Retrospective evaluation of outcomes of vaginal birth after caesarean section in a tertiary center: a single-center study from Turkey

Objectives: The aim of this study was to evaluate the trial of labor after caesarean (TOLAC) outcomes and determine its reliability by comparing it with elective repeat caesarean delivery (ERCD) and vaginal delivery. Material and methods: For this purpose, the outcomes of patients aged 18–40 years who had 57 TOLACs, 72 vaginal deliveries, and 60 elective caesarean sections in Ankara Koru Hospital between January 1, 2019, and January 1, 2022 were compared. Results: Gestational age was lower in the normal vaginal delivery (NVD) group than in the elective caesarean section and vaginal birth after caesarean delivery (VBAC) groups (p < 0.0005). The birth weight was statistically significantly lower in the NVD group than in the elective caesarean section and VBAC groups (p < 0.0002). No statistically significant correlation was found between the BMI values in all three groups (p < 0.586). There was no statistically significant difference between the groups in terms of pre- and post-natal haemoglobin and APGAR scores (p < 0.575)(p < 0.690)(p < 0.747). The rate of epidural and oxytocin use was higher in the NVD group than in the VBAC group (p < 0.001) (p < 0.037). There was no statistically significant correlation between the birth weights of the infants in the TOLAC group and failed VBAC (p < 0.078). No statistically significant correlation was observed between the use of oxytocin for induction and failed VBAC (p < 0.842). There was no statistically significant correlation between epidural anaesthesia and failed VBAC (p < 0.586). A statistically significant correlation was found between gestational age and caesarean section as a result of a failed VBAC (p < 0.020). Conclusions: The main reason for not preferring TOLAC continues to be uterine rupture. It can be recommended to eligible patients in tertiary centers. Because even when the factors increasing the success of VBAC were excluded, the rate of successful VBAC remained high

The Effect of the Ultrasonographically Determined Tubal Implantation Site in Ectopic Pregnancy on the Success of Methotrexate Treatment and Subsequent Reproductive Outcome

Objective: To study the prognostic significance of tubal implantation site on success of methotrexate (MTX) treatment and reproductive outcome in ectopic pregnancies (EP). Materials and Methods: Localization of ectopic pregnancies were determined and recorded by ultrasonography. Ninety-eight tubal EP cases meeting the conditions of haemodynamic stability and absence of fetal cardiac activity, were admistered MTX (50 mg/m intramuscularly). Main outcome measurements were as follows; positive result with methotrexate was regarded as decreasing beta-hCG titer in blood until it was zero. The necessity of any invasive intervention was considered as failed MTX therapy. Recurrent EP and intrauterine pregnancy rate was recorded in patients who desired to become pregnant within one year after treatment for EP. Results: Efficacy of MTX treatment was found to be 82.3%. It was successful in 91.6% of periampullar EP, but the success rate was 28.5% in periisthmic EP (p < 0.01). Periisthmic EP was found to be a poor prognostic factor for the success of MTX treatment (OR: 27.5; 95% CI: 6.8-110.8; p < 0.001). Fifty-nine patients desired pregnancy within one year after termination of EP. Although the overall cumulative pregnancy rates were similar, the rate of intrauterine pregnancy was significantly lower in periisthmic EP (25%) than in periampullar EP (87%) cases. Discussion: Ultrasonographically determined implantation site of tubal EP is a significant factor affecting success with MTX and the subsequent reproductive outcome

Selenium-Vitamin E Combination and Melatonin Modulates Diabetes-Induced Blood Oxidative Damage and Fetal Outcomes in Pregnant Rats

Oxidative stress is considered to be the main cause of diabetic complications. In the current study, we investigated the effect of selenium-vitamin E combination and melatonin on lipid peroxidation (LPO) and scavenging enzyme activity in the blood of streptozocin (STZ)-induced diabetic pregnant rats. Forty female Wistar rats were randomly divided into five groups. The first and second groups were used as the non-pregnant control and pregnant control groups, respectively. The third group was the pregnant diabetic group. Vitamin E plus selenium and melatonin were administered to the diabetic pregnant rats consisting fourth and fifth groups, respectively. Diabetes was induced on day 0 of the study by STZ. Blood samples were taken from all animals on the 20th day of pregnancy. LPO level was higher in diabetic pregnant rats than in control, although superoxide dismutase, catalase, and glutathione peroxidase activities were lower in diabetic pregnant animals than in control. LPO levels were lower both in the two treatment groups than in the diabetic pregnant rats, whereas selenium-vitamin E combination and melatonin caused a significant increase in the activities of these antioxidant enzymes (p < 0.01). In conclusion, vitamin E plus selenium seems to be a more potent antioxidant compared to melatonin in diabetic pregnant rats. Melatonin did not significantly affect the elevated glucose concentration of diabetic pregnant treated with melatonin group. Vitamin E plus selenium may play a role in preventing diabetes-related diseases of pregnant subjects

Serum lipid peroxidation and antioxidant potential levels in hyperemesis gravidarum

Hyperemesis gravidarum (HEG) is a severe form of nausea and vomiting with unknown etiology. Recent studies have suggested that there might be an etiologic role for Helicobacter pylori (HP) in HEG. HP is a Gram-negative bacterium that colonizes the gastric mucosa, increases the generation of reactive oxygen species (ROS), and decreases plasma antioxidants such as ascorbic acid. The aim of this study was to investigate plasma ROS activities and antioxidant status, and their relationship with HP infection, in HEG womens. Twenty-five HEG women, 20 gestational age- and gravida-matched healthy pregnant controls, and 15 nonpregnant women were examined for specific immunoglobulin G (IgG) against HP, serum malondialdehyde (MDA) as a measure of lipid peroxidation, and activity of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CT). Compared with controls, the seropositivity of HP for IgG was significantly higher (P 0.05). The results of the present study suggest that HEG is an oxidative stress condition, as reflected by the increased ROS activity and decreased antioxidant status, regardless of HP infection

Efficacy of intrauterine lidocaine for removal of a "lost" intrauterine device - A randomized, controlled trial

OBJECTIVE: To evaluate the efficacy of intrauterine lidocaine instillation in reducing patient discomfort during the removal of a "lost" intrauterine device (IUD)

Biochemical Markers in The Vaginal Washing and Insulin-Like Growth Factor Binding Protein in The Diagnosis of Membrane Rupture

OBJECTIVE: The aim of this study was to evaluate the diagnostic significance of IGFBP-1 applied by a dipstick method in comparison with nitrazine test and AFP/creatinine/HCG in the vaginal fluid. STUDY DESING: Thirty-six women with definite premature rupture of membranes (PROM) and 35 women without PROM were included in the study. Speculum examination, nitrazine test and IGFBP-1 detection by a rapid strip test and the analyses of AFP, HCG, and creatinine were performed. RESULTS: Sensitivity of IGFBP-1 test and nitrazine test was estimated to be 97%. Cut-off values for AFP (21 IU/l), creatinine (0.24 mg/dl) and HCG (702 mIU/ml) were determined by ROC analysis. Regression analysis revealed IGFBP-1 (p<0.01) as the most accurate test. Combination of AFP and creatinine was beneficial in discriminating membrane rupture (p<0.01). Likelihood ratios of PROM test, AFP, and combined AFP-creatinine tests were all of the same order of magnitude (≈34,≈0,05) and likely to be clinically important but not significantly different from each other in their clinical performance. CONCLUSION: IGFBP-1, AFP and combination of AFP-creatinine are accurate tests, holding immense importance with regard to clinical performance

Hyperemesis gravidarum complicated by Wernicke encephalopathy

BACKGROUND: Wernicke encephalopathy (WE) is a potentially fatal but reversible medical emergency. WE usually remains unrecognized in obstetric patients. Aim of the present study is to report a rare case of hyperemesis gravidarum that is complicated by WE. CASE: A 29 years-old, gravida 2, para 1 woman was admitted to Department of Obstetrics and Gynecology, Faculty of Medicine, Süleyman Demirel University in 2007 with an one week history of convulsions and confusion. The patient had nausea and vomiting accompanied by weight loss of 8 kg since she was pregnant. Symptoms of nausea and vomiting became severe in the last weeks. The patient had ataxia, nystagmus, confusion and general muscle weakness. Laboratory examinations were normal, except potassium levels (2.4 mmol/l) and ketonuria. There was no diagnosed lesion in the radiological examinations. The patient was diagnosed as WE, and she had replacement therapy with potassium and thiamine for 7 seven days. The patient responded well and was discharged. CONCLUSION: Hyperemesis gravidarum may cause WE which can be diagnosed clinically. Thiamine should be supplemented to pregnant women with prolonged vomiting to prevent development of WE