Comparison of Nulliparas Undergoing Cesarean Section in First and Second Stages of Labour: A Prospective Study in a Tertiary Teaching Hospital

Objective. We performed a prospective observational audit study to compare neonatal and maternal outcomes of the primary cesarean sections performed in first stage versus second stage of labour. Methods. One thousand three hundred and eighty-nine nullipara women who had undergone cesarean section in a tertiary teaching hospital between February 1, 2009 and January 31, 2010 were included in the study. Primary maternal outcomes of interest were uterine atonia, transfusion requirement, urinary system injury, requirement for hysterectomy, and duration of hospital stay. Results. A total of 1389 women underwent cesarean section at this 12 month time period. Of these 1389 cesarean sections, 1271 were in the first stage of the labour and 171 were in the second stage of the labour. Urinary injuries, transfusion requirement, and uterine atonia hysterectomy were significantly more frequent in women who underwent cesarean section in the second stage of the labour compared to women undergoing cesarean section in the first stage of the labour. Conclusion. Cesarean section in the second stage of the labour is associated with increased maternal and neonatal morbidities. Special attention is required to the patients undergoing cesarean section in the second stage of the labour

Impact of GnRH analogues on oocyte/embryo quality and embryo development in in vitro fertilization/intracytoplasmic sperm injection cycles: a case control study

<p>Abstract</p> <p>Background</p> <p>Despite the clinical outcomes of ovarian stimulation with either GnRH-agonist or GnRH-antagonist analogues for in vitro fertilization (IVF) being well analysed, the effect of analogues on oocyte/embryo quality and embryo development is still not known in detail. The aim of this case-control study was to compare the efficacy of a multiple-dose GnRH antagonist protocol with that of the GnRH agonist long protocol with a view to oocyte and embryo quality, embryo development and IVF treatment outcome.</p> <p>Methods</p> <p>Between October 2001 and December 2008, 100 patients were stimulated with human menopausal gonadotrophin (HMG) and GnRH antagonist in their first treatment cycle for IVF or intracytoplasmic sperm injection (ICSI). One hundred combined GnRH agonist + HMG (long protocol) cycles were matched to the GnRH antagonist + HMG cycles by age, BMI, baseline FSH levels and by cause of infertility. We determined the number and quality of retrieved oocytes, the rate of early-cleavage embryos, the morphology and development of embryos, as well as clinical pregnancy rates. Statistical analysis was performed using Wilcoxon's matched pairs rank sum test and McNemar's chi-square test. P < 0.05 was considered statistically significant.</p> <p>Results</p> <p>The rate of cytoplasmic abnormalities in retrieved oocytes was significantly higher with the use of GnRH antagonist than in GnRH agonist cycles (62.1% vs. 49.9%; P < 0.01). We observed lower rate of zygotes showing normal pronuclear morphology (49.3% vs. 58.0%; P < 0.01), and higher cell-number of preembryos on day 2 after fertilization (4.28 vs. 4.03; P < 0.01) with the use of GnRH antagonist analogues. The rate of mature oocytes, rate of presence of multinucleated blastomers, amount of fragmentation in embryos and rate of early-cleaved embryos was similar in the two groups. Clinical pregnancy rate per embryo transfer was lower in the antagonist group than in the agonist group (30.8% vs. 40.4%) although this difference did not reach statistical significance (P = 0.17).</p> <p>Conclusion</p> <p>Antagonist seemed to influence favourably some parameters of early embryo development dynamics, while other morphological parameters seemed not to be altered according to GnRH analogue used for ovarian stimulation in IVF cycles.</p

Mercury concentration in maternal serum, cord blood, and placenta in patients with amalgam dental fillings: effects on fetal biometric measurements

Aim: We aimed to determine the extent to which mercury is transmitted from the mother to fetus via the umbilical cord in patients with amalgam dental fillings, and its effect on fetal biometric measurements.Methods: Twenty-eight patients as the study group with amalgam fillings, and 32 of them as the control group were included in this prospective case-control study. The mercury levels were measured in the maternal and cord venous sera, and the placental samples. Two groups were compared in terms of these and the fetal/neonatal biometric measurements.Results: In the study group, the maternal and umbilical cord mercury levels were found to be significantly higher than those from the control group (p=0.006 and p=0.010, respectively). These high levels did not affect the fetal biometric measurements.Conclusions: The presence of high serum mercury levels in pregnant women with amalgam fillings is important, and warrants further long-term studies in order to investigate the fetal neurological effects as well

Gonadotropin releasing hormone antagonist use in controlled ovarian stimulation and intrauterine insemination cycles in women with polycystic ovary syndrome

Objective: To evaluate the effect of the GnRH antagonist on gonadotropin ovulation induction in women with PCOS. Materials and methods: A total of 175 intrauterine insemination (IUI) cycles in women with polycystic ovary syndrome (PCOS) were included in the study. Women in the control group (n = 87) underwent controlled ovarian stimulation (COS) with recombinant follicle stimulating hormone (r-FSH) only, while women in the study group (n = 88) were administered r-FSH plus cetrorelix. Results: As expected, the mean value of luteinizing hormone and progesterone, on the day of human chorionic gonadotropin administration were statistically significantly lower in patients receiving GnRH antagonist than the control group (p = 0.002). Premature luteinization occurred in only one of the patients in the GnRH antagonist group (1.1%) and in 15 of the 88 cycles in the control group (17.2%), showing a significant difference between the two groups (P = 0.001). The clinical pregnancy rate per cycle was higher in GnRH-antagonist group compared to the control group but the difference did not reach to a statistical significance (25% vs 14.9%, P = 0.096). Conclusions: Adding GnRH-antagonist in COS/IUI cycles in women with PCOS resulted in a lower incidence of premature luteinization but did not improve pregnancy rates. However, owing to some benefits, antagonist therapy could be considered as a reasonable alternative to IVF in order to reduce PCOS patients'emotional distress. Keywords: Controlled ovarian hyperstimulation, GnRH antagonist, In vitro fertilization, PCOS, Premature luteinizatio

Pulmonary recurrence after radical hysterectomy for uterine cervical carcinoma

Pulmonary spread from carcinoma of the uterine cervix, though uncommon, has been reported in 2.2–9.1% of all cervical cancers. The aim of this study was to evaluate the surgical, clinical, pathological factors and clinical outcomes of cervical cancer patients with pulmonary recurrence (PR). This study included 17 cervical cancer patients with PR after radical hysterectomy. The entire cohort consisted of 413 patients whose surgeries (type III radical hysterectomy + pelvic ± para-aortic lymphadenectomy) had been performed in our Gynaecologic Oncology Clinic between 1993 and 2018. Tumour size, lymph node metastasis and receiving adjuvant therapy were found to be effective for PR on univariate analyses in the main cohort (p = .042, p < .001 and p = .001, respectively). Therefore, performing adjuvant therapy to reduce the PR must be assessed properly with the information of lymph node status and tumour size obtained from the final pathology reports.Impact Statement What is already known on this subject? Pulmonary spread from carcinoma of the uterine cervix has been reported in 2.2–9.1% of all cervical cancers. Data related to clinico-pathological features of patients with pulmonary recurrence (PR) is limited. Diagnosis of a PR is considered to worsen the prognosis. What do the results of this study add? Tumour size, lymph node metastasis and receiving adjuvant therapy were found to be effective for PR on univariate analyses. What are the implications of these findings for clinical practice and/or further research? Performing adjuvant therapy to reduce the PR must be assessed properly with the information of lymph node status and tumour size obtained from the final pathology reports in patients with uterine cervical carcinoma

The effect of gestational hypertension on the maternal mean platelet volume

To evaluate the effect of gestational hypertension on the maternal mean platelet volume (MPV). The study group comprised pregnant women with gestational hypertension who gave birth to single, term, healthy fetuses and control group was pregnant women without any complications. MPVs were calculated within 24 hours in the intrapartum period. The mean MPV of 68 hypertensive and randomly selected 135 normotensive pregnant women were compared. The MPV of gestational hypertensive group was significantly higher (9.5±0.98 vs 9.2±0.9 fL; p=0.015). Using ROC analysis, the optimal MPV cut off value was found 9.25 fL with the sensitivity of 60.0% and the specificity of 61.0% (AUC=0.622, 95% CI=0.538-0.707, p=0.004) for the prediction of gestational hypertension. This study demonstrated that maternal MPV cannot be used to predict gestational hypertension in clinical practice due to its low sensitivity and specificity. However, further studies are needed to examine the predictive value of MPV in the progression of the hypertensive diseases of pregnancy. [Med-Science 2020; 9(1.000): 90-3

Evaluation of Maternal and Fetal Stress Hormones During the Process of Birth

Objective: This study aims to determine whether mode of delivery is associated with the endocrine stress response in mother and newborn. Study Design: This prospective observational study was conducted with 86 women with a normal singleton pregnancy who delivered healthy infants between 37 and 41 weeks of gestation in a tertiary center. Study groups included; (1) women undergoing normal vaginal delivery with epidural anesthesia, (2) women undergoing vaginal delivery with immersion in water for pain relief during labor, (3) women delivered through elective caesarean section without labor. After delivery, thyroid stimulating hormone, cortisol, insulin, prolactin and Beta-endorphin levels were measured in maternal and umbilical cord serum and their relationships between modes of delivery were investigated. Results: It was found that the concentrations of cortisol and beta-endorphin after vaginal delivery with immersion in water group in both mothers and infants were higher than other two modes of delivery and these differences were statistically significant. Umbilical cord concentration of cortisol was the lowest in the caesarean section group. Conclusions: Maternal and fetal stress response was found to be associated with the mode of delivery and labor

Effects of melatonin on uterine hypertrophy/hyperplasia: A preliminary experimental rat study

Endometrial hyperplasia is a process of endometrial proliferation that results in a thickening of the endometrial tissue. Melatonin might be able to change the pathophysiological process and prognosis into a positive way that might prevent and heal endometrial hyperplasia, which is the first stage of endometrial cancer. For this perspective, we tried to investigate the effect of melatonin on uterine hypertrophy/hyperplasia in an experimental rat model. Forty Wistar-Albino rats were undergone bilateral oophorectomy and randomized into four groups. To create a model of uterine hypertrophy/hyperplasia in all groups, except the control group [C] (n = 10), 4 mg/kg/day estradiol hemihydrate were given for 14 days. The uterine hypertrophy/hyperplasia was evaluated histopathologically in the left uterine horns, then the groups were treated for 14 days as follows; melatonin (10 mg/kg/day/po) [M] (n = 10), melatonin + estradiol hemihydrate (10 mg/kg/day/po and 4 mg/kg/day/po) [M + E] (n = 10), and dark environment [D] (n = 10). Finally, the effects of the melatonin were examined histopathologically in the right uterine horns. An uterine hypertrophy/hyperplasia model was established in all groups compared to the control group (p < 0.05). In the [M] and [M + E] groups, epithelial cell height and luminal epithelial cell height significantly decreased (41?m vs 12?m, p = 0.005; 14?m vs 10?m, p = 0.005, respectively for [M] group) and (32?m vs 14?m, p = 0.012; 17?m vs 10?m, p = 0.017, respectively for [M + E] group). The [D] group exhibited a significant decrease in epithelial cell height (33?m vs 20?m, p = 0.017). With or without estrogen exposure, melatonin-treated and physiologically melatonin-released rats experienced a significant uterine hypertrophy/hyperplasia recovery. Melatonin may have protective effects on endometrial hyperplasia