Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading.

We aimed to assess the effect of spermatic vein ligation on seminal total antioxidant capacity (TAC) in patients with varicocele. Twenty infertile male patients with varicocele and 20 normal fertile men (control group) were included in the study. All the male patients were diagnosed with primary infertility and varicocele. The patients with varicocele were divided into two groups as nonpalpable (GI) (eight patients) and palpable (GII-III) (12 patients) varicocele groups. All the patients underwent microsurgical spermatic vein ligation. Seminal TAC levels and sperm parameters were evaluated in all the patients. Preoperative sperm count, sperm motility, sperm morphology and seminal TAC levels with equivalent figures 3-6 months after spermatic vein ligation and the same values of the control group were compared. There was a statistically significant increase in the total seminal antioxidant capacity level after spermatic vein ligation, and there was a statistically significant increase in the sperm count, sperm motility and spermatozoa with normal morphology. However, evaluation of the patients for varicocele grade showed a statistically significant increase in the TAC level only in the GII-III varicocele group. Spermatic vein ligation can improve the total seminal antioxidant capacity levels especially in patients with middle and high grade varicocele.

Effectiveness of emergency cervical cerclage in patients with cervical dilation in the second trimester.

OBJECTIVE: Efficacy of emergency cerclage commensed in the second trimester is a controversial issue. In this study, we aimed to assess the success and associated complications of emergency cerclage in patients with cervical dilatation in the second trimester. MATERIAL AND METHODS: In this retrospective study, medical records of 75 pregnant women who had clinically and ultrasonographically confirmed cervical dilatation in the second trimester who had undergone cervical cerclage were analyzed. Pregnancy prolongation was the main outcome measure. RESULTS: Seventy-five women were included to the study. Mean age was 27 and mean gravidity of the patients was three. Mean cervical length was 28.5 mm (12-41 mm). The rate of spontaneous abortion, immature deliveries, prematurity and deliveries after 34 weeks were 2.7% (n = 2), 8% (n = 6), 12 (n = 9) and 77.7 (n = 58), respectively. Fetal survival rate was 89.1% (n = 65). Serious vaginal bleeding from the suture area was noted in two patients (2.6%). No postoperative complications occurred. CONCLUSION: Emergency cerclage is a simple surgical procedure with lower complication rates and can effectively prolong gestation to viability. It can be considered as a useful measure for patients with evidence of cervical changes in the second trimester.

Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations.

OBJECTIVES: To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature. PATIENTS AND METHODS: We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined. RESULTS: During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations. CONCLUSION: Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.

Outcome of pregnancies in women with thrombophilic disorders.

Women with thrombophilic disorders may have pregnancy complications including fetal loss (FL); however, the impact of thromboprophylaxis with low molecular weight heparin (LMWH) and previous obstetric history remains to be clarified. Our aim was to compare the effects of LMWH in three groups of women with thrombophilia who had varying numbers of prior fetal losses. We prospectively investigated the live birth rates in 66 women with thrombophilic conditions, treated with a LMWH (enoxaparin, 40 mg daily). Groups 1, 2 and 3 included patients with 0-1, 2-3 and ≥ 4 pregnancy losses, respectively. Groups 1, 2 and 3 had 90.47%, 83.78% and 50.00% live birth frequencies, respectively. Group 3 had a significantly lower chance of a live birth compared with Group 1, regardless of type of thrombophilic disorder. FL aetiology in thrombophilic patients with multiple miscarriages appears multifactorial, and thromboprophylaxis alone may not be sufficient.

Lack of platelet activation reflected by circulating soluble glycoprotein V in pre-eclampsia.

Pre-eclampsia (PE) is a human pregnancy-specific disorder of unknown aetiology. Although the quantitative relationship between platelet aggregation in PE is not clearly defined yet, we aimed to investigate the possible relationship between PE and platelet glycoprotein V (GPV), which is an integral platelet membrane protein involved in the function of the GPIb-V-IX receptor. Fifty patients with PE and 37 normotensive pregnant women (controls) were enrolled in this study. Fasting blood samples were collected and soluble GPV (sGPV) levels were determined using a commercially available enzyme immunoassay. No statistically significant difference in sGPV was found between PE patients and control subjects. There was no correlation between sGPV and platelet counts or between pregnancy duration and platelet counts. Further clinical and experimental investigations are needed to elucidate the pathological processes involved in the development of PE in complicated pregnancies.

Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata.

OBJECTIVE: The present study aimed to investigate the perinatal morbidity associated with multiple repeat cesarean deliveries (CD) and, thus, to achieve a body of evidence for the current practice of discouraging pregnancy after undergoing three CDs. PATIENTS AND METHODS: This study prospectively reviewed a total of 500 women who consecutively underwent CD between January 1, 2009 and April 1, 2009. The patients were allocated into four groups based on the number of CDs they had undergone (Group 1: first CD, Group 2: second CD, Group 3: third CD, Group 4: fourth CD). Data related with their demographic and clinical characteristics were recorded as well as their perioperative characteristics and clinical characteristics of the neonates born to them. Cochran-Armitage test for trends and Spearman rank correlation analysis test was used to evaluate the trend of perioperative complications and neonatal outcome with the increasing number of CDs. RESULTS: The mean age, gravidity and parity were significantly higher in groups 2-4 than those of the women who had their first CD (Group 1). The average operation time and mean delivery time as well as severe adhesions, bowel injury increased significantly with the number of CD. Neonatal characteristics were similar among groups except for a trend towards a decrease in the rate of meconium stained and a trend towards increase in the rate of neonatal sepsis with the increasing number of CD. CONCLUSIONS: We have found positive correlation between the maternal morbidity and the number of CDs. The occurrence of adhesions emerges as the most significant indicator of maternal morbidity, eventually leading to the neighboring organ injury and prolonged operation time.

Leptin levels and antihypertensive treatment in preeclampsia.

INTRODUCTION: This study was carried out to investigate changes in the plasma leptin concentrations during preeclampsia treatment and to determine whether antihypertensive treatments, aimed at decreasing leptin levels, would improve foetal outcomes. METHODS: A prospective study was undertaken in 57 pregnant women with preeclampsia (37 with mild and 20 with severe preeclampsia) and 46 normal pregnant women who were matched in maternal and gestational age and body mass index. The mild preeclampsia group was treated with alpha-methyldopa, while the severe preeclampsia group was treated with a combination of alpha-methyldopa and nifedipine. RESULTS: The severe preeclampsia group had significantly lower platelet counts, higher systolic and diastolic blood pressures and elevated serum uric acid concentrations. Pre-treatment plasma leptin levels were significantly increased in the severe preeclampsia group (range 18.3-49.5) compared to the the mild preeclampsia group (range 20.7-45.4) and normal controls (range 8.6-19.2). Post-treatment plasma leptin levels in both the mild and severe preeclampsia groups (range 10.2-23.5 and 11.3-24.4, respectively) were statistically similar to those of the control group (range 9.1-20.7). Estimated foetal weight, intrauterine growth retardation and demise were statistically similar in the three study groups. CONCLUSION: Plasma leptin concentrations were found to be elevated in women diagnosed with severe preeclampsia. However, the exact mechanism underlying the increased plasma leptin levels in preeclampsia and the functional role of leptin in the development of hypertension need to be further clarified. Leptin has a promising future as a valuable marker to identity women with a high risk for preeclampsia.