Gynecology Obstetrics & Reproductive Medicine

Usage of Surfactant and Evaluation of Lung Problems in Late Preterm Infants

Ozlem Yilman — 2023-12-26

OBJECTIVE: We aimed to evaluate surfactant frequency and surfactant indications, as well as lung problems in late preterm infants.

STUDY DESIGN: This retrospective and cross-sectional study was carried out by HSU Izmir Dr. Behcet Uz Pediatric Diseases and Surgery Research and Training Hospital. Infants who were born late preterm between January 2016 and January 2022 were hospitalized in the NICU due to respiratory distress in the first 24 hours. Lung problems and surfactant administration of these infants were evaluated. The frequency of surfactant dosages, their indications, and their effects were examined. As the control group, patients who were admitted to the NICU in the same period due to respiratory distress with similar indications but did not receive surfactant were considered.

RESULTS: It was observed that surfactant was not administered to 105 infants and surfactant was administered to 106 infants. The median gestational week of the infants included in the study was 35 (34/36) weeks and the birth weight was 2185 (1780/2590) grams. A significant difference was observed in birth weight between the groups (p<0.001). Invasive ventilation was required in 52.1% of all cases and noninvasive ventilation was required in 33.6%. In the delivery room, the need for resuscitation and intubation was higher in the group requiring surfactant (p=0.001). The most common lung pathology in the surfactant group was RDS.

CONCLUSION: It must not be forgotten that infants who are born late preterm infants are preterm infants and the evaluation of antenatal steroid administration must not be ignored.

Sildenafil as a Salvage Treatment for Ovarian Torsion: A Rat Model

Didem Alkas Yaginc — 2023-12-26

OBJECTIVE: In this study, we aimed to investigate the effect of sildenafil, acting as an anti-oxidant on the ischemic rat ovarian torsion model by pointing out ovarian reserve via AMH levels which is the best marker for oocyte pool.
STUDY DESIGN: This study is an experimental animal study conducted according to the principles of the Declaration of Helsinki. Twenty-seven rats were assigned into three groups, each consisting of nine individuals. Group 1: Sham operation (laparotomy only) was performed. Group 2: The torsion group had bilateral torsion and detorsion of the ovaries. Group 3: In Sildenafil and torsion group the rats received 0.7 mg/kg sildenafil (Viagra, Pfizer, New York, ABD) intraperitoneally one hour before torsion and detorsion operation. One month after the initial operation, blood was drawn via the intra-cardiac route, and serum antimullerian hormone (AMH) concentrations were studied.
RESULTS: The mean weights of the rats were similar 224 g, 229 g, and 222 g for groups 1, 2, and 3 respectively. Only one rat from Group 2(T/D) died during the experiment leaving eight rats for analysis. The mean value for AMH was 24.9227±12.19124 ng/ml and the mean value for weight was 226.22±19.200. The differences in AMH groups were not statistically significant (p=0.873)
CONCLUSIONS: As a result, as is shown in our study, the ovarian reserve may not be influenced by ischemia developed by ovarian torsion or any influences could not change AMH levels. Sildenafil which was given to the rats before detorsion to protect against reperfusion ischemia was found to be ineffective on ovary reserve according to AMH assessment.

Peripartum Ruptured Uterine Angioleiomyoma

Nora Mohamed — 2023-12-26

Uterine angioleiomyoma is a rare entity. Angioleiomyoma is a benign vascular tumor that originates from
the blood vessels. Although exceptionally they can be found in the uterus, they are commonly reported
in the lower extremity. Preoperative diagnosis is tricky. We are publishing this case to highlight uterine
contractions as a possible cause of the peripartum rupture.

The patient was in her fourth pregnancy, with a history of three vaginal deliveries. She presented to the
emergency department in our hospital with labor pain, at 39 weeks of gestation, and was admitted to the
labor unit in active labor. She had an uneventful vaginal delivery with a good neonatal outcome. After
delivery, the patient complained of abdominal pain, shoulder tip pain, and abdominal distention.

Examination revealed a tender mass felt on the left side of the uterus up to the left hypochondriac region, contracted uterus, and normal lochia. A CT (computed tomography) scan was carried out and was remarkable for a left-sided, mixed-density, abdominopelvic lesion, measuring 18×12×9 cm, and a moderate amount of hemoperitoneum. Intraoperatively there was 1 liter of free blood, ruptured left-sided, subserous myoma connected to a 20×15 cm hematoma. A myomectomy was carried out. Histopathology reported an angioleiomyoma with symplastic-type cells.

Although infrequent, complicated angioleomyoma should be suspected in the differential diagnosis of
abdominopelvic hematoma in patients with uterine fibroids

Comparison of Endometrial Microbiota Results Between Patients with Unexplained Infertility and Fertile Patients through 16s rRNA Sequencing

Gonca Ozten Dere — 2023-12-26

OBJECTIVE: The primary objective of our study was to compare the endometrial microbiota profiles of women with unexplained infertility and fertile women.

STUDY DESIGN: In this case control study a total of 15 patients with unexplained infertility and 15 patients who had a live birth in the last two years with proven fertility were recruited. Endometrial samples were collected and analyzed through next-generation sequencing of the bacteria-specific 16S ribosome gene.

RESULTS: Lactobacillus species represented the majority of the microbiome profile in both groups. The median percentage of the endometrial Lactobacillus between infertile patients and fertile patients was not statistically significant (p=0.9). Groups were divided into two categories: Lactobasillus dominant (Lactobacillus spp.> 90%, LD) and Non-Lactobacillus dominant (NLD). Lactobacillus dominance was detected in six of nine patients (66.7%) in the study group and four of nine patients (44.5%) in the control group, and no significant difference was observed between them (p=0.64).

CONCLUSION: According to our study results, no significant difference was observed between the endometrial microbiota profile of infertile and fertile patients. Further studies with larger sample sizes are needed to characterize the endometrial microbiota and its impact on reproduction.
Keywords: Microbiota, unexplained infertility, endometrial microbiota

Retrospective Analysis of Seasonal Changes in Semen Analysis Parameters

Sinan Ates — 2023-12-26

OBJECTIVE: Seasonal and environmental temperature changes may affect semen analysis results. This study aimed to evaluate the effect of seasonal changes on semen analysis parameters.

STUDY DESIGN: Cross-sectional study conducted at Trakya University Faculty of Medicine, Department of Obstetrics and Gynecology, Edirne, Türkiye. Data from 2055 semen analyses collected between January 2014 and December 2019 from 1358 patients living in the Thrace region of Türkiye were analyzed retrospectively. Sperm analysis was performed according to 2010 WHO criteria.

RESULTS: Sperm concentration was significantly higher in autumn months compared to spring and summer months (p<0.05). The total motility rate of sperm was significantly lower in winter months compared to other months (p<0.05). No statistically significant seasonal differences were observed in semen volume or morphology (p>0.05).

CONCLUSIONS: Our study showed that seasonal changes in semen analysis parameters, including peak sperm concentrations in autumn and low motility rates in winter, may be related to air temperature, daylight duration, etc., and may prompt further study of environmental conditions on male fertility.

Impact of Dienogest Alone or in Combination with Ethinylestradiol on the Quality of Life of Women with Endometriosis: A Prospective Cohort Study

Mujde Canday — 2023-12-26

OBJECTIVE: We aim to compare the effectiveness of oral contraceptives and dienogest, primarily by considering the quality of life scale. We also aim to compare the Cancer Antigen-125 and Anti-mullerian Hormone values.

STUDY DESIGN: Gynecological examination findings evaluated based on ESHRE and ASRM Guideline criteria are compatible with endometriosis, or a previous surgery pathology result is consistent with endometriosis, and patients whose imaging report was compatible with endometriosis were selected. Among the patients who were recommended medical treatment, patients selected as Dionegest 2mg+Ethinylestradiol 0.03 mg (Dienelle) treatment were considered Group 1, and patients deemed suitable for treatment with treatment 2mg Dionegest (Visanne) were considered Group 2. Pre-treatment Cancer Antigen-125/Anti-mullerian Hormone values and SF-36 were recorded.

RESULTS: There was no significant difference between drug groups in terms of education status, body mass index, family history, smoking, alcohol consumption, age, age at menarche, menstruation pattern, duration of menstruation, infertility, gestational status, job loss due to pain complaints, operation, and MRI findings (p>0.05). There was no significant difference between the drug groups regarding the quality of life before and after treatment (p>0.05). There was no significant difference between drug groups regarding endometrioma size, Cancer Antigen-125, and anti-mullerian hormone findings (p>0.05).

CONCLUSION: Evaluating our data, the efficacy and success of the two treatment protocols were the same. It seems more logical to prefer cost-effective oral contraceptive treatments with a low side-effect profile than high-cost Dionegest. Following the guidelines accepted step therapy in treating mild or moderate endometriosis, cyclic oral contraceptives may be recommended as first-line therapy.

Pregnancy-Associated Plasma Protein-A: Its Significance as a Single Biomarker for Adverse Obstetric Outcomes

Madhusudan Dey — 2023-12-26

OBJECTIVES: Low levels of pregnancy-associated plasma protein-A in pregnant women linked to unhealthy placentation and a spectrum of maternal and fetal complications. Its assessment as a single biomarker has the potential to identify high-risk pregnancies. This prospective observational study was conducted to find a correlation between low pregnancy-associated plasma protein-A levels in the first trimester of pregnancy with various obstetric outcomes to establish if it can be used as a single biomarker for counseling couples.

STUDY DESIGN: The study was conducted at Base Hospital, Delhi Cantt. Maternal serum pregnancy-associated plasma protein-A levels were assessed at 11 to 13+6 weeks of gestation, converted in multiples of the median and patients were followed till delivery. Maternal outcomes were recorded in terms of abortions, development of gestational hypertension, gestational diabetes, preeclampsia, placental abruption, fetal growth restriction, fetal demise, neonatal intensive care unit admission, etc., and analyzed to find an association with levels first trimester of pregnancy-associated plasma protein-A.

RESULTS: Low pregnancy-associated plasma protein-A levels showed a statistically significant association with gestational hypertension, preeclampsia, abortion, fetal demise, and also for adverse neonatal outcomes like APGAR <5 at 1 min, fetal growth restriction, neonatal intensive care unit admission, and perinatal deaths. No significant association was observed for preterm delivery, gestational diabetes, and placental abruption.

CONCLUSION: Serum pregnancy-associated plasma protein-A levels in the first trimester of pregnancy have the potential of being utilized as a validated marker for adverse pregnancy outcomes. Early identification of such pregnancies can help in optimizing feto-maternal outcomes through closer surveillance, timely intervention, and referral to tertiary care centers. Further research would help the fraternity in developing a prediction model.

Reassessing Nutritional Supplementation Program: The Impact of Maternal Vitamin B12 Levels on Feto-Maternal Outcomes

Pranjali Dhume — 2023-12-26

OBJECTIVES: In India, despite the high prevalence of vitamin B12 (vit B12) deficiency, the current public health policy focuses solely on iron and folic acid supplementation as a measure to prevent anaemia. Vit B12 is an important cofactor for enzymatic reactions related to DNA synthesis, folate, and cell metabolism. While folate deficiency has been acknowledged in not only the prevention of neural tube defects and other adverse pregnancy outcomes, the effects of low vit B12 status have not been well defined. It is becoming recognized that there is a much higher prevalence of B12 deficiency than earlier suspected, and more of its effect on maternal and fetal health is being reported. The current study was planned as an observational study to correlate the effects of vit B12 deficiency with respect to various feto-maternal outcomes.

STUDY DESIGN: In this prospective cohort study a total of 300 antenatal women were screened for vit B12 levels in the late first trimester and were followed up to find out co-existent folic acid deficiency, development of pregnancy complications like anemia, gestational hypertension/pre-eclampsia, fetal growth restriction (FGR), second-trimester abortions, gestational diabetes mellitus (GDM) and preterm deliveries.

RESULTS: It was found that most of the women with low B12 levels were vegetarian and had co-existent folic acid deficiency. They had a statistically significant increase in the incidence of anemia, pre-eclampsia, gestational diabetes, (small for gestational age) SGA/FGR, and preterm births.

CONCLUSION: The study suggests that low levels of vit B12 increase the likelihood of adverse feto-maternal outcomes. Further research involving larger sample sizes is necessary to confirm these findings and determine if vit B12 supplementation should be included in pregnancy nutritional supplements, especially in vegetarian women.

Evaluation of Hypertension and Renal Function in Preeclamptic Women: A Follow-Up Study at 6th Week of Postpartum

Ebru Ayguler — 2023-12-26

OBJECTIVES: Chronic hypertension stands as the primary contributing factor for cardiovascular ailments among women who have experienced preeclampsia. The purpose of this research is to examine how often preeclamptic symptoms persist at the postpartum 6th week.

STUDY DESIGN: The study included 50 singleton pregnant women in the third trimester who were diagnosed with preeclampsia according to ACOG criteria, were older than 18 years, had no known hypertension before the 20th gestational week, had no additional systemic disease, did not use medication, had no fetal chromosomal or structural abnormalities and delivered within 24-48 hours of hospitalization.

RESULTS: The mean age of preeclamptic pregnant patients was 29.26±7.15 years, the mean gestational week was 35.6±2.8, and the mean BMI was 31.3±4.9. Twenty (40%) of 50 preeclamptic patients had severe preeclampsia. The mean decrease in systolic blood pressure was 34.6±15.2 mmHg, while the mean decrease in diastolic blood pressure was 22.88±11.68 mmHg (p<0.001). The decrease in systolic and diastolic blood pressure at postpartum 6th week was statistically significant. The mean change in 24-hour urine protein value at postpartum 6th week was 2313.52 ± 2696.48 and the difference was statistically significant (p<0.001). There were 14 patients (28%) with persistent hypertension and 19 patients (38%) with persistent proteinuria.

CONCLUSIONS: Although preeclampsia is considered a complication of pregnancy, persistent hypertension, and proteinuria after delivery show us that preeclampsia is a disease that threatens maternal health even after delivery. These women should be followed up long-term period.

Low Fifth-Minute Apgar Score Analysed According to Robson Ten Group Classification at a Tertiary Hospital in Nigeria

Olakunle Makinde — 2023-12-26

OBJECTIVE: Robson classification can be used to analyze and audit other indices of delivery outcome besides cesarean section (CS). The objective is to analyze low fifth-minute APGAR scores according to Robson’s classification and present deducible conclusions.

STUDY DESIGN: A cross-sectional dataset of 584 neonates of parturients at the Federal Medical Centre Yenagoa (FMCY), Bayelsa State, Nigeria between July 2020 and April 2021 was analyzed. Neonates were classified by the corresponding Robson group with subgroup modification of their mothers. Data was analyzed using IBM SPSS Statistics version 25. Descriptive statistics and association between low fifth-minute APGAR Score and the Robson group are presented. The statistical significance is a p value <0.05.

RESULTS: The largest contribution (29.6%) to the low fifth-minute APGAR score was from Robson group 3. Group rate was high in groups 10b (66.7%), 7a (61.1%), 10a (53.6%), 9a (50.0%), 6a (50.0%), 5.2a (33.3%) and 10c (30.3%) relative to others. Neonates of parturients in Robson groups 6a (OR - 11.00; 95% CI-1.27-95.18; p Value-0.029), 7a (OR-17.29; 95% CI-3.06-97.52; p value-0.001), 9a (OR-11.00; 95% CI-1.48-81.61; p Value-0.019), 10a (OR-12.69; 95% CI-2.49 - 64.58; p value-0.002) and 10b (OR-22.00; 95% CI-1.33 -362.92; p value-0.031) had significantly higher odds of low fifth-minute APGAR score relative to 8c with the lowest group rate.

CONCLUSION: Meaningful deduction is possible with use of the Robson’s classification for audit of low APGAR Score. By this study, parturients in Robson groups 3, 5.2a, 6a, 7a, 9a, 10a, 10b, and 10c are identified for focused interventions towards improving APGAR score outcomes at FMCY.

Evaluation of Anxiety and Depression Levels in High-Risk Pregnancies During the COVID-19 Pandemic and Their Approaches to Vaccination: A Case-Control Study

Seval Yilmaz Ergani — 2023-12-26

OBJECTIVE: Anxiety and depression are associated with the interaction of many social factors, but pregnancy and puerperium are periods when patients are particularly sensitive to depression and anxiety. Assessing the level of anxiety and depression in high-risk pregnancies during the pandemic process and their attitudes toward vaccination.

STUDY DESIGN: In a case-control study, the Beck Depression and Beck Anxiety Scales were administered to 62 high-risk pregnant women and 296 normal pregnant women who registered at our hospital. At the end of the entire quarantine period and the use of the vaccine in our country, all patients were called and asked whether they had been vaccinated.

RESULTS: Anxiety and depression scores of normal patients were higher than those of patients in the risk group (p=0.002 and p<0.001, respectively). The anxiety and depression scores of the normal pregnant patients who were treated as outpatients were higher than those of the patients who were treated as inpatients (p=0.003 and p<0.001, respectively). Depression scores of patients in the last trimester of pregnancy were higher than those of patients at a smaller gestational age (p=0.009). Looking back to the pandemic period after vaccine discovery, depression scores of high-risk pregnant women were found to be higher and those who had a normal pregnancy had higher anxiety and depression scores (p=0.002, p<0.001, p<0.001).
CONCLUSIONS: Hospitalization had different effects on high-risk and normal pregnant women; while hospitalization increased anxiety in high-risk pregnancies, outpatient follow-up increased anxiety and depression in the normal group.