Ayse Nur Cakir Gungor

Randomized trial of vaginal prostaglandin E2 versus oxytocin for labor induction in term premature rupture of membranes.

OBJECTIVE The aim of this study was to compare the efficacy and safety of a prostaglandin E(2) (PGE(2)) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM) and low Bishop scores. MATERIALS AND METHODS A total of 240 women with singleton pregnancies at >or= 37 weeks, no prior uterine scar, vertex presentations, reactive nonstress tests, PROM for >or= 12 hours and Bishop scores of <or= 6 were randomly assigned to receive either oxytocin or vaginal PGE(2). The primary outcomes were time from induction to delivery and mode of delivery. RESULTS The time from labor induction to active labor onset was significantly shorter in the oxytocin group than in the PGE(2) group (4.9 +/- 4.1 vs. 8.5 +/- 3.6 hours; p = 0.02). The time from induction to delivery was also significantly shorter in the oxytocin group (3.4 +/- 1.5 vs. 9.6 +/- 4.7 hours; p = 0.02). Cesarean delivery rates were statistically similar in the oxytocin and PGE(2) groups (18.3 vs. 20.0%; p = 0.81). Neonatal outcomes were comparable in both groups. Comparable results were observed for nulliparous women included in the study population. CONCLUSION Oxytocin treatment seems to be superior to vaginal administration of PGE(2) to induce labor in term pregnancies complicated with PROM and unfavorable services.

The protective effect of quercetin on IMA levels and apoptosis in experimental ovarian ischemia-reperfusion injury.

OBJECTIVE To investigate the protective effect of quercetin (QE), an anti-inflammatory and anti-oxidant agent, on torsion-detorsion induced histopathological changes and blood IMA levels in experimental ovarian ischemia-reperfusion (IR) injury. STUDY DESIGN Twenty-four female Wistar rats were randomly divided into four groups in this study (n=6). Group I, (sham operation); Group II, torsion-detorsion plus saline (IR); Group III, torsion-detorsion plus solvent (dimethylsulfoxide: DMSO, IR+DMSO); Group IV, torsion-detorsion plus 15 mg/kg/bw quercetin (IR+QE) injected intraperitoneally 30 min prior to detorsion. After 3h of reperfusion, the right ovaries were removed surgically. The ovary tissue samples were fixed in 10% formalin solution for histopathological and immunohistochemical examination. Blood samples were obtained at the end of the procedures for each group of animals. RESULTS Ovarian sections in Groups II and III showed higher follicular cell degeneration, hemorrhage, vascular congestion and edema when compared with Group I. Administration of quercetin in rats significantly prevented degenerative changes in the ovary. Significantly less histopathological changes were found in Group IV compared with Groups II and III. Caspase-3 and TUNEL positive cells were detected in the ovarian surface, follicle epithelium, and stromal cells in all experimental groups, and there was a significant increase in Groups II and III compared with Group I (P<0.05). Treatment with quercetin decreased the number of caspase-3 and TUNEL positive cells. IR increased the ischemia modified albumin (IMA) levels in comparison to the sham group (1.06 ± 0.10 ABSU and 0.92 ± 0.08 ABSU, P<0.05). Quercetin administration before IR reduced the levels of IMA (0.93 ± 0.08 ABSU, P<0.05). CONCLUSION Administration of quercetin is effective in preventing tissue damage induced by IR injury in ovaries.

Acne severity and the Global Acne Grading System in polycystic ovary syndrome

To evaluate the association between acne, quantified by the Global Acne Grading System (GAGS), and abnormal clinical and laboratory markers of androgen excess in patients with polycystic ovary syndrome (PCOS).

Intracytoplasmic sperm injection outcomes of obstructive and nonobstructive azoospermic men

PurposeWe aimed to compare the outcomes of intracytoplasmic sperm injection (ICSI) cycles in ostructive and nonobstructive azoospermic men.MethodsIn this retrospective study, we searched the first ICSI cycle parameters of 211 azoospermic men. Our main outcomes were the average fertilization rate, implantation rate, pregnancy and miscarriage rates.ResultsThe results of this study showed that although the males with obstructive azoospermia had better fertilization and biochemical pregnancy rates than the ones with nonobstructive azoospermia, clinical pregnancy and miscarriage rates among the groups were similar.ConclusionICSI overcomes the obstacles related to the sperm in its function as a carrier but it cannot alter the message carried by the male gamete.

Relationship of QT dispersion with sex hormones and insulin in young women with polycystic ovary syndrome: an observational study.

OBJECTIVE Polycystic ovary syndrome (PCOS) is a common endocrinopathy in reproductive women. Cardiovascular disease risk factors are more frequent in this population. We aimed in this study to investigate presence of QT dispersion and effects of sex hormones and insulin on QT duration in young PCOS patients. METHODS This present study was cross-sectional observational study. A total of 47 women, 25 patients with PCOS and 22 healthy, were included. Serum testosterone, estradiol and insulin levels were studied and electrocardiography was performed at 2nd or 3th days of menstrual cycle. The study population was divided into groups according to serum testosterone and estradiol levels. Sub-groups and pairwise groups were compared by Mann-Whitney U or student t-test. The associations of QTc durations with hormone levels were calculated using Spearman rank correlation analysis. The results were evaluated at the p<0.05 significance level. RESULTS No differences found between groups regarding to demographic parameters. Estradiol and testosterone levels were higher in patients with PCOS (41.12 ± 13.59 vs. 35.57 ± 19.29 pg/mL, p=0.09 and 105 ± 58.5 vs. 17.6 ± 10.9 ng/dL, p=0.01, respectively). QT dispersion was significantly longer in PCOS patients (47.1 vs. 32.7 ms, p=0.01). A positive correlation was found between the serum insulin level and QTc min, QTc max, and QTc mean (r=0.402, p=0.011; r=0.341, p=0.033; r=0.337, p=0.036; respectively). QT dispersion with serum testosterone and estradiol levels were positively correlated (r=0.525, p=0.001 and r=0.326, p=0.046; respectively). CONCLUSION Our results suggest that QT dispersion is prolonged and testosterone, estradiol and insulin are associated with QT duration in young PCOS patients.

Perinatal outcomes of borderline diabetic pregnant women.

Abstract We examined the perinatal outcomes of borderline diabetic pregnant women who had impaired 50 g oral glucose challenge test (OGCT) results, but normal 100 g oral glucose tolerance test (OGTT) results. Our study group included 70 pregnant women who had increased 50 g OGCT results, but normal 100 g OGTT results, and a control group of 122 pregnant women with normal 50 g OGCT results. Polyhydramnios, macrosomia and neonatal birth weight were significantly higher in the study group. After adjusting the results for possibly affecting variables, the risk of polyhydramnios remained significant, while the risk of macrosomia and neonatal birth weight was not significant between the groups. The results from the study group were similar to the control group, when adjusted for other risk factors. Increased 50 g OGCT results in pregnant women can be accepted as a benign state if the 100 g OGTT results are normal.

Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery

Abstract Objective: Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST). Methods: Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation. Results: Out of the patients with no SG (n = 11), mild SG (n = 10) and severe SG (n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively (p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively (p = 0.561). Conclusions: To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation.

Does Omegaven have beneficial effects on a rat model of ovarian ischemia/reperfusion?

OBJECTIVE The beneficial effects of omega-3 fatty acids on an intestinal ischemia/reperfusion (I/R) model was shown previously. Therefore, we aimed to examine the potential beneficial effects of parenteral omega-3 fatty acids, a safe and inexpensive product, on a rat model of ovarian I/R. STUDY DESIGN A group of 39 rats was divided into six groups. Group 1 (Sham Group; n=6) underwent two laparotomies with a 3-h interval and their ovaries were removed 3h later. Group 2 (torsion-detorsion Group; n=7) had their ovaries torsioned clockwise and fixed at 720°; 3h later a detorsion operation was done and after another 3h, their ovaries were removed. Group 3 (n=7) and Group 4 (n=7) received the same treatment as Group 2; however, half an hour prior to detorsion, these rats received Omegaven at 1mL/kg and 5mL/kg, respectively. Group 5 (n=6) and Group 6 (n=6) received the same treatment as Group 1; however, half an hour prior to the second laparotomy, these rats received Omegaven at 1mL/kg and 5mL/kg, respectively. One ovary from each rat was evaluated histologically by hematoxylin and eosin (H&E) staining and the other ovary was homogenized and evaluated for total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI). RESULTS While we failed to show any significant relationship among groups in oxidative parameters, there was a significant worsening in the torsion-detorsion group in histological evaluation. High Omegaven doses, but not low doses, improved tissue injury scores of torsioned and detorsioned ovaries to the levels observed in the control group. CONCLUSION Omegaven improves the detrimental effects of ovarian I/R when used in sufficient doses. Its effects and dose adjustment on women with ovarian torsion must be investigated by further studies.

Effects of vaginal discharge on female sexual function

To assess the effects of vaginal discharge on female sexual dysfunction (FSD) by using the Female Sexual Function Index (FSFI).

Comparison of olive oil and lanolin in the prevention of sore nipples in nursing mothers.

Sore nipple is a frequently encountered problem among lactating women. This problem might cause severe pain and might end up with discontinuation of suckling. An effective method to prevent sore nipples have not been defined yet. Olive oil is an easily accessible and relatively cheap substance. Although it had been used for sore nipples in the Mediterranean countries for many years, the usage of olive oil in the management of sore nipples has not been discussed in the literature yet. We aimed to define a new, safe, effective, and cheap modality for preventing sore nipples. We conducted the study on the patients who were delivered in our clinic between February 2012 and June 2012. Ethical committee approval and the written consent of patients were obtained. An education on breastfeeding was given to all patients by the same nurse. Patients’ nipples were examined to evaluate if both of them were suitable for suckling or not. Patients who did not give consent, could not breastfeed in the first 24 hours, had a difference between nipples that might affect suckling, had contraindication for breastfeeding, did not have sore nipples with their previous babies, and had an allergy to either olive oil or lanolin were excluded. Patients were requested to put olive oil on one nipple and lanolin on the other one before suckling and breastfed the baby without cleaning the ointment. They were asked to use the same ointment to the same nipple every time until the end of the study. They were advised to use one of the modalities for both nipples if they were satisfied with the modality. They were also advised to record the time they chose the modality if a selection was done. After a month, patients were evaluated once more. They were asked about satisfaction from the modalities, their choice if there was, and the pain during the suckling. Data were analyzed with the SPSS version 11.5 software program (SPSS, Inc., Chicago, IL). A value of p < 0.05 was defined as statistical significance. The mean age of the 31 patients included to our study was 27.84 – 6.33 years. Among the study group 64.5% of them were primiparous, and 51.6% of them were delivered by cesarean section. Education levels of patients were evaluated: nine (29%) of them graduated from a primary school, 17 (54.9%) of them graduated from a secondary school, and five (16.1%) of them graduated from a university. From the study group, 15 patients (48.4%) lived in an urban area with a downtown, and 16 (51.6%) of them lived in rural areas. In total, 18 (58.1%) patients preferred olive oil, five (16.1%) preferred lanolin, three (9.7%) continued to use both modalities, and five (16.1%) of them gave up both methods at the end of 1 month ( p < 0.001). Although nine (29%) patients decided to choose one of the methods in the first week of the delivery, the rest made their choice after 1 week. Of the ones who had decided in the first week of delivery, eight (89%) patients chose olive oil, and one of them gave up both methods. When a regression analysis was done for age, education levels, gravidas, parities, pain during suckling, delivery route, and method choice, we found a significant relationship only between the pain during suckling and the choice of method. As it is well established, breastmilk is the ideal nutrition for a newborn. In a population-based study that examined the breastfeeding rate and patterns among 3,161 infants younger than 6 months, it was found that 22.8% of mothers experienced sore nipples. Unfortunately, sore nipple might cause breastfeeding cessation. When Mohammadzadeh et al. compared hind milk rubbing after suckling and lanolin usage three times a day with the control group, they concluded that there was no difference among groups in terms of clinical manifestations of sore nipples. Tachev et al. concluded that highly purified lanolin (Lansinoh ; Lansinoh Laboratories, Alexandria, VA) was suitable for both preventing and treating sore nipples. Melli et al. recommended peppermint gel for sore nipples compared with placebo and lanolin. Olive oil has strong antioxidant and antimicrobial properties, and it had been used for wound healing for a long time. It is also known that even parenteral usage of olive oil for newborns is safe. So it is well tolerated by the babies and the families. To our knowledge this is the first article that evaluates the satisfaction of lactating women with olive oil for preventing sore nipples in the English literature. Using the contralateral nipple of the patient as a control group is the major factor that strengthens our study. In this way we eliminated many factors that might affect our results.