OBJECTIVE: We aimed to investigate the effect of acupuncture performed as an adjuvant therapy to in
vitro fertilization, on pregnancy rates by performing acupuncture on the day of embryo transfer, one hour
before the procedure and one hour after the procedure.
STUDY DESIGN: In this open-label randomized prospective controlled study, 60 unexplained infertility
patients enrolled for in vitro fertilization treatment were randomized by a computer-based number generator
for acupuncture performance and no-treatment. All patients received rFSH (Gonal-F®) for ovulation
induction and the antagonist Cetrorelix (Cetrotide®) to prevent premature ovulation. Ovulation was
triggered by using hCG (Ovitrelle®) and egg collection was done after 36-48 hours. In the study group,
acupuncture was performed by intradermal needling, bilaterally with a sterile needle, both one hour before
and one hour after the embryo transfer. Acupuncture was not performed on the control group. The
results of the treatment were evaluated 12 days after embryo transfer.
RESULTS: Thirty patients were randomized into the study group and 30 patients were randomly placed
in the control group. Although there was no statistically significant difference between groups in terms of
β-hCG positivity, it was 43.3% in the study group and 36.7% in the control group (p>0.05).
CONCLUSION: The success rate of in vitro fertilization was higher in terms of pregnancy rate in the patient
group who received acupuncture procedure as well, but the difference was not statistically significant.
This may be due to the type of acupuncture procedure selected or insufficient sample size. As a
result, further studies involving larger numbers of participants and using different acupuncture techniques
are needed.
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OBJECTIVE: We aimed to investigate the role of incomplete of antenatal steroid therapy by comparing
with no and complete steroid exposure on mortality and morbidity in preterm infants.
STUDY DESIGN: This is a prospective, an observational study which includes preterm infants of 32
weeks of gestation and/or ≤1500 grams who were referred to Izmir Dr. Behcet Uz Children’s Hospital
NICU during the one year period. Infants were divided into three groups according to the administration
of antenatal steroid as those who received incomplete-dose antenatal steroid, complete dose steroid
therapy and those with no steroid exposure. Intubation at the delivery room, surfactant requirement, the
inotropic requirement in the first 72 hours and morbidities associated with prematurity were determined
as the primary results. Mortality and bronchopulmonary dysplasia at discharge and stage ≥2 retinopathy
were analyzed as secondary outcomes.
RESULTS: We found that 54 infants were born with an incomplete dose, 55 infants with complete dose
and 38 infants with no steroid therapy. Surfactant requirement, inotropic requirement, and hemodynamically
significant patent ductus arteriosus were lower in the steroid exposure group leading to a statistical
difference (p <0.05). Also, it was found that mortality and Bronchopulmonary dysplasia was lower in
the incomplete and complete dose steroid groups, leading to a statistical difference (p <0.05).
CONCLUSION: We speculate that even incomplete dose steroid may reduce mortality by reducing respiratory
distress syndrome.
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OBJECTIVE: Coital incontinence is the involuntary leakage of urine during sexual intercourse and is rarely reported in women with urinary incontinence. The aim of this study is to investigate the frequency of coital incontinence and its association with incontinence types. STUDY DESIGN: All sexually active women with urinary incontinence (diagnosed as self-reported) attending the out-patient gynecology clinic of a regional state hospital were interviewed consecutively between September 2017 and September 2018 about their experience with regards to coital incontinence. The clinical evaluation consisted of medical history, physical examination, and urine analysis. The SPSS 20 program designed for Windows was used for statistical analysis. RESULTS: Twenty-two of the 64 women who participated in the study were diagnosed with coital incontinence and the remaining 42 women were to be compared. 42 women were included in the control group, and 22 women were defined as the study group. The women with coital incontinence had significantly higher stress test positivity than the control group (p=0.00). No significant differences in the frequency of coital incontinence between incontinence types were found. The chi-square test was applied, and the p-value was >0.05 (p=0.110). So there was no statistically significant relationship between the type of incontinence and the frequency of coital incontinence. CONCLUSION: Coital incontinence is much more prevalent than expected and therefore patients with symptomatic urinary incontinence should be investigated for the presence of coital incontinence, as this may affect patient approach and treatment.
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OBJECTIVE: In the present study, we investigate the growth characteristics of very low birth weight premature infants of up to two years corrected age, considering the factors affecting growth and catch-up growth time. STUDY DESIGN: The demographic data, clinical features, and comorbidities of 77 preterm infants with birth weights of less than or equal to 1.500 g were examined, the infants’ growth statuses in the 40th gestational week and at 6, 12, 18 and 24 months the corrected age, including their weight, height and head circumference, were evaluated. RESULTS: The findings revealed that very low birth weight infants should be closely monitored either during their stay in the Neonatal Intensive Care Unit, or for up to 6 months corrected age, paying particular attention to growth data, and the appropriate supportive treatment should be administered. The applied support process is influential on the future somatic growth of preterm infants. It was noted in the study that bronchopulmonary dysplasia, proven sepsis, respiratory distress syndrome, steroid treatment for more than three days, patent ductus arteriosus, and ibuprofen treatment seemed to affect somatic growth negatively. CONCLUSION: Small for gestational age newborns were found to catch up with appropriate for gestational age newborns at 2 years corrected age in terms of growth, although the percentage of catch-up growth during follow-up at the 40th gestational week, and at the 6th, 12th and 18th months was lower than that of appropriate for gestational age newborns.
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Gunel ZIYADOVA, Altan KAVUNCUOGLU, Gonca OZTEN, Zafer Selcuk TUNCER
Gunel ZIYADOVA, Altan KAVUNCUOGLU, Gonca OZTEN, Zafer Selcuk TUNCER
Botryoid rhabdomyosarcoma originating from the cervix is rare among fertile women and constitutes 0.2% of all uterine cancers. A 26-year-old female patient with a cervical polyp presented with a case of sarcoma botryoides. The biopsy specimen confirmed the botryoid sarcoma of the uterine cervix and the patient underwent definitive surgery with lymphadenectomy. Pathology showed negative margins and total extraction of tumor. The tumor was confined to the cervix. The patient is considered group 1A in Intergroup rhabdomyosarcoma Working Group V (IRSG) criteria and the treatment plan continued with adjuvant vincristine, actinomycin D, cyclophosphamide chemotherapy. In the case of cervical polyps in the fertile age, the specimen must be carefully and histologically examined to rule out genital rabdomyosarcoma. Since the stage is a very important prognostic factor, an early diagnosis is crucial.
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OBJECTIVE: This study was aimed to investigate the effect of perineal massage in the second stage of labor in prevention perineal traumas during childbirth. STUDY DESIGN: This observational study was conducted with 171 nulliparous women delivered by vaginally between January 2017 and May 2019. All the patients managed by the selective episiotomy principle. All the patients were divided into two groups: the perineal massage group and the control group. The perineal massage was performed during the second stage of labor until the baby's head was birth. The control group received routine labor care. In the case of threatening tears in any patient and at the preference of the midwife, mediolateral episiotomy was performed. Following childbirth, the perineum and vagina were examined for perineal tears and episiotomy by the midwives. RESULTS: The length of the second stage of labor was significantly lower in the massage group (36±19 minute) compared with the control group (46±25 minute, p=0.024). Twenty-five women (28.8%) in the massage group had intact perineum after vaginal birth, compared with five (6.0%) in the control group (p=0.003). The rate of first- and second-degree perineal tears are higher in the massage group [28 patients (32.2%) and 9 patients (10.3%), respectively] than in the control group [10 patients (11.9%) and 5 patients (6.0%), respectively, p<0.001]. The incidence of episiotomy was significantly lower in the massage group (25 patients, 28.7%) than in the control group (64 patients, 76.1%, p<0.001). CONCLUSION: Perineal massage should be considered a routine intervention to reduce the incidence of perineal trauma.
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OBJECTIVE:In Ethiopia very little or probably nothing is known about the significance of obstetric emergencies. This study was therefore aimed at assessing magnitude, characteristics, and outcomes of obstetric emergencies in western Ethiopia. STUDY DESIGN: Institution based prospective cohort study was employed from January to June 2017. To select the hospitals, area sampling technique was used. Total of 567 pregnant women with obstetric emergencies presented and treated in respective hospitals during the study periods and met the inclusion criteria were consecutively included. Results: Majority (91.7%) of the identified obstetric emergencies have led to termination of pregnancy. Significant proportions of pregnant women (11%) who reached health facility died of obstetric emergencies. Pregnant women with obstetric emergencies traveled to facility carried by people were found to have died about 8 times more likely as compared to those who were transported by ambulance. While 29.21% of women gave birth to normal life births, stillbirth and neonatal death were 8.02% and 7.4% respectively. Higher number of neonatal death was also observed among mothers in whom final mode of delivery was a cesarean section (adjusted odds ratio: 0.19(0.05, 0.62) compared to spontaneous vaginal delivery. CONCLUSION: This study has revealed that obstetric emergencies are responsible for the significant number of maternal and perinatal death. If the women have been accessed early and received optimum emergency care, many cases of the occurred death would have been prevented. Better outcome can be achieved through maximum utilization of quality and comprehensive antenatal care and organized prehospital obstetric emergency services.
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OBJECTIVE: Nowadays, fresh embryo transfers and frozen embryo transfers are frequently employed in the treatment of in vitro fertilization. This study aims to compare the pregnancy outcomes in patients who underwent fresh embryo transfers and frozen embryo transfers. STUDY DESIGN:All patients who underwent fresh embryo transfers and frozen embryo transfers at the in vitro fertilization center, Ondokuz Mayis University between 2010 and 2017 were screened retrospectively and the pregnancy results were evaluated at one-year follow-up. The study included a total of 912 transfers, 679 of which were fresh embryo transfers and 233 were fresh embryo transfers, in 756 patients. Comparisons were made in terms of biochemical pregnancy, clinical pregnancy rate, ongoing pregnancy, and live birth rate. RESULTS: Ectopic pregnancy, biochemical pregnancy, and abortus in fresh embryo transfers were found to be significantly more than that in frozen embryo transfers (p=0.001). However, no statistically significant difference in terms of clinical or ongoing pregnancy rate or live birth rate was observed. Birth weight was significantly lower in fresh embryo transfers than in frozen embryo transfers (p=0.001, p= 0.031). Multiple pregnancies preeclampsia, preterm labor, and placental abruption did not show a statistically significant difference in fresh embryo transfers and frozen embryo transfers. Yet, gestational diabetes was significantly more in frozen embryo transfers (p=0.011). CONCLUSIONS:Early pregnancy complications in fresh embryo transfers are higher than that in frozen embryo transfers. In terms of neonatal results, higher birth weight and gestational diabetes are more prevalent in frozen embryo transfers. In this study, it has been shown that fresh embryo transfers are more often associated with negative pregnancy outcomes. frozen embryo transfers can be better for pregnancy results.
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OBJECTIVE: Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation. STUDY DESIGN: In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic. RESULTS: The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively. CONCLUSION: The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.
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OBJECTIVE: There are cases where ultrasonographic evaluation is inadequate in determining firsttrimester
healthy pregnancy. In these cases, both the patient and the clinician are involved in a worrying
expectation. The single serum progesterone measurement was tried to predict pregnancy prognosis
in short time period. This study evaluated the predictive value of a single serum progesterone measurement
in first-trimester pregnancy loss.
STUDY DESIGN: A prospective case-control study was conducted between July 2013 and July 2014 in
Tertiary Hospital. The study compared 106 patients with threatened abortion (vaginal bleeding or spotting)
before 13 weeks of gestation with 110 healthy control pregnancies. Samples of serum progesterone
were obtained on the day each patient was admitted to the hospital. A Beckman-Coulter macro-Enzymelinked
immunoassay (ELISA) system was used to measure serum levels of progesterone (Beckman-
Coulter, Ireland).
RESULTS: Progesterone levels were measured when the patients first visited the hospital and they
were followed until the end of the first trimester. Progesterone levels differed significantly (p=0.013) between
the two groups. The spontaneous abortion rate was significantly (p=0.044) higher in the case
group. Progesterone levels differed significantly (p=0.001) between ongoing pregnancy and spontaneous
abortion groups. Using a cut-off level of 10.7 ng/mL, the sensitivity, specificity, and positive and
negative predictive values were 92.1%, 44%, 92.6%, and 42.3%, respectively, for viable pregnancies.
CONCLUSION: A single measurement of progesterone levels in serum can predict the prognosis of a
viable first-trimester pregnancy, while it is less effective for identifying non-viable pregnancies.
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