Ayse Filiz Avsar

Pethidine versus tramadol for pain relief during labor

Objective: To evaluate and compare the analgesic efficacy and adverse effects of tramadol and pethidine in labor. Method: Fifty‐nine full term parturients were randomly assigned to one of two groups in active labor. Group 1 received 100 mg pethidine; group 2, 100 mg tramadol, intramuscularly. Analgesic efficacy, maternal side effects, changes in the blood pressure, heart rate, and duration of labor were assessed. Result: At 30 and 60 min after drug administration, pain relief was greater in the pethidine group than in tramadol group. The incidence of nausea and fatigue was higher in the tramadol group. Following drug administration the decrease in systolic and diastolic blood pressure and the increase in heart rate were statistically significant in both groups. No significant difference was found between the groups when compared for duration of labor and Apgar scores. None of the neonates developed respiratory depression. Conclusion: Pethidine seems to be a better alternative than tramadol in obstetric analgesia because of its superiority in analgesic efficacy and low incidence of maternal side effects.

Effect of maternal obesity and weight gain on gestational diabetes mellitus

The aim of the study is to evaluate the association between gestational diabetes mellitus (GDM) and maternal obesity and weight gain during pregnancy. A prospective cohort study screened 614 consecutive gravid patients for GDM using 50 g glucose challenge test (GCT). The pregnant women were divided into 4 groups according to their prepregnancy body mass index (BMI). Group I, II, III and IV constituted when the BMI < 18.5 kg/m2 (n = 16), 18.5–24.9 kg/m2 (n = 455), 25–29.9 kg/m2 (n = 122), and >30 kg/m2 (n = 21) respectively. All the pregnant women were also evaluated in terms of their weight gain during pregnancy and these cases were recruited in 3 groups as low, ideal and high weight gain groups. Overall, a positive 50 g GCT result was identified in 106/614 (17.8%) women. GDM was further diagnosed in 12/614 (1.95%) of subjects. The prevalence of GDM in Group II, III and IV was 1.31%, 3.28% and 9.52% respectively (p < 0.05). The cases of Group II in first and second trimester and Group III only in second trimester showed statistically significant positive results of 50 g GCT when they had excess weight gain compared to the ones whose weight gain were in normal range. Women planning pregnancy should be educated about the disadvantages of obesity, being over-weight and should be advised to have an ideal prepregnancy BMI and ideal weight gain during pregnancy.

Maternal serum 25(OH)D levels in the third trimester of pregnancy during the winter season

Objective. To measure serum 25(OH)D levels of pregnant women in the last trimester during the winter season and to determine the factors affecting their serum levels. Methods. In all, 79 pregnant women in the third trimester were examined between November 2008 and March 2009. Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels were measured. Maternal age, education, socioeconomic status (SES), nutrition, dressing habits, and level of sunlight exposure were determined and their correlation with serum 25(OH)D levels were statistically compared. Results. The mean serum 25(OH)D level of the study group was 11.95 ± 7.20 ng/ml, and the prevalence of severe vitamin D deficiency [25(OH)D < 10 ng/ml] in pregnant women was 45.6%. No association was detected between severe vitamin D deficiency and maternal age, gravidity, skin phototype, benefiting from ultraviolet index, and educational status of the cases. Also in patients who used multivitamin supplements and good SES, 25(OH)D levels were significantly higher (p = 0.046, p = 0.025, respectively). Conclusions. This study showed a remarkable high rate of vitamin D deficiency in pregnant women during the winter season and we have found high levels of vitamin D in patients supplemented with multivitamins and in ones with good SES.

The aromatase inhibitor letrozole reduces adhesion formation after intraperitoneal surgery in a rat uterine horn model

OBJECTIVE To investigate, in an experimental animal study, the effects of letrozole and tamoxifen in the reduction of adhesion formation following abdominopelvic surgery. STUDY DESIGN Thirty female Wistar albino rats were included and divided into three groups. One group received 500 μg/d tamoxifen and a second group received 1 mg/kg/d letrozole through an enteric tube. A third group did not receive any drugs and served as the control group. On the fifth day, a laparotomy was performed and the right uterine horn was injured by monopolar cautery. The left uterine horn was incised with a scalpel and sutured. The preventive therapy protocols were continued for 7 days after surgery. On the 14th day after first surgery the animals were sacrificed, and the intraperitoneal macroscopic adhesion formation and microscopic adhesion features were evaluated. The Kruskal-Wallis test was used to compare the scores of the macroscopic adhesion scores and histologic features among the three groups, followed by a post hoc Mann-Whitney test. The total histological score was analyzed with a one-way ANOVA, followed by post hoc Bonferroni correction tests. p values ≤0.05 were considered statistically significant. The level of significance was set at p≤0.016 for the post hoc tests. RESULTS The letrozole and tamoxifen groups had significantly lower adhesion scores for the right uterine horn than the control group (p=0.005 and p=0.013, respectively). For the left horn, however, only the letrozole group had a lower macroscopic adhesion score than the controls (p=0.011). The total histological score was significantly lower in the letrozole group than in the control group (p=0.014), but no differences were found between the tamoxifen group and the control group (p=0.954). Inflammation, fibroblastic activity, collagen formation and vascular proliferation were significantly lower in the letrozole group compared with the control group (p<0.05). The foreign body reactions were similar among the three groups (p>0.05). Tamoxifen administration did not result in any significant effects on the histological scores (p>0.05). CONCLUSION Letrozole resulted in a significant decrease in postoperative macroscopic adhesion formation and the total histological scores, but tamoxifen did not demonstrate a similar effect on the histological scores.

Maternal plasma total antioxidant status in preterm labor

Aim:  To investigate the role of oxidative stress and antioxidant status in preterm labor.

A large primary vaginal calculus in a woman with paraplegia.

Objective The study aimed to report a primary vaginal stone, an extremely rare entity, without vesicovaginal fistula in a woman with disability. Case We describe the case of a large primary vaginal calculus in a 22-year-old woman with paraplegia, which, surprisingly, was not diagnosed until she was examined under general anesthesia during a preparation for laparoscopy for an adnexal mass. The stone had not been identified by physical examination with the patient in a recumbent position or by transabdominal ultrasonography and pelvic tomography during the preoperative preparation. Vaginoscopy was not performed because the vagina was completely filled with the mass. As a result of its size and hard consistency, a right-sided episiotomy was performed and a 136-g stone was removed using ring forceps. A vesicovaginal fistula was excluded. There was no evidence of a foreign body or other nidus on the cut section of the stone, and it was determined to be composed of 100% struvite (ammonium magnesium phosphate). Culture of urine obtained via catheter showed Escherichia coli. After the surgical removal of the calculus without complications, a program of intermittent catheterization was started. The follow-up period was uneventful, and the patient was symptom free at 6 months after the operation. Conclusions We postulate that the calculus formed as a consequence of urinary contamination of the vagina in association with incontinence and prolonged maintenance in a recumbent posture. This report is important because it highlights that, although vaginal stones are very rare, their possibility should be considered in the differential diagnosis of individuals with long-term paraplegia.

Nuchal cord: is it really the silent risk of pregnancy?

Abstract Objective: To evaluate the relationship between entanglement of umbilical cord around the fetal neck and adverse perinatal outcomes. Methods: In this prospective cohort study, perinatal outcomes of 218 pregnancies complicated with nuchal cord (NC) (study group) were compared with 190 uncomplicated pregnancies (control group). Main outcome measures were umbilical cord pH values, APGAR scores and cesarean section (C/S) rates. Fetal distress was stated as an abnormal heart rate pattern on electronic fetal heart monitorization. Results: There were no statistically significant differences in maternal demographic and obstetric features, between groups. There were no statistically significant differences regarding C/S rates between groups, even though fetal distress was significantly the leading indication for cesarean delivery, in the study group (p = 0.021). The number of entanglement was significantly related with fetal distress (p < 0.001). There were no statistically significant differences in umbilical cord gas values, one-minute and five-minute APGAR scores between the groups. Furthermore, there was a significant male dominance in the study group (p = 0.014) and also, amniotic fluid indexes (AFI) were significantly higher in this group (p = 0.002). Conclusion: This study demonstrated that, entanglement of umbilical cord around the fetal neck or NC is not related with adverse perinatal outcomes such as acidosis and low APGAR scores. So that, a targeted care on NC via ultrasound during labor, is not an essential part of the examination.

Preoperative Neutrophil-to-Lymphocyte Ratio Has a Better Predictive Capacity in Diagnosing Tubo-Ovarian Abscess

Background: The aim of this study is to identify the inflammatory markers which predict a tubo-ovarian abscess (TOA) in the most accurate way. Methods: This study involves 312 women. Preoperative inflammatory markers in the study group were compared with those in the healthy control group to identify the most efficient predictor of TOA with a high sensitivity and specificity. The recommended cutoff values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell count, and red cell distribution width were determined using receiver operating characteristic curve (ROC) analyses. Results: The area under the curve (AUC = 0.99) in the ROC analysis was found to be statistically significant for NLR (p < 0.001) with a cutoff value of ≥4.15 (95% CI 0.97-1.00, sensitivity 95.2%, specificity 99.4%). The positive predictive value of NLR was 99.2%, and the negative predictive value was 96.7% (p < 0.001). The recommended threshold for PLR was found to be 164.37 (AUC = 0.95, 95% CI 0.93-0.98, sensitivity 86.7%, specificity 92%), and the cutoff point of the white blood cell count in the ROC analysis was 9.55 × 103/μl (AUC = 0.90, 95% CI 0.87-0.95, sensitivity 78.68%, specificity 96.68%). Conclusion: Preoperative NLR and PLR improve the predictive value of serum markers for the presence of TOA.

Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey

Objectives: To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry. Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p<0.05), and weight gain during pregnancy was associated with parity and increased infant birth weight (p<0.05). However, no correlations were observed between mean pregnancy weight gain and maternal complications (p>0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.

Single-dose methotrexate for the treatment of ectopic pregnancy: Our experience from 2010 to 2015

Objective: To evaluate the success of systemic single-dose methotrexate (MTX) treatment in patients with ectopic pregnancy (EP) and to investigate factors related to treatment success. Methods: This retrospective study had been performed in Yildirim Beyazit University between January 2010 and December 2015. Demographic and clinical characteristics, ultrasonografic findings, pretreatment serum β–human chorionic gonadotropin (β-hCG) and progesterone levels of 58 patients with EP were retrieved from hospital records retrospectively. The patients were grouped according to MTX treatment success (response vs. failure). Results: Single-dose MTX-treatment was successful in 72.4% (42/58) of patients. The mean pretreatment β-hCG level was significantly lower in responders than in failures (2080 ± 2322 vs. 5707 ± 3885 IU/L, p = 0.001), and 2678 IU/L was the most suitable cutoff to predict success (75% sensitivity, 73.8% specificity). Moreover, failure rate was 8.45 times more in group of patients whose β-hCG values were determined above the cutoff. The presence of fetal cardiac activity adversely affected treatment success (odds ratio = 12, p = 0.004). Treatment success was not affected by past history of ectopic pregnancy, thickness of endometrium, progesterone value or presences of pseudosac and free pelvic fluid. Conclusion: The success rate of single dose MTX in this study was 72.8 %, and we found that failure rate of MTX treatment was 8.45 times more in group of patients whose initial serum β-hCG values were above 2678 IU/L and 12 times more in patients with fetal cardiac activity