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Objective
To compare surgical outcomes, postoperative complications and costs between vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy in cases of large uteri.Methods
Prospective randomized controlled trial done at Ain Shams University Maternity Hospital, where 50 patients were recruited and divided into two equal groups (each 25 patients). First group underwent vaginal hysterectomy, and the second underwent laparoscopically assisted vaginal hysterectomy.Results
Patient characteristics were similar in both groups. As for surgical outcomes, estimated intraoperative blood loss (P = 0.90), operative time (P = 0.48), preoperative hemoglobin (P = 0.09), postoperative hemoglobin (P = 0.42), and operative complications (P = 1.0) did not differ between the two groups. The hospital costs (converted from Egyptian pound to U.S. dollars) were significantly higher in case of LAVH group [VH: $1060.86 ($180.09) versus LAVH: $1560.5 ($220.57), P value <0.001]. No significant difference exists in the duration of postoperative hospital stay between the two groups [VH: 49.92 h (28.50) versus LAVH: 58.56 (27.78), P = 0.28] or the actual uterine weight measured postoperatively [VH: 350.72 g (71.78) versus LAVH: 385.96 g (172.52), P = 0.35].Conclusion
Both vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy are safe procedures in cases of large uteri with no significant difference between them except in terms of costs as VH appears to be more cost effective.Clinical Trials.Gov
NCT02826304.3.
Ibrahim Abd Elgafor El Sharkwy Elsayed Hamdy Noureldin Ekramy Abd Elmoneim Mohamed Sherine Attia Shazly 《Journal of obstetrics and gynaecology of India》2018,68(5):408-413
Background
To compare between the sequential and concurrent use of vaginal misoprostol plus Foley catheter for labor induction.Methods
This single-center, non-blinded randomized study was conducted at the department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University. A total of 160 women with full term singleton pregnancy, cephalic presentation and bishop score ≤ 6 were randomized for labor induction with either concurrent or sequential use of vaginal misoprostol plus Foley catheter (80 cases in each group). The primary outcome measured was induction-to-delivery interval and secondary outcomes mesaured were vaginal delivery within 24 h, number of doses needed to induce labor, need of oxytocin for augmentation of labor, cesarean section rate, maternal or neonatal complications.Results
The mean induction-to-delivery interval was 22.33 ± 13.28 h versus 18.45 ± 14.34 h (p = 0.041) in sequential and concurrent group, respectively. The percentage of women who completed vaginal delivery within 24 h was 51% versus 61% (p = 0.046) in sequential and concurrent group, respectively. Other maternal and neonatal outcomes were similar in both groupsConclusion
Concurrent use of vaginal misoprostol plus Foley catheter for labor induction was associated with shorter induction-to delivery interval compared to sequential use, and it increases the rate of vaginal delivery in the first 24 h.4.
Purpose
Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation.Methods
40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia.Results
In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42.5% of the patients suffered from severe hypotension. We found a significant negative correlation between maternal blood pressure change and the resistant index (RI) of the umbilical artery (rs = ? 0.376, p = 0.017) and a significant positive correlation between maternal blood pressure and fetal middle cerebral artery.Conclusion
Healthy fetuses seem to compensate well in situations with decreased uteroplacental blood flow due to maternal hypotension measured by means of RI changes in the fetal umbilical and middle cerebral artery. This raises the question if growth-restricted and/or preterm fetuses are able to compensate similarly or if general anesthesia would be a method of choice.5.
Afsaneh Tehranian Roghayeh Hassani Zangbar Faezeh Aghajani Mahdi Sepidarkish Saeedeh Rafiei Tayebe Esfidani 《Gynecological surgery》2017,14(1):17
Background
The aim of this study was to investigate the effect of salpingectomy on ovarian function by measuring AMH.Methods
This study was a balanced, single-center, double-blind, randomized, controlled trial in Ruin Tan Arash Hospital, Tehran, between May 2013 and November 2014. A total of 30 patients undergoing elective abdominal hysterectomy were randomized into two groups, 15 with salpingectomy and 15 without salpingectomy. The primary objective of this study was to compare mean difference of anti-Mullerian hormone (AMH) between two groups. The secondary outcomes measured were follicle-stimulating hormone (FSH), operative time, and blood loss.Results
Serum AMH levels decreased at 3 months after hysterectomy in all patients (pre AMH 1.32 ± (0.91); post AMH 1.05 ± (0.88), P < 0.001), the salpingectomy group (pre AMH 1.44 ± (0.94); post AMH 1.13 ± (0.86), P < 0.001), and no salpingectomy group (pre AMH 1.2 ± (0.9); post AMH 0.97 ± (0.92), P < 0.001). The rate of decline of AMH levels after surgery did not differ between the two groups (25% (17–33%) vs. 26% (15–36%), P = 0.23) among the women with salpingectomy versus without salpingectomy, respectively. There was no difference in the mean operative time (mean difference 0.33, 95% CI ??22.21 to 22.86, P < 0.92), mean blood loss (mean difference ??0.66, 95% CI ??15.8 to 14.46, P < 0.97), and post FSH (mean difference 0.34, 95% CI ??1.2 to 1.88, P < 0.65) between both groups.Conclusions
Salpingectomy with abdominal hysterectomy is a safe treatment that does not have a deleterious effect on ovarian reserve.Trial registration
Iranian Registry of Clinical Trials, IRCT2014123118866N4 (www.IRCT.ir)6.
Purpose
To compare induction-to-delivery intervals of Foley catheters and double balloon catheters in second trimester pregnancy terminations.Methods
This randomized parallel study was conducted on women who underwent second trimester terminations between December 2016 and December 2017. Pregnant women in the second trimester with a Bishop score?<?6 were included in the study. Participants were randomized into two groups, the first being the Foley catheter group and the second being the double balloon catheter group. The time frames from insertion of catheters to the delivery were recorded in each group. A multiple regression analysis was carried out to examine the contribution of factors to the induction-to-delivery interval. A survival analysis was conducted to compare the Foley method and the double balloon method.Results
A total of 91 pregnant women were included in the final analysis. The induction-to-delivery interval was shorter in the Foley catheter group than in the double balloon catheter group (38 h 54 min?±?21 h 6 min versus 58 h 17 min?±?25 h 56 min). We also found that women with intrauterine fetal death (IUFD) had a shorter time to delivery compared to women with live fetuses (39 h 12 min?±?18 h 46 min vs 51 h 30 min?±?26 h 42 min, p?=?0.04). Women with a history of vaginal delivery also had a shorter induction-to-delivery time compared to women who never delivered vaginally before (38 h 12 min?±?17 h 42 min vs 53 h 54 min?±?27 h 18 min, p?=?0.004). In the multiple regression analysis, the most significant contributor to the induction-to-delivery time was the method used for induction of labor and followed by other factors including the viability of the fetus (live/IUFD), history of vaginal delivery and PPROM. The survival analysis showed that the induction-to-delivery interval was significantly shorter in the Foley catheter group than in the double balloon catheter group (HR 2.51, 95% CI 1.57–4.00, p?=?0.001).Conclusion
During the termination of second trimester pregnancies time from induction of labor to delivery is shorter with the Foley catheter compared to double balloon catheter.7.
Priya Sinha Amita Suneja Kiran Guleria Richa Aggarwal Neelam B. Vaid 《Journal of obstetrics and gynaecology of India》2018,68(1):39-44
Objective
To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of early pregnancy failure (EPF).Study Design
A randomized double-blind placebo-controlled clinical trial.Methods
Ninety-two women with EPF ≤12 weeks were recruited and randomly allocated to receive either mifepristone 200 mg (n = 46) or placebo (n = 46). Forty-eight hours later, patients in both the groups were given 800 µg misoprostol per-vaginum. If no expulsion occurred within 4 h, repeat doses of 400 µg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women ≤9 weeks by scan and 4 doses in women >9 weeks by scan.Results
Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate (86.7 vs. 57.8%, p = 0.009) and, hence, reduced the need for surgical evacuation (13.3 vs. 42.2%, p = 0.002), induction to expulsion interval (4.74 ± 2.24 vs. 8.03 ± 2.77 h, p = 0.000), mean number of additional doses of misoprostol required (0.68 vs. 1.91, p = 0.000), and side effects.Conclusion
Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone.8.
Purpose
To evaluate the clinical parameter associated with cesarean section diverticula anatomic healing via vaginal repair management.Methods
Observational cohort study. From Jul 2014 to Dec 2015, 143 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital, and 137(95.80%) were diagnosed using both transvaginal ultrasound and MRI. A total of 124 patients (86.71%) who were followed-up for more than 6 months after surgery were enrolled in this study. Excision and suture of CSD was performed through the vaginal approach. The defect sizes of the width, length, depth and TRM before or after repair were evaluated.Results
The mean preoperative duration of menstruation was 14.47 ± 3.30 days and the thickness of the remaining muscular layer was 2.65 ± 1.13 mm before surgery. The study revealed that the healing effects of CSD repair stabilized 3 months after surgery. At the median follow-up time (11.28 months), CSD disappeared after surgery in 64.52% of patients (80/124), and 60.0% of patients (48/80) reached ≤7 days of menstruation. Meanwhile, for 35.48% of patients (44/124), CSD persisted at the median follow-up after surgery, and 31.82% (14/44) of these patients reached ≤7 days of menstruation(P < 0.05). TRM at a median follow-up time after vaginal repair >7.88 mm, 92.11% (70/76) of CSD disappeared. Moreover, when preoperative CSD width ≤18.85 mm indicates that only 18.75% (12/64) of patients will present with CSD after vaginal repair, as determined by MRI (95% CI 0.515–0.737).Conclusion
The defect width of the preoperative CSD was the prognostic index of CSD anatomical repair effect. When the preoperative CSD width >18.85 mm, we should pay more attention to the edge of the defect during vaginal repairing.9.
Seok Hee Lee Hyun Ju Oh Min Jung Kim Geon A Kim Yoo Bin Choi Young Kwang Jo Erif Maha Nugraha Setyawan Byeong Chun Lee 《Journal of assisted reproduction and genetics》2017,34(7):929-938
Purpose
In contrast to most other mammals, canine oocytes are ovulated in an immature state and undergo oocyte maturation within the oviduct during the estrus stage. The aim of the study was to investigate whether oviduct cells from the estrus stage affect the maturation of oocytes and show gene expression patterns related to oocyte maturation.Methods
We analyzed MAPK1/3, SMAD2/3, and BMP6/15 expression in oviduct cells, cumulus cells, and oocytes from anestrus, estrus, and diestrus stages. Next, we investigated the effect of co-culture with oviduct cells derived from the estrus stage upon in vitro maturation (IVM) of canine oocytes.Results
There was significantly higher MAPK1/3 (1.42 ± 0.02 and 2.23 ± 0.06), SMAD2/3 (0.77 ± 0.03 and 2.39 ± 0.07), and BMP15 (2.21 ± 0.16) expression in oviduct cells at the estrus stage (P < 0.05). In cumulus cells, MAPK1 (1.26 ± 0.07), SMAD2/3 (0.82 ± 0.01, 1.04 ± 0.01), and BMP6 (13.09 ± 0.11) expression was significantly higher in the estrus stage (P < 0.05). In oocytes, significant upregulation of MAPK1/3 (14,960 ± 3121 and 1668 ± 253.4), SMAD3 (774.6 ± 79.62), and BMP6 (8500 ± 895.4) expression was found in the estrus stage (P < 0.05). After 72 h of IVM culture, a significantly higher maturation rate was observed in oocytes co-cultured with oviduct cells (10.0 ± 1.5%) than in the control group (3.2 ± 1.4%).Conclusions
We demonstrate that oviduct cells at the estrus stage highly expressed MAPK1/3, SMAD2/3, and BMP15. Furthermore, canine oviduct cells from the estrus stage enhance the culture environment for canine oocyte maturation.10.
Purpose
To compare the effectiveness of intravenous carbetocin to that of intravenous oxytocin for prevention of atonic postpartum hemorrhage (PPH) after vaginal delivery in high-risk singleton pregnancies.Methods
This triple-blind randomized controlled trial included singleton pregnant women who delivered at Siriraj Hospital between August 2016 and January 2017 and who were 20 years or older, had a gestational age of at least 34 weeks, had a vaginal delivery, and had at least one risk factor for atonic postpartum hemorrhage. Immediately after vaginal delivery, participants were randomly assigned to receive either 5 U of oxytocin or 100 mcg of carbetocin intravenously. Postpartum blood loss was measured objectively in mL using a postpartum drape with a calibrated bag.Results
A total of 174 and 176 participants constituted the oxytocin and carbetocin groups, respectively. The baseline characteristics were comparable between the groups. The carbetocin group had less postpartum blood loss (146.7?±?90.4 vs. 195.1?±?146.2 mL; p?<?0.01), a lower incidence of atonic PPH (0 vs. 6.3%; p?<?0.01), less usage of additional uterotonic drugs (9.1 vs. 27.6%; p?<?0.01), and a lower incidence of postpartum anemia (Hb?≤?10 g/dL) (9.1 vs. 18.4%; p?<?0.05) than the oxytocin group. No significant differences regarding side effects were evident between the groups.Conclusions
Intravenous carbetocin is more effective than intravenous oxytocin for the prevention of atonic PPH among singleton pregnancies with at least one risk factor for PPH.Clinical trial registration
TCTR20160715004.11.
Colleen D. McDermott Colin L. Terry Patrick J. Woodman Douglass S. Hale 《Archives of gynecology and obstetrics》2011,283(6):1303-1307
Purpose
The occurrence of stress urinary incontinence and pelvic organ prolapse can often coexist resulting in the need for concomitant surgical procedures to treat both conditions. The purpose of this study was to determine if tension-free vaginal tape (TVT®) at the time of laparoscopic sacral colpoperineopexy (LSCP) had an effect on distal anterior vaginal wall support.Methods
This was a retrospective cohort study of patients that had LSCP between January 2005 and December 2007 (n = 121). These patients were divided according to those with (n = 63) and without TVT (n = 58) at the time of LSCP. Pre- and postoperative information was compared between groups using Student’s t tests, ANCOVA, and Fisher’s exact tests (P ≤ 0.05).Results
Preoperatively, there were no significant differences between groups for all demographic and anatomic variables (P > 0.05). Patients were followed-up until 12 months after surgery. Patients with and without TVT had similar postoperative anterior vaginal wall measurements (points Aa and Ba) and stage of prolapse (P > 0.05). There were also no differences between groups with regard to recurrent prolapse symptoms or surgical satisfaction (P > 0.05).Conclusions
Tension-free vaginal tape at the time of LSCP did not improve postoperative distal anterior vaginal support.12.
Taru Gupta Mukta Rawat Nupur Gupta Sarika Arora 《Journal of obstetrics and gynaecology of India》2017,67(5):349-355
Introduction
Insulin resistance is one of the most common features of polycystic ovary syndrome, and some studies suggest that vitamin D deficiency may have role in insulin resistance.Objective
To study the effect of vitamin D supplementation on the clinical, hormonal and metabolic profile of the PCOS women.Study Design
Randomized, placebo-controlled, interventional, double-blind study.Materials and Methods
PCOS women were evaluated and enrolled after considering inclusion and exclusion criteria. They were randomized by block randomization with sealed envelope system done in two groups. In the study group (n = 25), patients were supplemented with vitamin D 60,000 IU weekly for 12 weeks, whereas control group (n = 25) was given placebo weekly for the same period. Both the groups were compared pre- and post-supplementation for variables like clinical profile, biochemical profile and metabolic profile. Statistical analysis was performed by the SPSS program for Windows, version 10.1 (SPSS, Chicago, IL).Result
In the study (n = 50), PCOS patients were enrolled; 34 patients (68%) were vitamin D deficient (≤20 ng/ml) out of which 10 patients (29%) were severely deficient (<10 ng/ml). Twelve patients (24%) were vitamin D insufficient showing high prevalence of vitamin D deficiency in the PCOS women. The difference in mean serum fasting glucose pre- and post-supplementation of vitamin D in study group was found to be statistically significant with p value of 0.041. There was significant difference seen in insulin resistance (IR) (2.38 ± 4.88–1.00 ± 0.58, p = 0.003), serum fasting insulin (10.34 ± 20.00–5.00 ± 3.25, p = 0.021), and increase in insulin sensitivity determined by QUICKI (0.37 ± 0.04–0.394 ± 0.009, p = 0.001) after supplementation with vitamin D.Conclusion
The study concluded that there was a beneficial effect of vitamin D supplementation on ovulatory dysfunctions and blood pressure. Post-supplementation, there were decrease in insulin resistance and increase in insulin sensitivity. In the study decreased serum fasting insulin level and fasting blood sugar after vitamin D supplementation suggest underlying role of vitamin D in glucose homeostasis.13.
Tilemachos?Kavvadias Birgitt?Schoenfisch Markus?Huebner Sara?Y.?Brucker Diethelm?Wallwiener Christl?Reisenauer
Purpose
Differences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS? in singleton and twins before and during delivery, as well at the early puerperium in healthy women undergoing CS at term.Methods
This prospective longitudinal study included women with twin (n = 27) or singleton pregnancies (n = 62) whose hemodynamic parameters were assessed by NICaS before an elective CS, after spinal anesthesia, immediately after delivery, after fascia closure, and within 24–36 and 48–72 h postpartum.Results
By 24–36 h postpartum, the mean arterial pressure and the total peripheral resistance equaled preoperative values in both groups. The CO increased throughout the CS and peaked immediately after delivery in the singleton group (P < 0.0001), after which it abruptly began to decline until reaching a nadir 24–36 h after delivery (P < 0.0001), while it remained steady throughout the CS and then dropped until 24–36 h after delivery in the twin group (P < 0.05). None of the studied parameters differed significantly between the groups for the 24–36 and 48–72 h postpartum measurements.Conclusions
Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS? in assessing cardiovascular-related pregnancy complications are warranted.14.
Ibrahim A. El sharkwy Elsayed H. Noureldin Ekramy A. Mohamed Ali A. Mohamed 《Gynecological surgery》2018,15(1):15
Background
Relieving postoperative pain and prompt resumption of physical activity are of the utmost importance for the patients and surgeons. Infiltration of local anesthetic is frequently used methods of pain control postoperatively. Laparoscopically delivered transversus abdominis plane block is a new modification of ultrasound-guided transversus abdominis plane block.This study was conducted to compare the efficacy of laparoscopic-guided transversus abdominis plane block with trocar site local anesthetic infiltration for pain control after gynecologic laparoscopy.Results
No statistically significant difference between the two groups in mean visual analogue scale at 1, 18, and 24 h (P?=?0.34, P?=?0.41, and P?=?0.61, respectively), while the mean visual analogue scale was significantly lower in the laparoscopic-guided transversus abdominis plane block group than in the trocar site local anesthetic infiltration group at 3, 6, and 12 h (P?=?0.049, P?=?0.011, and P?=?0.042, respectively). No statistically significant difference was observed in the cumulative narcotics consumed at 3 h (P?=?0.52); however, women with transversus abdominis plane block have consumed significantly less amount of narcotics than women with trocar site infiltration at 6, 12, and 24 h (P?=?0.04, P?=?0.038, and P?=?0.031 respectively). Patient satisfaction was significantly higher in the laparoscopic-guided transversus abdominis plane block group (P?=?0.035).Conclusion
Laparoscopic-guided transversus abdominis plane block is more effective in reduction of both pain scores in the early postoperative period and the cumulative narcotics consumption than trocar site local anesthetic infiltration in gynecologic laparoscopy.Trial registration
Clinical Trials.gov NCT0297345115.
Purpose
To compare the pregnancy outcome of the modified transvaginal cerclage performed preconception and during pregnancy.Methods
A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China. A total of 604 women with cervical incompetence underwent the cerclage, and the time of the operation was decided by the patients or depended on when the patient presented. Main outcome measures were the gestational age and the fetal outcome.Results
After the cerclage, the mean gestational age at delivery and the term delivery rate were significantly higher in history-indicated conception cerclage compared to preconception cerclage (36.8 ± 3.7 vs 35.8 ± 4.7, p < 0.01; 76.1 vs 66.9%, p < 0.05). The mean gestational age at delivery and the term delivery rate were significantly higher in ultrasound-indicated compared to physical examination-indicated conception cerclage (35.0 ± 5.7 vs 31.0 ± 5.5, p < 0.01; 63.2 vs 23.3%, p < 0.001). The fetal survival rate had no difference in these two comparisons, respectively.Conclusions
The modified transvaginal cervicoisthmic cerclage is a promising and safe technique to improve obstetric outcomes in women with cervical incompetence in different cerclage indications, and history-indicated conception cerclage appears to have better pregnancy outcome.16.
Manish Banker Azadeh Patel Ashwini Deshmukh Sandeep Shah 《Journal of obstetrics and gynaecology of India》2018,68(1):65-69
Introduction
Intrauterine insemination (IUI) is one of the most commonly performed procedure of assisted reproductive technology, for the treatment of infertility. Controlled ovarian hyperstimulation is an important first step while performing IUI. This study aims at establishing a relationship between stimulation protocol and pregnancy outcome following IUI.Methods
This is a retrospective study of 1001 cycles of IUI in which the patients were divided into two groups: Group A Clomiphene citrate (CC only) and Group B Clomiphene citrate and Gonadotropin or Gonadotropin alone(CC+GN OR GN alone). The primary outcome assessed was clinical pregnancy rates (CPRs), and the secondary outcomes were miscarriage rate (MR), multiple pregnancy rates (MPRs), follicle numbers and endometrial thickness (ET).Results
Significantly, higher CPR was observed in Group B in comparison with Group A (14.55 vs. 7.82%; p = 0.05). MR was much higher in Group A in comparison with Group B, (14.29 vs. 5.43%; p = 0.94), but it was non-significant. The follicle number and the ET of the Group A versus Group B are (1.54 ± 0.69 vs. 1.90 ± 1.04; p = 0.0003) and (8.56 ± 1.33 vs. 8.39 ± 1.29; p = 0.1784), respectively; and for subgroups, Group B1 and Group B2 are 1.92 ± 0.99 versus 1.65 ± 0.92; p = 0.0008 and 8.32 ± 1.27 vs. 8.69 ± 1.24; p = 0.0004, respectively.Conclusion
GN, either alone or the combination with CC, gives a higher CPR and a lower abortion rate following IUI, thus increasing the multiple pregnancy rate.17.
Anke?R.?Mothes Anja?Schlachetzki Kristin?Nicolaus Julia?Vorwergk Thomas?Lehmann Marc?P.?Radosa Henning?K.?Mothes Ingo?B.?Runnebaum
Purpose
This comparative cohort study evaluated the influence of surgical route for prolapse hysterectomy (vaginal or laparoscopically assisted) on the achievement of intended elective salpingo-oophorectomy, which was a procedural goal planned with the patient before primary vaginal native-tissue prolapse surgery.Methods
Consecutive patients who underwent total vaginal hysterectomy (TVH; n?=?163) or laparoscopically assisted vaginal hysterectomy (LAVH; n?=?144) and vaginal native-tissue repair for pelvic organ prolapse at Jena University Hospital were enrolled.Results
Peri- and postoperative parameters, including Clavien–Dindo (CD) classification of surgical complications, were compared between groups using Student’s t test, Fisher’s exact test, and multivariable regression. Patient characteristics were similar, except that grade IV prolapse was more common in the LAVH group (p?<?0.001). The following parameters differed between the TVH and LAVH groups: concomitant salpingectomy (1.2% vs. 34%) and salpingo-oophorectomy (45% vs. 66%), non-performance of intended salpingo-oophorectomy (36% vs. 0% OR 0.006, 95% CI < 0.001–0.083), adhesiolysis (0% vs. 44%), CD II–III complications (51% vs. 14.6% p < 0.001), operating time (153?±?61 vs. 142?±?27 min), and postoperative in-patient days (9.02?±?4.9 vs. 4.99?±?0.96; all p?<?0.001).Conclusions
LAVH enabled the safe performance of planned concomitant salpingo-oophorectomy in all cases. To achieve the procedural goal in such cases, laparoscopic assistance in prolapse hysterectomy should be considered.18.
Dagistan Tolga Arioz Mine Kanat-Pektas Nadire Tuncer Tulay Koken Bekir Serdar Unlu Gulengul Koken Mehmet Yilmazer 《Archives of gynecology and obstetrics》2015,291(5):1147-1152
Objectives
The present study aims to specify the role of l-carnitine in the pathogenesis of endometrial cancer by comparing the serum total l-carnitine levels of endometrial cancer patients with those of healthy women.Methods
Serum total l-carnitine concentrations were measured in patients with endometrioid-type endometrial cancer (n = 20) and healthy controls (n = 20) who were matched with respect to age and body mass index (BMI).Results
Stage I endometrial cancer was diagnosed in 12 women (60.0 %) whereas three women (15.0 %) had stage II disease, three women (15.0 %) had stage III disease and two women (10.0 %) had stage IV disease. The healthy controls and endometrial cancer patients were statistically similar in aspect of age, gravidity, parity, BMI, waist-to-thigh ratio, waist-to-hip ratio, menopause, complete blood count parameters, and serum biochemistry. Serum total l-carnitine levels of women with endometrial cancer were significantly lower than those of healthy women (respectively, 5,519.4 ± 2,712.5 vs 7,940.8 ± 3,566.6 ng/dl, p = 0.021). Moreover, serum total l-carnitine levels decreased significantly and progressively with advancing stage (stage I vs II vs III vs IV; 6,294.0 ± 2,885.1 vs 5,800.0 ± 441.2 vs 4,016.0 ± 2,833.3 vs 2,560.0 ± 67.9 ng/dl; p = 0.021).Conclusions
This is the first study to hypothesize that l-carnitine deficiency participates in the pathogenesis of endometrial cancer by means of a mechanism which is unrelated with obesity and increased amount of fat in human body.19.
Suyash S. Bhandekar Anahita R. Chauhan Arun Ambadkar 《Journal of obstetrics and gynaecology of India》2018,68(6):456-461
Background
Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study.Methods
This was a prospective comparative study of misoprostol for second-trimester (14–20 weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400 µg 4 h up to a maximum of five doses (2000 µg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction–abortion interval (AI) and need for surgical intervention were analyzed.Results
Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction–abortion interval was 19.59 h (21.66 vs. 18.57 h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3–4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group.Conclusions
Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.20.
L. Tamburino S. La Vignera V. Tomaselli R. A. Condorelli L. M. Mongioì A. E. Calogero 《Journal of assisted reproduction and genetics》2017,34(5):671-676