The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial.

The main purpose of this study was to evaluate the impact of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction. The second objective was to assess the relationship between fetal splanchnic circulation parameters and splanchnic oxygenation during the first week of life. A single-center, prospective, randomized study with 51 fetuses/infants was conducted. Fetal Doppler measurements including umbilical artery, middle cerebral artery, and superior mesenteric artery (SMA) were recorded in IUGR fetuses. After preterm delivery, the infants were randomly assigned to one of two feeding modalities: drip (3-h continuous) or intermittent (bolus in 10 min). Continuous regional splanchnic saturation (rSO2S) monitoring was carried out during the first week of life, simultaneously with continuous oxygen arterial saturation (SaO2) monitoring, and the infants' fractional oxygen extractions (FOE) were calculated. These parameters were evaluated as means on a daily basis for the first week of life, as well as pre-prandial and post-prandial measurements on the seventh day. Fetal Doppler flow velocimetry disturbances were present in 72.5% of the study cohort. The drip (26 infants) and intermittent (25 infants) groups were similar in demographic and clinical characteristics, as well as the prevalence of feeding intolerance and necrotizing enterocolitis. During the first week of life, there was no difference in daily mean rSO2S and FOE values between the drip and intermittent groups, whereas unfed infants had mostly lower rSO2S values. Pre-prandial and post-prandial rSO2S values remained stable in both groups. Also, no association was detected between fetal splanchnic circulation parameters and neonatal splanchnic oxygenation. RSO2S values were strongly correlated to gestational age and birth weight. During the whole week, except for the first 2 days, infants with umbilical catheters had significantly lower rSO2S values than infants without.  Conclusion: Our data suggest that the key factor in splanchnic oxygenation is feeding, not the feeding modality. In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.  Clinical Trial Registration: The Effect of Neonatal Feeding Modalities on Splanchnic Oxygenation, NCT05513495,  https://clinicaltrials.gov/ct2/results cond=&term=NCT05513495&cntry=TR&state=&city=&dist= . Retrospectively registered, date of registration: August 2022. What is Known: • It is known that preterm infants with IUGR are at increased risk of hypoxic-ischemic intestinal damage and impaired splanchnic oxygenation. What is New: • The key factor in splanchnic oxygenation of preterm infants with IUGR is feeding, not the feeding modality (drip or intermittent). • In addition, the umbilical vein catheter had a negative impact on splanchnic oxygenation.

The relationship of foetal superior mesenteric artery blood flow and the time to first meconium passage in newborns with late-onset foetal growth restriction.

This study aimed to assess the relationship between the foetal superior mesenteric artery (SMA) Doppler and the time to first meconium passage (FMP) in foetuses with late-onset foetal growth restriction. This single-centre, prospective, observational, cohort study included 57 patients with late-onset FGR. The newborn infants were divided into two groups: preterm (36.8%) and term (63.2%). The time to FMP of the infants was compared to the foetal SMA parameters obtained within a week before delivery. The median time to FMP was similar between two groups (p = .31). The SMA pulsatility index (PI) was higher in the preterm group (p < .01). There was no correlation between foetal SMA PI or resistance index and time to FMP. In late-onset FGR infants, our study found no association between SMA Doppler measurements and time to FMP. However, a significant difference was detected in SMA PI between preterm and term infants. Impact StatementWhat is already known in this subject? Foetal growth restriction (FGR) can affect splanchnic circulation of the foetus and this alteration can be associated with some disorders including necrotising enterocolitis.What do the results of this study add? Superior mesenteric artery (SMA) Doppler indices are not associated with first meconium passage in neonates with late-onset foetal growth restriction. The pulsatility index of SMA is significantly higher in foetuses delivered before term.What are the implications of these findings for clinical practice and/or further research? Further research should be conducted to investigate the relationship between foetal SMA Doppler indices and neonatal gastrointestinal morbidities in foetuses with early onset FGR with Doppler anomalies. These studies can shed light from the prenatal to the postnatal period, allowing clinicians to predict potential problems and take precautions.

Evaluation of interventricular septum movements in structurally normal foetuses during second and third trimester of pregnancy: A prospective observational study.

Foetal cardiac assessment is a standard part of antepartum obstetric ultrasound evaluation. Heart examination, including four-chamber view and outflow tract views, should be routinely performed for all women as recommended by The International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG). Although the anatomical survey of foetal heart is well-defined, current knowledge on myocardial contractility is scarce. The aim of our study was to investigate the interventricular septum (IVS) shortening in normal foetuses. Interventricular septum length and thickness were assessed by re-evaluation of 3-dimensional spatiotemporal image correlation (STIC) acquisition planes in second and third trimesters of pregnancy in otherwise structurally normal foetuses. Twenty-one foetuses were included to the study. Mean gestational age at second and third trimester investigations were 24.4 (±1.6) and 31.3 (±2), respectively. Systolic and diastolic IVS length and thickness were significantly correlated with the gestational age. Interventricular septum shortening and thickening indexes were not different between second and third trimesters. Foetal cardiac contractility is a subject that recently gained attention. The current study revealed that interventricular septum shortening and thickening was relatively stable during second and third trimesters of pregnancy.

Diffuse uterine adenomatoid tumor in a patient with chronic hepatitis C virus infection.

Uterine adenomatoid tumors are usually solitary lesions. Adenomatoid tumors diffusely infiltrating the entire myometrium have rarely been reported in the literature. A feature common to half of the reported cases of diffuse uterine adenomatoid tumor was an immunocompromised status of the patient caused by the medications for renal transplantation. In this article, we describe an unusual case of diffuse uterine adenomatoid tumor in a patient with chronic hepatitis C virus infection. Pelvic examination showed an irregular and enlarged uterus. Supracervical hysterectomy and bilateral salpingo-oophorectomy was performed with a clinical diagnosis of uterine leiomyoma. Pathological examination showed, in addition to multiple leiomyomas, diffuse uterine adenomatoid tumor. We suggested that the diffuse pattern in our patient might be related to immunosuppression secondary to chronic hepatitis C virus infection.

Sequential use of Foley catheter with misoprostol for second trimester pregnancy termination in women with and without caesarean scars: a prospective cohort study.

PURPOSE: The aim of this study is to evaluate the effectiveness and safety of misoprostol and Foley catheter in second trimester termination in women with and without caesarean section (CS) scars. MATERIALS AND METHODS: Women with an indication for pregnancy termination between 14 and 22 completed weeks of gestation were included to the study. Enrolled women were allocated into three groups: (1) women with no history of CS, (2) women with one CS and (3) women with ≥2 CS. Study consisted 337 patients (233 group 1, 88 group 2 and 16 group 3). Misoprostol and Foley catheter were used sequentially. The primary outcome was the induction to abortion interval. Secondary outcomes were the successful vaginal abortion rate, the percentage of abortions in 24 h and the rates of surgical removal of the placenta, Foley catheter use and major maternal complications (transfusions, thromboembolic events, uterine rupture and death). RESULTS: Demographic characteristics were comparable. All study outcomes were statistically similar among groups. There was no major maternal complication among all patients. CONCLUSIONS: Sequential use of misoprostol and Foley catheter is safe and effective in second trimester pregnancy termination for patients with and without CS scars.

Analgesic effects of acetaminophen, diclofenac and hyoscine N-butylbromide in second trimester pregnancy termination: a prospective randomized study.

OBJECTIVES: This prospective, randomized study aimed to compare the analgesic effects of acetaminophen, diclofenac and hyoscine-N-butylbromide (HnBB) in cases of second trimester pregnancy termination. METHODS: In 60 women with indications for second trimester pregnancy termination, three analgesic agents were randomized into three groups: group 1, acetaminophen; group 2, diclofenac; and group 3, HnBB. A visual analog scale (VAS) used for the evaluation of pain perception. The primary outcome of the study was mean VAS score during the procedure and last VAS score before the completion of termination. The secondary outcomes were the induction-to-abortion interval, the percentage of aborted cases within the first 24 h and finally the need for parenteral analgesia. RESULTS: Demographic characteristics were similar among the groups. The mean VAS and last VAS scores before termination did not differ among the groups (p = 0.3 and 0.2, respectively). The need for parenteral analgesia did not differ among the groups (p = 0.3). Although a shorter induction-to-abortion interval and greater number of cases with successful termination before 24 h were found in the HnBB group, the differences were not statistically significant (p = 0.6 and 0.5, respectively). CONCLUSIONS: Our study did not demonstrate a difference in pain perception among second trimester pregnancy termination cases using acetaminophen, diclofenac and HnBB.

Symptom distribution among infertile and fertile endometriosis cases with different stages and localisations.

OBJECTIVE: To evaluate endometriosis patients' symptoms and relate them to different stages and locations of endometriosis and also to fertility/infertility of the patients. STUDY DESIGN: Sixty-eight patients diagnosed with endometriosis constituted the population investigated in this cross-sectional observational study, 55 and 13 of whom were diagnosed from the visual findings recorded during laparoscopy and laparotomy, respectively. All cases were categorised as early- (stages I and II) or late (stages III and IV)-stage endometriosis and as fertile or infertile endometriosis. The extent of endometriosis was further divided into peritoneal, ovarian, and ovarian and peritoneal. Symptoms of dysmenorrhoea, deep dyspareunia, dyschesia and dysuria and also depressive mood state were analysed and compared among those different groups. RESULTS: Cyclic chronic pelvic pain was more relevant in late-stage endometriosis (P = 0.04). Deep dyspareunia, painful defecation, dysuria, infertility, and depressive state did not differ with stages of endometriosis or fertility status. Admission for pelvic pain of any duration was more prevalent among fertile patients with endometriosis (P = 0.008). Chronic noncyclic pelvic pain was more frequently observed in patients with fertile than in those with infertile endometriosis (P = 0.01). More cases in the fertile group experienced noncyclic pelvic pain (P = 0.04). More patients admitted with cyclic pelvic pain had ovarian or ovarian and peritoneal endometriosis than peritoneal endometriosis only (P = 0.03). Infertility was more prevalent among peritoneal endometriosis cases than among those with ovarian or peritoneal and ovarian involvement (P = 0.008). CONCLUSION: Symptoms of endometriosis may predict the stage and localisation of the disease to some extent.

Early postoperative changes in testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin after hysterectomy with or without concomitant oophorectomy.

OBJECTIVE: To investigate the cross-sectional associations of hysterectomy and oophorectomy status, chronological age, and body mass index with early postoperative plasma levels of total and free T, DHEAS, and sex hormone-binding globulin (SHBG). DESIGN: A cross-sectional study. SETTING: University hospital. PATIENT(S): Ninety-two women age 35-47 years who were scheduled for hysterectomy and/or oophorectomy, advocated for benign gynecological pathologies. INTERVENTION(S): Ninety-two eligible premenopausal women underwent hysterectomy and/or oophorectomy, with plasma T, DHEAS, and SHBG levels assayed before surgery and during the postoperative period. MAIN OUTCOME MEASURE(S): Effects of time x operation and age x operation interactions between oophorectomized and nonoophorectomized groups and within-subject main effect of time on plasma androgen levels. RESULT(S): Of 92 women, hysterectomy alone was performed in only 49 (53.3%) cases. Oophorectomy, either unilateral or bilateral, was performed in 35.8% of cases. Age x within-group interactions exhibited an important difference (P=.03) in total T levels. The time x between- and within-group interaction effects on plasma DHEAS levels of postoperative day 7, compared with day 1, were statistically significant (P<.001). The effect of time x group interaction was remarkable, in terms of SHBG levels during the postoperative period. Age x oophorectomy interaction exhibited a statistically significant change of decline in DHEAS levels on postoperative day 7 (P=.05). CONCLUSION(S): The present study demonstrated a time and operation effect decline in plasma DHEAS levels. In contrast, the time x operation interaction on SHBG levels exhibited an increase toward postoperative day 7.

Investigation of the incidence of hepatitis E virus among pregnant women in Turkey.

AIM: The aim of our study was to determine the prevalence of hepatitis E virus (HEV) among pregnant and non-pregnant women in Middle Anatolia, identify the factors that affect being HEV positive and to study the effects of HEV positivity on mother and fetus. METHODS: The study included 245 pregnant women who applied to various health centers and 76 cases in the same age range as the control. Blood samples taken from the cases were tested in terms of anti-HEV, IgM and IgG using the microELISA method. RESULTS: None of the blood samples tested revealed anti-HEV IgM positive, an indicator of acute infection, while 31 pregnant women (12.6%) and nine cases in the control group (11.8%) were found to have anti-HEV IgG positive (P > 0.05). It was seen that in pregnant women such factors as advanced age, lower educational and income levels and rural residence were correlated with higher anti-HEV IgG positive values (P < 0.05). HEV infection is endemic in Afyon and its vicinity. There were no statistical differences between pregnant women and non-pregnant women at similar ages in terms of HEV seropositivity. CONCLUSION: It can be suggested that pregnancy does not constitute a predisposition to HEV infection.