Effect of parity on first-trimester uterine artery Doppler indices and their predictive value for pregnancy complications.

AIM: To investigate the relationship between parity and first-trimester uterine artery Doppler indices and determine their predictive value for pregnancy complications. METHODS: In 679 singleton pregnancies (388 parous and 291 nulliparous) attending for routine care at 11-14 weeks of gestation, we recorded maternal characteristics, medical and obstetric history, the presence of protodiastolic notching and measured uterine artery resistance index (RI). RESULTS: Parous women had a lower prevalence of bilateral notches (64 vs. 77.6%; p = 0.0002), median level of RI did not show any significant difference. In parous cases complicated with pregnancy-induced hypertension (PIH) (0.78 vs. 0.70; p = 0.0003) or miscarriage (0.86 vs. 0.71; p = 0.0003) mean levels of RI were significantly higher than in the nulliparous cases. By using mean RI we could predict the cases with PIH (area under curve (AUC) 0.63; p = 0.012), early PIH (AUC 0.84; p < 0.0001) and miscarriage (AUC 0.87; p < 0.0001) in the group of parous women. CONCLUSION: Parity has a significant effect on uterine artery Doppler findings in the first trimester of pregnancy. In the group of parous women the mean level of RI had a higher predictive value for miscarriage, early PIH and PIH.

Different phenotypes of polycystic ovary syndrome in Turkish women: clinical and endocrine characteristics.

This study presents the differences in clinical, endocrine and metabolic parameters among different polycystic ovary syndrome (PCOS) phenotypes in Turkish women. Four hundred and ten women with PCOS were evaluated, while 97 healthy women served as controls. PCOS were defined by oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovaries on ultrasound (PCO). Patients were subdivided into four phenotypes: OA + HA + PCO (phenotype 1), OA + HA (phenotype 2), HA + PCO (phenotype 3), OA + PCO (phenotype 4). Phenotypes 1-4 were present in 47.1%, 13.2%, 21.2% and 18.5% of patients, respectively. They were also divided into three groups according to the BMI (<25 kg/m(2); 25≤ and ≤30 kg/m(2); and >30 kg/m(2)). ANOVA and Tukey post-hoc HSD tests were used. The LH levels and LH/FSH ratio were higher in phenotype 1 and 2 than phenotype 3. The LDL-C levels were higher in women with phenotype 1 and 4 than in women with phenotype 2. Women with BMI <25 kg/m(2) had higher levels of LH, LH/FSH ratio, and the HDL-C than other two groups. The levels of TG, LDL, fasting insulin and HOMA-IR increased with increasing BMI in four phenotypes. Results suggest that obesity seems to be the primary cause of metabolic disturbances in PCOS women.

Vitamin D status in the first-trimester: effects of Vitamin D deficiency on pregnancy outcomes.

OBJECTIVE: To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes. METHODS: Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry. RESULTS: The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01). CONCLUSION: A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally.

Hydrosonographic assessment of the effects of 2 different suturing techniques on healing of the uterine scar after cesarean delivery.

OBJECTIVE: To compare the effects of 2 suturing techniques (single versus double layer) on healing of the uterine scar after a cesarean delivery. METHODS: In the present randomized, prospective study, 36 women with a term pregnancy who had an elective cesarean delivery were randomly assigned to closure of the uterine incision with a single-layer locked suture or with a double-layer locked/unlocked suture. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed by hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing. RESULTS: There were no significant differences between the groups in terms of estimated blood loss, operation time, or additional hemostatic suture. However, the mean thickness of the residual myometrium covering the defect was 9.95 ± 1.94 mm after a double-layer closure and 7.53 ± 2.54 mm after a single-layer closure (P = 0.005). The mean healing ratio was significantly higher after a double-layer closure (0.83 ± 0.10) than after a single-layer closure (0.67 ± 0.15; P = 0.004). CONCLUSION: A double-layer locked/unlocked closure of the uterine incision at cesarean delivery decreases the risk of poor uterine scar healing.