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1.
Ronak Khandelwal Purvi Patel Dipa Pitre Tosha Sheth Nandita Maitra 《Journal of obstetrics and gynaecology of India》2018,68(1):51-57
Background
This study aims to compare the value of the Bishop score and cervical length measurement by transvaginal ultrasonography in predicting active labor within 6 h, induction-to-delivery interval, and the duration of active labor and to estimate the most useful cutoff points for the two methods.Methods
This is a prospective comparative study of Bishop score and cervical length measured by transvaginal sonography on 62 nulliparous subjects who underwent induction of labor.Results
The Bishop score of the subjects ranged from two to seven (2–7). The mean Bishop in this study population was 4.37 + 1.23. The mean cervical length in this study was 25.59 + 6.07. Bishop score was highly significant (P value < 0.0001) in predicting active phase of labor as compared to cervical length (P = 0.004). The best cutoff value for Bishop score to predict induction of labor within 6 h was more than 4 with sensitivity of 69% and specificity of 79%. Similarly, best cutoff value for cervical length to predict induction of labor within 6 h was less than or equal to 25 mm with sensitivity of 51% and specificity of 70%. Bishop score was more significant (P = 0.001) in predicting induction-to-delivery interval within 12 h as compared to cervical length (P = 0.01).Conclusion
The Bishop score was superior in predicting the response to induction as compared to the cervical length measured by transvaginal ultrasonography.2.
Sana Sahnoun Afifa Sellami Nozha Chakroun Malek Mseddi Hammadi Attia Tarek Rebai Saloua Lassoued 《Journal of assisted reproduction and genetics》2017,34(8):1067-1077
Purpose
To study the role of Toll-like receptor 4 (TLR4) in human spermatozoa and to assess sperm parameters, oxidative stress markers, and acrosome reaction in response to the stimulation of TLR4 by its ligand, the lipopolysaccharide (LPS), as a major endotoxin of Gram-negative bacteria.Methods
Our study was carried out in 73 sperm samples from patients undergoing semen analysis for couple infertility investigations. The studied patients were divided into three groups: normozoospermic fertile patients (n = 13), patients with abnormal and leukospermic semen (n = 13), and patients with abnormal and non-leukospermic semen (n = 47). TLR4 expression in human spermatozoa was initially analyzed by western blot. Sperm samples were incubated in the presence of LPS (200 ng/ml) for 18 h. Then, sperm motility and vitality were evaluated by microscopic observation and oxidative stress markers as malondialdehyde (MDA) and carbonyl groups (CG) were spectrophotometrically assessed in neat and selected sperm. A triple-stain technique was also performed to evaluate acrosome reaction in 15 sperm samples from infertile patients.Results
TLR4 expression was confirmed in human spermatozoa with a molecular weight of 69 kDa. In the normozoospermic group, no significant differences in sperm parameters and oxidative stress markers were shown after incubation with LPS in neat and selected sperms. Regarding samples from the non-leukospermic group, LPS reduced spermatozoa motility and vitality rates in selected sperm (P = 0.003; P = 0.004, respectively). A significant increase of MDA and CG levels was also detected (P = 0.01; P = 0.02, respectively). However, only the MDA levels were significantly increased (P = 0.01) in neat LPS-stimulated sperm. The same results were shown within the leukospermic group. The comparison between the two groups, leukospermic and non-leukospermic, in selected sperms showed a more important LPS effect in the leukospermic group significantly on motility and MDA rates (P = 0.006; P = 0.009, respectively). Furthermore, a significant decrease in reacted spermatozoa rate was detected in response to LPS in selected sperm samples from infertile men (P = 0.03).Conclusions
These findings indicate that human spermatozoa express TLR4 and respond to LPS stimulation with alterations in viability, motility, and the acrosome reaction implicating reactive oxygen species (ROS) production in sperm samples from infertile patients.3.
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
NCT02826304.4.
Objective
The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with uterine malformations.Study design
This was a retrospective population-based cohort study including women with a diagnosis of uterine malformation arised from workup for infertility or recurrent pregnancy loss, was accidental during pregnancy, or was noticed at the time of cesarean delivery.Results
A total of 280,721 pregnancies met the inclusion criteria and were divided into two study groups: (1) pregnancies in women with uterine malformations (n = 1099); and (2) controls (n = 279,662). The rate of women presenting uterine malformations was 0.39%. The prevalence of cervical os insufficiency was significantly higher in women with a uterine malformation than in the control group (3.6 vs. 0.4%, p < 0.001). A multivariate analysis, performed to evaluate risk factors for cervical insufficiency in women with uterine malformations. Mullerian anomalies (OR 6.19, 95% CI 4.41–8.70, p < 0.001), maternal age (OR 1.05, 95% CI 1.04–1.06, p < 0.001), recurrent abortions (OR 12.93, 95% CI 11.43–14.62, p < 0.001), and ethnicity (OR 2.86, 95% CI 2.454–3.34, p < 0.001) were found to be independently associated with the development of cervical insufficiency.Conclusion
Uterine anomalies have a strong association with cervical insufficiency. Women with uterine anomalies have an increased risk to develop pregnancy complications that arise from a loss in cervical function during the midtrimester or early third trimester.5.
Sarrah Ayuandari Katharina Winkler-Crepaz Monika Paulitsch Cora Wagner Claudia Zavadil Claudia Manzl Stephanie C. Ziehr Ludwig Wildt Susanne Hofer-Tollinger 《Journal of assisted reproduction and genetics》2016,33(12):1585-1593
Purpose
To study the influence of xenotransplantation on follicular recruitment and growth in cryopreserved/thawed human ovarian tissue.Method
Two 3-mm pieces of cryopreserved/thawed human ovarian tissue obtained from female cancer patients (n?=?11) were xenotransplanted into a subcutaneous neck pouch of 6-week-old ovarectomized SCID mice (n?=?33) for 4 (n?=?18) and 12 (n?=?15) weeks.Result
Thirty-two out of 33 mice survived the entire observation periods. Graft recovery rate was 95.58 % (65 of 68 grafts). The percentages of primordial follicles after 4 weeks (P?<?0.001) and 12 weeks (P?=?0.009) of grafting were significantly lower in comparison to pregraft controls. The percentage of secondary follicle was significantly higher after 4 weeks of grafting (P?=?0.018) and after 12 weeks (P?=?0.001) of grafting in comparison to pregraft controls. Ki67 immunohistochemistry showed that proliferative follicles were significantly higher after 4 and 12 weeks of grafting compared to pregraft controls (P?<?0.001). All follicles analyzed by TUNEL staining appeared healthy after xenotransplantation. The expression level of PTEN was reduced by 2.47-fold after 4 weeks of xenotransplantation, and this result was significant when 2?ΔCt were analyzed (P?=?0.042).Conclusion
The higher proportion of growing follicles compared to resting follicles observed after xenotransplantation is most likely due to downregulation of PTEN gene expression followed by acceleration of follicular recruitment.6.
W. H. Salem A. Abdullah O. Abuzeid K. Bendikson F. I. Sharara M. Abuzeid 《Journal of assisted reproduction and genetics》2017,34(5):581-586
Purpose
The objective of this study is to determine if IVF outcome disparities exist among MENA women in the USA in comparison to a control group of Caucasian women.Methods
A retrospective cohort study comparing MENA (N = 190) and Caucasian (N = 200) women undergoing their first IVF cycle between 5/2006 and 5/2014 was carried out at an academically affiliated fertility practice. All MENA cycles during that time period undergoing IVF/ICSI using autologous embryos and blastocyst transfers were compared to a control group of Caucasian women.Results
MENA women were significantly younger (32.9 vs 34.5, P < 0.005) and had a lower BMI (25.2 vs 27.1, P < 0.001). Male factor infertility was higher among partners of MENA women (62 vs 50%, P < 0.05). MENA women experienced decreased live birth rates per blastocyst transfer compared to Caucasian women after controlling for age and BMI (OR 0.55, 95% CI 0.35–0.85 P = 0.007). The odds of a miscarriage were also significantly higher among MENA women (OR 2.55, 95% CI 1.04–6.27 P = 0.036).Conclusion
Middle Eastern/North African women have worse IVF outcomes with decreased live birth rates per blastocyst transfer and increased miscarriage rates compared to Caucasian women.7.
Lucie Rolland Jeanne Perrin Virginie Villes Valérie Pellegrin Léon Boubli Blandine Courbiere 《Journal of assisted reproduction and genetics》2017,34(11):1523-1528
Purpose
Does the type of anesthesia (paracervical block (PCB) or general anesthesia (GA)) impact live birth rate, pain, and patient satisfaction?Methods
A non-randomized prospective cohort study was conducted in women treated for IVF. Two groups of patients were prospectively included: the PCB group (n = 234) and the GA group (n = 247). The type of anesthesia was determined by the patients. The primary endpoint was cumulative live birth rate by OR. Secondary endpoints were self-assessment of the patients’ peri-operative abdominal and vaginal pain vs the doctors’ evaluations during PCB, post-operative abdominal and vaginal pain level, and patient satisfaction in both groups. Pain levels were assessed with a numerical rating scale (NRS).Results
The live birth rate was similar in both groups (19.8% in the GA group vs 20.9% in the PCB group, P = 0.764). During oocyte retrieval in the PCB group, the physicians significantly under-estimated the vaginal pain experienced by the patients (3.04 ± 0.173 for patients vs 2.59 ± 0.113 for surgeons, P = 0.014). Post-operative vaginal and abdominal pain were significantly greater in the PCB group compared to the GA group (2.26 ± 0.159 vs 1.66 ± 0.123, respectively, P = 0.005, and 3.80 ± 0.165 vs 3.00 ± 0.148, respectively, P < 0.001). Patients were more significantly satisfied with GA than with PBC (P < 0.001).Conclusion
Because the LBR was similar in both groups and patient satisfaction was high, the choice of anesthesia should be decided by the patients.8.
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.9.
Kavitha Abraham Elsy Thomas Jessie Lionel 《Journal of obstetrics and gynaecology of India》2018,68(5):360-365
Purpose of study
To assess the maternal and perinatal complications associated with meconium-stained amniotic fluid (MSAF) in low-risk women in labor.Methods
This prospective cohort study was conducted at CMC Hospital, Vellore, India. Two hundred low-risk women who had artificial or spontaneous rupture of membranes after admission with MSAF were included in the study. Two hundred similar women with clear liquor were taken as controls. The primary outcomes considered were the incidence of chorioamnionitis and endomyometritis in the mothers. The secondary outcomes included postpartum hemorrhage and retained placenta in the mothers and respiratory distress, meconium aspiration, sepsis, and NICU admission in the newborn. Statistical analysis was done using Fischer exact test. Odds ratio, 95% confidence interval, and P value were estimated.Results
Compared to controls, those with MSAF had significantly higher rates of chorioamnionitis (2 vs. 8%, P = 0.006) and endomyometritis (3 vs. 9.5% P = 0.007). Among the secondary end points, only neonatal respiratory distress (8.5 vs. 1.5%; P = 0.001) and meconium aspiration (4 vs. 0%; P = 0.007) were found to be significantly increased in the meconium group.Conclusion
Statistically significant increased incidence of chorioamnionitis and endomyometritis in women with MSAF in labor established in our study strongly supports the use of prophylactic antibiotics in these women to prevent immediate and long-term consequences.10.
Purpose
To explore whether the symptoms of climacteric syndrome associated with its physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety–depression disorder.Methods
We recruited 78 climacteric patients with anxiety–depression disorder and 72 control participants in perimenopausal/postmenopausal without anxiety–depression disorder for this study. We measured symptoms using the Greene Climacteric Symptom Scale in all cases. We also collected demographic data and tested sexual hormone, blood pressure, bone density, cognitive, estrogen receptor-alpha (ERα) gene polymorphism as physiological factors, using HARS-14 and CHDS assessed psychological disorder degree.Results
C-MMSE scores as well as Estradiol and progesterone levels in the anxiety–depression disorder group were significantly lower compared to the control group (P < 0.01). In addition, the anxiety–depression disorder group had significantly higher Greene Climacteric Scale scores, as well as somatic symptoms compared to controls (P < 0.01). Moreover, the anxiety, depression and somatic symptoms of the Greene Climacteric Scale were positively correlated with HARS-14 and CHDS scores (P < 0.001) and negatively with estrogen level and C-MMSE scores (P < 0.05) in the anxiety–depression disorder group. Greene Climacteric Scale Symptoms were not significantly correlated with blood pressure, bone density or other factors (P > 0.05). There was no significant change in the allele frequency or the estrogen receptor-alpha gene polymorphisms, between the two groups (P > 0.05); however, the Pp genotype was negatively associated with C-MMSE scores (r = appraises, P = 0.033).Limitations
The sample size was relatively small.Conclusions
The symptoms of somatic symptoms in patients with climacteric syndrome and anxiety–depression disorder are associated with the emotional disorder but not with a physical disease. The Pp ERα polymorphism Pvu II is associated with a cognitive decrease.11.
Background
Recepteur d’origine nantais (RON) protein expression has been demonstrated to correlate with tumor progression, metastasis, and prognosis, and its mRNA expression increases in deeply infiltrating endometriotic lesions. However, it remains unclear whether RON protein expression also increases in endometriotic lesions, and may be a risk factor of malignant transformation in endometriotic lesions.Methods
The protein expression of RON in control (n = 19), eutopic (n = 16), and ectopic (n = 51) endometria, as well as in endometriosis-associated ovarian cancers (EAOC, n = 16) was determined by immunohistochemical (IHC) staining.Results
Endometriotic lesions expressed low levels of RON protein, but no RON protein expression appeared in matched eutopic or control endometrium. EAOC exhibited high levels of RON protein. The frequency and IHC score of RON protein expression were both significantly higher in EAOC [100.0% (14/14), 5.37 ± 0.74] than those in endometriotic lesions [51.0% (26/51), 2.15 ± 1.12; P = 0.002, 0.001]. Multivariate analysis of covariance only revealed a correlation of RON protein expression and EAOC (P = 0.006), but no correlations of RON protein expression and clinical parameters (P > 0.05).Conclusions
These obtained results suggest that increased RON expression might be involved in the pathogenesis of endometriosis and disease-associated ovarian cancers.12.
Ying Li Bingbing Deng Nengyong Ouyang Ping Yuan Lingyan Zheng Wenjun Wang 《Journal of assisted reproduction and genetics》2017,34(7):849-859
Purpose
Our study aimed to investigate the association of telomerase activity (TA) and telomere length (TL) in granulosa cells (GCs) with IVF outcomes of polycystic ovary syndrome (PCOS) patients, and the effects of oral contraceptive pill (OCP) pretreatment on these two parameters.Methods
One hundred sixty-three infertile women were enrolled and divided into a PCOS group (n = 65) and a non-PCOS group (n = 98). The PCOS group was further divided into an OCP pretreatment group (n = 35) and a non-OCP pretreatment group (n = 30), a TA <0.070 group (n = 34) and a TA ≥0.070 group (n = 31), and a TL <1 group (n = 41) and a TL ≥1 group (n = 24), respectively.Results
No obvious differences were observed in TA between these groups. The TL was 0.971 in PCOS group and 1.118 in non-PCOS group (P = 0.005). The patients with TL ≥1 accounted for 36.9% in PCOS group and 54.1% in non-PCOS group (P = 0.032). The average duration of infertility for PCOS patients was 5 years in TA <0.070 group and 4 years in TA ≥0.070 group (P = 0.038), and 5 years in TL <1 group and 3 years in TL ≥1 group (P = 0.006), respectively. No obvious differences were observed in IVF outcomes between these groups. No obvious differences were observed in TA, TL, or IVF outcomes between OCP pretreatment group and non-OCP pretreatment group in PCOS patients.Conclusions
Shorter TL was found in PCOS patients. The TA levels did not change significantly in PCOS patients. PCOS patients with a lower TA level and shorter telomeres had an earlier onset of infertility symptoms. No predictive value was found for TA and TL in terms of embryo quality or IVF outcomes in PCOS patients, and no effect OCP pretreatment was observed on either TA and TL.13.
Mahmoud Thabet Mohamed Sayed Abdelhafez Emad Ahmed Fyala 《Journal of obstetrics and gynaecology of India》2018,68(3):185-191
Objective
To describe the use of intrauterine inflated Foley’s catheter balloon for control of postpartum hemorrhage (PPH) during cesarean section (CS) in cases of abnormally invasive placenta previa aiming to preserve the uterus.Methods
Retrospective case–control study of the data of women who underwent elective CS on abnormally adherent placenta previa was carried out. Women in whom inflated Foley’s catheter balloon was used for control of PPH during CS (n = 40) were compared with a control group of women who underwent elective CS by the same technique but without use of intrauterine catheter balloon (n = 38).Results
Use of intrauterine inflated Foley’s catheter balloon significantly reduced the estimated amount of blood loss (P = 0.008), amounts of crystalloids, colloids and packed red blood cells transfusion (P = 0.025, 0.017 and 0.022, respectively), and the need for bilateral internal iliac artery (IIA) ligation (P = 0.016). No significant difference was observed between both groups regarding the use of massive transfusion protocol, performing cesarean hysterectomy, relaparotomy, and admission to the intensive care unit.Conclusion
Application of an intrauterine inflated Foley’s catheter balloon during CS in cases of morbidly adherent placenta previa helps to control PPH with preservation of the uterus and decreases the need for the invasive IIA ligation.14.
Jun F Yamin L Xinli X Zhe L Min Z Bo Z Wenli G 《Archives of gynecology and obstetrics》2012,285(5):1407-1413
Purpose
The aim of our study was to compare the efficacy and safety of uterine artery embolization (UAE) for symptomatic uterine fibroids with surgery.Methods
Both a randomized, controlled trial and meta-analysis of existing studies were performed.Results
Patients were randomly assigned in a 1:1 ratio to undergo either UAE or surgery with 63 patients undergoing UAE and 64 undergoing surgery. A meta-analysis of existing studies was also performed.There were significant improvements in UAE groups in most components of quality of life assessment at 6 months. Besides, the UAE group had a shorter hospital stay (P < 0.01) and a shorter recovery time (P < 0.01) compared with the surgical group. During the follow-up, there were no difference in complications incidence (58 vs. 65%, P > 0.05), but the UAE group had less major complications (0 vs. 6%, P < 0.05). Meta-analysis of existing studies including those from the current study, further suggested that UAE group had a shorter hospital stay, a shorter recovery time and less major complications than the surgical group.Conclusions
Compared with surgery, UAE has a shorter hospital stay, a shorter recovery time, and less major complications. More studies in the future need to done to evaluate its long-term effects and impact on fertility.15.
Nalini Sharma J. Lalnunnem Thiek Tanie Natung Santa Singh Ahanthem 《Journal of obstetrics and gynaecology of India》2017,67(4):253-257
Background
The incidence of post-partum anaemia (PPA) is 14–24%. Treatment of PPA with injectable iron replenishes the iron store. Ferric carboxymaltose complex (FCM) is a non-dextran containing intravenous iron agent, having a very low immunogenic potential, designed to be administered in large doses in a short period of time.Objective
To compare the efficacy and safety of intravenous FCM and iron sucrose (IS) in post-partum iron-deficiency anaemia.Material and Method
In this prospective, comparative study, 120 post-partum women with iron-deficiency anaemia (Hb < 10 g%) were divided into two groups. A fixed dose of 1000 mg of FCM or IS was given within 10 days of delivery. Hb and serum ferritin were repeated 14 days post-transfusion.Result
There is a mean increase in Hb (P value 0.000, 0.000) and ferritin (P value 0.000, 0.000) in both the groups. For intergroup comparison, independent Student’s t test was performed which showed FCM was superior to IS (P value 0.000 and 0.000).Conclusion
In our study, FCM was very effective in improving Hb concentration as well as in early replenishment of iron stores in patients with PPA. Large doses given in a short period of time not only save hospital resources but also improve patient satisfaction. It has significant benefit for use in the outpatient department. From this study, we can recommend its use in post-partum women with iron-deficiency anaemia.16.
Background
Pioglitazone was used to treat patients of PCOS in many researches, but the treatment has not been recognized by public or recommended by all the guidelines.Method
We conducted a meta-analysis of the related literatures to objectively evaluate the clinical effectiveness and safety by comparing pioglitazone with metformin administrated by PCOS patients. Searches were performed in Cochrane Library, EMBASE and PubMed (last updated December 2016).Results
Eleven studies among 486 related articles were identified through searches. Fixed effects and random effects models were used to calculate the overall risk estimates. The results of the meta-analysis suggest that improvement of the menstrual cycle and ovulation in pioglitazone treatment group was better than metformin group [OR = 2.31, 95% CI (1.37, 3.91), P < 0.001, I 2 = 41.8%]. Improvement of the F-G scores in metformin treatment group was better than pioglitazone group [SMD = 0.29, 95% CI (0.0, 0.59), P = 0.048, I 2 = 0.0%]. BMI was more elevated in pioglitazone group than in metformin group [SMD = 0.83, 95% CI (0.24, 1.41), P = 0.006, I 2 = 82.8%]. There were no significant differences of the other data between the two groups.Conclusions
This meta-analysis indicated that pioglitazone ameliorated menstrual cycle and ovulation better than metformin and metformin ameliorated BMI and F-G scores better than pioglitazone in treating patients with PCOS. Pioglitazone might be a good choice for the patients with PCOS who were intolerant or invalid to metformin for the treatment.17.
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)18.
Purpose
To assess the effect of advanced maternal age on the obstetrics and neonatal outcome of twin pregnancies.Methods
A retrospective study of 716 dichorionic–diamniotic twin pregnancies delivered at our institute. The study population was divided into two groups: women aged 35–39 years (group A, n = 142) and women aged ≥ 40 years (Group B, n = 48). The control group consisted of women younger than 35 years (group C, n = 516).Results
The rate of cesarean section (CS) was significantly higher among women older than 35 years compared to the control group (A 76.8% and B 87.5% vs C 65.7%, P = 0.001). Women older than 35 years were also at higher risk for developing hypertensive disorders (A 7.0%, B 14.6%, vs C 5.4%, P = 0.04). On multivariate regression analysis, maternal age was found to be independently associated with a higher rate of CS (odds ratio vs reference group C: group A 1.6, 95% CI 1.08–2.6; group B 3.2, 95% CI 1.3–7.8). There was no difference between the groups in the rate of neonatal complications.Conclusion
Women with twin pregnancy, older than 35 years, have a significantly higher rate of CS and hypertensive disorder. This rate increases with maternal age, with no increased rate of neonatal complications.19.
20.
Tilemachos?Kavvadias Birgitt?Schoenfisch Markus?Huebner Sara?Y.?Brucker Diethelm?Wallwiener Christl?Reisenauer