Murat Seval

Comparison of ambulatory versus conventional urodynamics in females with urinary incontinence.

We planned to compare the diagnostic accuracy of conventional urodynamics (UD) and ambulatory UD for the detection of detrusor over activity (DOA) and/or urodynamic stress incontinence (USI) in women presenting with urinary incontinence.

Problems with the diagnosis of endometriosis

Endometriosis is classically defined as the presence of endometrial glands and stroma in outside the uterine cavity. As the definition suggests that confirming the ectopic endometrial stroma and glands in ectopic location histopathologically should be necessary for the diagnosis of endometriosis. Therefore, this situation leads to the need for surgery like laparoscopy for diagnosis. However, this surgical diagnostic approach will not be reliable for all patients with suspected endometriosis. It seems to be an important problem that there is still no reliable clinically diagnostic method or pathognomonic clinical finding, which may allow accurate diagnosis of endometriosis without the need for surgery or histopathologic evaluation. While these clinical features are not pathognomonic for the endometriosis, they should be used as markers for creating high-risk population for endometriosis. Clinical features and the available diagnostic methods, their advantages and limitations for the endometriosis will be discussed in this article. The different options for clinical assessment, laboratory tests and imaging techniques will be summarized and the advantages and disadvantages of these methods will be evaluated. We will also discuss the gold standard definitive diagnostic options with their problematic aspects.

Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial

To evaluate whether routine vaginal examination during labor is associated with increased levels of anxiety and pain compared with transperineal ultrasound assessment.

Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle

OBJECTIVE(S) To present data of standardized ambulatory urodynamic monitoring (AUM) performed in women with overactive bladder syndrome (OAB) and to evaluate the relevance of AUM data with clinical findings of the patients. STUDY DESIGN Records of women with symptoms of OAB were retrospectively reviewed (n=249). Of women fulfilling the Overactive Bladder Awareness Tool (OAB-V8) with a score ≥8 and the 3-day voiding diary (VD) with a frequency >7/day (n=167), those who underwent urodynamic investigation were selected (n=76). The data of this study were retrieved from the records of Ankara University Cebeci Hospital and based on the AUM findings of single voiding cycle of women with OAB. AUM, which is among the institutionally approved primary urodynamic investigation methods, is performed with LUNA ambulatory monitoring recorder (MMS™) in the clinical setting with a standardized technique, in reproducing lower urinary tract symptoms of women since 2011. The relationship of the urodynamic data with the clinical findings were evaluated. RESULTS AUM traces of women (n=76) with OAB revealed 63.1% DO, 64.4% urgency and 77.7% urinary incontinence of which were 14.4% urgency urinary incontinence (UUI), 25% stress urinary incontinence (SUI) and 38.1% mixed urinary incontinence (MUI). OAB patients with DO reported more urinary incontinence episodes/day, nocturia and mixed urinary incontinence in the voiding diary (p<0.04) and had significantly higher irritative symptom bother reflected by the questionnaires (p<0.04). Women with DO were more likely to be postmenopausal (p=0.02) and were found to have more urgency (p<0.001), urgency episodes (p=0.05) and incontinence (urge and mixed) (p<0.001). However, no association was found between the extent of pelvic organ prolapse and the presence of DO. CONCLUSIONS AUM performed with a standardized technique during single voiding cycle seems to be a reliable method in reproducing symptoms of women with OAB. It provides both clinically relevant findings and objective documentation of urgency which is the main symptom for OAB. The detection of DO according to the ICS definition were also found to be concordant with urodynamicaly observed urgency and urinary incontinence. Objective and subjective clinical findings of OAB were found to be more severe in women with DO.

Dual suppression with oral contraceptive pills in GnRH antagonist cycles for patients with polycystic ovary syndrome undergoing intracytoplasmic sperm injection

OBJECTIVE To evaluate the effects of a gonadotropin-releasing hormone (GnRH) antagonist protocol, with or without oral contraceptive pill (OCP) pretreatment, in patients with polycystic ovary syndrome (PCOS) undergoing intracytoplasmic sperm injection (ICSI). STUDY DESIGN In this retrospective cohort study, 410 infertile patients with PCOS were assessed in their first ICSI cycles between January 2006 and June 2013. In Group A (n=208), patients underwent a long luteal GnRH agonist protocol, and in Groups B (n=143) and C (n=59), patients underwent a GnRH antagonist protocol. The patients in Group C also received OCPs containing 30mg of ethinyl oestradiol and 3mg of drospirenone prior to treatment. The main outcome measures were pregnancy and ovarian hyperstimulation syndrome (OHSS) rates. RESULTS Demographic features, body mass index, duration of infertility, serum baseline hormone levels, cycle outcomes, multiple pregnancy rates, miscarriage rates, OHSS rates, total number of Grade A embryos and total number of transferred embryos were comparable between the groups. Clinical pregnancy rates were 27.4%, 26.6% and 23.7% in Groups A, B and C, respectively (p=0.853). CONCLUSIONS OCP pretreatment was found to have no beneficial or adverse effects in patients with PCOS undergoing a GnRH antagonist protocol for ICSI, but can be used for cycle scheduling.

The Effects of Fibromyalgia Syndrome on Physical Function and Psychological Status of Pregnant Females

Objectives This study aims to investigate the frequency and most common symptoms of fibromyalgia syndrome (FS) among pregnant females and determine the impacts of FS on physical functioning and psychological status. Patients and methods A total of 360 pregnant females (mean age 26.5 years, range 19 to 42 years) were included. The subjects were divided into two groups in terms of having (FS group; n=136; mean age 27 years; range 19 to 41 years) or not having FS (control group; n=224; mean age 26.5 years; range 20 to 42 years). The impact of FS on physical functions was evaluated using Fibromyalgia Impact Questionnaire. Psychological statuses of the subjects were evaluated using State-Trait Anxiety Inventory, Wijma Delivery Expectancy/Experience Questionnaire, and Beck Depression Inventory. Results Low back pain was the most common complaint while fatigue was the most common symptom in FS group. FS group had higher levels of pain and physical disability (p<0.001) and also higher values of anxiety, fear of childbirth, and depression (p<0.001, for all values) compared to control group. Symptom severity and physical function scores were significantly correlated with increased levels of pain, depression, anxiety, and fear of childbirth (p<0.001, for all values). Conclusion Fibromyalgia syndrome is common among pregnant females. The existence of FS in pregnancy is a severe factor contributing to maternal stress, anxiety, and depression. Therapeutic measures for fibromyalgia syndrome should be well-established to support healthy pregnancy and good child health outcome.

Association of first trimester serum uric acid levels gestational diabetes mellitus development

Objective: To investigate the association of first trimester serum uric acid levels with the development of gestational diabetes mellitus (GDM) in low-risk pregnant women. Materials and Methods: In this retrospective data analysis, the results of pregnant women who completed both first trimester biochemical panel and two-step GDM screening were compared with an age-, body mass index, and gestational age-matched control group. The women were grouped as either GDM or impaired glucose tolerance (IGT) according to 100-g oral glucose challenge results. Uric acid levels were compared between the groups and diagnostic utility was tested with receiver-operating characteristics curves. Results: Sixty-six women in GDM group and 358 women in the IGT group were compared against 202 healthy pregnant women. The groups did not differ significantly in terms of parity, pre-gestational body mass index and gestational age. Serum samples for uric acid levels were obtained. The mean serum uric acid levels were significantly higher in the GDM and IGT groups (5.95 mg/dL (±0.97 mg/dL) and 4.76 mg/dL (±1.51 mg/dL), respectively) compared with the control group (3.76 mg/dL (±1.07 mg/dL) (p<0.001). The area under the curve for uric acid levels was 0.92 (95% confidence interval 0.88-0.95) for diagnosis of GDM. At a diagnostic threshold of 3.95 mg/dL, uric acid levels predicted development of GDM with 60% specificity and 100% sensitivity. Conclusion: First trimester serum uric acid has a linear association with the development of GDM and IGT.

AB0839 Fibromyalgia Syndrome in Pregnant Women; The Effects on Physical Functioning and Psychological Status

Background There are many unexplored issues related to the presence of fibromyalgia syndrome (FS) in pregnancy such as prevalence of FS, most common symptoms, the impact of FS on physical functioning, psychological status, and treatment of a fibromyalgic pregnant Objectives To investigate the frequency and most common symptoms of FS among pregnant woman and determine the impacts of FS on physical functioning and psychological status in those patients. Methods A total of 360 pregnants in the third trimester of pregnancy were included in the study. The pregnants were split into two groups in terms of having or not having FS. Group 1 was consisted of 136 pregnant women with FS. 224 pregnant women without FS were formed control group (group 2). The presence of fibromyalgia was investigated via 2010 ACR classification criteria. Widespread pain index and symptom severity scores of the patients were recorded. The impact of FS on physical functions was evaluated using fibromyalgia impact questionnaire. Psychological status of the patients were evaluated using state-trait anxiety inventory, the Wijma delivery expectancy/experience questionnaire and Beck depression inventory. Results 136 of 360 pregnants (37.7%) had FS. Mean ages of the 136 pregnants with FS was 27 years and of the 224 without FS was 26.5 years (p>0.05). Low back pain is the most common complaint and fatique is the most common symptom in pregnants group with FS. Compared with the pregnants group without FS, pregnants group with FS had higher values of pain severity and higher levels of physical disability (p<0.001). Pregnants group with FS had also higher values of anxiety, fear of childbirth and depression (p<0.001, for all values). Symptom severity score and physical impairment score were found to be significantly correlated with increased levels of pain, depression, anxiety, fear of childbirth, fatique, increased scores of waking unrefreshed, cognitive symptoms and increased rate of low back pain (p<0.001 for all values). Conclusions FS is common among pregnant women and the existence of FS in pregnancy is a severe factor for maternal stres, anxiety and depression. If we desire a healthy pregnancy and a good child outcome, we need to get therapeutic measures for fibromyalgia syndrome. Disclosure of Interest None declared