Hulusi B. Zeyneloglu

New rapid bed-side test to predict preterm delivery: phosphorylated insulin-like growth factor binding protein-1 in cervical secretions

Background.  Phosphorylated insulin‐like growth factor binding protein‐1 (phIGFBP‐1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP‐1 in cervical secretions by a rapid bed‐side test could be used to predict preterm delivery in patients with regular uterine contractions.

Black cohosh and fluoxetine in the treatment of postmenopausal symptoms : A prospective, randomized trial

The objective of this study was to evaluate the efficacy of fluoxetine and black cohosh in the treatment of women with postmenopausal symptoms. A total of 120 healthy women with menopausal symptoms were recruited to this prospective study with a follow-up period of 6 mo. They were randomly assigned to 1 of 2 groups and were treated with fluoxetine or black cohosh. After entry into the study, patients were examined at the first, second, third, and sixth months of the treatment period. The women kept diaries in which they reported the daily number and intensity of hot flushes and night sweats. In addition, at the beginning and end of the third month, they completed questionnaires consisting of a modified Kupperman Index, Beck’s Depression Scale, and a RAND-36 Quality-of-Life Questionnaire. Statistically significant differences were noted in the Kupperman Index and Beck’s Depression Scale at the end of the third month in both groups compared with baseline values. In the black cohosh group, the Kupperman Index decreased significantly compared with that in the fluoxetine group by the end of the third month. On the other hand, in the fluoxetine group, Beck’s Depression Scale decreased significantly compared with that in the black cohosh group. Monthly scores for hot flushes and night sweats decreased significantly in both groups; however, black cohosh reduced monthly scores for hot flushes and night sweats to a greater extent than did fluoxetine. At the end of the sixth month of treatment, black cohosh reduced the hot flush score by 85%, compared with a 62% result for fluoxetine. By the sixth month of the study, 40 women had discontinued the study—20 (33%) in the fluoxetine group and 20 (33%) in the black cohosh group. Compared with fluoxetine, black cohosh is more effective for treating hot flushes and night sweats. On the other hand, fluoxetine is more effective in improvements shown on Beck’s Depression Scale.

Intravenous albumin prevents moderate—severe ovarian hyperstimulation in in-vitro fertilization patients: a prospective, randomized and controlled study

OBJECTIVE To assess the effectiveness of intravenous administration of albumin in prevention of ovarian hyperstimulation syndrome (OHSS) in patients of an in-vitro fertilization program. STUDY DESIGN Prospective randomized study. Patients with hCG day E2 levels are 11010 pmol/l (3000 pg/ml) or more were recruited into two groups. Group A (n = 27) received 10 g 20%, 50 ml human albumin infusion before oocyte pick-up and no medication was administered in Group B (n = 28). RESULTS Patients were similar in terms of cycle characteristics. No moderate-severe OHSS developed in Group A whereas one severe OHSS case and four moderate OHSS cases developed in Group B. Statistical analysis revealed a significant (P < 0.05) protection in albumin treated group. CONCLUSION Human albumin proves effectiveness in prevention of moderate-severe OHSS.

Chromosome heteromorphisms: an impact on infertility

IntroductionCytogenetic heteromorphisms are described as heritable variations at specific chromosomal regions without a proven impact on phenotype.Materials and methodsWe compared the presence of chromosome heteromorphisms in the karyotypes of two patient groups. The first group of patients consisted of 276 individuals of 138 infertile couples. The second group, consisted of 1,130 amniocentesis samples. This group was considered to be a sample of the fertile population, as the fetus being karyotyped is the result of a spontaneous pregnancy. Fetal karyotyping was made due to the standard indications for prenatal diagnosis, such as abnormal maternal serum screening results. Results and discussionEighteen infertile patients (6.52%) and twenty fetuses (1.77%) were found to have chromosome heteromorphisms. The difference between the two groups was statistically significant (p < 0.0001).ConclusionThese results are consistent with other similar studies that suggest the yet undefined relationship between chromosome heteromorphisms and infertility.

Prediction of preterm delivery among women with threatened preterm labor.

Background/Aims: To determine predictive values of fetal fibronectin and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in cervicovaginal secretions and ultrasonographic measurement of cervical length for delivery <35 weeks in patients with uterine contractions. Methods: Our study included 51 women between 24 and 35 weeks’ gestation with uterine contractions and 90 controls. Cervicovaginal samples were analyzed for presence of fetal fibronectin and phIGFBP-1. Cervical length was measured by transvaginal sonography. Results: Preterm birth rate was 19.6% (10/51) in the study group. Negative predictive values of fetal fibronectin, phIGFBP-1 and ultrasonographic cervical length <20 mm, and <25 mm for delivery <35 weeks were 91.9, 92.3, 91.1, and 90.5%, respectively. Positive predictive values were 50, 58.3, 100 and 66.7%, respectively. When results of fetal fibronectin/phIGFBP-1 test and ultrasonographic cervical length <25 mm were combined, specificity and positive predictive values of each test for delivery within 7 days increased. Conclusion: Fetal fibronectin and phIGFBP-1 tests have approximately equivalent ability to predict delivery <35 weeks’ gestation. An ultrasonographic cervical length measurement >20 mm or a negative fetal fibronectin/phIGFBP-1 test obtained from patients with uterine contractions at 24–35 weeks’ gestation may avoid overdiagnosis.

Why women request cesarean section without medical indication

Objective. To understand the reasons of the cesarean delivery on maternal request (CDMR) without medical indication would help to reduce the rates of unnecessary cesarean-delivery (CD). The objective of this study is to determine the basal knowledge of women regarding normal delivery (ND) and CD and also to assess their attitudes about CDMR, and to find out the reasons influencing those attitudes. Methods. The study included 400 women who completed a 45-item questionnaire that assessed their basal knowledge of ND, CD, and their attitudes and beliefs about the mode of delivery and CDMR. Results. Mean age of the study population was 32 ± 10.2 years (range 18–66). Majority of the women would choose the ND because of its ‘being completely natural’ (89%) and no anesthesia and operative risk related with ND (76%). Only 33% of the women indicated that ND might cause genital organ prolapse and/or stress urinary incontinence and just 26% and 24% of the women would choose CD to prevent pelvic organ prolapse and stress urinary incontinence, respectively. On the other hand, 50% and 54% of the women would indicate that they could choose CD in order to prevent labor pain and to minimize the risk of fetal distress during the labor. Furthermore, 47% of the women had an opinion that that CD could be performed by maternal request without medical indication. Educational level had no effect of CDMR although more educated women had more accurate knowledge about the some risk and benefits of ND and CD. Binary logistic regression analysis revealed that fear of labor pain (p = 0.02, OR: 15.0, CI: 0.494–0.966), maternal age (p = 0.01, OR: 6.3,CI: 1.00–1.05), and knowledge about the relation between the ND and pelvic organ prolapse/urinary incontinence (p < 0.001, OR: 4.8, CI: 0.549–0.966) were the independent prognostic variables for the CDMR . Conclusion. Although majority of the women had wrong idea or no idea about the risks and benefits of CD, nearly half of them indicated that women can always demand CDMR. This study shows that basal knowledge of the women should be improved by education.

Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes.

OBJECTIVE To investigate the impact of embryo replacement depth on IVF and embryo transfer outcomes. DESIGN Retrospective analysis (May 2005 to November 2008) of 5,055 ultrasound-guided embryo transfers belonging to 3,930 infertile couples. The distance between the fundal endometrial surface and the catheter tip was measured and accordingly, patients were divided into five groups. SETTING Anatolia IVF Center, Ankara, Turkey. PATIENT(S) All patients enrolled in the IVF program undergoing embryo transfer. INTERVENTION(S) No patient received any additional procedure or intervention. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate (PR) and ongoing PR. RESULT(S) Mean total number of embryos transferred in groups 4 and 5 were significantly higher than in groups 2 and 3. Analysis of PRs and outcome of gestations in the five groups studied yielded similar PRs in all groups except for group 1. CONCLUSION(S) Pregnancy rates and ongoing PRs are higher if the embryos are replaced at a distance >10 mm from the fundal endometrial surface. In addition because significantly more embryos were replaced in cycles where the transfers occurred at a distance of >20 mm, a distance>10 mm to <20 mm seems to be the best site for embryo transfer to achieve higher PRs.

The effect of monocyte chemotactic protein 1 in intraperitoneal adhesion formation in a mouse model

OBJECTIVE Intraperitoneal adhesions are a significant cause of morbidity among women of reproductive age. Monocyte chemotactic protein 1 plays a role in the chemotaxis of mononuclear cells and fibroblasts into the peritoneal injury site. To evaluate its role in intraperitoneal adhesion formation, we used an established postsurgical adhesion model in mice. STUDY DESIGN Surgical adhesions in mice were induced by scraping and crushing peritoneal sites. We analyzed the injury sites for the temporal expression of monocyte chemotactic protein 1 messenger ribonucleic acid and cellular infiltration at 12 to 24 hours across 10 days and evaluated the effects of monocyte chemotactic protein 1 and anti-monocyte chemotactic protein 1 neutralizing antibody on adhesion formation. On induction of adhesions animals were randomly assigned to 1 of 4 groups: (1) control, (2) nonspecific immunoglobulin G, (3) monocyte chemotactic protein 1, (4) anti-monocyte chemotactic protein 1 antibody. Animals received daily intraperitoneal injections for 6 days. Adhesions were scored on day 14 and immunostained for fibroblasts and macrophages. RESULTS Adhesions developed consistently by the fifth postoperative day. We detected an increase in monocyte chemotactic protein 1 messenger ribonucleic acid expression at 48 hours; this remained until the fourth postoperative day. By the second day macrophages were present at the injury site. Animals treated with anti-monocyte chemotactic protein 1 antibody had significantly fewer adhesions develop than did the other three groups. CONCLUSION This study demonstrates that monocyte chemotactic protein 1 may play a role in adhesion formation. Inhibiting the action of this chemokine may help to prevent adhesions.

Polycystic ovary syndrome is associated with elevated plasma soluble CD40 ligand, a marker of coronary artery disease

OBJECTIVE To determine the level of plasma soluble CD40 ligand (sCD40L) in patients with polycystic ovary syndrome (PCOS). DESIGN Prospective study. SETTING Baskent University School of Medicine in Turkey. PATIENT(S) Thirty-one patients with PCOS and 31 non-PCOS (control) patients. INTERVENTION(S) Determination of plasma sCD40L and homocysteine levels. MAIN OUTCOME MEASURE(S) Plasma sCD40L, fasting glucose, fasting insulin, homeostatic model assessment insulin resistance index (HOMA-IR), LH, FSH, E(2), total T, DHEAS, total cholesterol, high- and low-density lipoprotein cholesterol, triglyceride, homocysteine, and high-sensitivity C-reactive protein (hsCRP). RESULT(S) The mean serum fasting insulin and HOMA-IR levels were significantly higher in the PCOS group. The mean serum homocysteine level was significantly higher in the PCOS group. Despite a trend for higher high-sensitivity C-reactive protein levels in the PCOS group, the difference did not reach statistical significance. The mean plasma sCD40L level in the PCOS group was significantly higher than that in the control group (5.14 +/- 3.65 ng/mL vs. 3.45 +/- 2.64 ng/mL, respectively). CONCLUSION(S) Polycystic ovary syndrome is associated with elevated levels of sCD40L and homocysteine.

Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: a randomized, double blind, placebo-controlled trial.

OBJECTIVE To evaluate the effectiveness of sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women. DESIGN Placebo-controlled, double-blind, randomized trial. SETTING University hospital. PATIENT(S) Fifty-two women with an indication for diagnostic hysteroscopy. INTERVENTION(S) Randomized women who had received either 200 mug of misoprostol (n = 25) or placebo (n = 27) sublingually 2 hours before hysteroscopy. Two subgroups (women with or without previous vaginal delivery) were formed. MAIN OUTCOME MEASURE(S) Number of women requiring cervical dilatation, duration of dilatation, ease of dilatation, and complications during procedure. RESULT(S) In the misoprostol group, 14 patients needed cervical dilatation, versus 21 in the placebo group. Duration of dilatation was longer in the placebo group than in the misoprostol group. In subgroup 1, seven patients in the misoprostol group (n = 13) and nine patients in the placebo group (n = 12) needed cervical dilatation. The duration of the dilatation was similar between the groups. In subgroup 2, both the need for cervical dilatation (58.3% vs. 80.0%) and the duration of dilatation (31.0 +/- 18.8 vs. 73.0 +/- 82.0 seconds) were found to be lower in the misoprostol (n = 15) than in the placebo (n = 12) group, respectively. Those differences were all not significant. CONCLUSION(S) Sublingual misoprostol before diagnostic hysteroscopy did not seem to facilitate cervical ripening statistically; however, the results are remarkable and are promising clinically. Further studies are required to reassess the use of sublingual misoprostol in patients before hysteroscopy.