Funda Gungor

Transient gestational diabetes insipidus diagnosed in successive pregnancies: review of pathophysiology, diagnosis, treatment, and management of delivery

Gestational diabetes insipidus (GDI) is a rare disorder characterised by polyuria, polydypsia, and excessive thirst usually manifesting in the third trimester of pregnancy. The etiology is thought to depend on excessive vasopressinase activity, a placental enzyme that degrades arginine-vasopressin (AVP), but not 1-deamino-8-d-arginine vasopressin (dDAVP), which is a synthetic form. This is a transient syndrome and may be associated with acute fatty liver of pregnancy and preeclampsia. The use of dDAVP in symptomatic cases has been proven as a safe method for both the mother and the fetus during the pregnancy. We report a case of recurrent gestational diabetes insipidus in successive pregnancies, which responded to dDAVP and subsided after delivery.

Connective tissue alterations in women with pelvic organ prolapse and urinary incontinence

Background. Alterations in collagen synthesis and metabolism have previously been reported in patients with pelvic organ prolapse (POP) and/or urodynamic stress incontinence (USI). Since urinary incontinence does not always associate with POP, the objective of this study was to examine connective tissues from patients with USI plus POP, and patients with prolapse only. Methods. Biopsies from the uterosacral ligaments were obtained during the operation from POP patients (n =28), and from continent women (control group, n =12) who underwent surgery for other benign reasons. POP patients were classified following urodynamic tests and symptom questionnaire with respect to the presence (n =14) or absence (n =14) of USI. N‐terminal propeptides of collagen (PINP and PIIINP), TGF‐β and leptin were measured in plasma. Hydroxyproline and glycosaminoglycan (GAGs) concentrations and total hexosaminidase activity were measured in tissue samples. Histological sections were prepared using Massons trichrome technique, and digitised solutions were used for imaging provided by Soft Imaging System GmBh. Statistical evaluations were made by the Kruskal‐Wallis test. Results. A significant decrease in hydroxyproline content was found in USI+POP women in comparison to controls (p<0.05). In contrast, histopathological examination revealed an increased density of collagen in USI+POP patients. Hexosaminidase activity was decreased in both groups with POP, but no change in the amount of GAGs was observed. Markers of collagen synthesis (PINP, PIIINP), and factors related to the collagen synthesis (TGF‐β, leptin) remained unaltered. Conclusion. Our biochemical and morphological findings suggest a different organisation of collagen fibres in tissues of patients with USI+POP, when compared with both the controls and the POP patients.

Urinary incontinence (UI) and quality of life (QoL) of the elderly residing in residential homes in Turkey.

The objective of this study was to evaluate urinary incontinence (UI) and its effect on the quality of life (QoL) of older people dwelling in residential homes in Turkey. A cross-sectional study was applied in residential homes. A total of 1110 people older than 60 years residing in five selected residential homes were studied. An interview was conducted with the residents who had sufficient cognitive function and agreed to participate. The QoL and the mental and the functional state of the residents were analyzed using the Kings Health Questionnaire (KHQ), Mini Mental State Examination (MMSE), and the Rankin Scale, respectively: Of the total pool, 694 residents were included in the study of which 56.48% (n=392) were female and 43.52% (n=302) were male. UI was present in 170 women and 63 men. Pad usage was more common in women (88%) than that in men (29.1%). The QoL subdimensions showed that women had higher scores than men. Urge UI (UUI) had more impact on the QoL than that on functional, mixed or stress incontinence. We concluded that UI negatively affects the QoL of older people living in residential homes. In particular, women and patients suffering from UUI are more severely affected.

Vascular Effects of Estrogen and Progestins and Risk of Coronary Artery Disease: Importance of Timing of Estrogen Treatment

The effects of estrogen and progestins on the vascular wall have drawn major medical attention, and significant controversy over various studies has been developed. Several experimental and observational studies have shown cardioprotective effects; however, prospective randomized trials showed an increase in cardiovascular events in postmenopausal women on estrogen/ medroxyprogesterone acetate treatment. The most significant parameter for cardiovascular benefit of estrogen seems to be the interval since the onset of menopause. In the early postmenopausal years, estrogen has beneficial effects on the vascular wall by inhibition of atherosclerosis progression, whereas in the late postmenopause, adverse effects like upregulation of the plaque inflammatory processes and plaque instability may develop. The effects of progestins on the cardiovascular system are not as clear and may differ according to the choice of progestins that is used. The aim of this review is to summarize the effects of estrogen and progestins on the vascular wall and their clinical implications.

Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence

Objective: Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women.

Recurrent suprapubic abscess and vaginal fistula after anterior intravaginal slingplasty

Anterior intravaginal slingplasty is a widely used procedure for the treatment of stress urinary incontinence. After the operation, defective wound healing, infection, and fistula formation may follow. We present an unusual complication of anterior IVS that is recurrent suprapubic abscess and vaginal fistula formation in a 72-year-old woman. Fistulography was obtained and revealed a fistula tract extending from the suprapubic incision through the entire length of the mesh. Removal of the mesh and obliteration of the fistula tract was performed. Although the symptoms were relieved, the patient started to have episodes of stress urinary incontinence three weeks after the procedure.

OP07.28: The perinatal outcome of 48 IUGR fetuses with ARED

Objective: To determine the perinatal outcome of fetuses with absent or reversed end-diastolic (ARED) flow in the umbilical artery (UA) Doppler. Methods: Forty-eight IUGR fetuses between 24 and 34 gestational weeks with findings of ARED flow in the UA were prospectively followed. The fetuses monitored by repeat blood flow Doppler measurements of arterial and venous vessels, cardiotocography and biophysical scoring. Maternal evaluation and follow up was also carried out for detection of development of pre-eclampsia. Delivery was planned when nonreassuring findings were detected in any test. Perinatal outcomes were investigated up to the end of the first month of life. Results: The overall survival of the fetuses until the end of neonatal period with ARED was 22.9% (37/48). Intrauterine fetal death was observed in three (6.3%) cases. All the three fetuses which had ARED before 26 weeks were all died in-utero. Of the three fetuses died in utero, two had reverse flow in umbilical artery, but normal ‘A wave’ in ductus venosus. Eight fetuses died in neonatal period (16.6%). The indications for delivery of the live born neonates which were subsequently died were nonreassuring CTG in three cases, reverse flow in UA and in a wave of DV in three cases, and reverse flow detected in UA in one case. Six cases were delivered between 26–28 weeks, and early neonatal death was observed in two cases. Among the 32 cases delivered between 28–32 weeks, fetal death is observed in one case and six of 31 live born neonates delivered between 28–32 weeks were subsequently died in neonatal period. All fetuses delivered at or beyond 34 weeks were survived. Conclusions: ARED in UA Doppler is an ominous finding associated with high perinatal mortality, and the mortality rate decreases as the gestational age at delivery advances.