Tension-free vaginal tape versus tension-free vaginal tape obturator in women with stress urinary incontinence

Background: To assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator in women with urodynamic stress incontinence. Methods: Prospective, randomized study. Initially, 91 patients were included in the study and 89 of them were available at 12 months follow-up. Forty-six patients were subjected to classic TVT procedure and 43 to transobturator vaginal tape from inside to outside (TVT-O) operation. There was no significant difference between the groups for age, BMI, menopausal status and prolapse. No patients had cystocele greater than stage I. Subjective and objective cure and improvement rate, mean operative time, hospital stay and complications incidence were assessed. Results: Mean operative time was significant shorter in the TVT-O group (17.4 +/- 6.9 min) compared to the TVT group (26.7 +/- 8.6 min). There was no significant difference in the duration of hospital stay between two groups. The objective cure rate for TVT group was 89%, the improvement rate was 6.5%, the failure rate was 4.3% and the subjective cure rate 73.9%. The objective cure rate for TVT-O group was 90%, the improvement rate was 7.6%, the failure rate was 2.5% and the subjective cure rate 76.7%. The hemoglobin loss ranged between 1.0 +/- 0.5 g/dl for TVT group and 0.9 +/- 0.4 g/dl for TVT-O group. Conclusion: The TVT-O technique presents success rates comparable to the classic TVT method in the short term. Copyright (c) 2006 S. Karger AG, Basel

The effects of adipose tissue and adipocytokines in human pregnancy

During pregnancy, important changes take place in maternal metabolism because of the growing fetus and placental formation. The increase in insulin resistance during pregnancy is paralleled by the progressive increase of maternal adipose tissue deposition. This review examines the topography of fat mass deposition during pregnancy in relation to factors such as parity and maternal age that might affect this deposition. We also examine adipose tissue markers, such as pregravid weight and weight gain during pregnancy, and their effect on fetal growth and pregnancy outcomes. In addition, this review studies the possible effects of cytokines that are produced by adipose tissue and the placenta on maternal metabolism and its complications. Finally, we also consider the possible role of maternal adipocytokines and fetal adipocytokines on fetal growth

Maternal mortality in Greece, 1996-2006

Objective: To present retrospective data for maternal deaths in Greece from 1996 to 2006. Methods: Demographic information and information on the causes of death was provided by the Hellenic Statistical Authority. Maternal deaths were assessed by cause of death, maternal age, and place of residence. The maternal mortality ratio (MMR) was estimated and expressed as the number of deaths per 100 000 live births. Results: From 1996 to 2006, 29 deaths were attributed to pregnancy and childbirth, yielding a total MMR of 2.63. The leading cause of direct deaths was hemorrhage and that of indirect deaths was cardiac disease. There was a borderline significant decline in the MMR during the study period. The MMR was significantly higher at the extremes of the reproductive age range. Conclusion: Maternal mortality in Greece is low; however, no formal data have been published since 1996. Knowledge of the causes of maternal death can lead to the prevention of maternal deaths and safer motherhood. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved

Pre- and early post-partum adiponectin and Interleukin-1beta levels in women with and without gestational diabetes

OBJECTIVE: To investigate maternal serum adiponectin and Interleukin-1beta (IL-1 beta) levels during the pre- and post-partum periods in pregnant women with and without Gestational Diabetes Mellitus (GDM). DESIGN: Thirty control pregnant Caucasian women without GDM and thirty Body Mass Index (BMI) and age-matched Caucasian women with GDM examined in the outpatient clinic between the 24(th) and 26(th) week of their pregnancy and on the 3(rd) day postpartum underwent anthropometry and had serum blood taken. Both groups, were monitored by a dietitian and had comparable weight gain during pregnancy. Birth weight was also measured. RESULTS: At the 3(rd) day postpartum, compared to the 2(nd) trimester of pregnancy, women with GDM had lower serum: adiponectin levels, lower serum IL-1 beta levels and lower Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) values. At the 2(nd) trimester of pregnancy, women with GDM had lower serum adiponectin levels, higher IL-1 beta and higher HOMA-IR values compared to women without GDM. At the 3(rd) day postpartum, women with GDM had lower serum adiponectin levels, higher IL-1 beta and higher HOMA-IR values compared to women without GDM. Second trimester serum adiponectin values of women with GDM correlated negatively with birth weight. CONCLUSIONS: Gestational diabetes is a state of insulin resistance associated with altered levels of proinflammatory cytokines, increased IL-1 beta and decreased adiponectin values. Both of these alterations might be attributed to placental pathology in pregnancies with GDM

Neonatal birth waist is positively predicted by second trimester maternal active ghrelin, a pro-appetite hormone, and negatively associated with third trimester maternal leptin, a pro-satiety hormone

In pregnancy physiological mechanisms activated by maternal appetite contribute to adequate energy intake for the mother and for the fetus. The role of maternal appetite-related peptides and their possible association with neonatal energy stores and glucose metabolism have not been investigated as yet. The aim was to investigate, during pregnancy, the association of fasting maternal appetite-related hormones levels [ghrelin (active), GLP1 (active), total PYY and leptin] with neonatal waist, percent total body fat and insulin levels at birth. Methods Forty-two normal and thirty eight overweight women (mean ± SD; age: 26.9 ± 2.5 years; pre-pregnancy BMI 26 ± 2.2 kg/m2) were seen during each of the three trimesters, had blood sampling and a 75 g oral glucose tolerance test. At birth, neonates underwent anthropometry and cord blood sampling for c-peptide, glucose, insulin. Results During all three trimesters maternal weight correlated positively with percent total neonatal body fat while during the second and third trimesters it correlated positively with birth weight. The second trimester maternal active ghrelin levels correlated positively with neonatal waist and were its best positive predictor. The third trimester maternal active ghrelin levels correlated positively with neonatal waist and negatively with percent total neonatal body fat, fetal cord blood insulin levels and were the best negative predictor of the latter. The third trimester maternal leptin levels correlated negatively with neonatal waist. Conclusions During pregnancy circulating maternal active ghrelin, a pro-appetite hormone, is associated with neonatal visceral energy storage (as expressed by neonatal waist). By inhibiting glucose-driven maternal insulin secretion, ghrelin might ensure adequate fasting glucose and nutrient supplies to the fetus while limiting overall fetal adipose tissue deposition