Zeynep Kamalak

Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries

OBJECTIVE To find diagnostic values and thresholds of ovarian volume and follicle number for Turkish patients with polycystic ovarian syndrome (PCOS) and to clarify whether the Rotterdam ultrasound criteria are optimal for the diagnosis of PCOS in Turkish patients. STUDY DESIGN Two hundred and fifty-one newly diagnosed PCOS cases according to Androgen Excess Society (AES) criteria (using clinical and biochemical parameters) and 65 regularly menstruating healthy, non-hirsute, normo-ovulatory volunteers as a control group were taken into the study. Evaluation of the ovaries and measurement of ovarian volumes of all cases were performed by transvaginal ultrasound. Ovarian volume (OV) and follicle number (FN) were recorded in all cases. RESULTS Mean and median OV were 12.5 ± 8.1 and 10.1cm(3) in PCOS cases. Mean and median FN in the PCOS group were 9.8 ± 2.8 and 10, respectively. In the control group, the mean and median OV were 5.4 ± 1.8 and 5.5 cm(3). Mean and median FN of controls was 5 ± 1.5 and 5, respectively. There were statistically significant differences in both OV and FN between PCOS patients and controls (all p < 0.001). Cut off values for ovarian volume in PCOS cases for the Turkish population were determined by receiver-operating characteristics (ROC) analysis. The areas under the curve (AUCs) for mean OV and mean FN were 0.938 and 0.998, respectively, indicating a good diagnostic power of the tested variables. Combining sensitivity and specificity using the Youden index, setting the cut off value for threshold OV and FN at 6.43 cm(3) and 8, respectively, yielded the best compromise between sensitivity and specificity. CONCLUSION There may be some differences in ultrasound characteristics of PCOS, resulting in differing diagnostic power and cut off points for different populations. OV and FN have powerful diagnostic value in determination of PCOS with different threshold values for different ethnicities.

Hyperemesis gravidarum and depression in pregnancy: is there an association?

Objective: The aim of this study was to evaluate the impact of hyperemesis gravidarum (HG) and sociodemographic parameters on depression during pregnancy. Study design: Between September 2010 and September 2011, 200 consecutive women with HG were defined as the study group and 200 consecutive pregnant women without any signs and symptoms of HG, and matched for age, parity, and gestational age were defined as the control group. The Beck depression inventory-II (BDI-II) questionnaire and sociodemographic questionnaire evaluating educational level, occupation, economic status, and obstetric history were given to all participants for self-completion. The forms were collected within 6 h of hospital admission. Groups were compared according to the presence of depression and predictors of depression were analyzed by regression analysis. Results: Median BDI-II scores in study and control groups were 15 and 5, respectively. The difference was statistically significant (p < 0.001). In the HG group, 35.1% of patients had mild depression, 26.0% moderate, and 17.8% had severe depression, while only 5% of patients in the control group had mild depression and 95% had no depression. Multivariate analysis showed that HG, age and family relationship were related to depression during pregnancy. Moreover, depression risk was increased 76-fold in patients with HG (odds ratio = 76.000; 95% confidence interval: 36.840–156.788; p < 0.001). Conclusion: Depression risk is increased in patients with HG, therefore not only medical therapy of HG, but also psychiatric evaluation should be considered for these patients.

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome.

The aim of this study was to examine the effect of adrenal versus ovarian androgen (dehydroepiandrosterone sulfate/total testosterone [DHEAS/TT]) on clinical presentation and related metabolic disturbances in Turkish women with polycystic ovarian syndrome (PCOS). Two hundred eighty PCOS cases were taken into the study. For all cases, the DHEAS/TT ratio was calculated. The median value of this ratio was 4.40. Patients with an androgen ratio lower than 4.40 were included in Group 1 and cases with a ratio higher than 4.40 were Group 2. The two groups were compared in terms of hormonal, biochemical and clinical parameters. Body mass index and waist circumference were lower, the Ferriman–Gallwey score was higher and the cycle length was shorter in Group 2. High DHEAS level was associated with better lipid profiles and lower levels of inflammatory markers, meaning good metabolic control in these women, in spite of increased hirsutism rates. In patients with PCOS, both androgens are usually high in proportion to each other. Therefore, it would be more meaningful to use the DHEAS/TT ratio for an assessment of the metabolic and phenotypic effects of PCOS.

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period.

OBJECTIVE To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.

Clitoral and labial sizes in women wıth PCOS.

The aim of this study was to examine the external genital features in Turkish women with polycystic ovary syndrome (PCOS). Thirty-two newly diagnosed PCOS cases and 35 healthy women were included the study. All women underwent a thorough gynaecological examination. Clitoral length, and labia minora length and width were recorded. The groups were compared for features of external genital structures. Clitoral and labial lengths were significantly higher in PCOS group. There was a strong correlation between clitoral length and modified Ferriman–Gallwey score. The most effective predictor of PCOS was found to be clitoral length. Clitoral length alone predicted 99.9% of PCOS patients. There were some subclinical genital changes in women with PCOS. These changes in PCOS patients may be a sign of hyperandrogenism and might have diagnostic value in indistinct cases.

Is There a Relationship Between Pelvic Organ Prolapse and Tissue Fibrillin-1 Levels?

PURPOSE Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. METHODS Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. RESULTS Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P=0.018) and menopause (P=0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P=0.006). CONCLUSIONS The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations.

Does quality of female sexual function improve after a transobturator tape procedure

Abstract The aim of this study was to use a questionnaire to evaluate any changes in sexual satisfaction of women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence. A total of 30 women agreed to participate in the study and were invited to fill out the Female Sexual Function Index (FSFI) questionnaire prior to surgery and 3 months after surgery. As a result, after the TOT operation, there was a statistically significant improvement in libido (desire), arousal, lubrication, orgasm and satisfaction. The TOT procedure seems to have a positive effect on female sexual function by reducing the urinary leakage during sexual activity and by decreasing the pain during or after sexual activity.

Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term

Abstract The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM. Impact statement The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups. Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.

Prenatal multivitamin supplementation increases birth weight

Background: The aim of this study is to examine whether there is any positive impact of prenatal iron and vitamin supplementation on birth weight, and if this practice could be a cause of macrosomia. Methods: A total of 1,838 term pregnant women were included in this study and were divided into four groups: iron group (women having only iron supplementation), vitamin (women using only multivitamins), vitamin+iron (women using both iron and multivitamin preparations), and control group (women having neither iron nor vitamin supplements). Statistical analysis was performed to compare age, gravida, parity, hemoglobin, BMI and birth weight. Groups were compared in terms of macrosomia and correlation analysis carried out between demographics and birth weight. Results: The birth weight was significantly higher in the vitamin group and the vitamin+iron group than in the iron group and the control group. Vitamin supplementation increased the risk of macrosomia 3.9 times, while vitamin+iron usage increased the risk 4.8 times. Conclusions: Uncontrolled use of multivitamins and/or iron supplements may increase tendency for fetal macrosomia. The use of multivitamins and/or iron supplements by pregnant women must take into account maternal age, maternal diet and maternal BMI. Our findings support a reduction in the unnecessary use of vitamin and iron supplements in pregnancy, and a reversal of the trend to start vitamin and iron supplementation without any control. The increasing prevalence of obesity and excessive weight in pregnant women should be a warning against the uncontrolled usage of vitamins and iron during pregnancy.

Polikistik Over Sendromlu hastalarda artmış ürik asit düzeyleri ve klinik ile ilişkisi

Amac: Polikistikover sendromu (PKOS) ureme cagindaki kadinlari etkileyen en sik endokrin bozukluktur. Klinik ve biyokimyasal ozellikleri metabolik sendrom ile benzerlik gostermektedir. Metabolik sendromlu hastalarda insulin direnci, serum urik asit duzeyi ile iliskilidir. Calismamizda PKOS hastalarinda serum urik asit duzeylerinin laboratuar ve klinik ile iliskisini incelemeyi amacladik. G erec ve Yontemler: Hastanemiz Endokrin Kliniginde takip edilen 172 PKOS hastasi, 34 yas ve vucut kitle indeksi (VKI) uyumlu kontrol grubu toplam 206 olgu katilmistir. Erken follikuler fazda, 12 saat aclik sonrasi kan ornekleri alinmistir. Bazal serum hormon duzeyleri immunoassay ile degerlendirildi. Bulgular: Urik asid duzeylerinin PKOS grubunda kontrol grubuna gore istatistiksel olarak anlamli bir sekilde daha yuksek saptanmistir (4,25 ± 1,07 PKOS, 3,7 ± 0,79 kontrol, P = 0,048). Urik asit ile VKI, total kolesterol, insulin, siklus suresi, Ferriman Gallwey skoru arasinda pozitif anlamli korelasyon, HDL kolesterol ile anlamli negatif korelasyon bulunmustur. Cok degiskenli logistik regresyon yapildiginda urik asit duzeylerinin PKOS grubunda yas ve VKI’den bagimsiz olarak iki kat daha yuksek oldugu saptanmistir. Sonuclar: Calismamizda PKOS grubunda urik asit duzeyleri anlamli bir sekilde yuksek bulunmus ve bu yuksekligin yas ve VKI’den bagimsiz oldugu gorulmustur. Urik asit ile kardiyovaskuler risk faktoru olan kolesterol, Trigliserit, VKI, insulin arasinda pozitif korelasyon gorulmustur. Klinik gosterge olan Ferriman Gallwey, siklus suresi acisindan da pozitif korelasyon saptanmistir. Artmis urik asit duzeyleri PKOS hastalarinda kardiyovaskuler hastalik olusumu icin bagimsiz bir risk faktoru olabilir, klinikte olumsuz sonuclari gosterebilir. Anahtar Kelimeler: Kardiyovaskuler, polikistik over sendromu, urik asit