Umit Goktolga

Oronasopharyngeal Suction versus No Suction in Normal and Term Infants Delivered by Elective Cesarean Section: A Prospective Randomized Controlled Trial

Background/Aim: There are controversies about the routine use of oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. Methods: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. Results: The mean SaO2 values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO2 of ≧92% (6 vs. 11 min) and ≧86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. The mean heart rates were consistently and significantly lower in the no suction group during the first 6 min except the second one. All neonates without suction had an Apgar score of 10 at the 5th min, while the mean ± SD for ONPS group was 9.34 ± 0.48 (p < 0.001). Conclusion: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section.

Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics

Summary The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favourable fertility characteristics treated for infertility. Medical records of 212 infertile couples who had undergone a total of 253 cycles were reviewed retrospectively. Inclusion criteria for women were age <35 years, antral follicle count >5, FSH <15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman’s age, partner’s age, total number of motile sperm (TMS) and motility, significantly influenced pregnancy rate. Pregnancy rate was the highest when women were aged <25 and TMS >10 × 106. Partner’s age significantly affected the pregnancy rate per cycle in women aged <30 years and TMS >10 × 106. Woman’s age (OR: 5.4 95% CI: 1.2–24.3) and TMS (OR: 0.06 95% CI: 0.003–0.89) were predictor variables as regards to pregnancy. Pregnancy rate was the highest in IUI cycles when woman was <25 years old, TMS was >10 × 106, and morphology was >4%. Male age was found to be another determining factor for IUI success, even if they had a normal spermiogram.

Opinions of infertile Turkish women on gamete donation and gestational surrogacy

OBJECTIVE To determine the approval levels of infertile Turkish women concerning gamete donation and gestational surrogacy. DESIGN Opinion survey. SETTING Assisted reproductive treatment center at Gulhane Military Medical Academy. PATIENT(S) 368 women who had applied for infertility treatment. INTERVENTION(S) The patients were asked to answer a questionnaire that included questions about the patients sociodemographic status, previous medical history with infertility treatment, and opinions on gamete donation and gestational surrogacy. MAIN OUTCOME MEASURE(S) Opinions of patients concerning gamete donation and gestational surrogacy. RESULT(S) Our data in this first study on infertile Turkish women show that some patients approve of gamete donation (23.3% for accepting oocytes and 3.4% for accepting sperm) and gestational surrogacy (15.1%). CONCLUSION(S) Donation and surrogacy are alternate treatments for the serious condition called infertility. As there are patients who would like to use these treatments, each of these patients should have the right to try any of them.

Isolated torsion of fallopian tube in a premenarcheal 12‐year‐old girl

Isolated torsion of fallopian tubes should be considered even at premenarcheal ages in cases of acute pelvic pain, and prompt surgery can preserve the tube and thus fertility. It is an uncommon emergency event and a difficult condition to evaluate clinically. This report focuses on a 12‐year‐old premenarcheal girl who presented with acute pelvic pain of 2 days. Pelvic ultrasound showed an adnexal mass on the left side. Laparoscopy was performed and an isolated tubal torsion was discovered. The tube was necrotic and salpingectomy was performed. The appendix appeared to be hyperemic and erectile. Appendectomy was also performed to rule out appendicitis. Its our recommendation that in the differential diagnosis of acute lower abdominal pain of girls, isolated torsion of the fallopian tubes should be considered. Also, preservation of the tube and fertility should be possible with prompt surgical intervention.

Oronasopharyngeal suction versus no suction in normal, term and vaginally born infants: a prospective randomised controlled trial.

This prospective randomised controlled trial aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term and vaginally born infants and was performed at a Turkish tertiary hospital from June 2003 to January 2004. A total of 140 newborns were enrolled in the trial (n = 70 per group). The no suction group showed lower mean heart rates through the 3rd and 6th minutes and higher SaO2 values through the first 6 mins of life (P < 0.001). The maximum time to reach SaO2 of ≥ 92% (6 vs. 11 min) and ≥ 86% (5 vs. 8 min) were shorter in the no suction group (P < 0.001).

Treatment of incidental adnexal masses at cesarean section: a retrospective study

In this study, we evaluated the management of incidental adnexal masses observed at the time of cesarean section in our clinic during January 1992 to January 2005. The number of total live births was 35,153 and 8330 of them were by cesarean section (23.69%). There were 68 cases of incidental adnexal masses greater than 5 cm (68/8330, 0.8%). All of the masses were removed at cesarean section. The pathologic diagnosis of the masses were as follows: benign—benign cystic teratoma 20 (29.4%), simple serous cyst 8 (11.8%), simple mucinous 9 (13.2%), endometrioma 3 (4.4%), cystadenoma 14 (20.6%), and paraovarian–paratubal cyst 13 (19.1%) and malignant—struma ovarii 1 (1.5%). Cystectomy procedure during cesarean section did not alter the morbidity of the operation. So, we recommend resection of such incidental adnexal masses at cesarean section to avoid possible surgical procedures in future for the patient, although there is controversial data in literature

Insulin resistance and its relationship with high molecular weight adiponectin in adolescents with polycystic ovary syndrome and a maternal history of polycystic ovary syndrome

OBJECTIVE To assess the rate of insulin resistance (IR) and the relationship between IR and high molecular weight (HMW) adiponectin in normal weight adolescents with polycystic ovary syndrome (PCOS) and a maternal history of PCOS. DESIGN Case-controlled study. SETTING Adolescent clinic of a teaching and research hospital. PATIENT(S) Forty normal weight adolescents with PCOS and a maternal history of PCOS and 40 normo-ovulatory age- and body mass index (BMI)-matched controls. INTERVENTION(S) A 75-g oral glucose tolerance test (OGTT) was performed for each participant. MAIN OUTCOME MEASURE(S) Homeostasis model assessment of IR and HMW adiponectin. RESULT(S) There were no statistically significant differences between the PCOS and control groups in terms of fasting glucose, fasting insulin, and lipid parameters. Although total and free T were significantly higher, HMW adiponectin levels were significantly lower in the PCOS group compared with the control group. When the PCOS group was compared according to the IR, the HMW adiponectin level was significantly lower in the adolescents with PCOS and IR. The adolescents with PCOS and biochemical hyperandrogenemia had significantly lower HMW adiponectin levels and significantly higher homeostasis model assessment of IR score compared with the adolescents with PCOS and normoandrogenemia. CONCLUSION(S) The adolescents with PCOS had a significantly increased rate of IR without clinical findings of metabolic disorders or obesity. The HMW adiponectin levels were negatively correlated with IR.

Anticipated and perceived pain from midtrimester amniocentesis.

To evaluate the anticipated and perceived pain and determine the factors contributing to pain perception in women undergoing midtrimester amniocentesis.

Tension-Free Vaginal Tape for Surgical Relief of Intrinsic Sphincter Deficiency: Results of 5-year Follow-up

STUDY OBJECTIVE We evaluated effectiveness of tension-free vaginal tape application for surgical relief of intrinsic sphincter deficiency. DESIGN A prospective study (Canadian Task Force classification II-3). SETTING Tertiary center of medical faculty. PATIENTS We studied 47 patients. INTERVENTIONS Tension-free vaginal tape procedure, questionnaire form, stress test, cotton swab test, and functional bladder volume measurements. MEASUREMENTS AND MAIN RESULTS Patients were grouped as intrinsic sphincter deficiency according to American College of Obstetricians and Gynecologists criteria. Operative results were documented at 6, 12, 36, and 60 months after the procedure by using a questionnaire form and objective tests of stress test, cotton swab test, and mean bladder functional volume measurement. At first visit 6 months after procedure, 70% (n = 35) of patients were completely satisfied, 9 (18%) had improved urine control, and 5 (10%) had no change in urine control. Results were: 72% (n = 36), 12% (n = 6), and 14 (n = 7%) at the end of the first year, and 66% (n = 33), 20% (n = 10), and 14% (n = 7) at the end of the third year, respectively. The fifth years follow-up visit revealed 57.4% (n = 27 of 47) satisfaction, 17.02% (8 of 47) improved urine control, and 25.5% (12 of 47) no change in urine control. CONCLUSION Tension-free vaginal tape procedure is a safe and effective technique for patients who have exclusively intrinsic sphincter deficiency. Long-term results will clarify the value of this procedure in comparison with classic antistress surgical techniques.

Maternal and umbilical cord ischemia-modified albumin levels in nonreassuring fetal heart rate tracings regarding the mode of delivery

Objective: To evaluate umbilical cord blood ischemia-modified albumin (IMA) levels in cases of fetal distress (FD) and to explore fetal blood IMA levels regarding the route of delivery. Methods: Umbilical cord and maternal serum IMA concentrations were assessed in term 40 cases with cesarean section (CS) due to FD, 76 cases with elective repeat CS and 85 cases with noncomplicated vaginal delivery. Results: The maternal and umbilical cord IMA levels were significantly lower in vaginal deliveries when compared with CS cases either in FD or previous CS groups (p = 0.02). Although no statistically significant difference was found in IMA levels of CS groups (previous CS vs. FD), cord blood IMA levels tend to be higher in FD group. Neither demographic characteristics nor fetal outcome parameters were found to have any correlation with maternal IMA levels. However, umbilical cord IMA levels were found to be negatively correlated with 1th min Apgar scores (r = –0.143, p = 0.043). Conclusions: IMA seems to be responsive to hypoxic FD showing the highest levels in cases with severe fetal hypoxia. Higher levels of IMA in cases with elective repeat CS might indicate acute transient hypoxia and possible myocardial ischemia in these cases.