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Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.

Background: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. Methods: This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. Results: During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. Conclusion: TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen.

Influence of Gum Chewing on Postoperative Bowel Activity after Cesarean Section

Objective: To assess the effects of gum chewing on postoperative bowel function after cesarean section. Material and Methods: Women who underwent cesarean section were randomized to either a gum-chewing group (n = 74) or a non-gum-chewing group (n = 76). The two groups were compared with respect to the return of bowel activity, postoperative analgesic and antiemetic drug requirement and postoperative hospital stay. Results: Bowel sounds appeared in a significantly shorter duration of time in the study group, the mean being 5.9 h as compared to 6.7 h in the control group (p < 0.01). The first passage of flatus postoperatively was 22.4 h in the gum-chewing group and 31 h in the control group (p < 0.001). The total length of hospital stay was shorter in the gum-chewing group (2.1 days) than in the control group (2.3 days), but it was not statistically significant (p > 0.05). Postoperative analgesic requirement in both groups was similar, but the postoperative antiemetic need in the gum-chewing group was lower than in the control group (p < 0.01). Conclusion: On the basis of the tolerability and results on bowel function, gum chewing provides a simple method for early recovery of bowel function after cesarean section.

Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns.

Objective. Aimed to investigate (a) the effect of non-stress test (NST) and music on maternal anxiety (b) the effect of maternal anxiety and music on fetal heart rate (FHR) changes. Material and method. The two hundred and one pregnant women coming for routine prenatal care were randomized to receive either music (n = 96) or no music (n = 105) during NST. Before and after the test, these women were asked to complete the Spielberg State-Trait Anxiety Inventory on two interviews; primary outcome was considered as a maternal state anxiety score before and after NST. Secondary outcome was the baseline FHR, the number of fetal movement, large accelerations, dubious NST, variable decelerations, and the minimum procedure time. Results. Before NST, the mean state anxiety score of the music and control groups was found as 38.1 ± 8.8 and 38.08 ± 8.2, respectively (p > 0.05). On the other hand, after NST, the mean state anxiety score of the music and control groups was found as 35.5 ± 8.2 and 40.2 ± 9.2, respectively (p < 0.001). While in control group, NST brought about a statistically significant increase in a state anxiety score (38.08 ± 8.2 versus 40.2 ± 9.2, p < 0.001), listening to music during NST resulted in decrease in a state anxiety score of the study group but it was not statistically significant (38.1 ± 8.8 versus 35.5 ± 8.2, p > 0.05). The baseline FHR of the music group was significantly higher than that of the control group (134.09 ± 7.2 versus 130.3 ± 5.7, p < 0.001).The number of fetal movement in the music group was significantly higher than that of the control group (8.9 ± 4.7 versus 5.9 ± 3.9, p < 0.001). The number of large accelerations in music group was significantly higher than that of the control group (5.7 ± 2.1 versus 4.5 ± 2.04, p < 0.001). The minimum procedure time in music group was significantly lower than that of control group (13.4 ± 5.2 versus 15.6 ± 6.1, p < 0.05). The number of dubious NST and variable decelerations was found to be similar for both groups (p > 0.05). Conclusion. NST has anxiogenic effects on mothers and listening to music during the test has positive impact on both maternal and fetal parameters but it is an open question whether maternal anxiety during pregnancy may affect fetal accelerations to such an extent that it could influence clinical judgments.

Diagnostic value of hysteroscopy and hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women

ObjectiveTo estimate the diagnostic value of hysteroscopy and hysterosonography in endometrial pathologies in asymptomatic postmenopausal women.Materials and methodsIn this prospective study, 77 asymptomatic postmenopausal women that had a suspicion of endometrial abnormalities based upon transvaginal ultrasonography were studied. The patients underwent transvaginal ultrasonography and hysterosonography. All patients then had office diagnostic hysteroscopy or operative hysteroscopy. The final diagnosis was made by operative hysteroscopy with resection and excision of the lesions or endometrial biopsy with vacuum curettage. Sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography, hysterosonography and diagnostic hysteroscopy were calculated.ResultsThe patients’ age ranged from 45 to 80. The most common frequent abnormalities were endometrial hyperplasia in transvaginal ultrasonography (62.33%), endometrial polyp in sonohisterography (57.14%), and also endometrial polyp in diagnostic hysteroscopy (51.94%). Transvaginal ultrasonography revealed a sensitivity of 59.7% and a specificity of 35.5%. Sonohysterography revealed a sensitivity of 88.8% and a specificity of 84.4%. Diagnostic hysteroscopy revealed a sensitivity of 91% and a specificity of 82%.ConclusionHysterosonography showed very good agreement with hysteroscopy for the diagnosis of endometrial abnormalities in asymptomatic postmenopausal women. In asymptomatic postmenopausal women that had a suspicion of endometrial abnormalities based upon transvaginal ultrasonography should undergo both hysterosonography and hysteroscopy.

Does Vaginal Irrigation with Saline Solution in Women with Infectious Vaginitis Contribute to the Clinical and Microbiological Results of Antibiotic Therapy

Aim: To compare the clinical and microbiological results between patients with infectious vaginitis receiving vaginal irrigation with saline or no irrigation before standard antibiotic therapy. Methods: Women with vaginitis (n = 109) were randomized to receive vaginal irrigation with saline or no irrigation before standard antibiotic therapy. The vaginal symptoms perceived by subjects and clinical findings were assessed with a standardized scale during four follow-up visits, and Gram stain Nugent scores and vaginal fluid cultures were analyzed at each visit. Results: Vaginal discharge (z = 7.159; p < 0.001), pruritus (z = 5.169; p < 0.001), itching (z = 2.969; p < 0.003) and odor scores (z = 2.303; p < 0.021) were significantly reduced in the study group compared to the control group between the first visit and 3–5 days after irrigation, before the start of antibiotic therapy. The second and third visits (15 and 30–45 days after antibiotic therapy) showed that the patients’ symptoms and amounts of visible vaginal discharge did not differ between the two groups. Moreover, the microbiological cures of patients in each group did not differ at these visits (z = 0.447; p = 0.655). Conclusion: Vaginal irrigation with saline significantly reduces self-reported symptoms in the short term but has no effect on long-term clinical and laboratory results in women with infectious vaginitis.

Ovarian vein thrombosis and Mirror syndrome in association with sacrococcygeal teratoma

Ballantyne’s syndrome has originally been described for hydrops fetalis, which is associated with rhesus isoimmunization; however, hydrops fetalis can also occur in association with non-immunological causes, including Ebstein’s anomaly, Galen’s vein aneurysm, fetal arrhythmias, and sacrococcygeal teratoma (SCT). SCT is the most commonly presenting tumor in newborn babies, occurring in approximately 1 in every 40,000 live births. Large or rapidly growing tumors are highly vascular, and lead to high-output cardiac failure, which is characteristic of hydrops fetalis. In non-immune hydrops fetalis maternal preeclampsia (Mirror syndrome) can also sometimes occur. The clinical manifestations of mirror syndrome are quite varied, and the pathophysiology of this syndrome is poorly understood.1–3 Ovarian vein thrombosis (OVT) is a rare complication of pregnancy; however, recognition and treatment of this condition are critical because a delay in diagnosis can lead to significant maternal morbidity. The diagnosis of OVT remains a challenge because there is no known profile of risk factors.4 In this manuscript, we describe a case of a rapidly growing SCT that is associated with Mirror syndrome and ovarian vein thrombosis.

Transcervical Intrauterine Levobupivacaine or Lidocaine Infusion for Pain Control during Endometrial Biopsy

BACKGROUND Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction. OBJECTIVES To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double-blinded trial in pre- and postmenopausal women. METHODS Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged. RESULTS Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group. CONCLUSION Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intrauterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.

Prenatal diagnosis and follow-up of giant sacrococcygeal teratoma

Sacrococcygeal teratoma is a non-organ-specific soft tissue lesion composed of extragonadal tissues located in the pericoccygeal region. Sacrococcygeal tumor, a germ cell tumor, is quite rare in the general population; however, it is the most common congenital tumor in newborns. The incidence for this tumor is estimated to be 1:40,000 live births [1]. Although it has a benign histological character, it has a relatively high mortality rate (>50%) among patients diagnosed prenatally [2]. We hereby, present a patient who presented to our department with an estimated gestational age of 32 weeks, whose fetus was observed to have a sacrococcygeal teratoma measuring 20 cm by ultrasound (US) and fetal magnetic resonance imaging (MRI) evaluations. A 23-year-old primigravid woman presented to our department for antenatal follow-up at the 32 gestationalweek. She stated that she had been followed-up regularly in another medical center throughout previous gestational weeks. A solid lesion with solid cyctic components with a size of 20 cm 18 cm located in the sacrococcygeal region of the fetus was detected on ultrasonic examination of the patient. Her amniotic index was measured as 210 mm and placentomegaly was noted. We confirmed the gestational age consistentwith32weeksof gestation. Furthermore, a detailed investigation was performed to affirm clear diagnosis. Color Doppler sonography designated that the mass was not well vascularized, and there was no evidence of fetal hydrops. Fetal echocardiographic examination was normal. Fetal MRI investigation revealed a solid lesion measuring 20 cm 17 cm with a hypointense peripheral margin extending through the pelvic and anal region, involving diffuse cyctic areas. Its main component was located at the right side of the fetus. The lesion primarily suggested the diagnosis of Type I sacrococcygeal teratoma (Fig. 1). The patient was hospitalized and monitored with serial US and external fetal monitoring. There was no designated

Recién nacida con tumoración genital interlabial de resolución espontánea: Caso clínico

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartners duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.

Seborrheic keratoses: a distinctive diagnoses of pigmented vulvar lesions: a case report

Seborrheic keratoses, a benign growth lesion, is a very common cutaneous lesion encountered in white races in the fourth and fifth decade. The occurrence of this lesion on the vulva is rare, as an isolated lesion or in association with lesions elsewhere. A 34-year-old woman reported with a hyperpigmented palpable lesion, approximately 5-10 mm in diameter, was found on the patients left labium majus. The clinical differential diagnosis of the pigmented lesions of the vulva is difficult often need a biopsy.