Onder Koc

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

OBJECTIVE Diagnosis 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. STUDY DESIGN 167 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. RESULTS Although 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. CONCLUSION Both 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.

Effects of pinealectomy and melatonin supplementation on endometrial explants in a rat model

OBJECTIVE To determine the effects of pinealectomy on endometrial explants in rats and evaluate the activity of superoxide dismutase (SOD) and catalase (CAT) and the levels of malondialdehyde (MDA) in the rat endometriosis model. STUDY DESIGN Rats with experimentally induced endometriosis were randomly divided into three groups after second-look laparotomies. Group 1 (pinealectomy, n = 8) and Group 2 (pinealectomy+melatonin, n = 8) underwent pinealectomies after the second-look laparotomies. Group 3 was presented as control group (vehicle solution+without pinealectomy (n = 6)). Melatonin was administered intraperitoneally for 4 weeks in Group 2, whereas an equal volume of vehicle solution was given to Groups 1 and 3. Evaluation of the volume of the endometrial explants, histopathological examination and preservation of explant epitheliums according to the scoring system were undertaken. RESULTS There was a statistically significant increase in spherical explant volumes of Group 1 compared to Groups 2 and 3. In Group 1, the level of MDA was significantly higher and SOD and CAT activity was significantly lower compared to Groups 2 and 3. A statistically significant increase in the epithelial lining scores of explants was noted in Group 1 compared to Groups 2 and 3. CONCLUSION The effects of pinealectomy on the progression of endometriosis explants were reversed by melatonin.

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.

Perineal leiomyoma mimicking complex Bartholin mass

Leiomyomas of the external genitalia are uncommon soft tissue tumors. We report the case of a 47-year-old woman with perineal leiomyomas mimicking Bartholins gland mass according to the preoperative magnetic resonance imaging (MRI) findings. Leiomyomas in the vulvar region should be differentiated from complicated Bartholin’s gland cysts and preoperative MRI findings may be misleading. The complete surgical excision should be the choice of treatment

Intraperitoneal administration of single dose type I collagen or low dose melatonin to prevent intraperitoneal adhesion formation: A comparative study

OBJECTIVE To compare the prevention of adhesion formation by type I collagen or melatonin solutions in the rat model. STUDY DESIGN A total of 40 female Wistar albino rats were randomly assigned to four groups-type I collagen, melatonin, vehicle control and sham groups. Following midline laparotomy, a standard injury was made on the right uterine horn using bipolar cautery. The animals in the sham group underwent midline laparatomy only. One milliliter of type I collagen, melatonin or vehicle control was instilled onto the injured area immediately before abdominal closure. Fourteen days after the surgery, the type and extent of adhesion formation as well as the uterine horn tissue superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels were measured. RESULTS Both the type and extent of adhesion formation were significantly lower in the type I collagen and melatonin groups compared to the control group. The tissue SOD and CAT activity was significantly higher, and MDA levels were significantly lower in the type I collagen and melatonin groups compared to the control group. CONCLUSION Intraperitoneal administration of type I collagen or low dose melatonin solution onto the injured areas may be an attractive adjuvant to reduce postoperative adhesion formation.

Role of elective cesarean section in prevention of pelvic floor disorders.

Purpose of review The article reviews the current evidence and the role of elective Cesarean section in the prevention of pelvic floor disorders (PFDs). Recent findings Recent studies have revealed that operative vaginal delivery is an important risk factor for PFDs. The cause of PFD is multifactorial. Pregnancy itself also increases the PFDs. Elective Cesarean section carries diminished risk for stress urinary incontinence. Pelvic floor muscle training should be offered to all women in their first pregnancy as a preventive strategy. Summary The health provider should not offer elective Cesarean section to a pregnant woman without any prior risk of pelvic organ disorder for the prevention of urinary stress incontinence, anal incontinence, or pelvic organ prolapsus weighing the risks of Cesarean section.

Labial fusion causing acute urinary retention in a young adult: a case report.

Labial fusion is defined as a partial or complete adherence of the labia minora. The labia minora adhesion is a common paediatric gynaecological problem, and occurs more frequently between three months and three years. Adhesions of the labia are rare in adult population. There are a few cases in the literature. The aetiology of labial adhesion probably relates to vaginal inflammation or irritation, and is associated with low oestrogen status. Labial fusions may be caused by infections, inflammatory conditions, dermatological conditions, lack of sexual activity, local trauma, genital circumcision and recurrent urinary tract infections. If the labial adhesions are severe or related to urinary problems, surgical treatment should be considered.

Oxytocin versus sustained‐release dinoprostone vaginal pessary for labor induction of unfavorable cervix with Bishop score ≥4 and ≤6: A randomized controlled trial

To compare the efficacy and safety of high‐dose intravenous oxytocin and sustained‐release dinoprostone vaginal pessaries for cervical ripening and labor induction in pregnant patients at term with poor Bishop scores.

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

OBJECTIVE To evaluate the association between maternal height and cervical length in the first and second trimesters in low-risk asymptomatic pregnant women. STUDY DESIGN Maternal 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. RESULTS Maternal 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). CONCLUSION Although 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.

In Vivo Evaluation of the Genotoxic Effects of Gonadotropins on Rat Reticulocytes

BACKGROUND Gonadotropins, as ovulation-inducing drugs, have been used widely to treat infertility. An epidemiologic correlation between infertility therapy and ovarian cancer development has been reported. However, the effect of gonadotropins in the formation of reproductive tract cancers is controversial. OBJECTIVE The aim of the study was to determine the in vivo genotoxic effects of gonadotropins on rat reticulocytes. METHODS In this prospective, randomized, controlled study, rats were randomly assigned to 1 of 5 groups. The calculated rat doses of 0.65 human menopausal gonadotropin (hMG), 0.95 hMG, 0.65 follitropin beta (FB), 0.95 FB, or normal saline (control group) were injected, respectively. These calculated rat doses (U/g) are based on average human gonadotropin doses of 150 and 225 IU/d for a 70-kg woman given in 2-mL saline (the control group received 2 mL of saline). Injections were administered once per day for 5 days, followed by 5 days of rest. Each treatment was repeated for 6 estrus cycles in the rats for a total of 12 estrus cycles. Six months after the last day of the 12(th) cycle, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situ micronuclei assay under light microscopy. The proportion of micronucleated cells, cells with anaphase bridge, nuclear buds, and other nuclear abnormalities were measured. RESULTS The number of cells with nuclear buds and binuclear abnormalities in the hMG 225 and FB 225 groups was significantly higher (P < 0.05) than that from the hMG 150, FB 150, and control groups in the cytogenetic analysis of bone marrow stem cells. An increased rate of genotoxicity in all gonadotropin groups versus that of placebo was found. CONCLUSION In rats, the micronucleus genotoxicity assay suggests a dose-dependent gonadotropin effect on genomic instability in bone marrow stem cells in vivo.