Maternal-fetal outcome associated with adolescent pregnancy in a tertiary referral center: a cross-sectional study

Objectives: This study was conducted to compare pregnancy outcomes of early-middle adolescent, late adolescent and adult women. Material and methods: The study focused on early-middle adolescent (n = 145), late adolescent (n = 1655) and adult (n = 1585) women who gave birth during 2014 through 2017, utilizing data obtained from the Zeynep Kamil Women and Children’s Health Training and Research Hospital. Pregnancy outcomes were determined according to the rates of preg¬nancy complications, including method of delivery, birth weight, as well as the rate of newborn intensive care admissions. Results: Comparisons between the studied groups for various pregnancy complications showed highest rates of pre¬term deliveries (PD), preterm premature rupture of membranes (PPROM) and neonatal intensive care unit admission in early-middle adolescent group, whereas the highest cesarean section rates were observed in the adult group (p < 0.001). Conclusions: Analysis of the data revealed that adolescent pregnancy, especially the early-middle adolescent pregnancies, is associated with increased risks of adverse pregnancy outcomes

Coagulation tests at trigger day in patients with Factor V Leiden Mutation to predict implantation failure

Objectives: The aim of this study was to assess the predictive value of coagulation tests at trigger day in patients with isolated factor V Leiden mutation who underwent intracytoplasmic sperm injection cycle (ICSI). Study Design:  Ninety women with isolated factor V Leiden mutation underwent ICSI cycles with an indication of unexplained infertility. In all participants antagonist protocol was used for ovarian hyperstimulation and coagulation tests including activated partial thromboplastin time (APTT), partial thromboplastin time (PT), international normalized ratio (INR), serum fibrinogen and D-dimer levels at trigger day were determined to predict successful implantation. All the clinical parameters specific for the treatment and some patient characteristics were recorded for each participants. Results: There was no significant difference between groups with and without succesfull implantation in terms of age, body mass index, basal hormone levels (follicle stimulating hormone, estradiol, progesterone at day 3 and antimullerian hormone) (P > 0.05). Estradiol and progestrone levels at trigger day were comparable between groups  (P > 0.05). Groups had similar endometrial thickness at embryo transfer day (P > 0.05). Some ovarian stimulation characteristics including initial gonadotropin dose, number of follicles > 17 mm, number of oocytes harvested and number of embryos were similar between groups (P > 0.05). Although there was no significant difference between groups with regard to APTT and PT levels, INR level were significantly lower while D-dimer levels and fibrinogen were significantly higher in cases without implantation (P < 0.05). Conclusion: D-dimer, fibrinogen and INR levels were significant predictors for successful implantation in women with isolated factor V Leiden who underwent ovulation hyperstimulation

Managemet of puerperal vulvovaginal hematoma with different suture technique; case report

Puerperal hematomas occur in 12 per 1000 deliveries and rarely cause maternal mortality. A 21-year-old female patient, gravida 2 parity 2, was admitted to our clinic with bilateral vulvar hematoma after a spontaneous vaginal delivery. Extensive hematomas are primarily treated with surgical debridement. Due to the consistency of hematoma after debridement, primary retention sutures were placed at the vulva and a silicon catheter was placed between the vulva and retention sutures. The patient was hospitalized for five days. The early diagnosis of puerperal hematomas is very important because many complications can be prevented with early diagnosis and treatment. [Med-Science 2017; 6(3.000): 579-81

Vaginal axis on MRI after unilateral and bilateral sacral hysteropexy: a controlled study

The objective of this study was to evaluate the vaginal position on magnetic resonance imaging (MRI) after bilateral abdominal sacral hysteropexy (BASH) and classical abdominal sacral hysteropexy (ASH) and to investigate which method keeps the vagina the most proximate to its original anatomical position. Ten patients, with 10 having BASH, 10 ASH and 10 being nulliparous, were compared. The angle between the vagina and the pubococcygeal plate, the angle between the upper and lower vaginal segments, the distance between the posterior fornix and the 2nd vertebra and the distances between the lateral fornices and spina ischiadica were measured on MRI. A p value less than .05 was considered statistically significant. The distance between the vaginal axis and the left spina ischiadica was greater in the ASH group compared to the control and the BASH group (p = .011, .047), while it was similar between the BASH group and the control individuals (p = .473). The angle between the upper and lower vaginal segments was greater in the ASH group compared to the control group (p = .004), while no significant difference was found between the BASH and control groups (p = .112). BASH keeps the vaginal axis at a more proximate location to its original anatomical position.IMPACT STATEMENT What is already known on this subject: In pelvic reconstructive surgery; the anatomic correction serves the functional results. What the results of this study add: On MRI examination bilateral abdominal sacral hysteropexy (mimicking uterosacral ligament), keeps the vagina closer to the original anatomic position than classical abdominal sacral hysteropexy. Hence functional outcomes could be better, especially in the long term. What the implications are of these findings for clinical practice and/or further research: This study may be of interest for clinicians in terms of different methods for pelvic floor surgery and may be of interest for researchers to investigate the relationship between anatomic position and functional outcomes especially in younger patients

Short Term Alterations of Hormone Profile Following Oocyte Pick-Up in Women with Polycystic Ovarian Syndrome to Assess the Effect of Multiple Needle Entries Into the Ovarian Cortex and Stroma

Objective: Some hormonal alterations after ovarian diathermy have been proposed in previous studies. Based on this data, we aimed to analyze some hormone profile changes following oocyte pick-up in women with polycystic ovarian syndrome. Study Designs: A total of 50 women with polycystic ovarian syndrome underwent ovarian stimulation for IVF cycle with an indication of anovulatory infertility. Some hormone profiles with the insulin resistance were assessed before and after oocyte pick-up to (early in the morning before starting stimulation and repeated 1 month later from oocyte pick-up day) assess whether high number of needle entries into the ovarian cortex and stroma result in similar effect with the diathermy. Results: Comparison of some variables revealed significantly decreased HOMA-IR and serum total testosterone concentrations after intervention. Correlation analyses showed significant correlations between number of needle entries, change in HOMA-IR, baseline total testosterone level and change in AMH level. Conclusion: Our data showed significant metabolic and hormonal alterations following oocyte pick up consistent with the effect of ovarian diathermy in women with polycystic ovarian syndrome

Effect of Total versus Partial Assisted Hatching on the Clinical Pregnancy Rates in Assisted Reproduction Technology

Objective: The objective of this study was to investigate the effect of total or partial assisted hatching on the clinical pregnancy rates in assisted reproduction technology. Study Design: This was a case-control study conducted from the beginning of January 2016 to the end of June 2017. A total of 404 cycles were included in this case-control study. Study population was divided into 3 groups: Group 1: Partial assisted hatching (n=118), Group 2: Total assisted hatching (n=81) and Control group (n=205). Results: In women of all ages, clinical pregnancy rates were similar between groups with total or partial assisted hatching compared to control group (p>0.05). The rates were also similar in subgroups of women with blastocyst or cleavage stage embryo transfers (p>0.05). Partial or total embryo hatching did not result in favorable outcome compared to control group either in women over 35 or younger than 35 years of age (p>0.05). In whole study group pregnancy rate was significantly higher in group with blastocyst stage embryo transfers (22.4 % versus 48.8%, p<0.05) Conclusion: Partial or total assisted hatching do not have any impact on the clinical pregnancy rates, no significant impact was determined in subgroup of women either

Serum Albumin Level Adjusted Progesterone Level on the Trigger Day is Not a Significant Predictor of Clinical Pregnancy

Objective: We aimed to assess the effect of serum albumin level adjusted progesterone levels on the trigger day on clinical pregnancy rate in ICSI cycles. Study Design: A total of 100 women undergoing ICSI cycles due to poor ovarian reserve or tubal factor infertility were included in this study. Serum progesterone and albumin levels on the trigger day were utilized to predict clinical pregnancy among normal and poor responders. Results: There were significant differences between groups with and without successful clinical pregnancy in terms of serum albumin (4.6 vs. 4.3 g/dl), progesterone levels (0.5 ng/mL vs. 0.7 ng/mL) on the trigger day and endometrial thickness (11.5 mm vs. 9.3 mm) (p<0.05, p<0.05 and p<0.05, respectively). In ROC analyses, progesterone level on the trigger day was found to be a significant predictor of clinical pregnancy (AUC=0.652, p=0.015). An optimal cut-off value of 0.55 ng/mL was obtained with 65% sensitivity and 57% specificity. Albumin level adjusted progesterone concentrations on the trigger day were 0.67 ng/mL versus 0.64 ng/mL, but this difference was not statistically significant (p>0.05).  Conclusion: Albumin adjusted progesterone concentrations may be utilized to determine cases for a freeze-all policy

Transcervical Foley balloon catheter and vaginal prostaglandin E2 insert combination vs. vaginal prostaglandin E2 insert only for induction of labor at term: a randomized clinical trial

WOS: 000459146500016PubMed ID: 30536117PurposeTo analyze the effect of combined application of intravaginal PGE2 insert and intracervical Foley balloon catheter for induction of labor.MethodsPatients with unfavorable cervices who required induction of labor from August 2017 to December 2017 were evaluated for the study. Three hundred and ten participants were randomly assigned to study (n:155) and control group (n:155). Nine patients in study group and seven patients in control group were excluded, because they declined to participate in the study. Totally, 294 women analyzed in this prospective randomized study: Group 1 (control group): labor induction with intravaginal PgE2 vaginal insert alone (n=148) and Group 2 (study group): intracervical Foley balloon catheter insertion adjunct to the intravaginal PgE2 insert (n=146). The primary outcome of our study was the period from induction to delivery. The secondary outcome was the period from induction to active phase of labor.ResultsIn the analysis of primiparous pregnants, combination of intracervical Foley balloon catheter and intravaginal PgE2 insertion was shown to be associated with shorter duration from induction to active stage of labor (1000 vs. 585min, P0.05) and also to delivery (933.1 vs. 777.9, P>0.05, Table2) in subgroup of women with the previous vaginal delivery.ConclusionsCombined application of intracervical Foley balloon catheter and intravaginal PgE2 insert may result in a shorter time from labor induction to delivery without rising the risk of cesarean section in primiparous women with an unfavorable cervix