Goal: 16 - Barış, Adalet ve Güçlü Kurumlar
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Administration of rectal cytotec versus rectal buscopan before hysteroscopy
Introduction:Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming. Material and methods:This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30 degrees lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure. Results:Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively (p = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (p=.11). There was no difference with regard to other studied parameters. Summary:HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage
Introduction and hypothesis Uterine fundal pressure is applied to accelerate birth by increasing the expulsive force of the uterus in the second stage of delivery. The aim of the study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on the rate of pelvic floor damage among primiparous women using three-dimensional transperineal ultrasonography. Methods The women were divided into two groups: the fundal pressure group included women where the fundal pressure maneuver was applied (n = 39); the control group included women who delivered spontaneously without fundal pressure (n = 47). 3D-TPU was performed within 48 h of delivery, and LAM biometry, LAM defect and loss of tenting were determined. Results Anteroposterior hiatal dimensions on resting, maximal Valsalva and maximal PFMC were found to be higher in the fundal pressure group (p < 0.0001,p = 0.008,p = 0.007, respectively). The mean hiatal area at rest was larger in the fundal pressure group than in the control group (p = 0.04). The rate of LAM defect was significantly higher in the fundal pressure group (p = 0.001). The rate of loss of tenting was significantly higher in the fundal pressure group (p < 0.0001). According to multivariate regression models, the fundal pressure was the only independent factor associated with LAM defect (OR = 5.63; 95% CI = 12.01-15.74) and loss of tenting (OR = 8.74; 95% CI = 2.89-26.43). Conclusions Fundal pressure during the second stage of delivery is associated with a higher risk of LAM defect and loss of anterior vaginal wall support.
Chronotype anc Sleep Quality Assessment of Patients with Polycystic Ovary Syndrome
Aim: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women during the reproductive ages. The purpose of this study was to investigate the chronotype and sleep quality of PCOS patients.
Are chronotype and subjective sleep quality associated with preeclampsia and preterm birth?
The physiological and physical changes in pregnancy affect the sleep-wake cycle. Limited data exist to evaluate the effect of sleep quality and chronotype during pregnancy on adverse pregnancy outcomes. It is hypothesized that there could be a tendency for the evening chronotype and sleep disturbances to lead to the development of preeclampsia and preterm birth. A total of 313 pregnant women were included. Women were divided into three groups: Group A (control - problem-free), Group B (preeclampsia) and Group C (preterm birth). There were significant differences in the mean PSQI score between the groups (A vs C and A vs B) (p < 0.01). Women in the preterm and the preeclampsia groups reported significantly worse sleep quality. There was a significant difference in the mean MEQ scores between groups (A vs C and A vs B) (p < 0.01). The ratio of the evening-types was significantly higher for the preterm and preeclampsia groups (p < 0.01). Multivariate logistic regression analysis revealed that there is a negative association between preeclampsia/preterm birth and MEQ score, positive association between preeclampsia/preterm birth and PSQI score. Chronotype and sleep quality measurements could provide a simple and feasible way in the prediction of adverse pregnancy outcomes.
Vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC): technique and mean 20 months outcomes
The main purpose of our study is to evaluate the efficacy and safety of vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC) for apical pelvic organ prolapse. We retrospectively reviewed the results of twenty-three women with stage III and IV prolapse treated with VALSAC between April 2017 and June 2019. With a mean follow-up of 20 months, apical pelvic organ prolapse was cured in 95.7 % of patients. There was no complication in terms of mesh exposure, persistent pain, hematoma, infection. The mean pre- and post-operative POP-Q scores were, for the Aa point, 1.61 +/- 1.82 cm and -1.96 +/- 0.87 cm (p < 0.01), for the C point, 2.87 +/- 1.6 cm and -5.26 +/- 1.86 cm (p < 0.01) for the Ap point, -1.43 +/- 0.89 cm and -2.09 +/- 0.59 cm (p < 0.01). VALSAC is a promising minimally invasive technique for pelvic floor reconstruction that appears to provide good outcomes. Content: The main purpose of our study is to evaluate the efficacy and safety of vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC) for apical pelvic organ prolapse.
2-D and 3-D ultrasonographic characteristics of the ovary in women with PCOS and multifollicular ovaries
In this prospective study, seventy-six patients (PCOS group; n = 36, multifollicular ovary group; n = 40) were evaluated by 2-D and 3-D ultrasonography. VOCAL programme, echogenicity, number of follicles and blood flow parameters were evaluated. The patients with PCOS had a higher total ovarian volume, mean stromal volume and stromal echogenicity (18.6 +/- 4.75 to 10.2 +/- 3.4p .05). 3 D power Doppler parameters included VI, FI, and VFI values of the patients with PCOS were higher when compared to those of the patients with multifollicular ovary (3.82 +/- 2.65 to 1.78 +/- 1.2,p < .01; 50.76 +/- 4.45 to 40.6 +/- 3.64,p = .03; and 2.34 +/- 1.02 to 1.12 +/- 0.65,p = .02, respectively). Our results revealed that total ovarian volume, stromal volume and echogenicity; VFI, VI, and FI could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.Impact statement What is already known on this subject?Ultrasonography is considered the new diagnostic tool for PCOS. Enlarged ovaries with multiple small follicles peripherally located around increased ovarian stroma with increased stromal echogenicity are the sonographic features of polycystic ovaries. What do the results of this study add?3-D Doppler ultrasonography may be more specific in the determination of multifollicular and polycystic ovaries when compared to RI and PI in 2-D Doppler ultrasonography. Moreover, 3-D power Doppler ultrasonography could be useful for differential diagnosis in women with PCOS and multifollicular ovaries. What are the implications of these findings for clinical practice and/or further research?In clinical practice, the differentiation of multifollicular ovaries and polycystic ovaries (PCO) is difficult with the use of 2-D sonography alone. Therefore, 3-D ultrasound and power Doppler may also be used in addition to 2-D ultrasound for the differentiation of multifollicular ovaries and PCO.