Ismail Ozdemir

Comparison of the diagnostic efficacy of the two rapid bedside immunoassays and combined clinical conventional diagnosis in prelabour rupture of membranes

OBJECTIVEnDiagnosis of prelabour rupture of membranes (PROM) may be challenging. Conventional diagnostic methods such as speculum examination, ferning pattern, and pH detection are not satisfactorily accurate. Two relatively new, commercially available rapid bedside immunoassay strip tests, for placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (ILGFBP-1), are alleged to be more accurate. We compared the diagnostic efficacy of PAMG-1 and ILGFBP-1 immunoassay tests and combined conventional clinical diagnostic methods in PROM.nnnSTUDY DESIGNn167 pregnant women with signs and/or symptoms of PROM were prospectively evaluated with a combination of conventional clinical tests including speculum examination, nitrazine, ferning pattern, and pooling, in addition to PAMG-1 and ILGFBP-1 immunoassays. Differences in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the diagnostic methods were compared.nnnRESULTSnAlthough the PAMG-1 assay was more accurate, the PAMG-1 immunoassay, ILGFBP-1 immunoassay, and combined conventional clinical diagnosis were, in fact, all highly accurate with no significant difference in sensitivity, specificity, PPV, NPV, or accuracy.nnnCONCLUSIONnBoth rapid bedside strip tests may be used in clinical practice with similar efficacy in diagnosing PROM, particularly as a backup when diagnosis is still in doubt following a combination of conventional diagnostic methods.

The effect of ethinyl estradiol–cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome

ObjectiveWomen with polycystic ovary syndrome (PCOS) have multiple risk factors for cardiovascular disease. The cardiovascular risk marker homocysteine (Hcy) is elevated in women with PCOS. This prospective study investigated the effect of oral contraceptives containing ethinyl estradiol–cyproterone acetate (EE–CA) on serum Hcy levels in women with PCOS.Study designA total of 30 women with PCOS were enrolled in this prospective study. The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group. All women took oral contraceptives containing EE/CA (35xa0μg/2xa0mg) for 3xa0months. Serum samples for Hcy, lipid profile and hormones were obtained during the early follicular phase (days 3–5) of the spontaneous or progestin-induced bleeding at baseline, and after the third treatment cycle.ResultsThree months of EE–CA therapy significantly decreased the Hcy levels from 55.97xa0±xa016.04 to 54.03xa0±xa016.15 (Pxa0=xa00.01). A significant correlation was observed between the Hcy and total and free testosterone levels (rxa0=xa00.44, Pxa0=xa00.015 and rxa0=xa00.46, Pxa0=xa00.001 respectively).ConclusionsAlthough the decrease in Hcy levels with EE–CA therapy was statistically significant, further studies are necessary to determine the clinical benefit of this treatment.

Post‐partum haemorrhage from the lower uterine segment secondary to placenta praevia/accreta: Successful conservative management with Foley balloon tamponade

Profuse bleeding from the lower uterine segment secondary to placenta praevia/accreta during caesarean delivery is a challenging problem in obstetrics. We present our experiences using intrauterine Foley balloon tamponade for the conservative management of post‐partum haemorrhage from the lower uterine segment. Intraoperative haemostasis was achieved in all women who were unresponsive to other conservative methods. Foley balloon tamponade may be considered in the management of lower uterine segment bleeding at caesarean delivery.

Effect of anesthesiological strategies on neonatal bilirubin levels during cesarean section: a prospective and randomized trial

PurposeNeonatal jaundice, a frequent problem in neonatology, can be influenced by many factors. Here, we sought to clarify the role of anesthesia and to compare the effects of various anesthesiological strategies on neonatal bilirubin levels during cesarean section.MethodsWe prospectively enrolled 167 ASA I–II status uncomplicated pregnant women who delivered by cesarean section as the study group. The patients were randomized based on anesthesiological strategy: inhalation (IA), spinal (SA), total intravenous (TIVA), and epidural anesthesia (EA) groups. Neonatal total (TB) and direct bilirubin (DB) levels at the 24th hour and 5th day of life and the need for phototherapy were compared between the groups.ResultsDirect bilirubin levels at 24th hour of SA group and EA group were higher compared to IA group (pxa0=xa00.008). When DB levels at fifth day were compared, levels in group TIVA were significantly higher than group SA (pxa0=xa00.019). TB levels at fifth day in group TIVA were higher than SA and EA groups (pxa0=xa00.05). The percentage of newborns needing phototherapy did not differ significantly among groups, but was highest in the TIVA group (25%), followed by the IA (15%), EA (10%) and SA (7%) groups (pxa0=xa00.08).ConclusionsEA and SA at cesarean section seem to be better among the four anesthesia techniques considering neonatal hyperbilirubinemia. Our findings are consistent with the idea that anesthesia may be a risk factor for hyperbilirubinemia. Although anesthesia may not significantly increase the need for interventions such as phototherapy, it may increase the burden of time, labor and cost.

Vaginal removal of prolapsed pedunculated submucosal myoma during pregnancy

Pedunculated submucosal myomas are generally associated with infertility and are most often encountered during the preconception period. This report describes a 38-y-old pregnant woman in whom a pedunculated submucosal myoma resulted in preterm labor and was successfully removed vaginally at 26 wk gestation. The procedure described here is simple and quick and can be performed during pregnancy, if necessary.

Can maternal height predict shorter cervical length in asymptomatic low-risk pregnant women?

OBJECTIVEnTo evaluate the association between maternal height and cervical length in the first and second trimesters in low-risk asymptomatic pregnant women.nnnSTUDY DESIGNnMaternal height and cervical length of 146 asymptomatic women with singleton pregnancies at low risk for preterm birth were measured during the first and second trimesters. Preterm birth was defined as birth before <37 gestational weeks. Correlations between maternal height and cervical length measurements were determined using Pearson correlation analysis. The women were also divided into three groups based on height percentiles: <25% (Group I), 25-75% (Group II) and >75% (Group III). Cervical lengths were compared among groups. Correlations between cervical length and maternal height and statistically significant differences in cervical length among height percentile groups were the main outcomes.nnnRESULTSnMaternal height was positively but weakly correlated with first and second trimester cervical lengths (p=0.047, r=0.167 and p=0.039, r=0.197 respectively). The mean first trimester cervical lengths were significantly different between the groups (p=0.04). There were no significant differences, however, in the mean second trimester cervical lengths among the three groups although the difference was close to significance (p=0.06).nnnCONCLUSIONnAlthough our results indicate a relationship between maternal height and cervical length in our population, maternal height seems to have only limited value in identifying women to be screened for shorter cervical length in a low risk asymptomatic population.