One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials

INTRODUCTION: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches. MATERIAL AND METHODS: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM. RESULTS: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach. CONCLUSIONS: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes

Association between red blood cell distribution width and polycystic ovary syndrome

Aims: The red blood cell distribution width (RDW) is being recognized as a marker of chronic inflammation and routinely reported as part of a complete blood count (CBC) without any additional costs. High levels of RDW associate with oxidative stress and cardiovascular disease risk. We aimed to investigate the relation between the level of RDW and high-sensitive C-reactive protein (hs-CRP), HOMA-IR, BMI and body fat percentage in women with polycystic ovary syndrome (PCOS). Materials and methods: Cross-sectional and observational studies were conducted in 90 subjects with PCOS and 87 age-and BMI-matched controls. Body fat percentage, CBC, fasting serum glucose, serum insulin, hs-CRP, lipids, and total and free-testosterone levels were measured. Results: RDW levels were significantly higher in the PCOS group compared with the control group (12.98 +/- 0.92% versus 12.59 +/- 0.84%, p = 0.004). RDW levels were positively correlated with hs-CRP, HOMA-IR and BMI. Multivariate analysis showed that high-RDW levels were associated with PCOS. Subjects with the highest quartile RDW levels were nearly 2.8 times more likely to develop PCOS compared with subjects with the lowest quartile RDW. ROC curve analysis showed that RDW levels were useful as a diagnostic marker for PCOS. The optimal cut-off value for detecting PCOS was >= 12.54% (sensitivity 67% and specificity 70%). Conclusions: RDW levels were higher in women with PCOS, and high-RDW levels were independently associated with PCOS. This link in between RDW and PCOS may be due to an underlying chronic inflammation in subjects with PCOS

Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility

It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. The aim of this study was to examine the presence of tubal peristaltic dysfunction in unexplained infertility (UI). Hysteroscopy was performed in 35 women with UI and in 37 healthy fertile women. Bilateral tubal peristalses were assessed hysteroscopically by the observation of methylene blue injection and its transport to the Fallopian tubes. Tubal patency was evaluated with laparoscopic chromopertubation. Two women in control group (6.67%) and eight women in UI group (30.77%) had no tubal peristalsis, at least one tube with normal tubal patency. The difference was statistically significant (p = .019). Tubal peristaltic dysfunction may be a hidden cause of subfertility in women with bilateral patent Fallopian tubes. There is a definite need for larger trials to identify tubal peristaltic dysfunction as a cause of UI.Impact statement What is already known on this subject? Unexplained infertility has no identified pathophysiologic basis. It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. What do the results of this study add? Tubal peristaltic dysfunction was detected in two tubes (3.70%) in a control group and nine tubes (19.57%) in women with unexplained infertility, when the tubes were patent. The difference was statistically significant (p = .012). What are the implications of these findings for clinical practice and/or further research? In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility

Accuracy of a new hysteroscopic method in the assessment of tubal patency: Hysteroscopic Chromotubation

Objective The aim of this study was to evaluate the diagnostic accuracy of hysteroscopic chromopertubation (HCT) in the assessment of tubal patency by comparing its results with laparoscopic chromopertubation (LCT). Study Design The population of this prospective cohort study consisted of both fertile and infertile women. Sixty-four women were included to the study. HCT was assessed by the observation of the transport of highly concentrated methylene blue from uterine cavity to tubal ostia. The results of HCT were compared with the results of LCT as a gold standard. The accuracy of HCT, sensitivity, specificity, positive and negative predictive values in diagnosing tubal patency were calculated. Results The results of HCT and LCT were evaluated for right and left tubes, separately. One hundred and twenty-eight tubes were determined. Sensitivity, specificity, positive and negative predictive values for HCT were; 85.85%, 59.09%, 91% and 46.43%, respectively. Conclusion This study’s result showed that HCT had high sensitivity and moderate specificity values in the assessment of tubal patency. HCT during office hysteroscopy could give the chance to practitioners to assess tubal patency without subjecting the patient to multiple procedures

Endometrial flushing alpha(V)beta(3) integrin, glycodelin and PGF2 alpha levels for evaluating endometrial receptivity in women with polycystic ovary syndrome, myoma uteri and endometrioma

The aim of this cross-sectional study is to compare endometrial flushing fluid levels of alpha(V)beta(3) integrin, glycodelin and PGF2 alpha during the midluteal phase of the menstrual cycle of women with polycystic ovary syndrome (PCOS, n=20), myoma uteri (n=20) and endometrioma (n=19) with the healthy controls (n=20). After collecting samples at the midluteal phase of ovulatory volunteers and storing them at -80 degrees C, alpha(V)beta(3) integrin, glycodelin and PGF2 alpha levels were analyzed using ELISA. The mean ages of the groups were 28.90 +/- 5.45, 37.25 +/- 2.73, 32.84 +/- 6.62 and 32.15 +/- 5.18 in PCOS, myoma uteri, endometrioma and control groups, respectively. The alpha(V)beta(3) integrin level (ng/ml) was statistically significantly higher in endometrioma group (9.70 +/- 1.72, p<0.05) as compared to myoma uteri and control groups. Similarly, glycodelin level (ng/ml) was significantly higher in endometrioma group (341.04 +/- 93.32) than PCOS (p<0.01), myoma uteri (p<0.001) and healthy subjects (p<0.001). Moreover, PGF2 alpha level (350.04 +/- 464.50 ng/ml) was significantly higher in PCOS group relative to myoma uteri (p<0.001), endometrioma (p<0.05) and control (p<0.05) groups. In conclusion, alpha(V)beta(3) integrin level was significantly higher in endometrioma subjects than those with myoma uteri and control groups; glycodelin level was significantly higher in endometrioma group than other three groups, and lastly, PCOS patients had significantly higher PGF2 alpha levels than those patients with myoma uteri, endometrioma and controls

Arcuate artery calcification on transvaginal sonography may predict coronary artery heart disease

Atherosclerosis is a systematic disease affecting all arteries and is the most common cause of mortality. Our aim was to evaluate the predictive value of the presence of uterine arcuate artery calcification (AAC) for coronary heart disease (CHD) in women. Seventy women presenting with angina pectoris or a finding suggestive of cardiac ischaemia in non-invasive tests, scheduled for angiography between June 2014 and July 2015 were recruited in the study. One day before the coroner artery angiography, all of the patients were examined about the presence of AAC by transvaginal ultrasonography and were classified in the presence of CHD. CHD is classified as obstructive (obstruction >70%) or as non-obstructive (obstruction <70%) according to the severity of stenosis. The association of AAC is evaluated with the presence and severity of CHD that's diagnosed by angiography. CHD was present in 87.2% of women with positive for AAC and in 4.3% of who were negative for AAC (p = .001). AAC positive women were more likely to develop obstructive CHD than non-obstructive CHD (66.6% versus 30.9%, p = .001), respectively. Sensitivity and specificity of AAC for CHD were 97.6% and 78.5%, respectively. AAC detected by transvaginal ultrasound seems to have a strong association with both presences of CHD and the severity of disease.Impact statement What is already known on this subject? Atherosclerosis affecting all arteries is the primary cause of mortality and morbidity of coronary heart disease (CHD) (Lim et al. 2011). Uterine artery calcification and its association with atherosclerosis were first reported by Camiel et al. (1967). Ozdemir et al. (2016) found a correlation between carotid artery intima thickness and the presence of uterine arcuate artery calcification (AAC). What do the results of this study add? Very few studies have been performed in this area investigating the relationship of AAC and non-invasive predictors of atherosclerosis or the relationship between arterial calcifications and cardiovascular or systemic disease. Our study is the first to evaluate the correlation between AAC and CHD confirmed using coronary artery angiography at a high sensitivity rate (97.6%). What are the implications of these findings for clinical practice and/or further research? Our study presents an alternative, easy and non-invasive method for the prediction of subclinical CHD in clinical practice. From the view of a gynaecologist, cardiology consultation of patients with AAC detected by transvaginal ultrasonography during the routine gynaecologic examination may be useful and protective against serious cardiac problems. Thus, this study is of great importance in terms of predicting when the majority of CHD patients are asymptomatic or in the subclinical phase

Primary pure ependymoma: a rare entity of the ovary

Ependymomas are an uncommon glial tumors that usually arise from the central nervous system but they can occasionally occur in various extra-axial regions. Pure ovarian ependymoma, classified as differentiated glioma, was first described by Kleinman et al in 1984 and only a few cases have been reported since then. A 48 year-old multiparous woman with the diagnosis of left adnexal mass underwent surgery. Macroscopic evaluation of the left ovary showed 11x8 cm sized smooth-walled mass. Microscopic examination revealed small to medium sized cells with hyperchromatic, round to oval nuclei and scanty cytoplasm, perivascular pseudorosettes. Immunohistochemical staining for GFAP, vimentin, estrogen and progesterone receptors were positive. Based on these histopathologic and immunohistochemical features, the tumor was diagnosed as an ovarian ependymoma. As they seem rare, there is no verified treatment modality for ovarian ependymomas. , it is important to report these rare tumors, to shed light to the management and follow-up of them. To establish standard treatment modalities for neuroectodermal tumors of the ovary, it is essential to discuss all cases of ovarian epenymoma in the literature. [Med-Science 2016; 5(4.000): 1021-3