor was induced. She underwent an emergency caesarean delivery because of fetal distress. During caesarean section, ovarian biopsies were taken and a histopathological diagnosis of hyperreactio luteinalis was determined. The female fetus also presented virilization. CONCLUSION: Although infrequent, hyperreactio luteinalis with both maternal and fetal virilization can occur in women with spontaneous singleton pregnancies. The clinical manifestations in such women may be complicated by severe preeclampsia.

Comparison of pregnancy outcomes in different localizations of uterine fibroids.

OBJECTIVE: The basic aim of this study is to compare the pregnancy outcomes in cases with uterine fibroids located at the anterior and posterior uterine walls. MATERIALS AND METHODS: A total of 84 pregnant women with a diagnosis of uterine myoma larger than 30 millimeter (mm) in diameter were included in the study to determine the obstetric outcomes. In 64 (76.20%) patients, myomas were detected at the anterior uterine wall (group 1), while 20 (23.80%) were detected at the posterior uterine wall (group 2). All patients were followed monthly until the end of pregnancy. Demographic and obstetric characteristics were compared between the two groups. RESULTS: There were no significant differences in age, gravida, parity, and myoma size between the two groups. A significant difference existed between the groups with regard to pelvic pain. Posterior located fibroids were associated with more pelvic pain (p = 0.001). No difference was observed between the two groups with regard to the rates of preterm delivery, bleeding in early pregnancy, infants with small for gestational age, and hospitalization period during pregnancy. Women with posterior located myomas had significantly higher miscarriage rates. CONCLUSION: Our findings suggest that pregnancies with uterine fibroids are at increased risk for complications. Posterior located fibroids larger than 30 mm in diameter are associated with severe pelvic pain compared to anterior located fibroids.